Premium
Characterizing Dual Atrioventricular Nodal Physiology in Pediatric Patients with Atrioventricular Nodal Reentrant Tachycardia
Author(s) -
BLURTON DOMINIC J.,
DUBIN ANNE M.,
CHIESA NANCY A.,
VAN HARE GEORGE F.,
COLLINS KATHRYN K.
Publication year - 2006
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.1540-8167.2006.00452.x
Subject(s) - medicine , cardiology , tachycardia , atrial flutter , nodal , atrioventricular node , palpitations , atrioventricular block , ablation
Dual atrioventricular (AV) nodal physiology, defined as an AH jump ≥50 msec with a 10 msec decrease in A1A2, is the substrate for atrioventricular nodal reentrant tachycardia (AVNRT) and yet it is present in a minority of pediatric patients with AVNRT. Our objective was to characterize dual AV nodal physiology as it pertains to a pediatric population. Methods/Results: We retrospectively reviewed invasive electrophysiology studies in 92 patients with AVNRT (age12.1 ± 3.7 yrs) and in 46 controls without AVNRT (age 13.3 ± 3.7 yrs). Diagnoses in controls: syncope (N = 31), palpitations (N = 6), atrial flutter (N = 3), history of atrial tachycardia with no inducible arrhythmia (N = 3), and ventricular tachycardia (N = 3). General anesthesia was used in 49% of AVNRT and 52% of controls, P = 0.86. There were no differences in PR, AH, HV, or AV block cycle length. With A1A2 atrial stimulation, AVNRT patients had a significantly longer maximum AH achieved (324 ± 104 msec vs 255 ± 67 msec, P = 0.001), and a shorter AVNERP (276 ± 49 msec vs 313 ± 68 msec P = 0.0005). An AH jump ≥50 msec was found in 42% of AVNRT versus 30% of controls (P = 0.2). Using a ROC graph we found that an AH jump of any size is a poor predictor of AVNRT. With atrial overdrive pacing, PR ≥ RR was seen more commonly in AVNRT versus controls, (55/91(60%) vs 6/46 (13%) P = 0.000). Conclusions: Neither the common definition of dual AV nodes or redefining an AH jump as some value <50 msec are reliable methods to define dual AV nodes or to predict AVNRT in pediatric patients. PR ≥ RR is a relatively good predictor of AVNRT.