Journal Article

Retrograde slow pathway conduction in patients with atrioventricular nodal re-entrant tachycardia

Demosthenes G. Katritsis, Kenneth A. Ellenbogen, Anton E. Becker and A. John Camm

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 7, pages 458-465
Published in print July 2007 | ISSN: 1099-5129
Published online May 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum067
Retrograde slow pathway conduction in patients with atrioventricular nodal re-entrant tachycardia

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Aims To study retrograde slow pathway conduction by means of right- and left-sided septal mapping.

Methods and results Nineteen patients with slow–fast atrioventricular nodal re-entrant tachycardia (AVNRT) were studied before and after slow pathway ablation. Simultaneous His bundle recordings from right and left sides of the septum, using trans-aortic and trans-septal electrodes, were made during right ventricular pacing. Pre-ablation, decremental retrograde ventriculo-atrial (VA) conduction without jumps or discontinuities was recorded in eight patients (group 1). In six patients, retrograde conduction jumps were demonstrated (group 2) and in the remaining four patients, there was minimal prolongation of stimulus to atrium (St-A) intervals (group 3). The maximal difference (ΔSt-A) between St-A intervals obtained with pacing at a constant cycle length of 500 ms and at the cycle length with maximal retrograde VA prolongation was significantly longer measured from the right His compared with the left His (122 ± 25 vs. 110 ± 33 ms, P = 0.02, respectively) in group 1 and group 2 (140 ± 23 vs. 110 ± 35 ms, P = 0.03), but not in group 3 (10 ± 4 vs. 13 ± 8 ms, P = 0.35). Post-ablation, ΔSt-A intervals were similar between right and left His recordings (77 ± 37 vs. 76 ± 33 ms, P = 0.53, respectively) in group 1, (100 ± 24 vs. 103 ± 21 ms, P = 0.35) group 2, and (63 ± 32 vs. 66 ± 33 ms, P = 0.35) group 3.

Conclusion In patients with typical AVNRT, retrograde conduction through the slow pathway results in earliest retrograde atrial activation on the left side of the septum and catheter ablation in the right inferoparaseptal area abolishes this pattern. These findings are compatible with the concept of slow pathway conduction by means of the inferior AV nodal extensions.

Keywords: Atrioventricular node; Slow pathway; Tachycardia; Ablation

Journal Article.  3594 words.  Illustrated.

Subjects: Cardiovascular Medicine

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