TY - JOUR
T1 - Atypical atrioventricular nodal reentrant tachycardia
T2 - Prevalence, electrophysiologic characteristics, and tachycardia circuit
AU - Katritsis, Demosthenes G.
AU - Sepahpour, Ali
AU - Marine, Joseph E.
AU - Katritsis, George D.
AU - Tanawuttiwat, Tanyanan
AU - Calkins, Hugh
AU - Rowland, Edward
AU - Josephson, Mark E.
N1 - Publisher Copyright:
© 2015 Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Aims This study aimed at assessing the prevalence, electrophysiologic characteristics, and mechanism of atypical atrioventricular nodal reentrant tachycardia (AVNRT). Methods and results We studied 925 consecutive patients with AVNRT. Atrial-His (AH) and His-atrial (HA) intervals were measured during atypical AVNRT (HA > 70 ms), and compared with measurements in 34 patients with typical (slow-fast) AVNRT. Assuming that conduction velocity over the fast pathway is similar in the anterograde and retrograde directions, the AH interval during the fast-slow form should be smaller than the HA during slow-fast. Atypical AVNRT was diagnosed in 59 patients (6.4%), median age 50 years (range 19-79 years), and 37 (59.7%) of them female. Fast-slow AVNRT was diagnosed in 44 patients (74.5%), and slow-slow AVNRT in 9 patients (15.2%). The remaining six patients (10.2%) could not be reliably classified due to inconsistent AH, and HA/AH patterns or variable intervals. Tachycardia induction with anterograde conduction jumps was seen in two patients with the fast-slow, and in three patients with slow-slow or intermediate forms. Atrial-His in the fast-slow group was significantly longer than HA in the slow-fast group, 99.7 ± 40.5 ms vs. 45.8 ± 7.7 ms, P < 0.001. Tachycardia cycle length was longer in fast-slow compared with slow-fast, 379.1 ± 68.5 ms vs. 317.1 ± 42.8 ms, P < 0.001. Conclusion Of AVNRT cases, 6.4% are atypical and may display patterns that do not necessarily correspond to the fast-slow or slow-slow conventional types. Atypical fast-slow and typical AVNRT do not appear to utilize the same limb for fast conduction.
AB - Aims This study aimed at assessing the prevalence, electrophysiologic characteristics, and mechanism of atypical atrioventricular nodal reentrant tachycardia (AVNRT). Methods and results We studied 925 consecutive patients with AVNRT. Atrial-His (AH) and His-atrial (HA) intervals were measured during atypical AVNRT (HA > 70 ms), and compared with measurements in 34 patients with typical (slow-fast) AVNRT. Assuming that conduction velocity over the fast pathway is similar in the anterograde and retrograde directions, the AH interval during the fast-slow form should be smaller than the HA during slow-fast. Atypical AVNRT was diagnosed in 59 patients (6.4%), median age 50 years (range 19-79 years), and 37 (59.7%) of them female. Fast-slow AVNRT was diagnosed in 44 patients (74.5%), and slow-slow AVNRT in 9 patients (15.2%). The remaining six patients (10.2%) could not be reliably classified due to inconsistent AH, and HA/AH patterns or variable intervals. Tachycardia induction with anterograde conduction jumps was seen in two patients with the fast-slow, and in three patients with slow-slow or intermediate forms. Atrial-His in the fast-slow group was significantly longer than HA in the slow-fast group, 99.7 ± 40.5 ms vs. 45.8 ± 7.7 ms, P < 0.001. Tachycardia cycle length was longer in fast-slow compared with slow-fast, 379.1 ± 68.5 ms vs. 317.1 ± 42.8 ms, P < 0.001. Conclusion Of AVNRT cases, 6.4% are atypical and may display patterns that do not necessarily correspond to the fast-slow or slow-slow conventional types. Atypical fast-slow and typical AVNRT do not appear to utilize the same limb for fast conduction.
KW - Atypical atrioventricular nodal tachycardia
KW - Fast-slow tachycardia
KW - Nodal extensions
KW - Slow-slow tachycardia
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U2 - 10.1093/europace/euu387
DO - 10.1093/europace/euu387
M3 - Article
C2 - 25643989
AN - SCOPUS:84936744672
SN - 1099-5129
VL - 17
SP - 1099
EP - 1106
JO - Europace
JF - Europace
IS - 7
ER -