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Visualization of the Antegrade Fast and Slow Pathway Inputs in Patients with Slow‐Fast Atrioventricular Nodal Reentrant Tachycardia
Author(s) -
SUZUKI ATSUSHI,
YOSHIDA AKIHIRO,
TAKEI ASUMI,
FUKUZAWA KOJI,
KIUCHI KUNIHIKO,
TANAKA SATOKO,
ITOH MITSUAKI,
IMAMURA KIMITAKE,
FUJIWARA RYUDO,
NAKANISHI TOMOYUKI,
YAMASHITA SOICHIRO,
MATSUMOTO AKINORI,
KONISHI HIROKI,
ICHIBORI HIROTOSHI,
HIRATA KENICHI
Publication year - 2014
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/pace.12363
Subject(s) - medicine , nodal , tachycardia , coronary sinus , atrioventricular node , atrial septum , cardiology , sinus rhythm , reentrancy , bundle of his , electrocardiography , anatomy , electrical conduction system of the heart , atrial fibrillation , physics , condensed matter physics
Mapping of the antegrade fast pathway (A‐FP) exact sites and antegrade slow pathway (A‐SP) input locations has not been well described. Methods In 56 patients with slow‐fast atrioventricular nodal reentrant tachycardia (SF‐AVNRT), pacing during sinus rhythm and entrainment pacing during SF‐AVNRT were performed at various sites in the triangle of Koch and coronary sinus (CS) to identify the A‐FP and A‐SP inputs. User‐defined three‐dimensional electro‐anatomical mapping of the stimulus‐His potential (St‐H) interval and anatomical location was performed. The A‐FP input was defined as the site of the shortest St‐H interval, and A‐SP input as the site of the shortest St‐H interval and with a postpacing‐interval equal to the tachycardia cycle length. The locations of the A‐FP and A‐SP inputs were mapped as a ratio of the distance between the His bundle (HB) and CS orifice (CSO), and the HB‐CSO axis was divided into three zones: superior‐, mid‐, and inferior septum. The distance between the A‐SP and A‐FP inputs was calculated using the distance from each input to the HB and HB‐CSO axis. Results Only 30 patients were included in this study because the A‐SP mapping failed in 26. The A‐SP input was distributed to the superior septum in four, mid‐ or inferior septum in 25, and CS in one. An A‐SP input which was located less than 10 mm from the A‐FP input was observed in one of four patients with a superior septum A‐SP. Conclusions An A‐SP input at the superior septum seemed to be a potential risk for atrioventricular nodal injury during ablation.