Heterogeneity of Retrograde Fast-Pathway Conduction Pattern in Patients With Atrioventricular Nodal Reentry Tachycardia

Anselme, Frédéric; Hook, Bruce G.; Monahan, Kevin M.; Frederiks, J.; Callans, David J.; Zardini, Marco; Epstein, Laurence M.; Zebede, Joseph; Josephson, Mark E.

doi:10.1161/01.cir.93.5.960

Cited by 91 publications

(37 citation statements)

References 24 publications

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“…29 Although such a variant retrograde atrial activation was not observed in the present study, it is likely that in some patients the atrionodal inputs to the fast pathway may be anatomically displaced more inferiorly. Similarly, the presence of multiple antegrade slow AV nodal pathways has been reported.…”

Section: Tachycardia Circuit In Avnrtcontrasting

confidence: 58%

Electrophysiological Delineation of the Tachycardia Circuit in Atrioventricular Nodal Reentrant Tachycardia

et al. 1999

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Background-The exact boundaries of the reentry circuit in atrioventricular nodal reentrant tachycardia (AVNRT) have not been convincingly defined. Methods and Results-To define the tachycardia circuit, single extrastimuli were delivered during AVNRT to 8 sites of the right intra-atrial septum: 3 arbitrarily divided sites of the AV junction extending from the His bundle (HB) site to the coronary sinus ostium (CSOS) (sites S, M, and I) and the superior (S-CSOS), inferior (I-CSOS), posterior (P-CSOS), and posteroinferior (PI-CSOS) portions of the CSOS and the CSOS in 18 patients. The mean tachycardia cycle length (TCL) was 368Ϯ52 ms. Retrograde earliest atrial activation was observed at the HB site in all patients. The longest coupling intervals of single extrastimuli that reset AVNRT at sites S, M, I, I-CSOS, CSOS, S-CSOS, P-CSOS, and PI-CSOS were 356Ϯ51, 356Ϯ51, 355Ϯ52, 357Ϯ51, 318Ϯ47, 305Ϯ53, 311Ϯ56, and 312Ϯ56 ms, respectively, and the following return cycles at these sites were 368Ϯ52, 368Ϯ53, 367Ϯ53, 367Ϯ53, 407Ϯ66, 431Ϯ73, 415Ϯ55, and 412Ϯ56 ms, respectively. The longest coupling intervals at sites S, M, I, and I-CSOS did not differ from each other and were longer than those at CSOS and S-, P-, and PI-CSOS (PϽ0.0001). The return cycles at sites S, M, I, and I-CSOS did not differ from the TCL, whereas those at CSOS and S-, P-, and PI-CSOS were longer than the TCL (PϽ0.0001). Conclusions-The perinodal atrium extending from the HB site to I-CSOS was involved in the tachycardia circuit. I-CSOS was thought to be the entrance of the slow pathway. (Circulation. 1999;100:621-627.)

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Section: Tachycardia Circuit In Avnrtcontrasting

confidence: 58%

Electrophysiological Delineation of the Tachycardia Circuit in Atrioventricular Nodal Reentrant Tachycardia

et al. 1999

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“…Moreover, the size of the recording range of bipolar and unipolar electrograms may be too large for the dimension of KT, although several studies on mapping of KT have been made using a similar size of recording electrodes. 2,7,17,33 Therefore, further studies using smaller sizes of the recording electrodes may be useful to confirm the results of the present study.…”

Section: Study Limitationssupporting

confidence: 72%

Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Pandozi

Ficili

Galeazzi

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-The presence of a conduction block at the level of the Koch triangle (KT) and the origin of the multicomponent potentials inside this area are controversial issues. We investigated the propagation of the sinus impulse into the KT and the characteristics of multicomponent potentials recorded in that area in patients with and without atrioventricular nodal reentrant tachycardia (AVNRT). Methods and Results-Thirty-two patients (16 with AVNRT, 16 without AVNRT) underwent a sinus rhythm electroanatomic mapping of the right atrium (RA). Conduction velocities in the RA and in the KT were evaluated quantitatively on activation maps and qualitatively on isochronal and propagation maps. The presence, location, and timing of different types of multicomponent potentials were evaluated. A mean of 149Ϯ44 points were sampled in the RA, whereas a mean of 79Ϯ21 points were collected inside the KT. Propagation block at the level of crista terminalis was not found in any patient, whereas slow conduction inside the KT was found in all (

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“…The existence of an upper common pathway can now be rather easily refuted by subsequent evidence indicating that multiple atrial breakthroughs are extremely common, and retrograde activation often changes in timing and/or activation without significant alteration in tachycardia cycle, thus negating the notion of a simplistic focal atrial exit site. [21][22][23] The perinodal transitional tissue is the route to the atrium, and in this context it may be considered as a common pathway of tissue but not a discrete site.…”

Section: Upper and Lower Common Pathwaysmentioning

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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Heterogeneity of Retrograde Fast-Pathway Conduction Pattern in Patients With Atrioventricular Nodal Reentry Tachycardia

Cited by 91 publications

References 24 publications

Electrophysiological Delineation of the Tachycardia Circuit in Atrioventricular Nodal Reentrant Tachycardia

Electrophysiological Delineation of the Tachycardia Circuit in Atrioventricular Nodal Reentrant Tachycardia

Propagation of the Sinus Impulse Into the Koch Triangle and Localization, Timing, and Origin of the Multicomponent Potentials Recorded in This Area

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

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