1. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a "Superior" Slow Pathway: A Distinct Supraventricular Tachyarrhythmia.
- Author
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Kaneko Y, Naito S, Okishige K, Morishima I, Tobiume T, Nakajima T, Irie T, Ota M, Iijima T, Iizuka T, Tamura M, Tamura S, Saito A, Igawa O, Kato R, Matsumoto K, Suzuki F, and Kurabayashi M
- Subjects
- Adenosine Triphosphate pharmacology, Aftercare, Aged, Aged, 80 and over, Atrioventricular Node physiopathology, Bundle of His physiopathology, Cardiac Catheterization, Cardiac Pacing, Artificial, Catheter Ablation, Electrocardiography, Electrocardiography, Ambulatory, Female, Heart Conduction System drug effects, Humans, Isoproterenol pharmacology, Male, Middle Aged, Retrospective Studies, Tachycardia, Atrioventricular Nodal Reentry classification, Tachycardia, Atrioventricular Nodal Reentry diagnosis, Tachycardia, Atrioventricular Nodal Reentry surgery, Tachycardia, Supraventricular classification, Tachycardia, Supraventricular diagnosis, Tachycardia, Supraventricular surgery, Heart Conduction System physiopathology, Tachycardia, Atrioventricular Nodal Reentry physiopathology, Tachycardia, Supraventricular physiopathology
- Abstract
Background: The existence of an atypical fast-slow (F/S) atrioventricular nodal reentrant tachycardia (AVNRT) including a superior (sup) pathway with slow conductive properties and an atrial exit near the His bundle has not been confirmed., Methods and Results: We studied 6 women and 2 men (age, 74 ± 7 years) with sup-F/S-AVNRT who underwent successful radiofrequency ablation near the His bundle. Programmed ventricular stimulation induced retrograde conduction over a superior SP with an earliest atrial activation near the His bundle, a mean shortest spike-atrial interval of 378 ± 119 milliseconds, and decremental properties in all patients. sup-F/S-AVNRT was characterized by a long-RP interval; a retrograde atrial activation sequence during tachycardia identical to that over a sup-SP during ventricular pacing; ventriculoatrial dissociation during ventricular overdrive pacing of the tachycardia in 5 patients or atrioventricular block occurring during tachycardia in 3 patients, excluding atrioventricular reentrant tachycardia; termination of the tachycardia by ATP; and a V-A-V activation sequence immediately after ventricular induction or entrainment of the tachycardia, including dual atrial responses in 2 patients. Elimination or modification of retrograde conduction over the sup-SP by ablation near the right perinodal region or from the noncoronary cusp of Valsalva eliminated and confirmed the diagnosis of AVNRT in 4 patients each., Conclusions: sup-F/S-AVNRT is a distinct supraventricular tachycardia, incorporating an SP located above the Koch triangle as the retrograde limb, that can be eliminated by radiofrequency ablation., (© 2015 American Heart Association, Inc.)
- Published
- 2016
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