To the Editor—Response:

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We appreciate Dr. Katritsis’s interest in our article on atypical atrioventricular (AV) nodal reentrant tachycardia (AVNRT) with eccentric coronary sinus activation, 1 Otomo K. Nagata Y. Uno K. Fujiwara H. Iesaka Y. Atypical atrioventricular nodal reentrant tachycardia with eccentric coronary sinus activation: electrophysiological characteristics and essential effects of left-sided ablation inside the coronary sinus. Heart Rhythm. 2007; 4: 421-432 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar which suggested the presence of an upper common pathway (UCP) in 4 (1%) of the 340 cases with all forms of AVNRT. In his letter to the editor, Dr. Katritsis points out that the concept of a UCP was only speculative and should be abandoned because data 2 Loh P. de Bakker J.M. Hocini M. Thibault B. Hauer R.N. Janse M.J. Reentrant pathway during ventricular echoes is confined to the atrioventricular node: high-resolution mapping and dissection of the triangle of Koch in isolated, perfused canine hearts. Circulation. 1999; 100: 1346-1353 Crossref PubMed Scopus (27) Google Scholar , 3 Anselme F. Hook B. Monahan K. Frederiks J. Callans D. Zardini M. Epstein L.M. Zebede J. Josephson M.E. Heterogeneity of retrograde fast-pathway conduction pattern in patients with atrioventricular nodal reentry tachycardia: observations by simultaneous multisite catheter mapping of Koch’s triangle. Circulation. 1996; 93: 960-968 Crossref PubMed Scopus (84) Google Scholar , 4 McGuire M.A. Lau K.-C. Johnson D.C. Richards D.A. Uther J.B. Ross D.L. Patients with two types of atrioventricular junctional (AV nodal) reentrant tachycardia Evidence that a common pathway of nodal tissue is not present above the reentrant circuit. Circulation. 1991; 83: 1232-1246 Crossref PubMed Scopus (96) Google Scholar , 5 Katritsis D.G. Ellenbogen K.A. Becker A.E. Atrial activation during atrioventricular nodal reentrant tachycardia: studies on retrograde fast pathway conduction. Heart Rhythm. 2006; 3: 993-1000 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar , 6 Keim S. Werner P. Jazayeri M. Akhtar M. Tchou P. Localization of the fast and slow pathways in atrioventricular nodal re-entrant tachycardia by intraoperative ice mapping. Circulation. 1992; 86: 919-925 Crossref PubMed Scopus (95) Google Scholar in the literature argue against the presence of a UCP. Nevertheless, we still believe that, in at least some AVNRT cases, the tachycardia circuit would be subatrial and the concept of a UCP would be required to explain the unusual phenomena, including ventriculoatrial (VA) dissociation.