What is the mechanism of wide QRS tachycardia?

Kaneko, Yoshiaki; Nakajima, Tadashi; Iizuka, Takashi; Tamura, Shuntaro; Kurabayashi, Masahiko

doi:10.1111/pace.13687

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…We made the diagnosis of AVNRT with a bystander NF pathway with good probability. It appears likely that these theoretical difficulties between the NFRT and AVNRT with bystander NF pathway will continue even though the vast majority of these patients are cured by slow pathway ablation 12,32–35 …”

Section: Discussionmentioning

confidence: 99%

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An interesting response to His‐synchronous ventricular stimulation: What is the mechanism of this supraventricular tachycardia?

Turhan¹,

Hidayet

Tunçez

et al. 2022

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 99%

“…12,[32][33][34][35] Riles EM, Badhwar N, Scheinman MM. Clinical features and sites of ablation for patients with incessant supraventricular tachycardia from concealed nodofascicular and nodoventricular tachycardias.…”

mentioning

confidence: 99%

An interesting response to His‐synchronous ventricular stimulation: What is the mechanism of this supraventricular tachycardia?

Turhan¹,

Hidayet

Tunçez

et al. 2022

Cardiovasc electrophysiol

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“…A slow pathway modification performed in this case eliminated tachycardia induction. It appears likely that these theoretical difficulties between the NFRT and AVNRT with bystander NF pathway will continue even though the vast majority of these patients are cured by slow pathway ablation …”

Section: Discussionmentioning

confidence: 99%

An uncommon response to a His refractory premature ventricular complex during a short RP supraventricular tachycardia: What is the mechanism?

Şahin

Özeke²,

Çay³

et al. 2019

Pacing Clinical Electrophis

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A 33-year old woman presented with regular palpitations and documented a short RP narrow QRS complex tachycardia. A 12-lead surface electrocardiography during sinus rhythm showed no delta waves. At electrophysiological study, the retrograde conduction was decremental and concentric with the earliest activation site at the His bundle region. Para-Hisian pacing indicated retrograde conduction over the fast pathway of the atrioventricular (AV) node. No retrograde dual AV nodal physiology was observed, while programmed atrial extrastimuli exhibited an AH interval jump, demonstrating the presence of anterograde dual AV nodal pathways. No pre-excitation was inducible at any pacing site or atrial rate. After the AH interval jump, a narrow QRS tachycardia at a cycle length (CL) of 360 ms was reproducibly induced.A single late ventricular premature complex (VPC) applied from the right ventricular apex (RVA) during the tachycardia is shown in Figure 1. What is the mechanism of this tachycardia? DISCUSSIONThe differential diagnosis of a short RP supraventricular tachycardia with the earliest atrial activation in the His bundle region includes atrial tachycardia (AT) originating from near the AV node, orthodromic reciprocating tachycardia (ORT) using a septal accessory pathway, typical (slow-fast form) atrioventricular nodal reentrant tachycardia (AVNRT), junctional tachycardia (JT), and orthodromic nodofascicular (NF), or nodoventricular (NV) reentrant tachycardia (NFRT/NVRT). 1-6 The tachycardia with a short septal VA interval of <70 ms excludes ORT, although septal AT with a prolonged AV conduction is possible. 3 The His-refractory VPC stopped the tachycardia without changing the retrograde atrial activation sequence (RAAS) and AA interval, which excludes the diagnosis of AT and JT, leaving us the possibility of NFRT or AVNRT with bystander NF pathway. 4,7,8 Whereas a His-refractory VPC terminates the tachycardia without conducting to the atrium, it should not have any effect on the ongoing tachycardia during AVNRT. However, the presence of an NF or NV pathway connected to the nodal slow pathway may explain the paradoxical delay in His or termination of tachycardia by VPC maintaining the same RAAS (Figure 2). Although NF/NV connections are rare accessory pathways,their presence must be recognized because they can lead to diagnostic confusion, whether or not they participate in the tachycardia. 9-11 The para-Hisian pacing is generally not useful since an AV nodal response is not diagnostic of pure AV nodal conduction but can also be observed with a NF pathway. 12 The tachycardia induction with critical AH jump is also not discriminative evidence. Because the His bundle is not part of the AVNRT circuit, in theory it should be possible to dissociate the His-bundle potential from the tachycardia, 13 which favor AVNRT compared with NFRT. 14,15 Ho et al reported that the His-refractory VPC is the only maneuver to identify a concealed, bystander NFRT during atypical AVNRT. 12 It can terminate AVNRT in the presence of a concealed...

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“…• other forms of AV nodal reentrant arrhythmias (slow/slow type)-11%; we have three types of slow/slow AVNRT depending on where the slow pathway is located, which is reflected by the descending branch of the reentry loop, or more than two reentry waves, etc. (Mani and Pavri, 2014; Katrisis and Josephson, 2016;Kaneko et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Stochastic models of the slow/fast type of atrioventricular nodal reentrant tachycardia and tachycardia with conduction aberration

Jackowska-Zduniak

2022

International Journal of Applied Mathematics and Computer Scien

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Models are proposed to describe the heart's action potential. A system of stochastic differential equations is used to recreate pathological behaviour in the heart such as atrioventricular nodal reentrant tachycardia (AVNRT) and also AVNRT with conduction aberration. Part of the population has abnormal accessory pathways: fast and slow. An additional pathway is not always induced, since the deterministic model is not proper due to a stochasticity in this process. Introduction of a stochastic term allows modelling a pre-excitation perturbation (such as unexpected excitation by premature contractions in atrium (PAC)) which triggers the mechanism of AVNRT. Also, a system of AVNRT with additional conduction aberration, which is a rare type of arrhythmia, is considered. The aim of this work is to propose a mathematical model superior to the deterministic one that recreates this disease better and allows understanding its mechanism and physical dependencies, which may help to propose a new therapy of AVNRT. Results are illustrated with numerical solutions.

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What is the mechanism of wide QRS tachycardia?

Cited by 4 publications

References 6 publications

An interesting response to His‐synchronous ventricular stimulation: What is the mechanism of this supraventricular tachycardia?

An interesting response to His‐synchronous ventricular stimulation: What is the mechanism of this supraventricular tachycardia?

An uncommon response to a His refractory premature ventricular complex during a short RP supraventricular tachycardia: What is the mechanism?

Stochastic models of the slow/fast type of atrioventricular nodal reentrant tachycardia and tachycardia with conduction aberration

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