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Multiple Atrioventricular Nodal Pathways in Humans:
Author(s) -
LEE KATHY L.,
CHUN HINGSON M.,
LIEM L. BING,
LAUER MICHAEL R.,
YOUNG CHARLIE,
SUNG RUEY J.
Publication year - 1998
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1998.tb00894.x
Subject(s) - medicine , nodal , atrioventricular node , cardiology , electrical conduction system of the heart , nodal signaling , electrocardiography , tachycardia , microbiology and biotechnology , gastrulation , embryo , embryogenesis , biology
Multiple AV Nodal Pathways. Introduction : Multiple AV nodal pathway physiology can be demonstrated in certain patients with clinical AV reentrant tachycardia. Methods and Results : Evidence suggesting multiple AV nodal pathway conduction was present in seven (two males; age range 15 to 75 years) of 78 patients (9%) who underwent electrophysiologic studies for AV nodal tachycardia. The presence of two discrete discontinuities in the AV nodal conduction curves suggested triple AV nodal pathway conduction. Detailed mapping of their retrograde atrial activation sequence was performed along the tricuspid annulus from the coronary sinus ostium to the His‐bundle electrogram recording site. Three zones (anterior, middle, and posterior) correspond to the upper, middle, and lower third of the triangle of Koch, respectively. The fast pathway exits were determined as anterior (4/7) or middle (3/7), the intermediate pathway exits as middle (4/7) or posterior (3/7), and the slow pathway exits as middle (1/7) or posterior (6/7). Other evidence suggesting multiple AV nodal pathway conduction includes: (1) triple ventricular depolarizations from a single atrial impulse; (2) sequential dual ventricular echoes; (3) spontaneous transformation between the slow‐fast and fast‐slow forms of AV nodal reentrant tachycardia; and (4) persistent cycle length alternans during AV nodal reentrant tachycardia. In four patients, all three pathways were shown to be involved in AV nodal echoes or reentrant tachycardia. Conclusion : Multiple AV nodal pathways are not uncommon and can be identified by careful electrophysiologic elucidation and mapping technique.