Reentrant and Nonreentrant Forms of Atrio‐Ventricular Nodal Tachycardia Mimicking Atrial Fibrillation

Dixit, Sanjay; Callans, David J.; Gerstenfeld, Edward P.; Marchlinski, Francis E.

doi:10.1111/j.1540-8167.2006.00410.x

Cited by 34 publications

(34 citation statements)

References 12 publications

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“…1:2 AV conduction is a rare form of antegrade simultaneous conduction through 2 AV nodal pathways (fast and slow AV nodal pathways), and has been reported to result in both AVNRT and a nonreentrant form of tachycardia 5, 6. Previous reports of double ventricular response have only included adult subjects.…”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest in an adolescent with Uhl’s anomaly: Two unusual cardiac arrhythmia mechanisms

Moak

Pearson

Clark

et al. 2016

HeartRhythm Case Reports

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Section: Discussionmentioning

confidence: 99%

Cardiac arrest in an adolescent with Uhl’s anomaly: Two unusual cardiac arrhythmia mechanisms

Moak

Pearson

Clark

et al. 2016

HeartRhythm Case Reports

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“…The infrequency and obscurity of dual nodal response tachycardia in all probability contributes to under diagnosis and misclassification. Dual nodal responses have been misclassified as bigeminy 7 (supraventricular or ventricular) and as atrial fibrillation due to variable antegrade conduction down the fast and slow pathways in a case series of patients referred for pulmonary vein isolation 8 ; moreover, tachycardia‐mediated cardiomyopathy has been associated with nonreentrant SVT 9 . Fortunately, catheter ablation of the slow pathway is curative 10,11 …”

Section: Discussionmentioning

confidence: 99%

Nonreentrant Supraventricular Tachycardia Misdiagnosed as Inappropriate Sinus Tachycardia

Bhatt

Monahan

2011

Pacing Clinical Electrophis

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We report a case of a woman with incessant palpitations initially misdiagnosed as inappropriate sinus tachycardia that proved refractory to β-blockers. At the time of electrophysiologic testing, a sustained narrow-complex tachycardia with a 1:2 atrioventricular relationship was repeatedly initiated by a posterior fascicle depolarization induced by means of a timed ventricular extrastimulus. The tachycardia was repeatedly terminated with a timed atrial extrastimulus, which excluded junctional bigeminy and confirmed the diagnosis of nonreentrant supraventricular tachycardia. Catheter ablation of the slow pathway eliminated dual-pathway conduction and tachycardia.

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“…Intermittently, there are nonconducted atrial depolarizations with block in both the fast and slow pathways. This was initially misdiagnosed as atrial fibrillation, which has previously been described 1,2 . After the initial diagnosis was made, there were several other interesting findings.…”

mentioning

confidence: 88%

One to One Atrioventricular Conduction via a Double Response with Two Levels of Block

Lowery¹,

Belardi²,

Bargas³

et al. 2010

Cardiovasc electrophysiol

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A 49-year-old woman presented with palpitations and progressive fatigue and dyspnea. An echocardiogram demonstrated normal left ventricular function and mitral annular calcification. Telemetry monitoring demonstrated an irregular tachycardia with periods of one to one and suspected 1 to 2 atrioventricular conduction (double response) as well as Figure 1. There are 3 mechanisms of block demonstrated among these 2 cycles. The first atrial depolarization is conducted through the fast pathway. The second atrial beat is conducted through the fast pathway with a normal HV and through the slow pathway with a longer HV. The third atrial depolarization is conducted slower through both the fast and slow pathway (longer AH intervals) with the slow pathway conduction blocked below the level of the His. The fourth atrial depolarization is blocked at the level of the AV node allowing for recovery of both AV nodal pathways and the infra-Hisian conduction system. The second cycle is very similar to the first, with conduction through the fast pathway, followed by conduction through the fast and slow pathways, but with a different level of block for the third atrial beat. The fast pathway conducts with additional decrement, and the slow pathway does not conduct from this atrial beat. The fourth atrial beat again blocks in the AV node. atrioventricular block. After analysis of her ECG, she underwent an electrophysiology study to provide definitive diagnosis and treatment. The recorded intracardiac electrograms are shown in Figure 1.With atrial depolarization, there were 2 patterns identified. The majority of the beats demonstrated either conduction down the fast pathway to the His and ventricle, followed by slow pathway conduction to the ventricle (double response), or conduction solely down the fast pathway. Intermittently, there are nonconducted atrial depolarizations with block in both the fast and slow pathways. This was initially misdiagnosed as atrial fibrillation, which has previously been described. 1,2 After the initial diagnosis was made, there were several other interesting findings. AV nodal block was the mechanism for most nonconducted atrial beats, except for intermittent infra-Hisian block (seen in Fig. 1) that could not be reproduced after ablation of the slow pathway. This

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Reentrant and Nonreentrant Forms of Atrio‐Ventricular Nodal Tachycardia Mimicking Atrial Fibrillation

Cited by 34 publications

References 12 publications

Cardiac arrest in an adolescent with Uhl’s anomaly: Two unusual cardiac arrhythmia mechanisms

Cardiac arrest in an adolescent with Uhl’s anomaly: Two unusual cardiac arrhythmia mechanisms

Nonreentrant Supraventricular Tachycardia Misdiagnosed as Inappropriate Sinus Tachycardia

One to One Atrioventricular Conduction via a Double Response with Two Levels of Block

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