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Chiale PA, Baranchuk A, González MD, Sánchez RA, Garro HA, Fernández PA, Avalos CQ, Enriquez A, Elizari MV. The mechanisms of spontaneous termination of reentrant supraventricular tachycardias. Int J Cardiol 2015; 191:151-8. [DOI: 10.1016/j.ijcard.2015.04.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 03/23/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
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2
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González M, Quiroga C, Fernández P, Garro H, Chiale P. Diferentes tiempos de conducción auriculoventricular y fenómeno de alternancia en los intervalos del ciclo en taquicardia por reentrada nodal AV de la variedad común. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:87-90. [DOI: 10.1016/j.acmx.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/16/2013] [Accepted: 04/22/2014] [Indexed: 11/28/2022] Open
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3
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Clementy N, Rebotier N, Babuty D. Pacemaker "dysfunction" treated by radiofrequency ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:772-4. [PMID: 22670703 DOI: 10.1111/j.1540-8159.2012.03442.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 01/09/2012] [Accepted: 02/07/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Nicolas Clementy
- Cardiologie B Department, University François Rabelais, Tours, France.
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4
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Tanaka S, Yoshida A, Fukuzawa K, Takei A, Kanda G, Takami K, Kumagai H, Takami M, Itoh M, Imamura K, Fujiwara R, Hirata KI. Recognition of inferiorly dislocated fast pathways guided by three-dimensional electro-anatomical mapping. J Interv Card Electrophysiol 2011; 32:95-103. [DOI: 10.1007/s10840-011-9595-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/01/2011] [Indexed: 11/25/2022]
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5
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Massumi R, Shehata M. Doubling of the ventricular rate by interpolated junctional extrasystoles resembling supraventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:945-9. [PMID: 20497352 DOI: 10.1111/j.1540-8159.2010.02763.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a study of seven cases of paroxysmal supraventricular tachycardia, it was noted that the fast rate was not caused by the mechanism of rapid firing, reentry, or dual atrioventricular nodal conduction but by an abrupt doubling of the rate by interpolation of junctional extrasystoles between adjacent sinus beats while the sinus mechanism remained undisturbed. Dual ventricular response to a single atrial depolarization was seriously considered in each case. The intervals separating the junctional extrasystoles tended to be quite fixed, thus conforming to the pattern of junctional parasystole with an intrinsic rate very close to the rate of the dominant sinus rhythm. The paroxysms of tachycardia were transient, lasting a few seconds to 3.5 minutes. The onset and termination of the paroxysms were completely unpredictable and appeared unrelated to any change in the basic sinus rate or other identifiable mechanism. In only one case, case 7, the concept of dual ventricular response appeared tenable. However, as will be discussed later, the mechanism of junctional parasystole was found to be physiologically more acceptable.
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Affiliation(s)
- Rashid Massumi
- Cedars Sinai Heart Institute, Los Angeles, California, USA.
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6
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Clementy N, Casset-Senon D, Giraudeau C, Cosnay P. Tachycardiomyopathy Secondary to Nonreentrant Atrioventricular Nodal Tachycardia: Recovery After Slow Pathway Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:925-8. [PMID: 17584278 DOI: 10.1111/j.1540-8159.2007.00784.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nonreentrant atrioventricular (AV) nodal tachycardia is a rare form of arrhythmia due to simultaneous anterograde conduction in dual AV pathways, one atrial impulse triggering two ventricular complexes. We report the case of a 74-year-old man referred for incessant palpitations resistant to antiarrhythmic medication, and effort dyspnea. A nonreentrant AV nodal tachycardia is diagnosed with electrophysiological study. A dilated cardiomyopathy with left ventricular dysfunction is found with gated blood pool single-photon emission computed tomography. A radiofrequency catheter ablation of the slow pathway is successfully performed. The patient is reassessed 11 months after ablation. He is asymptomatic and left ventricular function has fully recovered.
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Affiliation(s)
- Nicolas Clementy
- Cardiology B Department and CNRS UMR 6542, Trousseau Hospital, Tours, France.
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7
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Yokoshiki H, Sasaki K, Shimokawa J, Sakurai M, Tsutsui H. Nonreentrant atrioventricular nodal tachycardia due to triple nodal pathways manifested by radiofrequency ablation at coronary sinus ostium. J Electrocardiol 2006; 39:395-9. [PMID: 16895765 DOI: 10.1016/j.jelectrocard.2005.08.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2005] [Indexed: 11/28/2022]
Abstract
We report a case of complex supraventricular tachycardia manifested by radiofrequency delivery. Initially, the patient presented with orthodromic atrioventricular reentrant tachycardia via a left-sided accessory pathway that was successfully eliminated. Atrial tachycardia originating from coronary sinus ostium was also induced. Radiofrequency delivery at the coronary sinus ostium induced a narrow QRS tachycardia with irregular R-R intervals. A detailed analysis explained that the tachycardia could be a nonreentrant mechanism due to triple atrioventricular nodal pathways: an atrial excitation evokes double ventricular response due to simultaneous activation of the fast and slow pathways, and the next one activates ventricle through the intermediate pathway.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
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8
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Tomasi C, De Ponti R, Tritto M, Barilli AL, Bottoni N, Zardini M, Menozzi C, Spadacini G, Salerno-Uriarte JA. Simultaneous Dual Fast and Slow Pathway Conduction upon Induction of Typical Atrioventricular Nodal Reentrant Tachycardia: Electrophysiologic Characteristics in a Series of Patients. J Cardiovasc Electrophysiol 2005; 16:594-600. [PMID: 15946355 DOI: 10.1046/j.1540-8167.2005.40449.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Simultaneous dual atrioventricular nodal conduction (SDNC) through slow (SP) and fast pathway (FP) is a rare phenomenon observed upon the induction of atrioventricular nodal reciprocating tachycardia (AVNRT). The aim of this study is to report the electrophysiological features of patients showing typical AVNRT induced through SDNC. METHODS AND RESULTS Among 461 consecutive patients with typical AVNRT submitted to radiofrequency catheter ablation (RFCA), seven patients (1.5%) with SDNC at tachycardia onset (group I: 6 female; age 60-72 years, mean 65.2 +/- 3.8 years) and 118 age-matched controls (group II: 60 female; age 60-88 years, mean 68.4 +/- 6.8 years) were considered. Controls were further subdivided into two subgroups according to age: subgroup A (94 patients, age 60-75 years) and subgroup B (24 patients, age >75 years). The value of the following parameters was significantly higher in group I than in group II and in subgroup A: A-H interval [113 +/- 26 vs. 89 +/- 27 (P < 0.01) vs. 84 +/- 19 (P < 0.001)], ventriculoatrial conduction effective refractory period [355 +/- 85 vs. 293 +/- 87 (P < 0.05) vs. 281 +/- 82 (P < 0.05)], SP conduction time upon AVNRT induction [444 +/- 104 vs. 350 +/- 72 (P < 0.01); vs. 345 +/- 67 (P < 0.001)], AVNRT cycle length [484 +/- 103 vs. 396 +/- 71 ms (P < 0.05); vs. 384 +/- 69 (P < 0.05)], and rate of AVNRT induction from ventricle [71% vs. 10% (P = 0.001); vs. 6% (P = 0.001)]. Differences were mostly not significant between group I and subgroup B. SP location and RFCA success rate were similar in all groups. CONCLUSION In a population of AVNRT patients, SDNC at AVNRT induction is infrequent and it prevails beyond the fifth decade of life and in females. SDNC is associated with peculiar AVN conduction features, which resemble the age-related modifications of AVN conduction.
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Affiliation(s)
- Corrado Tomasi
- U.O. di Cardiologia Interventistica, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
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9
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Abstract
The case of an 8-year-old girl with incessant nonsustained left bundle branch block-like tachycardia refractory to antiarrhythmic drug therapy is reported. Electrophysiologic study revealed the presence of a right-sided accessory atriofascicular pathway. Episodes of nonsustained tachycardia were found to be based upon a dual response in AV conduction over the Mahaim fiber to one P wave. No reentrant tachycardia could be induced. The arrhythmia was cured by catheter ablation targeting a Mahaim potential at the right lateral tricuspid annulus. The findings can be explained by longitudinal dissociation in a single Mahaim fiber, a fiber distally diverging into two fibers with different conduction times, or (less likely) two closely located Mahaim fibers with different conduction times.
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Affiliation(s)
- Eduardo Back Sternick
- Department of Arrhythmia and Electrophysiology of BIOCOR Instituto, Nova Lima, Brazil.
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10
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Gaba D, Pavri BB, Greenspon AJ, Ho RT. Dual Antegrade Response Tachycardia Induced Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:533-6. [PMID: 15078410 DOI: 10.1111/j.1540-8159.2004.00476.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a rare case of tachycardia induced cardiomyopathy resulting from nearly incessant dual antegrade response tachycardia. Criteria necessary for sustaining dual antegrade responses are discussed, including: (1) sufficient antegrade dissociation of the AV node; (2) absence of retrograde conduction over each AV nodal pathway following antegrade conduction over its counterpart; (3) difference between fast and slow pathway conduction times exceeding His-Purkinje refractoriness; and (4) critical timing of sinus impulses relative to preceding AV nodal conduction. Both the arrhythmia and cardiomyopathy were successfully treated by slow pathway ablation.
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Affiliation(s)
- Deepak Gaba
- Department of Medicine, Division of Cardiovascular Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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11
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Mansour M, Marrouche N, Ruskin J, Natale A, Keane D. Incessant nonreentrant tachycardia due to simultaneous conduction over dual atrioventricular nodal pathways mimicking atrial fibrillation in patients referred for pulmonary vein isolation. J Cardiovasc Electrophysiol 2003; 14:752-5. [PMID: 12930257 DOI: 10.1046/j.1540-8167.2003.02527.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It has been reported that conduction over the fast and slow pathways of the AV node can occur simultaneously, leading to a double ventricular response from each atrial beat. We report the cases of two patients referred to us for evaluation of symptomatic, incessant, and irregular narrow-complex tachycardia, misdiagnosed as atrial fibrillation, for consideration of pulmonary vein isolation. At presentation, careful evaluation of the electrograms revealed the presence of two ventricular activations for each atrial beat. At electrophysiologic study, both patients were found to have nonreentrant tachycardias arising from simultaneous conduction over the fast and slow pathways of the AV node. In one patient, the tachycardia had resulted in cardiomyopathy. Slow AV nodal pathway ablation performed in both patients resulted in cure of their tachycardias and recovery of ventricular function in the patient with cardiomyopathy.
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Affiliation(s)
- Moussa Mansour
- Cardiac Unit, Massachusetts General Hospital, Gray 109, 55 Fruit Street, Boston, MA 02114, USA.
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12
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Fraticelli A, Saccomanno G, Pappone C, Oreto G. Paroxysmal supraventricular tachycardia caused by 1:2 atrioventricular conduction in the presence of dual atrioventricular nodal pathways. J Electrocardiol 1999; 32:347-54. [PMID: 10549910 DOI: 10.1016/s0022-0736(99)90005-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
One-to-two atrioventricular conduction, ie, the double response to a single sinus or atrial impulse, resulting in two QRS complexes for one P wave, is a rare manifestation of dual atrioventricular (AV) nodal pathways. This report describes the case of a 61-year-old woman with continuous episodes of supraventricular tachycardia caused by independent conduction to the ventricles of sinus impulses over both the fast and the slow AV nodal pathway, giving rise to a ventricular rate that was twice the sinus rate. A wide spectrum of electrocardiographic manifestations of 1:2 AV conduction was observed on the surface electrocardiogram. The diagnosis was suggested by several elements including evidence of dual AV nodal pathways during sinus rhythm and cycle length alternans during tachycardia. The patient underwent successful slow pathway ablation with complete disappearance of symptoms and electrocardiographic manifestations of 1:2 AV conduction.
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MESH Headings
- Atrioventricular Node/physiopathology
- Atrioventricular Node/surgery
- Cardiac Pacing, Artificial
- Catheter Ablation
- Electrocardiography
- Electrocardiography, Ambulatory
- Female
- Humans
- Middle Aged
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Tachycardia, Paroxysmal/diagnosis
- Tachycardia, Paroxysmal/physiopathology
- Tachycardia, Paroxysmal/surgery
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
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Affiliation(s)
- A Fraticelli
- INRCA Dipartimento di Cardiologia, Ancona, Italy
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13
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Maury P, Zimmermann M, Metzger J, Crevoisier JL, Adamec R. Association between nonreentrant supraventricular tachycardia and atrioventricular node reentrant tachycardia: a presentation of dual AV node physiology. Pacing Clin Electrophysiol 1999; 22:1410-5. [PMID: 10527027 DOI: 10.1111/j.1540-8159.1999.tb00639.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Persistent simultaneous conduction of P waves over a fast and a slow nodal pathway defines the nonreentrant type of supraventricular tachycardia, usually not associated with reciprocating movements. We report a unique association between this uncommon tachycardia and a usual AV nodal reentrant tachycardia, made possible by the existence of three different nodal pathways.
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Affiliation(s)
- P Maury
- Department of Internal Medicine, University Hospital, Geneva, Switzerland
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14
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Fujii E, Kasai A, Omichi C, Teramura S, Yasuda M, Uchida F, Nakano T. Electrophysiological characteristics during slow pathway ablation of posterior atrioventricular junctional reentrant tachycardia. Pacing Clin Electrophysiol 1998; 21:2510-6. [PMID: 9825376 DOI: 10.1111/j.1540-8159.1998.tb01210.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to compare the electrophysiological characteristics of posterior and anterior atrioventricular junctional reentrant tachycardia (AVJRT) during radiofrequency (RF) catheter ablation of a slow pathway. Twenty-four patients with common AVJRT, including 4 posterior (P) and 20 anterior AVJRT (A) were studied. We analyzed the retrograde atrial activation sequence of junctional rhythm and the presence of transient HA block during slow pathway ablation. When HA block developed, the AH interval before ablation and immediately after the end of energy delivery was measured. Successful ablation sites were divided into three groups; high (H), middle (M), and low (L) from the His bundle to the floor of the coronary sinus orifice. The results were: (1) the number of successful ablation sites were H 0, M 1, L 3 in P and H 1, M 8, L 11 in A; (2) the HA interval during AVJRT in P was longer than that in A (109 +/- 48 ms vs 43 +/- 6 ms, P < 0.01); (3) the retrograde atrial activation sequence during junctional rhythm was strictly concordant with that during AVJRT in both groups, but HA block developed during slow pathway ablation more often in P than in A (100% vs 30%, P < 0.01); and (4) The AH interval did not lengthen after HA block developed in P. These data suggest that another pathway does exist from the AV node to the atrium in addition to anterograde fast pathway and slow pathway, and that this pathway is used as the retrograde limb of P.
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Affiliation(s)
- E Fujii
- Department of Internal Medicine, Matsusaka City Hospital, Japan.
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15
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Fishberger SB, Mehta D, Rossi AF, Langan MN, Marx SO, Gomes JA. Variable effects of adenosine on retrograde conduction in patients with atrioventricular nodal reentry tachycardia. Pacing Clin Electrophysiol 1998; 21:1254-7. [PMID: 9633068 DOI: 10.1111/j.1540-8159.1998.tb00185.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adenosine has been demonstrated to reliably produce transient block of atrioventricular nodal (AVN) conduction, and has been advocated as a method of differentiating retrograde conduction via the atrioventricular node from accessory pathway conduction. However, the response of retrograde AVN to adenosine in patients with typical atrioventricular nodal reentry tachycardia (AVNRT) remains unclear. We evaluated 13 patients (mean age 45 +/- 20 years) with typical AVNRT prior to AVN modification. During right ventricular pacing, a rapid bolus of adenosine (0.2 mg/kg; maximum 18 mg) was administered. Adenosine sensitivity, defined by transient ventriculoatrial block, was observed in six patients, while in seven patients ventriculoatrial conduction was unaffected. An adenosine bolus administered during sinus rhythm or atrial pacing resulted in antegrade atrioventricular block in all the adenosine resistant patients in whom this was performed (n = 6). Comparisons of AVN electrophysiological characteristics between the adenosine sensitive and adenosine resistant patients were performed. There was no difference with respect to ventriculoatrial effective refractory period, ventriculoatrial Wenckebach, AVNRT cycle length, and His to atrial echo interval in AVNRT. However, there was a trend toward a longer antegrade fast pathway ERP in the adenosine sensitive group (P = 0.07). Electrophysiological properties do not predict retrograde AVN adenosine sensitivity. Adenosine does not cause retrograde AVN block in all patients with AVNRT, and therefore cannot reliably distinguish between retrograde conduction via the AVN or an accessory pathway.
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Affiliation(s)
- S B Fishberger
- Division of Pediatric Cardiology, Mount Sinai Medical Center, New York 10029-6574, USA
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16
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Glotz de Lima G, Roy D, Talajic M, Dubuc M. One-to-two atrioventricular conduction causing nonreentrant tachycardia: successful treatment with radiofrequency ablation. Pacing Clin Electrophysiol 1998; 21:1152-4. [PMID: 9604249 DOI: 10.1111/j.1540-8159.1998.tb00163.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The anatomical substrate for AV nodal reentrant tachycardia (AVNRT) is well known and is due to anterograde conduction through a slow conducting pathway and retrograde conduction using a fast conducting pathway. In this report, we describe a patient with AVNRT who also presented with frequent episodes of paroxysmal nonreentrant tachycardia due to the occurrence of two conducted ventricular beats for each sinus depolarization. Palpitations and arrhythmias were abolished after radiofrequency ablation of the slow pathway.
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Affiliation(s)
- G Glotz de Lima
- Department of Medicine, Montreal Heart Institute, Quebec, Canada
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17
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Lee CS, Lai WT, Wu JC, Sheu SH, Wu SN, Belardinelli L. Differential effects of adenosine on antegrade and retrograde fast pathway conduction in atrioventricular nodal reentry. Am Heart J 1997; 134:799-806. [PMID: 9398091 DOI: 10.1016/s0002-8703(97)80002-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Although adenosine depresses antegrade atrioventricular (AV) nodal conduction, the effects of adenosine on antegrade and retrograde fast pathway conduction in AV nodal reentry have not been determined. In 17 patients (five men, 12 women, mean age 49 +/- 12 years) with common slow-fast AV nodal reentrant tachycardia, the antegrade slow pathway conduction was selectively and completely ablated by radiofrequency catheter ablation while the antegrade and retrograde fast pathway conduction remained intact. During high right atrial pacing at a mean pacing cycle length of 474 +/- 36 msec, adenosine was rapidly injected intravenously at an initial dose of 0.5 mg followed by stepwise increases of 0.5 mg or 1.0 mg given at 5-minute intervals until second-degree AV block developed. During right ventricular apical pacing at the same pacing cycle lengths (mean 474 +/- 36 msec) as those in the study of antegrade conduction, intravenous injection of incremental doses of adenosine was repeated until ventriculoatrial (VA) block occurred. The adenosine-induced prolongation of VA conduction was also determined in the presence of verapamil (loading dose 0.15 mg/kg, maintenance dose 0.005 mg/kg/min) in seven of 17 patients. The dose of adenosine required to produce AV block, the increase in the atrio-His interval by 50% and the maximal response were 3.4 +/- 1.4 mg, 1.8 +/- 0.6 mg, and 58% +/- 5%, respectively. On the other hand, the dose of adenosine required to produce VA block, the increase in the VA interval by 50%, and the maximal response were 8.2 +/- 2.9 mg, 3.4 +/- 0.6 mg, and 20% +/- 5%, respectively, in the control and 3.7 +/- 0.5 mg, 3.5 +/- 0.7 mg, and 23% +/- 5%, respectively, in the presence of verapamil. In conclusion, adenosine has a differential potency to depress AV and VA conduction in patients with AV nodal reentry, with greater potency for slowing antegrade fast than retrograde fast pathway conduction. Verapamil had an additive effect to adenosine on slowing retrograde VA conduction, which further supports the evidence that the retrograde fast pathway in part involves an AV nodal-like structure.
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Affiliation(s)
- C S Lee
- Department of Internal Medicine, Kaohsiung Medical College, Taiwan, Republic of China
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18
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Ajiki K, Murakawa Y, Yamashita T, Oikawa N, Sezaki K, Kotsuka Y, Furuse A, Omata M. Nonreentrant supraventricular tachycardia due to double ventricular response via dual atrioventricular nodal pathways. J Electrocardiol 1996; 29:155-60. [PMID: 8728601 DOI: 10.1016/s0022-0736(96)80126-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Narrow and wide QRS tachycardias associated with various rhythm disturbances were recognized during 24-hour ambulatory eletrocardiographic monitoring in a 65-year-old man with coronary artery disease. Laddergram analysis revealed the presence of dual atrioventricular nodal pathways. Non-reentrant supraventricular tachycardia due to simultaneous fast and slow conduction through the dual atrioventricular nodal pathways was confirmed by electrophysiologic study. The atrial rate determined the occurrence of simultaneous conduction, and extrastimulation failed to induce a double ventricular response. Enhanced vagal activity was thought to play a critical role in provoking this phenomenon. Radiofrequency catheter ablation of the slow pathway eliminated the arrhythmias.
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Affiliation(s)
- K Ajiki
- Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan
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19
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Anselme F, Frederiks J, Boyle NG, Papageorgiou P, Josephson ME. An unusual cause of tachycardia-induced myopathy. Pacing Clin Electrophysiol 1996; 19:115-9. [PMID: 8848367 DOI: 10.1111/j.1540-8159.1996.tb04800.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- F Anselme
- Harvard Thorndike Electrophysiologic Institute, Beth Israel Hospital, Boston, Massachusetts 02215, USA
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20
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Li HG, Klein GJ, Natale A, Thakur RK, Yee R. Nonreentrant supraventricular tachycardia due to simultaneous conduction over fast and slow AV node pathways: successful treatment with radiofrequency ablation. Pacing Clin Electrophysiol 1994; 17:1186-93. [PMID: 7521046 DOI: 10.1111/j.1540-8159.1994.tb01479.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 55-year-old woman with frequent problematic supraventricular tachycardia is presented. The tachycardia was irregular with predominantly normal QRS morphology and was refractory to multiple antiarrhythmic drugs. At electrophysiology study, the tachycardia was inducible with atrial or ventricular extrastimuli and dual pathways were observed. In contrast to the situation usually seen with dual atrioventricular node physiology, the slow pathway had a longer effective refractory period than the fast pathway and reentrant tachycardia was not induced. Simultaneous conduction over the fast and slow pathways during sinus rhythm was shown to be the mechanism for clinical tachycardia. The tachycardia was successfully treated using radiofrequency ablation of the slow pathway.
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Affiliation(s)
- H G Li
- Department of Medicine, University of Western Ontario, London, Canada
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21
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McGuire MA, Yip AS, Lau KC, Lo CW, Richards DA, Uther JB, Ross DL. Posterior ("atypical") atrioventricular junctional reentrant tachycardia. Am J Cardiol 1994; 73:469-77. [PMID: 8141088 DOI: 10.1016/0002-9149(94)90677-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to characterize a relatively rare type of atrioventricular (AV) junctional reentrant tachycardia (AVJRT). Posterior AVJRT is a type of AV nodal tachycardia in which the site of earliest atrial activation is posterior to the AV node near the coronary sinus orifice. The mechanism of this tachycardia is not well understood. The characteristics of posterior AVJRT (n = 15) were compared with those of anterior ("common") AVJRT (n = 146) and supraventricular tachycardia using single posterior septal accessory pathways (n = 13). During posterior AVJRT, the AH interval was longer than the retrograde conduction time (His to earliest atrial activity) in 11 cases (73%), indicating that these tachycardias were not fast-slow types of AVJRT. The mean ventriculoatrial (VA) interval in posterior AVJRT (93 +/- 41 ms) was longer than in anterior AVJRT (11 +/- 20 ms; p < 0.005), but was similar to that in tachycardias using accessory pathways (106 +/- 16 ms; p = NS). The site of earliest atrial activation during posterior AVJRT was similar to that in tachycardias using accessory pathways. In all cases of accessory pathway-mediated tachycardia, atrial activation could be advanced by ventricular extrastimuli delivered coincident with the His deflection, but atrial activation was not advanced in any case of posterior AVJRT unless the extrastimulus was delivered > 80 ms before the His deflection. Anterograde conduction was similar in the posterior and anterior AVJRT groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M A McGuire
- Cardiology Unit, Westmead Hospital, Sydney, New South Wales, Australia
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22
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Kalbfleisch SJ, Strickberger SA, Hummel JD, Williamson BD, Man KC, Vorperian VR, Langberg JJ, Morady F. Double retrograde atrial response after radiofrequency ablation of typical AV nodal reentrant tachycardia. J Cardiovasc Electrophysiol 1993; 4:695-701. [PMID: 8305989 DOI: 10.1111/j.1540-8167.1993.tb01255.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- S J Kalbfleisch
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022
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McGuire MA, Bourke JP, Robotin MC, Johnson DC, Meldrum-Hanna W, Nunn GR, Uther JB, Ross DL. High resolution mapping of Koch's triangle using sixty electrodes in humans with atrioventricular junctional (AV nodal) reentrant tachycardia. Circulation 1993; 88:2315-28. [PMID: 8222125 DOI: 10.1161/01.cir.88.5.2315] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recent evidence suggests that atrioventricular junctional reentrant tachycardia (AVJRT) uses a reentrant circuit that involves the atrioventricular (AV) node, the atrionodal connections, and perinodal atrial tissue. Electrogram morphology has been used to target the delivery of radiofrequency energy to the site of the "slow pathway," a component of this reentrant circuit. The aim of this study was to localize precisely the sites of atrionodal connections involved in AVJRT and to examine atrial electrogram morphologies and their spatial distribution over Koch's triangle. METHODS AND RESULTS Electrical activation of Koch's triangle and the proximal coronary sinus was examined in 13 patients using a 60-point plaque electrode and computerized mapping system. Recordings were made during sinus rhythm (n = 12), left atrial pacing (n = 8), ventricular pacing (n = 12), and AVJRT (n = 12). During sinus rhythm electrical activation approached Koch's triangle and the AV node from the direction of the anterior limbus, activating the anterior part of the triangle before the posterior part. A zone of slow conduction during sinus rhythm was found within Koch's triangle in 64% of patients. The pattern of atrial activation in Koch's triangle during anterograde fast pathway conduction was similar to that seen during anterograde slow pathway conduction. Retrograde fast pathway conduction during ventricular pacing and during anterior (typical) AVJRT caused earliest atrial activation at the apex of Koch's triangle near the AV node-His bundle junction. In individual patients the site of earliest atrial activation was similar for both anterior AVJRT and retrograde fast pathway conduction during ventricular pacing. Retrograde slow pathway conduction during ventricular pacing and during posterior (uncommon or atypical) AVJRT caused earliest atrial activation posterior to the AV node near the orifice of the coronary sinus. This posterior or "slow pathway" exit site was 15 +/- 4 mm from the His bundle. In individual patients the site of earliest atrial activation was similar for both posterior AVJRT and retrograde slow pathway conduction during ventricular pacing. In one patient anterograde and retrograde conduction occurred via separate slow pathways during AVJRT: Complex atrial electrograms with two or more components were observed near the coronary sinus orifice and in the posterior part of Koch's triangle in all cases. These were categorized as either low or high frequency potentials according to the rapidity of the second component of the electrogram. Low frequency potentials were present at the site of earliest atrial excitation during retrograde slow pathway conduction in 5 of 5 cases (100%) and high frequency potentials in 4 of 5 cases (80%). However, both slow and high frequency potentials could be found at sites up to 16 mm from the site of earliest atrial excitation. CONCLUSIONS At least two distinct groups of atrionodal connections exist. The site of earliest atrial activation during anterior AVJRT is similar to that of fast pathway conduction during ventricular pacing. This site is close to the His bundle-AV node junction. The site of earliest atrial activation during posterior AVJRT is similar to that of slow pathway conduction during ventricular pacing. This site is near the coronary sinus orifice, approximately 15 mm from the His bundle. The anterograde slow pathway appears to be different from the retrograde slow pathway in some patients. Double atrial electrograms are an imprecise guide to the site of earliest atrial excitation during retrograde slow pathway conduction.
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Affiliation(s)
- M A McGuire
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
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24
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Abstract
The classical model of "atrioventricular (AV) nodal" reentrant tachycardia suggests that the reentrant circuit is entirely within the compact AV node and that AV nodal tissue is present proximal and distal to the circuit. Recent evidence from mapping studies and from examination of the effects of curative procedures, however, suggests that the upper end of the circuit uses perinodal atrial or transitional tissue. Moreover, the anatomical substrate of dual "AV nodal" pathways is likely to be the multiple connections between compact AV node and atrium rather than discrete intranodal pathways. The antegrade slow pathway appears to be situated at the posteroinferior approaches to the AV node in the region between the coronary sinus orifice and the tricuspid annulus. The retrograde fast pathway appears to be situated in the anterior atrionodal connections at the apex of Koch's triangle, close to the His bundle. The lower turnaround point of the circuit is likely to be within the AV node.
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Affiliation(s)
- M A McGuire
- Cardiology Department, Westmead Hospital, Sydney, New South Wales, Australia
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25
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Ward DE, Garratt CJ. The substrate for atrioventricular "nodal" reentrant tachycardia: is there a "third pathway"? J Cardiovasc Electrophysiol 1993; 4:62-7. [PMID: 8287237 DOI: 10.1111/j.1540-8167.1993.tb01213.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- D E Ward
- Cardiology Department, St George's Hospital, London, United Kingdom
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26
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Sakurada H, Sakamoto M, Hiyoshi Y, Tejima T, Motomiya T, Sugiura M, Hiraoka M. Double Ventricular Responses to a Single Atrial Depolarization in a Patient with Dual AV Nodal Pathways. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 1992; 15:28-33. [PMID: 1370997 DOI: 10.1111/j.1540-8159.1992.tb02898.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Electrophysiological study was performed in a patient with atrioventricular nodal reentrant tachycardia (AVNRT). Double ventricular responses through dual AV nodal pathways were observed by atrial extrastimulus technique followed by initiation of AVNRT. The difference in conduction time between the slow and fast AV nodal pathways was longer than 320 msec. A ventricular extrastimulus delivered during sinus rhythm, which was not followed by ventriculoatrial conduction, also induced AVNRT. These findings indicated the presence of an antegrade critical delay and retrograde block in the slow AV nodal pathway, criteria necessary for the occurrence of a double ventricular response.
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Affiliation(s)
- H Sakurada
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Japan
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27
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Kim SS, Lal R, Ruffy R. Paroxysmal nonreentrant supraventricular tachycardia due to simultaneous fast and slow pathway conduction in dual atrioventricular node pathways. J Am Coll Cardiol 1987; 10:456-61. [PMID: 3110241 DOI: 10.1016/s0735-1097(87)80032-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Electrophysiologic studies were performed on a 49 year old woman who had paroxysmal nonreentrant supraventricular tachycardia due to simultaneous anterograde conduction through dual atrioventricular (AV) node pathways. Slow pathway conduction was inversely related to the preceding sinus cycle length and fast pathway conduction was determined by the Hs-A interval (measured from the His potential due to slow pathway conduction to the onset of the subsequent atrial electrogram). Major determinants of sustained simultaneous anterograde fast and slow pathway conduction during sinus rhythm were 1) a retrograde unidirectional block in both fast and slow pathways, and 2) a critical conduction delay in the slow pathway and a long enough Hs-A interval to allow sequential conduction of impulse from both pathways. Flecainide was successful in preventing recurrences of the tachycardia by eliminating slow pathway conduction during long-term follow-up.
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28
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Miles WM, Klein LS, Minardo JD, Zipes DP. Two retrograde atrial responses from one ventricular complex in the permanent form of junctional reciprocating tachycardia. Am J Cardiol 1987; 59:1004-6. [PMID: 2436467 DOI: 10.1016/0002-9149(87)91148-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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29
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Curtiss EI, Fogoros RN, Uretsky BF, Follansbee WP, Salerni R. Electrocardiographically discrete right and left ventricular QRS complexes: a case report. J Electrocardiol 1987; 20:162-8. [PMID: 3598457 DOI: 10.1016/s0022-0736(87)80106-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A patient with congestive cardiomyopathy manifested a right ventricular QRS followed after 80 msec. by a left ventricular QRS in response to a single atrial depolarization. The ventricular sequence was reversible when the left ventricle was paced directly. Virtually the entire ipsilateral ventricular ejection period occurred during diastolic filling of the contralateral ventricle. Triggered left ventricular pacing, using the right ventricular electrogram as trigger, shortened the QRSRV-QRSLV interval and resulted in a reduction of left ventricular filling pressure and a significant rise in cardiac output. These findings indicated an independent contribution of this unique form of interventricular conduction disturbance to deterioration in hemodynamic performance.
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30
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Yeh SJ, Wu YC, Lin FC, Hung JS, Wu D. Pseudosimultaneous fast and slow pathway conduction: a common electrophysiologic finding in patients with dual atrioventricular nodal pathways. J Am Coll Cardiol 1985; 6:927-32. [PMID: 4031309 DOI: 10.1016/s0735-1097(85)80508-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Two ventricular responses following termination of rapid atrial pacing were noted in 24 of 87 patients with dual atrioventricular (AV) nodal pathways and supraventricular tachycardia. In all 24 patients, the AH intervals of the first and second ventricular responses were comparable with those of the fast and slow pathways, respectively. Careful analysis of the whole pacing sequence revealed that, in 21 patients, this phenomenon resulted from sustained slow pathway conduction with long AH intervals. In these patients, as the AH interval of each paced beat was progressively lengthened during pacing, the corresponding His bundle and ventricular responses were pushed one cycle behind the current atrial paced beat, so that the last paced beat was followed by two His bundle and ventricular responses. In only three patients did double ventricular responses result from simultaneous fast and slow pathway conduction. One of these three patients also showed two ventricular responses resulting from sustained slow pathway conduction. Several factors predispose to the occurrence of this phenomenon in patients with dual AV nodal pathways. These include an ability to sustain slow pathway conduction, a longer slow pathway AH interval, a shorter sinus AH interval (fast pathway) and a shorter atrial paced cycle length that sustains slow pathway conduction. In conclusion, sustained slow pathway conduction with resultant long AH intervals is the mechanism of two ventricular responses following termination of atrial pacing in most patients with dual AV nodal pathways. This phenomenon should be distinguished from the rare occurrence of double ventricular responses to an atrial impulse due to simultaneous fast and slow pathway conduction.
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31
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Littmann L, Tenczer J, Temesvári A, Fenyvesi T. Wenckebach periodicity with apparent 1:2 conduction over the atrioventricular node: the problem of interpretation. Am J Cardiol 1985; 55:1429-30. [PMID: 3993586 DOI: 10.1016/0002-9149(85)90522-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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32
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Lin FC, Yeh SJ, Wu D. Determinants of simultaneous fast and slow pathway conduction in patients with dual atrioventricular nodal pathways. Am Heart J 1985; 109:963-70. [PMID: 3993531 DOI: 10.1016/0002-8703(85)90236-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Double His bundle and ventricular responses to a single atrial impulse caused by a simultaneous fast and slow pathway conduction was observed during electrophysiologic study in three patients with dual-pathway atrioventricular nodal reentrant paroxysmal supraventricular tachycardia. In patient No. 1 this phenomenon occurred during rapid atrial pacing, in patient No. 2 during both rapid atrial pacing and delivery of a single atrial extrastimulus, and in patient No. 3 during delivery of double atrial extrastimuli. Retrograde unidirectional block in the slow pathway was suggested by retrograde induction of tachycardia at a long ventricular paced cycle length and/or long ventricular coupling interval in all three patients. Our findings suggest that major determinants of this phenomenon include: a sufficient conduction delay in the slow pathway so that the distal tissue is able to respond for the second time, and a retrograde unidirectional block in the slow pathway so that the fast pathway impulse will not enter and collide with the oncoming slow pathway impulse.
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33
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Buss J, Kraatz J, Stegaru B, Neuss H, Heene DL. Unusual mechanism of PR interval variation and nonreentrant supraventricular tachycardia as manifestation of simultaneous anterograde fast and slow conduction through dual atrioventricular nodal pathways. Pacing Clin Electrophysiol 1985; 8:235-41. [PMID: 2580285 DOI: 10.1111/j.1540-8159.1985.tb05755.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Noninvasive recordings in a 69-year-old woman showed two distinct PR intervals of about 0.21 and 0.58 s, suggestive of dual AV nodal conduction. Various unusual mechanisms of transition from short to long and from long to short conduction intervals and phenomena of concealed conduction were due to the presence of two functionally separated intranodal pathways. Refractoriness of the slow pathway was associated with bradycardia. Episodes of tachycardia exhibited a one-to-two relationship between P-waves and ventricular activations as a consequence of simultaneous anterograde fast and slow conduction leading to double ventricular responses to single P-waves.
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Lin FC, Yeh SJ, Wu D. Double atrial responses to a single ventricular impulse due to simultaneous conduction via two retrograde pathways. J Am Coll Cardiol 1985; 5:168-75. [PMID: 3964802 DOI: 10.1016/s0735-1097(85)80100-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Electrophysiologic studies were performed in two patients. In one patient (Case 1) with ventricular pre-excitation and paroxysmal supraventricular tachycardia, studies after diltiazem administration showed two QRS responses to a single atrial stimulus during atrial pacing at a cycle length of 300 ms. The first QRS response with full pre-excitation and short PR interval was consistent with accessory pathway conduction, while the second QRS response with a normal duration and an atrio-His bundle interval of 350 ms was consistent with normal pathway conduction. The second QRS response was followed by initiation of supraventricular tachycardia. Studies after verapamil administration on a separate day disclosed two atrial responses to a single QRS complex during ventricular pacing at cycle lengths between 330 and 280 ms, suggesting simultaneous retrograde accessory and normal pathway conduction. In Case 2 with a supraventricular tachycardia using a fast atrioventricular nodal pathway for anterograde and a slow ventriculoatrial pathway for retrograde conduction, two atrial responses to a single QRS complex were observed during ventricular pacing at cycle lengths between 500 and 400 ms. The first atrial response showed a stimulus to atrial interval of 120 ms and an atrial activation sequence with the low septal right atrium being earlier than other atrial sites, suggesting retrograde fast pathway conduction. The second atrial response showed a stimulus to atrial interval of 505 ms and an atrial activation sequence with low septal right atrium being simultaneous with the proximal coronary sinus, suggesting retrograde slow pathway conduction.(ABSTRACT TRUNCATED AT 250 WORDS)
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35
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Chazov EI, Rosenshtraukh LV, Shugushev KK. Ethmozin. II. Effects of intravenous drug administration on atrioventricular nodal reentrant tachycardia. Am Heart J 1984; 108:483-9. [PMID: 6382989 DOI: 10.1016/0002-8703(84)90412-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Electrophysiologic studies were performed in 11 patients with atrioventricular (AV) nodal reentrant tachycardia (SVT) before and after intravenous administration of 1.5 to 2 mg/kg ethmozin. Initially, 9 of 11 patients had induction of sustained SVT, and two remaining patients had nonsustained SVT and atrial echoes, respectively. Ethmozin terminated induced SVT in six of nine patients. In six of nine patients ethmozin prevented the development of sustained SVT, indicating that ethmozin depressed retrograde fast pathway AV nodal conduction. In four of these patients atrial echoes were abolished. In the two remaining cases ethmozin prevented the induction of nonsustained SVT. In only three of these nine patients was sustained SVT induced. Anterograde fast and slow pathway properties did not significantly change with ethmozin administration. Effective refractory period (ERP) of the ventriculoatrial (VA) conduction system and ventricular paced cycle length producing VA block was 305 +/- 40 (mean +/- SEM) and 347 +/- 38 msec before and 424 +/- 105 and 475 +/- 71 msec after ethmozin administration, respectively (p less than 0.01, n = 8), suggesting depression of retrograde pathway with ethmozin administration. Ethmozin significantly (p less than 0.05) lengthened PA, AH, HV, and PR intervals (36 +/- 11 to 45 +/- 14 msec, 84 +/- 21 to 93 +/- 17 msec, 42 +/- 8 to 50 +/- 7 msec, and 163 +/- 23 to 190 +/- 31 msec, respectively). No significant change was observed in sinus rate, QRS and QT intervals, or ERP of atrium and ventricle. Thus, a single intravenous dose of ethmozin terminated induced SVT and prevented induction of sustained SVT in most patients, reflecting depression of retrograde fast pathway conduction.
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Gomes JA, Kang PS, Hariman RJ, El-Sherif N, Lyons J. Electrophysiologic effects and mechanisms of termination of supraventricular tachycardia by intravenous amiodarone. Am Heart J 1984; 107:214-21. [PMID: 6695655 DOI: 10.1016/0002-8703(84)90367-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Electrophysiologic studies were performed in nine patients with reentrant paroxysmal supraventricular tachycardia (PSVT) during a control period and following 5 mg/kg body weight of intravenous amiodarone (Cordarone, Labaz) administered as a slow continuous infusion over 15 to 20 minutes. All nine patients had induction of sustained PSVT during control studies. In seven of nine patients (group 1) the tachycardia was due to atrioventricular (AV) nodal reentry, and in two of nine patients (group 2) a concealed retrograde bypass tract was incorporated in the reentrant process. In group 1, following amiodarone, all seven patients lost the ability to sustain PSVT with either absence of atrial echoes (one patient) or induction of less than or equal to 3 echo beats (six patients) with termination of PSVT in the antegrade pathway (three patients) or retrograde pathway (two patients) or both (one patient). In group 2, following amiodarone, both patients lost the ability to sustain PSVT with absence of atrial echoes (one patient) on induction of a single echo beat (one patient) with block in the retrograde pathway (i.e., the concealed retrograde bypass tract). Amiodarone significantly increased (1) atrial cycle length for AV nodal Wenckebach block, (2) antegrade functional refractory period of the AV node, (3) antegrade effective refractory period of the AV node, (4) ventricular paced cycle length for ventricular atrial block, and (5) the retrograde functional refractory period of the ventricular-atrial conducting system.(ABSTRACT TRUNCATED AT 250 WORDS)
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Sutton FJ, Lee YC. Supraventricular nonreentrant tachycardia due to simultaneous conduction through dual atrioventricular nodal pathways. Am J Cardiol 1983; 51:897-900. [PMID: 6829449 DOI: 10.1016/s0002-9149(83)80151-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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38
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Shenasa M, Gilbert CJ, Schmidt DH, Akhtar M. Procainamide and retrograde atrioventricular nodal conduction in man. Circulation 1982; 65:355-62. [PMID: 7053895 DOI: 10.1161/01.cir.65.2.355] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Recent studies that show a depressant effect of procainamide (PA) on retrograde conduction in patients with atrioventricular (AV) nodal reentrant tachycardia (RT) have suggested possible incorporation of AV nodal bypass tracts. Electrophysiologic effects of i.v. PA, 10 mg/kg, on retrograde AV nodal conduction were examined in 13 patients without RT, demonstrable AV nodal refractory period curves, or accessory pathways. Ventriculoatrial (VA) conduction was recorded before and after PA using intracardiac electrograms, incremental ventricular pacing and extrastimulation. With incremental pacing during the control, VA block occurred at a mean cycle length (CL) of 364.6 +/- 87.9 msec. After PA, VA conduction was abolished in five of 13 patients due to onset of retrograde block in the AV node; in seven of 13, VA block occurred at a longer paced CL after PA (344.2 +/- 51.2 msec vs 477.1 +/- 93.2 msec). In one patient, PA did not affect VA conduction. PA invariably produced prolongation in the VA interval at comparable CL of pacing. With ventricular premature stimulation, the retrograde H2A2 intervals during the control period were short (less than 50 msec) in seven of 13, intermediate (60-100 msec) in three of 13 and long (greater than 100 msec) in three of 13 cases. PA either abolished H2A2 conduction (H2 but no A2) or prolonged the H2A2 intervals by 5-20 msec in most cases in this series. The data suggest that i.v. PA almost uniformly depresses retrograde AV nodal conduction in the intact human heart. This depressant response to PA is not indicative of presence of partial or complete AV nodal bypass tracts.
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