Electrophysiologic Characteristics of Atrioventricular Nodal Reentrant Tachycardia: Implications for the Reentrant Circuits

Lockwood, Deborah; Otomo, Kenichiro; Wang, Zulu; Forresti, Sara; Nakagawa, Hiroshi; Beckman, Karen J.; Scherlag, Benjamin J.; Patterson, Eugene; Lazzara, Ralph; Jackman, Warren M.

doi:10.1016/b0-7216-0323-8/50062-2

Cited by 56 publications

(77 citation statements)

References 55 publications

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“…A decapolar catheter (5-mm inter-electrode distance) was advanced into the coronary sinus (CS) via the left subclavian vein, with the most proximal pair of electrodes positioned 1-2 cm from the CS ostium. Localisation of the ostium was facilitated by: (1) observing, in the left anterior oblique projection, the entry point into the CS of the diagnostic catheter; and (2) stimulation from the proximal CS was associated with inverted P waves in inferior leads [10][11][12]. The distal pair of electrodes of quadripolar catheters and the proximal pair of electrodes of the decapolar catheter were used for pacing.…”

Section: Electrophysiological Studymentioning

confidence: 99%

“…Prematurity of the test atrial impulse was reduced in 10-ms decrements. If AVNRT was not induced during these manoeuvres (31 patients) the whole protocol was repeated during isoprenaline infusion that increased gradually until a stable sinus rate 25% higher than the initial basic rate but of at least 100 bpm was achieved [11,12]. Finally, all patients had inducible AVNRT, diagnosed using the standard criteria [5,13].…”

Section: Electrophysiological Studymentioning

confidence: 99%

“…The rightward anterior extension, considered as an electrophysiological substrate for the FP, travels from the anterior limbus of the fossa ovalis along the tendon of Todaro with the ERAA usually recorded at the same site recording the His bundle potential, in the apex of the ToK [4,9,13,[16][17][18][19]. The rightward posterior extension, which represents the electrophysiological substrate for the SP, travels within the ToK along the septal leaflet of the tricuspid annulus (TA) with the ERAA usually recorded between the TA and CS ostium, in the base of the ToK [9,12,13,19]. It has been known for some time that the leftward posterior extension can provide the LA input to the AV node, showing a preferential access from the left inferior septum [3-5, 8, 10, 11, 13, 20, 21].…”

Section: Anterograde Avn Transmission During Pacingmentioning

confidence: 99%

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The effect of atrial pacing site on electrophysiological properties of the atrioventricular junction and induction of atrioventricular nodal reentry in patients with typical atrioventricular nodal reentrant tachycardia

Kiedrowicz

Kaźmierczak²,

Wielusiński³

2017

Kardiol Pol

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A b s t r a c tBackground: Clinical studies in humans have shown the site of atrial stimulation to influence atrioventricular (AV) conduction times and refractory periods, the demonstration of dual AV nodal (AVN) pathways, and induction of AVN reentry. These studies often found conflicting results. Moreover, among enrolled patients a minority of them were found to have AVN reentrant tachycardia (AVNRT). Aim:The purpose of this study was to investigate the effect of right and left atrial pacing on the electrophysiological properties of the AV junction in the typical AVNRT population.Methods: Ninety-two consecutive patients with typical AVNRT were included. Atrial pacing was performed from the high right atrium (HRA) and the left atrium via the proximal coronary sinus (CS). Results:Stimulation from either the HRA or the CS could result in dual AVN physiology and AVNRT. No site-dependent differences in the ease of induction of dual AVN pathways with variability of initiation from either site were found. However, AVNRT was easier to induce from the HRA. With CS pacing the leftward but not the rightward AVN approaches were the entry point to the AV node because of significantly shorter AH conduction times compared to HRA pacing. Conduction over the leftward AVN extensions could initiate the tachycardia with significantly shorter critical AH interval compared to conduction over the rightward AVN extensions; however, the AH interval during AVNRT and its cycle length were not significantly different. Conclusions:Rightward and leftward AVN extensions are regular features of the AV node. Their different electrophysiological properties lead to variation in the demonstration of discontinuous AVN conduction and AVNRT during right and left atrial pacing. Despite the observation that the left AVN extensions could compose the entry point to the reentrant circuit, there is no evidence that they constitute the critical component of sustained typical AVNRT.

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Section: Electrophysiological Studymentioning

confidence: 99%

Section: Electrophysiological Studymentioning

confidence: 99%

Section: Anterograde Avn Transmission During Pacingmentioning

confidence: 99%

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The effect of atrial pacing site on electrophysiological properties of the atrioventricular junction and induction of atrioventricular nodal reentry in patients with typical atrioventricular nodal reentrant tachycardia

Kiedrowicz

Kaźmierczak²,

Wielusiński³

2017

Kardiol Pol

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“…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][12][13] Thus, 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).…”

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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“…Это связано с наличием длинного общего пути -третьего компонента петли реентри при АВУРТ, демон-стрирующего, как правило, декрементное прове-дение и имеющего в своем составе большое ко-личество узловой ткани [5,[10][11][12]. Короткий ин-тервал H-A в данном случае является разностью времени ретроградного проведения по медленно-му пути и такого же медленного проведения по общему нижнему пути [3]. Поскольку исходно имела место АВ блокада, было решено выполнять абляцию на фоне асин-хронной стимуляции предсердий.…”

unclassified

Slow/Slow Type of Atrioventricular Nodal Reentrant Tachycardia in First Degree Atrioventricular Block

Мамчур¹,

Хоменко²,

Бохан³

et al. 2016

Kompleks. probl. serdečno-sosud. zabol.

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Представлен клинический случай электрофизиологического исследования и катетерной абляции атриовентрикулярной уз-ловой реципрокной тахикардии типа slow/slow при наличии атриовентрикулярной блокады первой степени, имитирующей пред-сердную эктопическую или ортодромную тахикардию. Описаны приемы дифференциальной диагностики и объяснены механизмы феномена.Ключевые слова: атриовентрикулярная узловая реципрокная тахикардия. the report describes the case of slow/slow type of atrioventricular nodal reentrant tachycardia in first degree atrioventricular block which simulate atrial ectopic or orthodromic tachycardia. differential diagnosis technique is described and mechanisms of the phenomenon are illustrated. SLOW/SLOW TYPEKey words: atrioventricular nodal reentrant tachycardia.Атриовентрикулярная узловая реципрокная та-хикардия (АВУРТ) -самая распространенная та-хиаритмия, около 52 % из всех пациентов с супра-вентрикулярными тахикардиями [1,2,6]. Меха-низмом возникновения аритмии является реентри между быстрым и медленным путями атриовен-трикулярного (АВ) проведения. В настоящее вре-мя выделяют три электрофизиологических типа АВУРТ: к типичной форме относят АВУРТ slow/ fast, к атипичной -fast/slow и slow/slow формы тахикардии [5][6][7]. Последняя, наиболее редкая, встречается в 4 % всех случаев АВУРТ [1,2]. В статье представлен клинический случай элек-трофизиологического исследования и катетерной абляции атриовентрикулярной узловой реци-прокной тахикардии типа slow/slow при наличии атриовентрикулярной блокады первой степени, имитирующей предсердную эктопическую или ортодромную тахикардию.Пациентка З., 45 лет, обратилась в поликлинику кардиологического диспансера с жалобами на вне-запно возникающие эпизоды учащенного ритмич-ного сердцебиения, не купирующиеся вагусными пробами. В наличии имеются записи ЭКГ, выпол-ненные бригадами скорой медицинской помощи, на которых регистрируется узкокомплексная тахи-кардия с регулярными интервалами R-R (рис. 1).При обращении к терапевту по месту житель-ства была выполнена запись ЭКГ вне пароксиз-ма, на которой отмечалась АВ блокада I степени (рис. 2). При этом на фоне тахикардии имелась за-зубрина на ST-T в отведении V1, что было расце-нено как ретроградный зубец P. На синусовом рит-ме, помимо нарушения АВ проведения, складыва-лось впечатление о наличии небольшой δ-волны. Поэтому рабочим диагнозом стал манифестный синдром WPW, ортодромная тахикардия. Опреде-лены показания к проведению внутрисердечного электрофизиологического исследования (ЭФИ) и катетерной радиочастотной абляции (РЧА). До момента планового поступления пациентки в ста-ционар от использования изоптина решено было отказаться из-за наличия исходного нарушения АВ проведения, поэтому о его влиянии на тахи-кардию информации не было.При проведении ЭФИ на синусовом ритме за-регистрирован супрагисиальный тип АВ блокады, что свидетельствовало о нарушении или полном

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Electrophysiologic Characteristics of Atrioventricular Nodal Reentrant Tachycardia: Implications for the Reentrant Circuits

Cited by 56 publications

References 55 publications

The effect of atrial pacing site on electrophysiological properties of the atrioventricular junction and induction of atrioventricular nodal reentry in patients with typical atrioventricular nodal reentrant tachycardia

The effect of atrial pacing site on electrophysiological properties of the atrioventricular junction and induction of atrioventricular nodal reentry in patients with typical atrioventricular nodal reentrant tachycardia

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Slow/Slow Type of Atrioventricular Nodal Reentrant Tachycardia in First Degree Atrioventricular Block

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