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Superior Type of Atypical AV Nodal Reentrant Tachycardia: Incidence, Characteristics, and Effect of Slow Pathway Ablation
Author(s) -
OTOMO KIYOSHI,
NAGATA YASUTOSHI,
TANIGUCHI HIROSHI,
UNO KIKUYA,
FUJIWARA HIDEOMI,
IESAKA YOSHITO
Publication year - 2008
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.1540-8159.2008.01127.x
Subject(s) - medicine , tachycardia , ablation , cardiology , radiofrequency ablation , catheter ablation , nodal , atrioventricular node , coronary sinus , atrial tachycardia
Background:Atypical atrioventricular (AV) nodal reentrant tachycardias (AVNRT) usually exhibit the earliest retrograde atrial activation (ERAA) at the right inferoseptum (Rt‐IS) or proximal coronary sinus (PCS). The purpose of this study was to characterize atypical AVNRT with the ERAA at the right superoseptum (Rt‐SS).Methods:Seventy‐three atypical AVNRTs induced in 63 cases were classified into the superior type with the ERAA at the Rt‐SS and inferior type with the ERAA at the Rt‐IS or PCS.Results:There were nine superior (12%) and 64 inferior types of atypical AVNRT (88%) in seven and 56 cases, respectively. The superior type exhibited a short atrial‐His interval during the tachycardia (166 ± 41 ms), long His‐atrial interval during the tachycardia (H‐At:156 ± 38 ms), and ventricular pacing at the tachycardia cycle length (TCL) (H‐Ap:201 ± 36 ms), and evidence for a lower common pathway, including second‐degree AV block (four tachycardias) and an H‐Ap being longer than the H‐At (nine tachycardias). The TCL was shorter in the superior type than in the inferior type (322 ± 35 vs 404 ± 110 ms; P < 0.02). In the inferior type, all tachycardias were eliminated after the ablation at the Rt‐IS (44 tachycardias) or PCS (20 tachycardias) where an ERAA was recorded. In the superior type, ablation at the Rt‐IS was ineffective; however, ablation at the right midseptum eliminated seven (78%) of the nine tachycardias.Conclusions:The tachycardia circuit of the superior type might have deviated to a more superior part of Koch's triangle than that of the inferior type.