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Narrow Complex Tachycardia with VA Block: Diagnostic and Therapeutic Implications
- Source :
- Pacing and Clinical Electrophysiology. 21:1196-1206
- Publication Year :
- 1998
- Publisher :
- Wiley, 1998.
-
Abstract
- To review our experience with cases of narrow complex tachycardia with VA block, highlighting the difficulties in the differential diagnosis, and the therapeutic implications. Prior reports of patients with narrow complex tachycardia with VA block consist of isolated case reports. The differential diagnosis of this disorder includes: automatic junctional tachycardia, AV nodal reentry with final upper common pathway block, concealed nodofascicular (ventricular) pathway, and intra-Hissian reentry. Between June 1994 and January 1996, six patients with narrow complex tachycardia with episodes of ventriculoatrial block were referred for evaluation. All six patients underwent attempted radiofrequency ablation of the putative arrhythmic site. Three of six patients had evidence suggestive of a nodofascicular tract. Intermittent antegrade conduction over a left-sided nodofascicular tract was present in two patients and the diagnosis of a concealed nodofascicular was made in the third patient after ruling out other tachycardia mechanisms. Two patients had automatic junctional tachycardia, and one patient had atrioventricular nodal reentry with proximal common pathway block. Attempted ablation in the posterior and mid-septum was unsuccessful in patients with nodofascicular tachycardia. In contrast, those with atrioventricular nodal reentry and automatic junctional tachycardia readily responded to ablation. The presence of a nodofascicular tachycardia should be suspected if: (1) intermittent antegrade preexcitation is recorded, (2) the tachycardia can be initiated with a single atrial premature producing two ventricular complexes, and (3) a single ventricular extrastimulus initiates SVT without a retrograde His deflection. The presence of a nodofascicular pathway is common in patients with narrow complex tachycardia and VA block. Unlike AV nodal reentry and automatic junctional tachycardia, the response to ablation is poor.
- Subjects :
- Adult
Male
Tachycardia
medicine.medical_specialty
Time Factors
Adolescent
Radiofrequency ablation
medicine.medical_treatment
Catheter ablation
law.invention
Diagnosis, Differential
Electrocardiography
Heart Conduction System
law
Internal medicine
Humans
Medicine
cardiovascular diseases
medicine.diagnostic_test
business.industry
General Medicine
Reentry
medicine.disease
Ablation
Heart Block
Junctional tachycardia
Child, Preschool
Anesthesia
Catheter Ablation
cardiovascular system
Cardiology
Female
medicine.symptom
Differential diagnosis
Cardiology and Cardiovascular Medicine
business
Anti-Arrhythmia Agents
Follow-Up Studies
Subjects
Details
- ISSN :
- 15408159 and 01478389
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Pacing and Clinical Electrophysiology
- Accession number :
- edsair.doi.dedup.....053eba94592a87b38e783e18cb1df6e7