New insights into the mechanisms of fast and slow conduction in the atrioventricular node

High‐density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re‐entrant tachycardia, integrated with direct recording of atrio‐ventricular node structure potential

“…Our results are in line with those reported by Heidbüchel and Jackman, 8 who showed the presence of a common lower pathway in 84% of patients with slow‐slow AVNRT and in all patients with fast‐slow AVNRT, but only in 10% of those with slow‐fast AVNRT. If these hypotheses were to be unequivocally proven, it is our opinion, in agreement with Katritsis and Anderson's recent hypothesis, that the time‐honored term AVNRT is not correct and should be replaced by “atrioventricular junctional reentrant tachycardia” (AVJRT) 19 …”

“…The median time of complete RA mapping (during SR plus tachycardia) was 17 [13][14][15][16][17][18][19][20][21][22][23][24] minutes. Baseline clinical characteristics and procedural data are reported in Table 1.…”

“…If these hypotheses were to be unequivocally proven, it is our opinion, in agreement with Katritsis and Anderson's recent hypothesis, that the time-honored term AVNRT is not correct and should be replaced by "atrioventricular junctional reentrant tachycardia" (AVJRT). 19…”

Atrioventricular nodal re‐entrant tachycardia: Are there unknown long‐term consequences of ablating the (incompletely) known?

“…Although atrioventricular nodal re‐entrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia (PSVT), the exact anatomic location of this enigmatic circuit and its dimensions are not entirely understood but likely involves inferior nodal extensions along the septum (“slow pathway”) and working myocardium of atrial septum (“fast pathway”) 1–3 . Nevertheless, catheter ablation can potentially cure this often‐troubling arrhythmia and thus is recommended as first‐line therapy for patients who have significant symptoms as an alternative to chronic pharmacologic therapy 4 .…”

“…most common form of paroxysmal supraventricular tachycardia (PSVT), the exact anatomic location of this enigmatic circuit and its dimensions are not entirely understood but likely involves inferior nodal extensions along the septum ("slow pathway") and working myocardium of atrial septum ("fast pathway"). [1][2][3] Nevertheless, catheter ablation can potentially cure this often-troubling arrhythmia and thus is recommended as first-line therapy for patients who have significant symptoms as an alternative to chronic pharmacologic therapy. 4 This class I recommendation is based on the high success rates (>95%) and the low frequency of serious complications of ablation that targets the presumed anatomical site of the slow pathway.…”