Bystander Accessory Pathway During AV Node Re‐entrant Tachycardia

Smith, Woollcott; Broughton, Archer; Mj, Reiter; Dw, Benson; Ao, Grant; Jj, Gallagher

doi:10.1111/j.1540-8159.1983.tb05293.x

Cited by 43 publications

(6 citation statements)

References 15 publications

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“…26 In the electrophysiology laboratory, preexcited reciprocating tachycardia occurred spontaneously during sinus rhythm in four patients, followed premature atrial contraction in three, and followed a His bundle extrasystole in two ( figure 1, A). In the remaining 20 patients, who had multiple accessory pathways, the reentrant circuits were often quite varied and are diagrammed in figure 1, B through F. listed in tables 2 and 3 and are illustrated in figure 6. Sixteen were located in the left free wall, five in the right free wall, and one in the anterior septum.…”

Section: Resultsmentioning

confidence: 99%

Preexcited reciprocating tachycardia in patients with Wolff-Parkinson-White syndrome: incidence and mechanisms.

Bardy

Packer²,

German

et al. 1984

Circulation

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During the electrophysiologic study of 435 patients referred for evaluation of WolffParkinson-White syndrome, 42 (10%) had preexcited reciprocating tachycardia (defined as a macroreentrant tachycardia that used an accessory atrioventricular [AV] pathway for antegrade conduction).The ages of the patients ranged from 9 to 67 years (27 + 14). Thirty-three were male patients, nine female, and eight had Ebstein's anomaly. Preexcited reciprocating tachycardia cycle length was 220 to 430 msec (294 ± 42). Significant hemodynamic compromise in the laboratory directly related to preexcitated reciprocating tachycardia occurred in only one patient. However, in 10 patients a transformation to atrial fibrillation was seen after a spontaneously occurring premature atrial contraction. Only 17 of the 42 patients with preexcited reciprocating tachycardia during electrophysiologic study had the same tachycardia documented clinically. These 17 patients were more often younger with multiple accessory pathways and with no history of orthodromic reciprocating tachycardia when compared with 25 patients in whom preexcited reciprocating tachycardia could be induced only in the laboratory. Preexcited reciprocating tachycardia was induced in the laboratory in 22 of 374 (6%) patients with single accessory pathways and in 20 of 61 (33%) of those with multiple accessory pathways. In the 20 patients with multiple accessory pathways, the spectrum of reentrant circuits included fusion over two or more accessory pathways or fusion over both an accessory pathway and the AV node.

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Section: Resultsmentioning

confidence: 99%

Preexcited reciprocating tachycardia in patients with Wolff-Parkinson-White syndrome: incidence and mechanisms.

Bardy

Packer²,

German

et al. 1984

Circulation

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“…No patient with inducible ART had a single posteroseptal accessory pathway.2 Of the 30 patients with this form of tachycardia, 21 (68%) underwent surgery, during which the accessory pathway location was confirmed by epicardial mapping,9-1" and the accessory pathway was successfully divided. Of the left free wall pathways, all were located at least 4 cm from the coronary sinus orifice as determined at surgery or calculated at the initial electrophysiology study from the earliest site of retrograde atrial activation indicating the accessory pathway location and both the characteristic cavitary atrial electrogram and typical fluoro- 30 36 Age (years) 31± 13 34±14 Sex (male/female) 25 1 (3%) Multiple 0 (0%)* 0 (0%)* ORT, orthodromic reciprocating tachycardia; ART, antidromic reciprocating tachycardia; AF, atrial fibrillation; VF, ventricular fibrillation.…”

Section: Methods Patient Populationmentioning

confidence: 99%

Physiological substrate for antidromic reciprocating tachycardia. Prerequisite characteristics of the accessory pathway and atrioventricular conduction system.

1992

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“…43 In this case, atrial extrastimuli fail to induce advancement of the following preexcited QRS complex, the next retrograde His bundle deflection where apparent, and the subsequent atrial deflection without changing the retrograde atrial activation sequence, as may happen in the presence of a macroreentrant loop ( Figure 6). Although no extensive series have been published, application of entrainment criteria (SA-VA and PPI-TCL) from the apex 44 or the apex and the base for differential entrainment 45 is theoretically appealing and has been proposed to distinguish between antidromic AVRT and AVNRT with a bystander fiber.…”

Section: Electrophysiology Studymentioning

confidence: 99%

Atrioventricular Nodal Reentrant Tachycardia

2010

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A trioventricular nodal reentrant tachycardia (AVNRT) represents the most common regular supraventricular arrhythmia in humans. 1 The precise anatomic site and nature of the pathways involved have not yet been established, and several attempts to provide a reasonable hypothesis based on anatomic or anisotropic models have been made. 2 There has been considerable evidence that the right and left inferior extensions of the human atrioventricular (AV) node and the atrionodal inputs they facilitate may provide the anatomic substrate of the slow pathway, and a comprehensive model of the tachycardia circuit for all forms of AVNRT based on the concept of atrionodal inputs has been proposed. 2 Still, however, the circuit of AVNRT remains elusive. Recently, time-honored conventional schemes for the diagnosis and classification of the various forms of the arrhythmia have been refuted in part by evolving evidence. Recognition of the various types of AVNRT is important, however, to expedite diagnosis and allow implementation of appropriate ablation therapy without complications. We present an update on AVNRT with a particular emphasis on electrophysiological criteria used for the differential diagnosis of regular, supraventricular tachycardias. ECG PresentationTypically, AVNRT is a narrow-complex tachycardia, ie, QRS duration Ͻ120 ms, unless aberrant conduction, which is usually of the right bundle-branch type, or a previous conduction defect exists. Tachycardia-related ST depression and RR-interval variation may be seen. RR alternans in AVNRT has been attributed to the proposed model of a figure of 8 reentry with continuous crossing over of antegrade activation through an inferior input to the contralateral superior input via the node. 2 In the typical form of AVNRT (slow-fast), abnormal (retrograde) PЈ waves are constantly related to the QRS and in the majority of cases are indiscernible or very close to the QRS complex (RPЈ/RR Ͻ0.5). Thus, PЈ waves are either masked by the QRS complex or seen as a small terminal PЈ wave that is not present during sinus rhythm (Figure 1). In the atypical form of AVNRT (fast-slow), PЈ waves are clearly visible before the QRS, ie, RPЈ/PЈR Ͼ0.75 (Figure 2), denoting a "long RP tachycardia," and are negative in leads II, III, aVF, and V 6 but positive in V 1 . PЈ waves are shallow in the inferior leads in the rare form of anterior fast-slow AVNRT. 3 Although AV dissociation is usually not seen, it can occur because neither the atria or the ventricles are necessary for the reentry circuit. If the tachycardia is initiated by atrial ectopic beats, the initial (ectopic) PЈ wave usually differs from the subsequent (retrograde) PЈ waves (Figure 1).

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Bystander Accessory Pathway During AV Node Re‐entrant Tachycardia

Cited by 43 publications

References 15 publications

Preexcited reciprocating tachycardia in patients with Wolff-Parkinson-White syndrome: incidence and mechanisms.

Preexcited reciprocating tachycardia in patients with Wolff-Parkinson-White syndrome: incidence and mechanisms.

Physiological substrate for antidromic reciprocating tachycardia. Prerequisite characteristics of the accessory pathway and atrioventricular conduction system.

Atrioventricular Nodal Reentrant Tachycardia

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