Location of the Lower Turnaround Point in Typical AV Nodal Reentrant Tachycardia:

Li, Yi Gang; Bender, Birgit; Bogun, Frank; Grönefeld, Gerian; Hohnloser, Stefan H.

doi:10.1111/j.1540-8167.2000.tb00733.x

Cited by 22 publications

(16 citation statements)

References 27 publications

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“…30 In up to one-third of patients with AVNRT the lower turnaround point of the circuit is within the His bundle, thus arguing against an intranodal circuit as a universal feature of AVNRT. 31 Differences in the location of the lower turnaround sites of AV nodal reentry relatively to the His bundle have also been shown in experimental studies. 32 Thus, block during AVNRT does not necessarily define a 'lower common pathway'; it just defines longer refractory period below the circuit.…”

Section: Av Block Without Recording Of a His Electrogram As Well As Rmentioning

confidence: 88%

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Katritsis

Josephson

2016

Arrhythmia &Amp; Electrophysiology Review

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Atrioventricular nodal reentrant tachycardia (AVNRT) denotes re-entry in the area of the AV node, and represents the most common regular arrhythmia in the human.1 Although several models have been proposed to explain the mechanism of the arrhythmia in the context of the complex anatomy and the anisotropic properties of the atrioventricular (AV) node and its atrial extensions (see Figure 1), 2 the actual circuit of AVNRT still remains elusive. Recent studies suggest a three-dimensional AV node with greater variability in the space constant of tissue and poor gap junction connectivity due to differential expression of connexin isoforms, that provide an explanation of dual conduction and nodal reentrant arrhythmogenesis. 3,4 AV junctional arrhythmias are presented in Table 1. Classification schemes for AVNRT have been mainly based on the conventional concept of longitudinally dissociated dual AV nodal pathways that conduct around a central obstacle (see Table 2).In typical slow-fast AVNRT the onset of atrial activation appears prior to, at the onset, or just after the QRS complex, thus maintaining an atrial-His/His-atrial ratio, AH/HA >1. The HA interval is usually <70 ms, measured from earliest deflection of the His bundle activation to the earliest rapid deflection of the atrial activation in the His bundle electrogram, and the VA interval, measured from the onset of ventricular activation on surface ECG to the earliest rapid deflection of the atrial activation on the His bundle electrogram, is <60 ms. 1,5,6 In atypical, fast-slow form of atypical AVNRT, the retrograde atrial electrogram begins after ventricular activation with an AH/HA ratio <1. The HA interval is prolonged, ≥70 msec, and the VA interval is ≥60 msec. 5,6 The atypical, slow-slow form, represents, by definition, an arrhythmia utilising two slow pathways. The AH/HA ratio is ≥1 but the HA interval is ≥70 msec, and the AH interval exceeds 200 ms. [7][8][9] There are several inherent limitations of this classification. The distinction between fast-slow and slow-slow atypical AVNRT is often arbitrary in view of the lack of a unanimously accepted definition. In order to establish the diagnosis of a truly fast-slow form, it has been proposed that the AH interval should be less than 185 ms 10 or 200 ms. 6 This criterion, however, has not been adopted by other investigators. 11-13Thus, tachycardias with a relatively prolonged AH interval but an AH/ HA ratio <1 cannot be reliably classified as either fast-slow or slow-slow (see Figure 2). Furthermore, the term 'fast-slow' implies that the fast component of slow-fast AVNRT is the same as the fast in the fast-slow type. There is now evidence that this is not the case in patients who present with both types of tachycardia.14,15 Typical slow-fast and atypical fast-slow AVNRT appear to utilise different anatomical pathways for fast conduction. In addition, electrophysiological behaviour compatible with multiple pathways may also be seen, and in some patients, several forms of AVNRT may be inducible at electrophy...

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Section: Av Block Without Recording Of a His Electrogram As Well As Rmentioning

confidence: 88%

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Katritsis

Josephson

2016

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

show abstract

“…Whether the His‐Purkinje conduction system is involved in the reentrant circuit of AVNRT has been controversial. Li et al 4 measured HA intervals in patients with AVNRT and demonstrated that the lower turnaround point of the reentrant circuit of AVNRT was within the His bundle in only one third of patients and was above the His bundle in most of the patients. Yagi et al 5 analyzed the effects of spontaneous development of bundle branch block patterns on both the HA and VA intervals during AVNRT, and they proposed that the right bundle branch might be involved in the AVNRT circuit in some patients.…”

Section: Discussionmentioning

confidence: 99%

Variation of HA Intervals in Atrioventricular Nodal Reentrant Tachycardia with Atrioventricular Block:

Lee

Tai

Lin

et al. 2004

Cardiovasc electrophysiol

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“…Li et al used a quantitative model to demonstrate that the lower turnaround point of AVNRT circuit was above the His-bundle in more than half of the 70 patients with AVNRT [15]. Yagi et al found that 5 (13%) of the 38 patients with spontaneous development of complete or incomplete RBBB during AVNRT had prolongation of the VA and HA intervals, and the HA interval changed concordantly in nearly the exact amount with the change in the VA interval.…”

Section: Significance Of Transient Rbbb During Anvrtmentioning

confidence: 92%

“…model, optic mapping and intraoperative ice mapping, to localize the circuit of AVNRT; these studies demonstrated the lower turnaround point of the circuit of AVNRT is above or within the His-bundle [12][13][14][15][16][17]. If RBBB influenced the antegrade slow pathway conduction of AVNRT, the AH interval might be different between AVNRT with persistent RBBB and those without RBBB (Fig.…”

Section: Significance Of Persistent Rbbb During Avnrtmentioning

confidence: 97%

Effects of right bundle branch block during atrioventricular nodal reentrant tachycardia

Lee¹,

Lee²,

Tai³

et al. 2005

International Journal of Cardiology

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Location of the Lower Turnaround Point in Typical AV Nodal Reentrant Tachycardia:

Cited by 22 publications

References 27 publications

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Variation of HA Intervals in Atrioventricular Nodal Reentrant Tachycardia with Atrioventricular Block:

Effects of right bundle branch block during atrioventricular nodal reentrant tachycardia

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