Doppelte Ventrikelerregung bei dualer AV-Knoten-Leitungsphysiologie: Katheterablation des langsamen Leitungsweges des dualen AV-Knotens

Abstract

A variety of electrocardiographic manifestations of dual AV nodal physiology have been reported. The specific subtype dual ventricular response is considered as a very rare phenomenon. We present the case of a 53 year old lady who suffered from paroxysmal regular tachycardias for more than seven years. In the last 6 months the symptomatology of the cardiac arrhythmia changed to more persistent und irregular rhythm disturbances. Treatment with class Ia antiarrhythmic drugs and beta-blocking agents failed. The latter even seemed to worsen her very disturbing palpitations. After examination of the ECG recordings, the diagnosis of dual AV nodal physiology with double ventricular response was made--the lady was referred to our institution for electrophysiological testing and radiofrequency catheter ablation of the slow pathway. An invasive electrophysiological study reconfirmed the diagnosis of a dual AV nodal conduction pattern with irregular double ventricular response. The radiofrequency catheter ablation of the the slow pathway achieved a complete cessation of the double ventricular response. This satisfactory outcome was confirmed by analysis of a postinterventional 24 hour holter recording and an exercise stress test. During a follow-up period of three months, the patient remained free of symptoms and there was no recurrence of dual AV nodal conduction physiology in the surface ECG.

Simultaneous Dual Fast and Slow Pathway Conduction upon Induction of Typical Atrioventricular Nodal Reentrant Tachycardia: Electrophysiologic Characteristics in a Series of Patients

“…As already mentioned, SDNC phenomenon is also known to be responsible for another very unusual tachycardia, called NRJT, with a characteristic short-long cycle pattern due to the consecutive driving of a single atrial impulse through AVN fast and slow pathway with a 1:2 AV ratio. [7][8][9][10][11][12][13][14][15][16][17][18][19] Interestingly, simultaneous dual conduction over a Mahaim fiber with nodal-like conduction has been recently reported, which brought about a form of non-reentrant tachycardia similar to NRJT. 26 Although a detailed analysis of NRJT cases is beyond the aim of this study, some aspects are worth mentioning.…”

“…Over the years, a few cases have been reported where simultaneous dual AV node conduction (SDNC) occurs at the induction of a typical atrioventricular nodal reentrant tachycardia (AVNRT), which has been amenable to a successful treatment by conventional slow pathway radiofrequency energy (RF) ablation 2–6 . Moreover, in some other rare cases, SDNC has been observed during normal sinus rhythm at a critical rate: if sustained, it causes a peculiar form of arrhythmia called non‐reentrant junctional tachycardia (NRJT) 7–19 …”

“…[2][3][4][5][6] Moreover, in some other rare cases, SDNC has been observed during normal sinus rhythm at a critical rate: if sustained, it causes a peculiar form of arrhythmia called non-reentrant junctional tachycardia (NRJT). [7][8][9][10][11][12][13][14][15][16][17][18][19] However, no studies on SDNC in large populations have so far been published, and its electrophysiological (EP) features are not yet fully clarified.…”