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Atrioventricular Nodal Reentrant Tachycardia (atrioventricular + nodal_reentrant_tachycardia)

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Medical Sciences	100%

Selected Abstracts

Spontaneous Onset of Ventricular Fibrillation during Atrioventricular Nodal Reentrant Tachycardia

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009
CHRISTIAN VON BARY M.D.
No abstract is available for this article. [source]

Differentiating Atrioventricular Nodal Reentrant Tachycardia from Junctional Tachycardia: Novel Application of the Delta H-A Interval

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2008
KOMANDOOR SRIVATHSAN M.D.
Introduction: Junctional tachycardia (JT) and atrioventricular nodal reentrant tachycardia (AVNRT) can be difficult to differentiate. Yet, the two arrhythmias require distinct diagnostic and therapeutic approaches. We explored the utility of the delta H-A interval as a novel technique to differentiate these two tachycardias. Methods: We included 35 patients undergoing electrophysiology study who had typical AVNRT, 31 of whom also had JT during slow pathway ablation, and four of whom had spontaneous JT during isoproterenol administration. We measured the H-A interval during tachycardia (H-AT) and during ventricular pacing (H-AP) from the basal right ventricle. Interobserver and intraobserver reliability of measurements was assessed. Ventricular pacing was performed at approximately the same rate as tachycardia. The delta H-A interval was calculated as the H-AP minus the H-AT. Results: There was excellent interobserver and intraobserver agreement for measurement of the H-A interval. The average delta H-A interval was ,10 ms during AVNRT and 9 ms during JT (P < 0.00001). For the diagnosis of JT, a delta H-A interval , 0 ms had the sensitivity of 89%, specificity of 83%, positive predictive value of 84%, and negative predictive value of 88%. The delta H-A interval was longer in men than in women with JT, but no gender-based differences were seen with AVNRT. There was no difference in the H-A interval based on age , 60 years. Conclusion: The delta H-A interval is a novel and reproducibly measurable interval that aids the differentiation of JT and AVNRT during electrophysiology studies. [source]

Acute Blood Pressure Changes After the Onset of Atrioventricular Nodal Reentrant Tachycardia: A Time-Course Analysis

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2005
MEHDI RAZAVI M.D.
Introduction: We aimed to characterize blood pressure (BP) response at the beginning of atrioventricular nodal reentrant tachycardia (AVNRT) and its relationship to orthostatic challenge and variable atrioventricular interval. Methods and Results: In this prospective study of 17 consecutive patients with documented AVNRT, mean BP was analyzed in the supine and upright positions during sinus rhythm, AVNRT, and pacing with atrioventricular delay of 150 msec (AV150) and 0 msec (AV0). Mean BPs were compared at 3,5 seconds, 8,10 seconds, and 28,30 seconds after the onset of AVNRT or pacing. BP decreased immediately after AVNRT initiation, with gradual recovery during the first 30 seconds from 71.9 ± 16.5 mmHg to 86 ± 13.8 mmHg, P < 0.01. A similar pattern was observed during AV0, but not during AV150, pacing. While supine, mean BP decrease was more pronounced during AVNRT and AV0 pacing (,26.1% and ,32.1%, respectively) than during AV150 pacing (,8%, P = 0.02 and P = 0.07, respectively). This difference subsided 30 seconds after the onset of AVNRT or pacing. When upright, the mean BP time course was similar, but mean BP recovery during AVNRT was slower, and the difference between mean BP during AVNRT and AV150 persisted at 30 seconds. Conclusions: The initial mean BP decrease during AVNRT recovered gradually within 30 seconds. A short atrioventricular interval is associated with a greater mean BP decrease at the onset of tachycardia. These observations may explain clinical symptoms immediately after the onset of AVNRT. [source]

Spontaneous Transition of 2:1 Atrioventricular Block to 1:1 Atrioventricular Conduction During Atrioventricular Nodal Reentrant Tachycardia:

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2003
Evidence Supporting the Intra-Hisian or Infra-Hisian Area as the Site of Block
Introduction: The incidence of spontaneous transition of 2:1 AV block to 1:1 AV conduction during AV nodal reentrant tachycardia has not been well reported. Among previous studies, controversy also existed about the site of the 2:1 AV block during AV nodal reentrant tachycardia. Methods and Results: In patients with 2:1 AV block during AV nodal reentrant tachycardia, the incidence of spontaneous transition of 2:1 AV block to 1:1 AV conduction and change of electrophysiologic properties during spontaneous transition were analyzed. Among the 20 patients with 2:1 AV block during AV nodal reentrant tachycardia, a His-bundle potential was absent in blocked beats during 2:1 AV block in 8 patients, and the maximal amplitude of the His-bundle potential in the blocked beats was the same as that in the conducted beats in 4 patients and was significantly smaller than that in the conducted beats in 8 patients (0.49 ± 0.25 mV vs 0.16 ± 0.07 mV, P = 0.007). Spontaneous transition of 2:1 AV block to 1:1 AV conduction occurred in 15 (75%) of 20 patients with 2:1 AV block during AV nodal reentrant tachycardia. Spontaneous transition of 2:1 AV block to 1:1 AV conduction was associated with transient right and/or left bundle branch block. The 1:1 AV conduction with transient bundle branch block was associated with significant His-ventricular (HV) interval prolongation (66 ± 19 ms) compared with 2:1 AV block (44 ± 6 ms, P < 0.01) and 1:1 AV conduction without bundle branch block (43 ± 6 ms, P < 0.01). Conclusion: The 2:1 AV block during AV nodal reentrant tachycardia is functional; the level of block is demonstrated to be within or below the His bundle in a majority of patients with 2:1 AV block during AV nodal reentrant tachycardia, and a minority are possibly high in the junction between the AV node and His bundle. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1337-1341, December 2003) [source]

Irregular Atrial Activation During Atrioventricular Nodal Reentrant Tachycardia:

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2003
Evidence of an Upper Common Pathway
Controversy continues regarding the precise nature of the reentrant circuit of AV nodal reentrant tachycardia, especially the existence of an upper common pathway. In this case report, we show that marked variation and irregularity in atrial activation (maximum AA interval variation of 80 msec) can exist with fixed and constant activation of the His bundle and ventricles during AV nodal reentrant tachycardia in a 45-year-old female patient. We propose that irregular atrial activation is due to variable and inconsistent conduction from the AV node to the atria through the perinodal transitional cell envelope extrinsic to the reentrant circuit. Our observations support the concept of an upper common pathway, at least in some patients with AV nodal reentrant tachycardia.(J Cardiovasc Electrophysiol, Vol. 14, pp. 309-313, March 2003) [source]

Atrioventricular Nodal Reentrant Tachycardia in Children: Effect of Slow Pathway Ablation on Fast Pathway Function

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2002
GEORGE F. VAN HARE M.D.
AV Nodal Reentry in Children.Introduction: Prior studies in adults have shown significant shortening of the fast pathway effective refractory period after successful slow pathway ablation. As differences between adults and children exist in other characteristics of AV nodal reentrant tachycardia (AVNRT), we sought to characterize the effect of slow pathway ablation or modification in a multicenter study of pediatric patients. Methods and Results: Data from procedures in pediatric patients were gathered retrospectively from five institutions. Entry criteria were age < 21 years, typical AVNRT inducible with/without isoproterenol infusion, and attempted slow pathway ablation or modification. Dual AV nodal pathways were defined as those with > 50 msec jump in A2-H2 with a 10-msec decrease in A1-A2. Successful ablation was defined as elimination of AVNRT inducibility. A total of 159 patients (age 4.4 to 21 years, mean 13.1) were studied and had attempted slow pathway ablation. AVNRT was inducible in the baseline state in 74 (47%) of 159 patients and with isoproterenol in the remainder. Dual AV nodal pathways were noted in 98 (62%) of 159 patients in the baseline state. Ablation was successful in 154 (97%) of 159 patients. In patients with dual AV nodal pathways and successful slow pathway ablation, the mean fast pathway effective refractory period was 343 ± 68 msec before ablation and 263 ± 64 msec after ablation. Mean decrease in the fast pathway effective refractory period was 81 ± 82 msec (P < 0.0001) and was not explained by changes in autonomic tone, as measured by changes in sinus cycle length during the ablation procedure. Electrophysiologic measurements were correlated with age. Fast pathway effective refractory period was related to age both before (P = 0.0044) and after ablation (P < 0.0001). AV block cycle length was related to age both before (P = 0.0005) and after ablation (P < 0.0001). However, in dual AV nodal pathway patients, the magnitude of change in the fast pathway effective refractory period after ablation was not related to age. Conclusion: Lack of clear dual AV node physiology is common in pediatric patients with inducible AVNRT (38%). Fast pathway effective refractory period shortens substantially in response to slow pathway ablation. The magnitude of change is large compared with adult reports and is not completely explained by changes in autonomic tone. Prospective studies in children using autonomic blockade are needed. [source]

Incidence and Clinical Significance of Inducible Atrial Tachycardia in Patients with Atrioventricular Nodal Reentrant Tachycardia

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2001
CHRISTIAN STICHERLING M.D.
Significance of Atrial Tachycardia.Introduction: The purpose of this prospective study was to determine the prevalence and clinical significance of inducible atrial tachycardia in patients undergoing slow pathway ablation for AV nodal reentrant tachycardia who did not have clinically documented episodes of atrial tachycardia. Methods and Results: Twenty-seven (15%) of 176 consecutive patients who underwent slow pathway ablation for AV nodal reentrant tachycardia were found to have inducible atrial tachycardia with a mean cycle length of 351 ± 95 msec. The atrial tachycardia was sustained in 7 (26%) of 27 patients and was isoproterenol dependent in 20 patients (74%). The atrial tachycardia was not ablated or treated with medications, and the patients were followed for 9.7 ± 5.8 months. Six (22%) of the 27 patients experienced recurrent palpitations during follow-up. In one patient each, the palpitations were found to be due to sustained atrial tachycardia, nonsustained atrial tachycardia, recurrence of AV nodal reentrant tachycardia, paroxysmal atrial fibrillation, sinus tachycardia, and frequent atrial premature depolarizations. Thus, only 2 (7%) of 27 patients with inducible atrial tachycardia later developed symptoms attributable to atrial tachycardia. Conclusion: Atrial tachycardia may be induced by atrial pacing in 15% of patients with AV nodal reentrant tachycardia. Because the vast majority of patients do not experience symptomatic atrial tachycardia during follow-up, treatment for atrial tachycardia should be deferred and limited to the occasional patient who later develops symptomatic atrial tachycardia. [source]

Patterns of Accelerated Junctional Rhythm During Slow Pathway Catheter Ablation for Atrioventricular Nodal Reentrant Tachycardia: Temperature Dependence, Prognostic Value, and Insights into the Nature of the Slow Pathway

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2000
ALAN B. WAGSHAL M.D.
Slow Pathway Accelerated Junctional Rhythm. Introduction: Although accelerated junctional rhythm (AJR) is a knuwn marker for successful slow pathway (SP) ablation sites. AJR may just be a regional effect of the anisotropic conduction properties of this area of the heart. We believe that detailed assessment of the AJR might provide insight into the SP specificity of this AJR and perhaps the nature of the SP itself. Methods and Results: Our ablation protocol consisted of 30-second, 70°C temperature-controlled ablation pulses with assessment after each pulse. Serial booster ablations were performed at the original successful site and at least 2 to 3 nearby sites to assess for residual AJR after the procedure in 50 consecutive SP ablations. We defined three distinct patterns of AJR: continuous AJR that persisted until the end of energy delivery (group 1, 25 patients); alternating or "stuttering" AJR that persisted throughout energy delivery (group II, 9 patients); and AJR that ended abruptly during energy delivery (group III, 16 patients). Mean ablation temperatures in the three groups was 57°± 5°C, 54°± 5°C, and 63°± 5°C, respectively (P = 0.0002 for groups I and II vs group III). Ten of 34 (29%) patients in groups I and II ("low-temperature ablation") exhibited residual SP (jump and/or single echo heats) despite tachycardia noninducibility, and 25 of 34 (73%) patients had residual AJR during the booster ablations, but neither of these was seen in any group III patients. Conclusion: Ablation temperature correlates with the pattern of AJR produced during SP ablation. That higher temperature lesions simultaneously abolish all SP activity as well as the focus of AJR suggests that this AJR is specific for the SP and is not a nonspecific regional effect. [source]

Analysis of Atrioventricular Nodal Reentrant Tachycardia with Variable Ventriculoatrial Block: Characteristics of the Upper Common Pathway

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2009
KENJI MORIHISA M.D.
Background: The precise nature of the upper turnaround part of atrioventricular nodal reentrant tachycardia (AVNRT) is not entirely understood. Methods: In nine patients with AVNRT accompanied by variable ventriculoatrial (VA) conduction block, we examined the electrophysiologic characteristics of its upper common pathway. Results: Tachycardia was induced by atrial burst and/or extrastimulus followed by atrial-His jump, and the earliest atrial electrogram was observed at the His bundle site in all patients. Twelve incidents of VA block: Wenckebach VA block (n = 7), 2:1 VA block (n = 4), and intermittent (n = 1) were observed. In two of seven Wenckebach VA block, the retrograde earliest atrial activation site shifted from the His bundle site to coronary sinus ostium just before VA block. Prolongation of His-His interval occurred during VA block in 11 of 12 incidents. After isoproterenol administration, 1:1 VA conduction resumed in all patients. Catheter ablation at the right inferoparaseptum eliminated antegrade slow pathway conduction and rendered AVNRT noninducible in all patients. Conclusion: Selective elimination of the slow pathway conduction at the inferoparaseptal right atrium may suggest that the subatrial tissue linking the retrograde fast and antegrade slow pathways forms the upper common pathway in AVNRT with VA block. [source]

Abnormal Atrioventricular Node Conduction and Atrioventricular Nodal Reentrant Tachycardia in Patients Older Versus Younger Than 65 Years of Age

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009
MIHAELA GRECU M.D.
Study Objective: We examined the possible role of atrioventricular node (AVN) conduction abnormalities as a cause of AVN reentrant tachycardia (RT) in patients >65 years of age. Study Population: Slow pathway radiofrequency catheter ablation (RFCA) was performed in 104 patients. Patients in group 1 (n = 14) were >65 years of age and had AV conduction abnormalities associated with structural heart disease. Patients in group 2 (n = 90) were <65 years of age and had lone AVNRT. Results: Patients in group 1 versus group 2 (66% vs. 46% men) had a first episode of tachycardia at an older age than in group 2 (68 ± 16.8 vs 32.5 ± 18.8 years, P = 0.007). The history of arrhythmia was shorter in group 1 (5.4 ± 3.8 vs 17.5 ± 14, P = 0.05) and was associated with a higher proportion of patients with underlying heart disease than in group 2 (79% vs 3%, P < 0.001). The electrophysiological measurements were significantly shorter in group 2: atrial-His interval (74 ± 17 vs 144 ± 44 ms, P = 0.005), His-ventricular (HV) interval (41 ± 5 vs 57 ± 7 ms, P = 0.001), Wenckebach cycle length (329 ± 38 vs 436 ± 90 ms, P = 0.001), slow pathway effective refractory period (268 ± 7 vs 344 ± 94 ms, P = 0.005), and tachycardia cycle length (332 ± 53 vs 426 ± 56 ms, P = 0.001). The ventriculoatrial block cycle length was similar in both groups. The immediate procedural success rate was 100% in both groups, and no complication was observed in either group. One patient in group 2 had recurrence of AVNRT. One patient with a 98-ms HV interval underwent permanent VVI pacemaker implantation before RFCA procedure. Conclusion: In patients undergoing RFCA for AVNRT at >65 years of age had a shorter history of tachycardia-related symptoms than patients with lone AVNRT. The longer AVN conduction intervals and refractory period might explain the late development of AVNRT in group 1. [source]

Cryoablation for Atrioventricular Nodal Reentrant Tachycardia in Young Patients: Predictors of Recurrence

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2008
NIKHIL K. CHANANI M.D.
Background: Recurrence rates of atrioventricular nodal reentry tachycardia (AVNRT) after cryoablation continue to remain high despite excellent initial success rates. Our objective was to evaluate the clinical outcomes of cryoablation for AVNRT with the 4-mm and 6-mm tip cryoablation catheters in a young population and to elicit predictors of arrhythmia recurrence. Methods: We retrospectively reviewed all patients who underwent cryoablation for AVNRT at the UCSF/Stanford Pediatric Arrhythmia Center from January 2004 to February 2007. Results: One hundred fifty-four patients (age 13.7 years (3.2,24.4)) underwent cryoablation for AVNRT of which 144 patients had inducible AVNRT (123 sustained and 21 nonsustained) and 10 had presumed AVNRT. Initial success was achieved in 95% (146/154), with no difference between the 4-mm (93%) and 6-mm (98%) cryoablation catheter tips (P = 0.15). There was no permanent atrioventricular (AV) block. Transient third-degree AV block occurred in nine patients (6%), with no difference between the 4-mm (4%) and 6-mm (9%) tip (P = 0.13). AVNRT recurrence was documented in 14% in a median time of 2.5 months (0.25,20). Recurrences were lower with the 6-mm (9%) versus the 4-mm (18%) tip, but this did not reach statistical significance (P = 0.16). With univariate analysis, a longer fluoroscopy time was the only significant factor associated with recurrence. Multivariate analysis failed to identify any significant predictor of AVNRT recurrence. Conclusion: Outcomes of cryoablation for AVNRT continue to be good without the complication of AV block. We could not identify any specific parameter associated with AVNRT recurrence. Further improvements in cryoablation technique will be necessary to reduce recurrences. [source]

Upper and Lower Common Pathways in Atrioventricular Nodal Reentrant Tachycardia:

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2007
Refutation of a Legend?
The concepts of upper and lower common pathways represent long-standing controversies of atrioventricular nodal reentrant tachycardia (AVNRT). Over the last years there has been considerable evidence against the presence of a lower and, especially, an upper common pathway as distinct entities that can be identified in most patients with atrioventricular reentrant tachycardia. The mechanism and relevance of these concepts remain speculative. [source]

The Electrophysiological Characteristics in Patients with Ventricular Stimulation Inducible Fast-Slow Form Atrioventricular Nodal Reentrant Tachycardia

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2006
PI-CHANG LEE M.D.
Background: Atrioventricular nodal reentrant tachycardia (AVNRT) can usually be induced by atrial stimulation. However, it seldom may be induced with only ventricular stimulation, especially the fast-slow form of AVNRT. The purpose of this retrospective study was to investigate the specific electrophysiological characteristics in patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation. Methods: The total population consisted of 1,497 patients associated with AVNRT, and 106 (8.4%) of them had the fast-slow form of AVNRT and 1,373 (91.7%) the slow-fast form of AVNRT. In patients with the fast-slow form of AVNRT, the AVNRT could be induced with only ventricular stimulation in 16 patients, Group 1; with only atrial stimulation or both atrial and ventricular stimulation in 90 patients, Group 2; and with only atrial stimulation in 13 patients, Group 3. We also divided these patients with slow-fast form AVNRT (n = 1,373) into two groups: those that could be induced only by ventricular stimulation (Group 4; n = 45, 3%) and those that could be induced by atrial stimulation only or by both atrial and ventricular stimulation (n = 1.328, 97%). Results: Patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation had a lower incidence of an antegrade dual AVN physiology (0% vs 71.1% and 92%, P < 0.001), a lower incidence of multiple form AVNRT (31% vs 69% and 85%, P = 0.009), and a more significant retrograde functional refractory period (FRP) difference (99 ± 102 vs 30 ± 57 ms, P < 0.001) than those that could be induced with only atrial stimulation or both atrial and ventricular stimulation. The occurrence of tachycardia stimulated with only ventricular stimulation was more frequently demonstrated in patients with the fast-slow form of AVNRT than in those with the slow-fast form of AVNRT (15% vs 3%, P < 0.001). Patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation had a higher incidence of retrograde dual AVN physiology (75% vs 4%, P < 0.001), a longer pacing cycle length of retrograde 1:1 fast and slow pathway conduction (475 ± 63 ms vs 366 ± 64 ms, P < 0.001; 449 ± 138 ms vs 370 ± 85 ms, P = 0.009), a longer retrograde effective refractory period of the fast pathway (360 ± 124 ms vs 285 ± 62 ms, P = 0.003), and a longer retrograde FRP of the fast and slow pathway (428 ± 85 ms vs 362 ± 47 ms, P < 0.001 and 522 ± 106 vs 456 ± 97 ms, P = 0.026) than those with the slow-fast form of AVNRT that could be induced with only ventricular stimulation. Conclusion: This study demonstrated that patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation had a different incidence of the antegrade and retrograde dual AVN physiology and the specific electrophysiological characteristics. The mechanism of the AVNRT stimulated only with ventricular stimulation was supposed to be different in patients with the slow-fast and fast-slow forms of AVNRT. [source]

Pseudotermination of Atrioventricular Nodal Reentrant Tachycardia Related to Isorhythmic Atrioventricular Dissociation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2003
MITSUNORI MARUYAMA
Unusual manifestations of the mode of termination were observed in a patient with atrioventricular nodal reentrant tachycardia (AVNRT). After administration of verapamil during AVNRT, isorhythmic atrioventricular dissociation occurred without termination of the tachycardia. The sinus rate was slightly faster than that of the AVNRT, leading to the P wave preceding the QRS complex with a normal PR interval (e.g., pseudotermination). This phenomenon emphasizes the importance of continuous monitoring during an attempt to terminate AVNRT. (PACE 2003; 26:2338,2339) [source]

P Wave Dispersion Predicts Recurrence of Paroxysmal Atrial Fibrillation in Patients with Atrioventricular Nodal Reentrant Tachycardia Treated with Radiofrequency Catheter Ablation

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2006
Basri Amasyali M.D.
Background: Paroxysmal atrial fibrillation (AF) recurs in up to one-third of patients with atrioventricular nodal reentrant tachycardia (AVNRT) treated with slow pathway ablation. Therefore, identification of patients at risk for recurrence of AF after slow pathway ablation is important because of the necessity for additional therapies. The purpose of this study was to determine whether successful slow pathway ablation influences P wave parameters and whether these parameters predict the recurrence of paroxysmal AF in patients with both AVNRT and paroxysmal AF after ablation. Methods: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) were compared to 36 age-matched controls with AVNRT only (Group 2). P wave durations and P dispersion were measured before and after ablation. Results: No significant differences were observed between P wave parameters observed before and after ablation. Maximum P wave durations (Pmax) and P dispersion (Pdisp) were significantly higher in Group 1 than in Group 2 (P < 0.001 for both) whereas minimum P wave durations did not differ between groups, both before and after ablation. Ten patients (28%) in Group-1 had recurrence of AF during a mean follow-up of 34 ± 11 months. Univariate predictors of AF recurrence were Pdisp ,35.5 ms (P < 0.010), left atrial diameter >40 mm (P < 0.010), mitral or aortic calcification (P < 0.010), Pmax ,112 ms (P < 0.050), valvular heart disease (P < 0.050), and atrial vulnerability (induction of AF lasting >30 second) after ablation (P < 0.050). However, only Pdisp ,35.5 ms (P < 0.050) and left atrial diameter >40 mm (P < 0.010) were independent predictors of AF recurrences. Conclusion: This study suggests that P wave dispersion could identify patients with AVNRT susceptible to recurrence of AF after slow pathway ablation. [source]

The Electrophysiological Characteristics in Patients with Ventricular Stimulation Inducible Fast-Slow Form Atrioventricular Nodal Reentrant Tachycardia

Inducible Atrioventricular Nodal Reentrant Echo Behind Organic 2:1 Infra-Hisian Block During Sinus Rhythm

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2006
CHIH-SHENG CHU
A 77-year-old male patient with an intermittent 2:1 infra-Hisian block during sinus rhythm was presented with dizziness and near-syncope. During electrophysiological (EP) study, dual atrioventricular (AV) nodal pathways and retrograde fast pathway were easily induced by atrial and ventricular programmed stimulation, respectively. A typical slow-fast AV nodal reentrant echo beat also could be demonstrated by single atrial extrastimulation. Atrioventricular nodal reentrant tachycardia (AVNRT) can occasionally exhibit 2:1 AV block. Conversely, AV nodal reentry property had been rarely reported behind 2:1 infra-Hisian block. The EP presentation from this case may support the notion that tissues below the His are not part of the reentrant circuit of AVNRT. [source]

Electrophysiological Characteristics and Catheter Ablation in Patients with Paroxysmal Supraventricular Tachycardia and Paroxysmal Atrial Fibrillation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008
SHIH-LIN CHANG M.D.
Introduction: Paroxysmal supraventricular tachycardia (PSVT) is often associated with paroxysmal atrial fibrillation (AF). However, the relationship between PSVT and AF is still unclear. The aim of this study was to investigate the clinical and electrophysiological characteristics in patients with PSVT and AF, and to demonstrate the origin of the AF before the radiofrequency (RF) ablation of AF. Methods and Results: Four hundred and two consecutive patients with paroxysmal AF (338 had a pure PV foci and 64 had a non-PV foci) that underwent RF ablation were included. Twenty-one patients (10 females; mean age 47 ± 18 years) with both PSVT and AF were divided into two groups. Group 1 consisted of 14 patients with inducible atrioventricular nodal reentrant tachycardia (AVNRT) and AF. Group 2 consisted of seven patients with Wolff-Parkinson-White (WPW) syndrome and AF. Patients with non-PV foci of AF had a higher incidence of AVNRT than those with PV foci (11% vs. 2%, P = 0.003). Patients with AF and atypical AVNRT had a higher incidence of AF ectopy from the superior vena cava (SVC) than those with AF and typical AVNRT (86% vs. 14%, P = 0.03). Group 1 patients had smaller left atrial (LA) diameter (36 ± 3 vs. 41 ± 3 mm, P = 0.004) and higher incidence of an SVC origin of AF (50% vs. 0%, P = 0.047) than did those in Group 2. Conclusion: The SVC AF has a close relationship with AVNRT. The effect of atrial vulnerability and remodeling may differ between AVNRT and WPW syndrome. [source]

Differentiating Atrioventricular Nodal Reentrant Tachycardia from Junctional Tachycardia: Novel Application of the Delta H-A Interval

Acute Blood Pressure Changes After the Onset of Atrioventricular Nodal Reentrant Tachycardia: A Time-Course Analysis

Atrioventricular Nodal Tachycardia in a Patient with Anomalous Inferior Vena Cava with Azygos Continuation and Persistent Left Superior Vena Cava

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2009
MIGUEL A. ARIAS M.D., Ph.D.
A 39-year-old female patient was referred for ablation of recurrent episodes of atrioventricular nodal reentrant tachycardia. A combination of an anomalous inferior vena cava with azygos continuation and a persistent left superior vena cava was discovered. A nonfluoroscopic navigation system was very useful for catheter ablation of the tachycardia in this unusual case of anomalous venous system of the heart. [source]

Analysis of Atrioventricular Nodal Reentrant Tachycardia with Variable Ventriculoatrial Block: Characteristics of the Upper Common Pathway

Upper and Lower Common Pathways in Atrioventricular Nodal Reentrant Tachycardia:

Rapid Atrial Pacing: A Useful Technique During Slow Pathway Ablation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2007
LEONARDO LIBERMAN M.D.
Background: Catheter ablation is the treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT) with a success rate of 95,98%. The appearance of junctional rhythm during radiofrequency (RF) application to the slow pathway has been consistently reported as a marker for the successful ablation of AVNRT. Ventriculoatrial (VA) conduction during junctional rhythm has been used by many as a surrogate marker of antegrade atrioventricular nodal (AVN) function. However, VA conduction may not be an accurate or consistent marker for antegrade AVN function and reliance on this marker may leave some patients at risk for antegrade AVN injury. Objective: The purpose of this study is to describe a technique to ensure normal antegrade AVN function during junctional rhythm at the time of RF catheter ablation of the slow pathway. Methods: Retrospective review of all patients less than 21 years old who underwent RF ablation for AVNRT at our institution from January 2002 to July 2005. During RF applications, immediately after junctional rhythm was demonstrated, RAP was performed to ensure normal antegrade AVN function. Postablation testing was performed to assess AVN function and tachycardia inducibility. Results: Fifty-eight patients underwent RF ablation of AVNRT during the study period. The mean age ± SD was 14 ± 3 years (range: 5,20 years). The weight was 53 ± 15 Kg (range: 19,89 Kg). The preablation Wenckebach cycle length was 397 ± 99 msec (range: 260,700 msec). Fifty-four patients had inducible typical AVNRT, and four patients had atypical tachycardia. The mean tachycardia cycle length ± SD was 323 ± 62 msec (range: 200,500 msec). Patients underwent of 8 ± 7 total RF applications (median: 7; range 1 to 34), for a total duration of 123 ± 118 seconds (median: 78 sec, range: 20,473 sec). Junctional tachycardia was observed in 52 of 54 patients. RAP was initiated during junctional rhythm in all patients. No patient developed any degree of transient or permanent AVN block. Following ablation, the Wenckebach cycle length decreased to 364 ± 65 msec (P < 0.01). Acutely successful RF catheter ablation was obtained in 56 of 58 patients (96%). Conclusion: Rapid atrial pacing during radiofrequency catheter ablation of the slow pathway is a safe alternative approach to ensure normal AVN function. [source]

Pseudotermination of Atrioventricular Nodal Reentrant Tachycardia Related to Isorhythmic Atrioventricular Dissociation

Electrophysiologic Characteristics of Wide QRS Complexes during Pharmacologic Termination of Sustained Supraventricular Tachycardias with Verapamil and Adenosine: Observations from Electrophysiologic Study

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009
Cengizhan Türko, lu M.D.
Background: In this study we evaluate wide QRS complexes observed during pharmacologic termination of supraventricular tachycardias. Methods: Patients with supraventricular tachycardia, undergoing electrophysiologic study were enrolled. 12 mg of adenosine or 10 mg of verapamil were administered during tachycardia, under continuous monitoring of intaracardiac and surface electrocardiograms. Electrocardiographic features of ventricular ectopy were noted. Results: Seventy-four patients were enrolled. 48 patients were randomized to adenosine and 26 to verapamil. Five different appearance patterns of ventricular ectopy were observed during termination of tachycardias. All wide QRS complexes were of ventricular origin and all of them were observed during the termination of tachycardia. Adenosine more frequently resulted in appearance of ventricular beats (15.4% vs 41.7%, P = 0.003), and this was more frequently observed in patients with atrioventricular nodal reentrant tachycardia. Patients with ventricular beats were younger than those without, in both, verapamil (47.5 ± 15.6 vs 65.0 ± 8.8 years, P = 0.04) and adenosine (40.9 ± 13.8 vs 49.7 ± 16.8, P = 0.03) groups. Left bundle branch block (LBBB)/superior axis morphology was most frequent morphology in adenosine group (55%). Two of 4 patients in verapamil group displayed LBBB/inferior axis QRS morphology and another 2 patients displayed LBBB/superior axis morphology. Conclusions: Noncatheter induced, five different appearance patterns and four distinct morphologies of ventricular origin were observed. Most of them do not directly terminate tachycardia, but are associated with its termination and are not observed in ongoing tachycardia. [source]

P Wave Dispersion Predicts Recurrence of Paroxysmal Atrial Fibrillation in Patients with Atrioventricular Nodal Reentrant Tachycardia Treated with Radiofrequency Catheter Ablation

The VA Relationship After Differential Atrial Overdrive Pacing: A Novel Tool for the Diagnosis of Atrial Tachycardia in the Electrophysiologic Laboratory

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2007
MITSUNORI MARUYAMA M.D.
Introduction: Despite recent advances in clinical electrophysiology, diagnosis of atrial tachycardia (AT) originating near Koch's triangle remains challenging. We sought a novel technique for rapid and accurate diagnosis of AT in the electrophysiologic laboratory. Methods: Sixty-two supraventricular tachycardias including 18 ATs (10 ATs arising from near Koch's triangle), 32 atrioventricular nodal reentrant tachycardias (AVNRTs), and 12 orthodromic reciprocating tachycardias (ORTs) were studied. Overdrive pacing during the tachycardia from different atrial sites was performed, and the maximal difference in the postpacing VA intervals (last captured ventricular electrogram to the earliest atrial electrogram of the initial beat after pacing) among the different pacing sites was calculated (delta-VA interval). Results: The delta-VA intervals were >14 ms in all AT patients and <14 ms in all AVNRT/ORT patients, and thus, the delta-VA interval was diagnostic for AT with the sensitivity, specificity, and positive and negative predictive values all being 100%. When the diagnostic value of the delta-VA interval and conventional maneuvers were compared for differentiating AT from atypical AVNRT, both a delta-VA interval >14 ms and "atrial-atrial-ventricular" response after overdrive ventricular pacing during the tachycardia were diagnostic. However, the "atrial-atrial-ventricular" response criterion was available in only 52% of the patients because of poor ventriculoatrial conduction. Conclusions: The delta-VA interval was useful for diagnosing AT irrespective of patient conditions such as ventriculoatrial conduction. [source]