The prevalence and characteristics of coexisted atrioventricular nodal reentrant tachycardia and idiopathic left fascicular ventricular tachycardia.

Abstract

Coexistence of idiopathic left fascicular ventricular tachycardia (ILFVT) and atrioventricular nodal reentrant tachycardia (AVNRT) has been rarely reported. The study aimed at elucidating the prevalence of coexisted AVNRT in patients with ILFVT during longitudinal follow-up. The electrophysiological properties and clinical predictors of coexisted ILFVT and AVNRT were investigated. From 1999 to 2017, a total of 108 patients (age: 33.7 ± 14.3, 84 male) with ILFVT from one tertiary center were consecutively enrolled. The prevalence of coexisted arrhythmias was explored during a longitudinal follow-up and the electrophysiological parameters from the index procedure were compared. During a mean follow-up period of 106.8 ± 69.5 months, 21 of 108 patients (19.4%) had coexisted AVNRT. The electrophysiological study demonstrated patients with coexisted ILFVT and AVNRT were characterized by more antegrade dual AV node conduction (52.4%vs. 19.5%, P=0.002; 9.5%), shorter antegrade slow pathway effective refractory period (285.1 ± 34.1ms vs. 329.2 ± 69.2ms, P=0.034), longer retrograde fast pathway effective refractory period (368.9 ± 56.7ms vs. 312.5 ± 95.2, P=0.036), and less VA dissociation (19.0%vs. 60.9%, P=0.001) than those without a coexisted AVNRT. Multivariate logistic analysis showed that presence of antegrade dual AV nodal physiology and retrograde VA conduction could predict a coexisted AVNRT in patients with ILFVT (P=0.005, OR: 4.80, 95% CI: 1.65-14.37 and P=0.002, OR: 0.14, 95% CI: 0.04-0.49, respectively). There was a high prevalence of coexisted AVNRT in patients with ILFVT during longitudinal follow-up. The presence of antegrade dual AV nodal physiology and retrograde VA conduction can predict the coexisted AVNRT in patients with ILFVT.