Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Using a Slow Pathway Extending to the Superoanterior Right Atrium

Abstract

We report a case of atypical fast-slow atrioventricular nodal reentrant tachycardia (AVNRT) using a slow pathway variant extending to the superoanterior right atrium. The AVNRT diagnosis was confirmed by using standard electrophysiological criteria that exclude a diagnosis of atrial tachycardia and atrioventricular reentrant tachycardia. The earliest atrial activation during tachycardia was found in the superoanterior right atrium adjacent to the tricuspid annulus, where the first delivery of radiofrequency energy terminated and eliminated the inducibility of the tachycardia.

Antegrade slow pathway mapping of typical atrioventricular nodal reentrant tachycardia based on direct slow pathway capture

“…In this study, all ASps were located at the anatomical slow pathway region. However, slow pathway is sometimes located at the mitral annulus, tricuspid annulus, and non‐coronary cusp of Valsalva 23‐27 . In such cases, whether or not our method worked well was uncertain.…”

“…However, slow pathway is sometimes located at the mitral annulus, tricuspid annulus, and non-coronary cusp of Valsalva. [23][24][25][26][27] In such cases, whether or not our method worked well was uncertain.…”

Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V‐A‐A‐V response

“…Instead, we diagnosed AT when ≥1 of the following original three criteria were fulfilled (Table S2): The first observation was an earliest site of atrial activation during tachycardia in the right atrial (RA) free wall, away from the tricuspid annulus, including the interatrial septum and near the sinus node, 12 or in the RA free wall adjacent to the tricuspid annulus, between 8 and 11 o'clock in the left anterior oblique fluoroscopic view (site of origin criterion). This criterion excluded, in particular, the misdiagnosis as AT, of atypical F/S‐AVNRT with earliest sites of atrial activation in the superior, 3–5 superoanterior 22 or inferolateral RA 23 Second was the observation of intra‐atrial fusion during ventricular entrainment of the tachycardia 24 (intra‐atrial fusion criterion; Figure 1).…”

“…[3][4][5] Consequently, we believe that, among the criteria proposed currently, none is reliably diagnostic of AT-HB or AT-CS. Furthermore, although the observation of an earliest site of atrial activation away from the septum during tachycardia is generally indicative of AT, 12 regions in the superoanterior 22 or inferolateral 23 RA free wall, along the tricuspid annulus, might also appear as the earliest atrial site during atypical F/S-AVNRT. All observations considered, we used the original criteria for a diagnosis of AT in this study.…”

Atypical Slow-Slow Atrioventricular Nodal Reentrant Tachycardia with Use of a Superior Slow Pathway

“…Recently, we have reported a case of atypical fastslow AVNRT using a SP extending superoanterior right atrium. 3) Understanding of the superior SP and AVNRT with variants of the SP is increasing. This report describes a case of atypical slow-slow AVNRT with a superior SP.…”