<p>Atrioventricular Nodal Reentrant Tachycardia: Current Perspectives</p>

Abstract

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common, highly symptomatic paroxysmal supraventricular tachycardia. Despite pharmacological treatment and vagal maneuvers for acute termination, catheter ablation has emerged as the first line treatment for the cure of AVNRT episodes. Several studies during recent years have investigated the efficacy, safety and long-term effect of both radiofrequency ablation and cryoablation of the slow pathway for the treatment of AVNRT. Innovations such as mapping systems and dedicated catheters have contributed by extending the indication to AVNRT ablation, even in particular subset populations such as children and congenital heart disease patients. We performed this review with the aim aim of summarizing and discussing current perspectives on the treatment of AVNRT, mainly focusing on catheter ablation energy sources and long-term results.

Voltage and propagation mapping: New tools to improve successful ablation of atrioventricular nodal reentry tachycardia

“…Additionally, there is an increased risk for damage to the AV node with a conventional step-wise approach to targeting the slow pathway. [7][8][9][10][11][12][13][14] In our study, 3D mapping with voltage and propagation mapping was a simple technique obtained without additional catheters and costs. Combining LVB and CP, we achieved a procedural endpoint at first erogation in most patients.…”

“…While conventional approaches for AV nodal modification have proven to be successful, multiple slow pathways, anatomical challenges, and interprocedure recurrences may complicate and prolong such procedures. Additionally, there is an increased risk for damage to the AV node with a conventional step‐wise approach to targeting the slow pathway 7–14 . In our study, 3D mapping with voltage and propagation mapping was a simple technique obtained without additional catheters and costs.…”

“…Endpoint in both techniques is complete elimination of the slow pathway at the end of the procedure. 7 The slow pathway is located along the inferior side of Triangle of Koch (TK), toward the tricuspid valve with an atrial voltage ratio 1/10 to 1/2 that of the ventricular voltage. [8][9][10][11][12][13] Ablative therapy is applied in the region of the slow pathway until either a junctional response is produced (radiofrequency [RF] energy), or non-inducibility with, or without, AV nodal echo beats results.…”

“…Both energy sources have been extensively investigated in terms of acute success, safety, and long‐term efficacy, 4–6 each one presenting some advantages and disadvantages compared to the other. Endpoint in both techniques is complete elimination of the slow pathway at the end of the procedure 7 . The slow pathway is located along the inferior side of Triangle of Koch (TK), toward the tricuspid valve with an atrial voltage ratio 1/10 to 1/2 that of the ventricular voltage 8–13 .…”

The Safety of Cardioversion in Supra Ventricular Tachycardia Patient with Pregnancy

“…Cardiac examination revealed a grade 2 systolic murmur, echocardiographic examination revealed a minimal pericardial effusion, typical AVNRT (slow-fast). [19][20] Initial management of this case was carried out by vagal maneuvers, but the patient's response was not effective, followed by pharmacotherapy given metoprolol, the patient's response was refractory, hemodynamic signs were found to be unstable, cardioversion was carried out starting from 30 Joules to 50 Joules and 100 Joules. In the next attack of SVT, a Vagal maneuver was performed on the patient, with a less effective response, a non-dihydropyridine CCB drug was administered, namely diltiazem.…”