Atypical atrioventricular nodal reentrant tachycardia: prevalence, electrophysiologic characteristics, and tachycardia circuit

Katritsis, Demosthenes G.; Sepahpour, Ali; Marine, Joseph E.; Katritsis, George; Tanawuttiwat, Tanyanan; Calkins, Hugh; Rowland, Edward; Josephson, Mark E.

doi:10.1093/europace/euu387

Cited by 46 publications

(23 citation statements)

References 28 publications

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“…Spontaneous decrease of the VA interval with parallel to increase in AH interval is most likely explained by the transition from an atypical AVNRT to a typical AVNRT by a spontaneous AH jump due to block in the antegrade and decremental slow pathway . Indeed, it would be only speculative to make a concise correlation with anatomy since the AH change over a slow pathway might be both due to functional decremental conduction or perhaps more than one distinct anatomical slow pathway.…”

Section: Discussionmentioning

confidence: 99%

An irregular supraventricular tachycardia: What is the mechanism?

Karimli¹,

Kara²,

Korkmaz³

et al. 2019

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 99%

An irregular supraventricular tachycardia: What is the mechanism?

Karimli¹,

Kara²,

Korkmaz³

et al. 2019

Pacing Clinical Electrophis

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“…Appropriate diagnosis in this setting is of importance for the avoidance of prolonged procedures with high fluoroscopy times and unnecessary radiofrequency lesions. Spontaneous changes of the VA interval without changes in the retrograde atrial activation sequence suggest coexistent forms of typical and atypical AVNRT . Moreover, if this occurs with a stable ventricular rate, it suggests that the atrium is not a necessary component and confirms the diagnosis of AVNRT.…”

Section: Electrophysiologic Techniques For Differential Diagnosismentioning

confidence: 90%

“…AVNRT may display eccentric atrial activation and septal pathways may have decremental conduction properties and concentric retrograde atrial activation, thus making the differential diagnosis challenging. Although retrograde atrial activation sequence is usually concentric in AVNRT, heterogeneity of both fast and slow conduction patterns has been well described, and all forms of AVNRT may display variable retrograde activation patterns . Posterior or left‐septal fast pathways may occur in up to 7.6% in patients with typical AVNRT, and studies on left‐septal mapping indicate that were left septal His recordings routinely performed in patients with AVNRT, left‐sided retrograde fast pathways would be documented in a considerable proportion of patients studied .…”

Section: Electrophysiologic Techniques For Differential Diagnosismentioning

confidence: 99%

Supraventricular tachycardias: differential diagnosis at bedside and in the electrophysiology laboratory

Katritsis

2016

Continuing Cardiol Educ

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Clinical and electrophysiologic criteria used for the differential diagnosis of regular supraventricular tachycardias (SVT) are presented. Although several electrocardiographic clues may assist differential diagnosis, this is usually accomplished at electrophysiology study and, most often, is between atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia due to a concealed accessory pathway, and atrial tachycardia. Atrial and, mainly, ventricular pacing maneuvers during sinus rhythm or tachycardia have been used with variable success rate. In clinical practice, these techniques cannot be applied to all cases, and multiple criteria have to be used for the differential diagnosis of narrow complex tachycardias with atypical characteristics. Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4469457/Activity.aspx

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“…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 electrophysiology study.…”

mentioning

confidence: 99%

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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Atypical atrioventricular nodal reentrant tachycardia: prevalence, electrophysiologic characteristics, and tachycardia circuit

Abstract: Of AVNRT cases, 6.4% are atypical and may display patterns that do not necessarily correspond to the fast-slow or slow-slow conventional types. Atypical fast-slow and typical AVNRT do not appear to utilize the same limb for fast conduction.

Cited by 46 publications

References 28 publications

An irregular supraventricular tachycardia: What is the mechanism?

An irregular supraventricular tachycardia: What is the mechanism?

Supraventricular tachycardias: differential diagnosis at bedside and in the electrophysiology laboratory

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

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