An unusual long RP tachycardia: What is the mechanism?

Egami, Yasuyuki; Ukita, Kohei; Kawamura, Akito; Nakamura, Hitoshi; Matsuhiro, Yutaka; Yasumoto, Koji; Tsuda, Masaki; Okamoto, Naotaka; Tanaka, Akihiro; Matsunaga‐Lee, Yasuharu; Yano, Masamichi; Shutta, Ryu; Nishino, Masami; Tanouchi, Jun

doi:10.1111/jce.14821

Cited by 3 publications

(9 citation statements)

References 4 publications

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“…The first step was identification of the presence of a concealed atrioventricular AP or cNVP. The presence of either AP, except the NFP, was recognized on observation of tachycardia reset without any change in the atrial sequence and/or termination without atrial capture upon His‐refractory PVC that exhibited a fused QRS morphology 2,4–9 . In our study, presence of either AP was recognized in 14 of the 17 AVNRTs.…”

Section: Resultssupporting

confidence: 52%

“…Differentiation of orthodromic reciprocating tachycardia (ORT) incorporating a concealed nodoventricular pathway (cNVP) from atrioventricular nodal reentrant tachycardia (AVNRT) is particularly challenging and requires careful interpretation of the intracardiac electrograms 1–3 . Furthermore, differential diagnosis is not necessarily exclusive of ORT or AVNRT; there are several reports of AVNRT with a bystander cNVP 1–9 . However, criteria have not yet been developed for systematic diagnosis of AVNRT with a bystander cNVP because of the difficulty in differentiating this arrhythmia from NV‐ORT, and this lack leads to underdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

Nagashima,

Maruyama,

Kaneko

et al. 2023

Journal of Arrhythmia

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BackgroundThis study aimed to establish a systematic method for diagnosing atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed nodoventricular pathway (cNVP).MethodsWe analyzed 13 cases of AVNRT with a bystander cNVP, 11 connected to the slow pathway (cNVP‐SP) and two to the fast pathway (cNVP‐FP), along with two cases of cNVP‐related orthodromic reciprocating tachycardia (ORT).ResultsThe diagnostic process was summarized in three steps. Step 1 was identification of the presence of an accessory pathway by resetting the tachycardia with delay (n = 9) and termination without atrial capture (n = 4) immediately after delivery of a His‐refractory premature ventricular contraction (PVC). Step 2 was exclusion of ORT by atrio‐His block during the tachycardia (n = 4), disappearance of the reset phenomenon after the early PVC (n = 7), or dissociation of His from the tachycardia during ventricular overdrive pacing (n = 1). Moreover, tachycardia reset/termination without the atrial capture (n = 2/2) 1 cycle after the His‐refractory PVC was specifically diagnostic. Exceptionally, the disappearance of the reset phenomenon was also observed in the two cNVP‐ORTs. Step 3 was verification of the AVN as the cNVP insertion site, evidenced by an atrial reset/block preceding the His reset/block in fast–slow AVNRT with a cNVP‐SP and slow–fast AVNRT with a cNVP‐FP or His reset preceding the atrial reset in slow–fast AVNRT with a cNVP‐SP.ConclusionAVNRT with a bystander cNVP can be diagnosed in the three steps with few exceptions. Notably, tachycardia reset/termination without atrial capture one cycle after delivery of a His‐refractory PVC is specifically diagnostic.

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Section: Resultssupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

Nagashima,

Maruyama,

Kaneko

et al. 2023

Journal of Arrhythmia

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“…Among 10 patients from 7 previous reports of atypical AVNRT with bystander NV/NF pathways, the His-refractory VES was associated with reset of the tachycardia, with delay in 4 patients (40%) and termination of the tachycardia without atrial capture in 7 patients (70%) ( Supplemental Table 1 ). 1 , 2 , 3 , 4 , 5 , 6 , 7 Either phenomenon was observed in all patients.…”

Section: Discussionmentioning

confidence: 74%

“…However, when concealed NV/NF pathway connecting to SP is present in patients with atypical AVNRT, the His-refractory VES is associated with reset of the tachycardia with delay and/or termination of the tachycardia without atrial capture. 1 , 2 , 3 , 4 , 5 , 6 , 7 The former was observed in SVT-1a and SVT-1b, and the latter was observed in SVT-1b. The reset of the tachycardia with delay occurs because the decremental conduction of the retrograde SP to which the concealed NV/NF pathway is connected exceeds the earliness of the VES.…”

Section: Discussionmentioning

confidence: 92%

“…Although the concealed NV/NF pathway sometimes causes orthodromic reciprocating tachycardia (ORT) acting as a part of the reentry circuit, it is mostly a bystander conduction tract observed in patients with atrioventricular nodal reentrant tachycardia (AVNRT). 1 , 2 , 3 , 4 , 5 , 6 , 7 However, orthodromic atrioventricular reciprocating tachycardia (AVRT) with bystander concealed NV/NF pathway in patients with accessory pathways (APs) has not been reported. Here we report a case of preexcitation syndrome showing atypical AVNRT and orthodromic AVRT with a bystander concealed NV/NF pathway.…”

Section: Introductionmentioning

confidence: 99%

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A case of preexcitation syndrome showing atypical atrioventricular nodal reentrant tachycardia and orthodromic atrioventricular reciprocating tachycardia with a bystander concealed nodoventricular/nodofascicular pathway

Nishiwaki

Shizuta

Tanaka

et al. 2022

HeartRhythm Case Reports

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SVT quest: The adventure diagnosing narrow QRS tachycardia

Nagashima,

Michaud,

et al. 2024

Journal of Arrhythmia

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In the field of cardiac electrophysiology, there is a universal desire: the discovery of a flawless diagnostic maneuver for supraventricular tachycardias (SVTs). This is not merely a wish but a shared odyssey. To improve diagnostic accuracy and achieve sufficient sensitivity and specificity, numerous diagnostic maneuvers have been proposed. However, each has its limitations and prompts a search for new diagnostic techniques. This continuous cycle of discovery and refinement, which we titled “SVT Quest” is reviewed in chronological sequence. This adventure in diagnosing narrow QRS tachycardia unfolds in 3 steps: Step 1 involves differentiating atrial tachycardia from other SVTs based on the observations such as V‐A‐V or V‐A‐A‐V response, ΔAA interval, VA linking, the last entrainment sequence, and response to the atrial extrastimulus. Step 2 focuses on differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia based on the observations such as tachycardia reset upon the premature ventricular contraction during His refractoriness, uncorrected/corrected postpacing interval, differential ventricular entrainment, orthodromic His capture, transition zone analysis, and total pacing prematurity. Step 3 characterizes the concealed nodoventricular/nodofascicular pathway and His‐ventricular pathway‐related tachycardia based on observations such as V‐V‐A response, ΔatrioHis interval, and paradoxical reset phenomenon. There is no single diagnostic maneuver that fits all scenarios. Therefore, the ability to apply multiple maneuvers in a case allows the operator to accumulate evidence to make a likely diagnosis. Let's embark on this adventure!

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An unusual long RP tachycardia: What is the mechanism?

Cited by 3 publications

References 4 publications

Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

Systematic observation‐based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway

A case of preexcitation syndrome showing atypical atrioventricular nodal reentrant tachycardia and orthodromic atrioventricular reciprocating tachycardia with a bystander concealed nodoventricular/nodofascicular pathway

SVT quest: The adventure diagnosing narrow QRS tachycardia

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