Atrioventricular Nodal Reentrant Tachycardia in Implantable Cardioverter Defibrillators: Diagnosis and Troubleshooting

Abstract

Inappropriate therapies are frequent in patients with implantable cardioverter defibrillators (ICDs) and are associated with adverse outcomes, including increased mortality. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common reentrant supraventricular tachycardia (SVT) and a cause of inappropriate therapies in these patients. In the present article we review the problem of AVNRT in ICD patients with a focus on diagnosis and the available algorithms to improve arrhythmia discrimination and prevent inappropriate shocks.

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

“…Inappropriate therapies are frequent in patients with ICDs and are associated with adverse outcomes, including increased mortality. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common reentrant narrow complex tachycardia (NCT) and a cause of inappropriate therapies in these patients 1–3 . The differential diagnosis of NCT with ventriculoatrial (VA) dissociation or variable block to the atrium includes junctional ectopic tachycardia (JET), AVNRT with a block in the upper (proximal) common pathway (UCP), orthodromic nodofascicular (NF)/nodoventricular (NV) re‐entry, and a focal tachycardia from the proximal or distal His–Purkinje system (HPS) 4–10 …”

Atrioventricular 1:1 tachycardia effectively terminated by antitachycardia pacing

“…Another possibility would be to inactivate the dual-chamber detection criteria (and rely on the morphology criterion to diagnose SVT, assuming that there is no aberrancy). Excellent reviews of ICD troubleshooting in the setting of AVNRT have been published [4,5].…”

Successful Identification of and Discrimination Between Atrial and Ventricular Arrhythmia with the Aid of Pacing and Defibrillator Devices

“…[ 27 ] Recently, the multi-centre PRAETORIAN trial reported that in patients without a pacing indication, an S-ICD was non-inferior to the transvenous ICD with respect to device-related complications and inappropriate shock, with no difference in appropriate shock between the two arms. [ 28 ]…”