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A case of preexcitation syndrome showing atypical atrioventricular nodal reentrant tachycardia and orthodromic atrioventricular reciprocating tachycardia with a bystander concealed nodoventricular/nodofascicular pathway.

ABSTRACT:

SUBMITTER: Nishiwaki S

PROVIDER: S-EPMC9289061 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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A case of preexcitation syndrome showing atypical atrioventricular nodal reentrant tachycardia and orthodromic atrioventricular reciprocating tachycardia with a bystander concealed nodoventricular/nodofascicular pathway.

Nishiwaki Shushi S Shizuta Satoshi S Tanaka Munekazu M Komasa Akihiro A Kohjitani Hirohiko H Kimura Takeshi T

HeartRhythm case reports 20220513 7

PMID: 35860777

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Systematic observation-based diagnosis of atrioventricular nodal reentrant tachycardia with a bystander concealed nodoventricular pathway.

Project description:BackgroundThis study aimed to establish a systematic method for diagnosing atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed nodoventricular pathway (cNVP).MethodsWe analyzed 13 cases of AVNRT with a bystander cNVP, 11 connected to the slow pathway (cNVP-SP) and two to the fast pathway (cNVP-FP), along with two cases of cNVP-related orthodromic reciprocating tachycardia (ORT).ResultsThe diagnostic process was summarized in three steps. Step 1 was identification of the presence of an accessory pathway by resetting the tachycardia with delay (n = 9) and termination without atrial capture (n = 4) immediately after delivery of a His-refractory premature ventricular contraction (PVC). Step 2 was exclusion of ORT by atrio-His block during the tachycardia (n = 4), disappearance of the reset phenomenon after the early PVC (n = 7), or dissociation of His from the tachycardia during ventricular overdrive pacing (n = 1). Moreover, tachycardia reset/termination without the atrial capture (n = 2/2) 1 cycle after the His-refractory PVC was specifically diagnostic. Exceptionally, the disappearance of the reset phenomenon was also observed in the two cNVP-ORTs. Step 3 was verification of the AVN as the cNVP insertion site, evidenced by an atrial reset/block preceding the His reset/block in fast-slow AVNRT with a cNVP-SP and slow-fast AVNRT with a cNVP-FP or His reset preceding the atrial reset in slow-fast AVNRT with a cNVP-SP.ConclusionAVNRT with a bystander cNVP can be diagnosed in the three steps with few exceptions. Notably, tachycardia reset/termination without atrial capture one cycle after delivery of a His-refractory PVC is specifically diagnostic.

| S-EPMC10848616 | biostudies-literature

High-density mapping of the tachycardia circuit in atrioventricular nodal reentrant tachycardia.

Project description: Not available

| S-EPMC5419940 | biostudies-literature

Successful cryoablation of an atypical slow-slow atrioventricular nodal reentrant tachycardia utilizing a superior slow pathway

Project description: Not available

| S-EPMC10511899 | biostudies-literature

Significant respiratory-related fluctuations in atrioventricular nodal conduction time in a case of atrioventricular nodal reentrant tachycardia.

Project description: Not available

| S-EPMC11312021 | biostudies-literature

Three-dimensional mapping of junctional beats during atrioventricular nodal reentrant tachycardia cryoablation.

Project description:Cryoablation of slow pathway doesn't usually cause junctional beats. If this occurs, the nearness to AV compact node is supposed. 3d electroanatomical mapping during this unusual finding may help to clarify the relationship between junctional beats (JBs) during cryomapping/cryoablation and Koch's triangle.

| S-EPMC9535762 | biostudies-literature

Antegrade slow pathway mapping of typical atrioventricular nodal reentrant tachycardia based on direct slow pathway capture.

Project description:BackgroundRadiofrequency (RF) ablation of typical atrioventricular nodal reentrant tachycardia (tAVNRT) is performed without revealing out the location of antegrade slow pathway (ASp). In this study, we studied a new electrophysiological method of identifying the site of ASp.MethodsThis study included 19 patients. Repeated series of very high-output single extrastimulations (VhoSESts) were delivered at the anatomical slow pathway region during tAVNRT. Tachycardia cycle length (TCL), coupling interval (CI), and return cycle (RC) were measured and the prematurity of VhoSESts [ΔPM (= TCL - CI)] and the prolongation of RCs [ΔPL (= RC - TCL)] were calculated. Pacing sites were classified into two categories: (i) ASp capture sites [DSPC(+) sites], where two different RCs were shown, and ASp non-capture sites [DSPC(-) sites], where only one RC was shown. RF ablation was performed at DSPC(+) sites and/or sites with catheter-induced mechanical trauma (CIMT) to ASp.ResultsDSPC(+) sites were shown in 13 patients (68%). RF ablation was successful in all patients without any degree of atrioventricular block nor recurrence. Total number of RF applications was 1.8 ± 1.1. Minimal distance between successful ablation sites and DSPC(+)/CIMT sites and His bundle (HB) electrogram recording sites was 1.9 ± 0.8 mm and 19.8 ± 6.1 mm, respectively. ΔPL of more than 92.5 ms, ΔPL/TCL of more than 0.286, and ΔPL/ΔPM of more than 1.565 could identify ASp with sensitivity of 100%, 91.1%, and 88.9% and specificity of 92.9%, 97.0%, and 97.6%, respectively.ConclusionsSites with ASp capture and CIMT were close to successful ablation sites and could be useful indicators of tAVNRT ablation.

| S-EPMC7896471 | biostudies-literature

Atrial-His-atrial and atrial-His-His-atrial responses during slow-fast atrioventricular nodal reentrant tachycardia.

Project description: Not available

| S-EPMC10123928 | biostudies-literature

Diagnosis and treatment of atrioventricular nodal reentrant tachycardia: a case report illustrating clinical management and ablation strategy.

Project description:BackgroundAtrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular arrhythmia that is frequently encountered in an otherwise healthy patient population. Recent guidelines of the European Society of Cardiology underline the role of catheter ablation in the long-term management of these patients.Case summaryThis case describes the clinical presentation and treatment options in a patient with typical slow/fast AVNRT, the most common subform of AVNRT, where antegrade conduction occurs over the slow pathway and retrograde conduction over the fast pathway. The ablation strategy in these patients is illustrated based on intracardiac recordings in combination with per-procedural three-dimensional imaging.DiscussionAtrioventricular nodal reentrant tachycardia is a common arrhythmia with good prognosis but significant impact on quality of life of affected patients. Catheter ablation should be considered early as it can be performed safely and with a very high success rate.

| S-EPMC7501927 | biostudies-literature

Association Between the Coronary Sinus Ostial Size and Atrioventricular Nodal Reentrant Tachycardia in Patients With Pulmonary Arterial Hypertension.

Project description:AimsThe incidence of atrioventricular nodal reentrant tachycardia (AVNRT) is higher in pulmonary arterial hypertension (PAH) patients than in the general population. AVNRT is reportedly associated with a larger coronary sinus (CS) ostium (CSo). However, the correlation between AVNRT and CSo size in PAH patients is poorly investigated. We aimed to investigate the impact of CSo size on AVNRT and identify its risk factors in PAH.Methods and resultsOf 102 PAH patients with catheter ablation of supraventricular tachycardia (SVT), twelve with a confirmed AVNRT diagnosis who underwent computed tomographic angiography were retrospectively enrolled as the study group. The control group (PAH without SVT, n = 24) was matched for sex and BMI at a 2:1 ratio. All baseline and imaging data were collected. Mean pulmonary artery pressure was not significantly different between the two groups (65.3 ± 16.8 vs. 64.5 ± 17.6 mmHg, P = 0.328). PAH patients with AVNRT were older (45.9 ± 14.8 vs. 32.1 ± 7.6 years, P = 0.025), had a larger right atrial volume (224.4 ± 129.6 vs. 165.3 ± 71.7 cm3, P = 0.044), larger CSo in the left anterior oblique (LAO) plane (18.6 ± 3.3 vs. 14.8 ± 4.0 mm, P = 0.011), and larger CSo surface area (2.08 ± 1.35 vs. 1.45 ± 0.73 cm2, P = 0.039) and were more likely to have a windsock-shape CS (75% vs. 16.7%, P = 0.001) than those without AVNRT. A linear correlation was shown between CSo diameter in the LAO-plane and the atrial fractionation of the ablation target for AVNRT (R 2 = 0.622, P = 0.012).ConclusionAnatomical dilation of the CSo is a risk factor for AVNRT development in patients with PAH.

| S-EPMC8814530 | biostudies-literature

Radiofrequency Catheter Ablation for Pediatric Atrioventricular Nodal Reentrant Tachycardia: Impact of Age on Procedural Methods and Durable Success.

Project description:Background Catheter-based slow-pathway modification (SPM) is the treatment of choice for symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). We sought to investigate the interactions between patient age and procedural outcomes in pediatric patients undergoing catheter-based SPM for AVNRT. Methods and Results A retrospective cohort study was performed, including consecutive patients undergoing acutely successful SPM for AVNRT from 2008 to 2017. Those with congenital heart disease, cardiomyopathy, and accessory pathways were excluded. Patients were stratified by age quartile at time of SPM. The primary outcome was AVNRT recurrence. A total of 512 patients underwent successful SPM for AVNRT. Age quartile 1 had 129 patients with a median age and weight of 8.9 years and 30.6 kg, respectively. Radiofrequency energy was used in 98% of cases. Follow-up was available in 447 (87%) patients with a median duration of 0.8 years (interquartile range, 0.2-2.5 years). AVNRT recurred in 22 patients. Multivariable Cox proportional hazard modeling identified atypical AVNRT (hazard ratio [HR], 5.83; 95% CI, 2.01-16.96; P=0.001), dual atrioventricular nodal only (HR, 4.09; 95% CI, 1.39-12.02; P=0.011), total radiofrequency lesions (HR, 1.06 per lesion; 95% CI, 1.01-1.12; P=0.032), and the use of a long sheath (HR, 3.52; 95% CI, 1.23-10.03; P=0.010) as predictors of AVNRT recurrence; quartile 1 patients were not at higher risk of recurrence (HR, 0.45; 95% CI, 0.10-1.97; P=0.29). Complete heart block requiring permanent pacing occurred in one quartile 2 patient at 14.9 years of age. Conclusions Pediatric AVNRT can be treated with radiofrequency-SPM with high procedural efficacy and minimal risk of complications, including heart block. Atypical AVNRT and dual atrioventricular nodal physiology without inducible tachycardia remain challenging substrates.

| S-EPMC9238659 | biostudies-literature

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