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Physiology of “Atypical” Atrioventricular Junctional Reentrant Tachycardia Occurring Following Radiofrequency Catheter Modification of the Atrioventricular Node
Author(s) -
GOLDBERGER JEFFREY,
BROOKS RODNEY,
KADISH ALAN
Publication year - 1992
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1992.tb04171.x
Subject(s) - medicine , atrioventricular node , nodal , tachycardia , bundle of his , cardiology , catheter , electrical conduction system of the heart , surgery , electrocardiography
The physiology of atypical atrioventricular junctional reentrant (achycardia (AVJRT) occurring following catheter modification of the AV node is poorly defined. Six patients undergoing radiofrequency current catheter modification of the AV node had inducible atypical AVJRT before or after AV nodal modification. Typical AVJRT was differentiated from atypical AVJRT by a ventriculoatrial (VA) time < 60 msec in the His‐bundle electrogram recording. Five of six patients had typical AVJRT and two had atypical AVJRT prior to AV nodal modification. Following anterior approach AV nodal modification, previously undetected atypical AVJRT was induced in four patients. Earliest retrograde atrial activation in the posterior septum was documented in all patients with atypical AVJRT prior to modification and in three four patients with atypical AVJRT following modification. The AH intervals during tachycardia were 320 ± 52 msec in typical AVJRT, 88 ± 33 msec in the premodification atypical AVJRTs, and 172 ± 12 msec in the postmodification atypical AVJRTs (P − 0.0001). The AHJRA ratios were 4.1 ± 0.9 in typical AVJRT, 0.5 ± 0.2 in the premodification atypical AVJRTs, and 0.9 ± 0.2 in the postmodification atypical AVJRTs (P = 0.0001). Two patients with postmodificafion atypical AVJRT underwent further posterior approach AV node modification that resulted in VA block. One patient with postmodification atypical AVJRT had further anterior approach AV nodal modification that resulted in heart block. The retrograde limb of the atypical AVJRT seen following anterior approach AV nodal modification is a posterior, slow pathway.