Nodal Reentrant Tachycardia In Patient Research Articles

Cryoablation of the Slow Atrioventricular Nodal Pathway via a Transbaffle Approach in a Patient with the Mustard Procedure for d-Transposition of the Great Arteries

The ablation of atrioventricular (AV) nodal reentrant tachycardia in patients with the Senning or Mustard procedure is quite challenging because these atrial baffle procedures isolate the AV node from systemic venous access. Cryoablation is commonly utilized for AV nodal slow pathway modification in patients with structurally normal hearts. The cryoablation technique offers the advantage of monitoring AV nodal conduction during lesions, with the ability to terminate a lesion prior to permanent injury to the AV node. This case describes the successful cryoablation of the slow AV nodal pathway via the transbaffle approach in a patient with d-transposition of the great arteries status post the Mustard procedure.

Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patient with Interruption of Inferior Vena Cava

We present a 72‐year‐old man with interruption of inferior vena cava (IVC) with azygos continuation, who underwent radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT).We recorded a His bundle electrogram with an electrode catheter positioned in the aortic root. We also introduced an electrode catheter through the right femoral vein, advanced it via an enlarged azygos vein and the superior vena cava and positioned it at the right ventricular apex (RVA). AVNRT was induced by programmed pacing from a coronary sinus catheter introduced through the left subclavian vein. It was successfully ablated with an ablation catheter introduced through the right internal jugular vein.In a patient with interruption of IVC, it is impossible to access the right side of the heart directly via femoral vein and IVC. In this case, however, alternative routes to the His bundle, RVA and ablation site enabled us to perform an electrophysiologic study and a successful catheter ablation.

Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patient with Interruption of Inferior Vena Cava

We present a 72-year-old man with interruption of inferior vena cava (IVC) with azygos continuation, who underwent radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). We recorded a His bundle electrogram with an electrode catheter positioned in the aortic root. We also introduced an electrode catheter through the right femoral vein, advanced it via an enlarged azygos vein and the superior vena cava and positioned it at the right ventricular apex (RVA). AVNRT was induced by programmed pacing from a coronary sinus catheter introduced through the left subclavian vein. It was successfully ablated with an ablation catheter introduced through the right internal jugular vein. In a patient with interruption of IVC, it is impossible to access the right side of the heart directly via femoral vein and IVC. In this case, however, alternative routes to the His bundle, RVA and ablation site enabled us to perform an electrophysiologic study and a successful catheter ablation.

Atrioventricular Nodal Reentrant Tachycardia in Patients Referred for Atrial Fibrillation Ablation: Response to Ablation That Incorporates Slow-Pathway Modification

Atrioventricular Nodal Reentrant Tachycardia in Patients Referred for Atrial Fibrillation Ablation: Response to Ablation That Incorporates Slow-Pathway Modification

Origin of Junctional Rhythm During Radiofrequency Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patients Without Structural Heart Disease

Junctional rhythm is commonly observed during radiofrequency catheter ablation of the fast or slow pathways of atrioventricular nodal reentrant tachycardia (AVNRT). However, the origin of these beats remains unclear. We analyzed the retrograde atrial activation sequence of 16 patients (mean ± SD: 41.2 ± 18.9 years old) undergoing catheter ablation for typical AVNRT with detailed catheter mapping of the triangle of Koch. The earliest atrial activations were concordant during tachycardia and junctional rhythm in only 5 of 16 patients. The findings suggest that junctional rhythm is unlikely to represent direct stimulation of the atrioventricular (AV) node via a discrete slow pathway but rather results from enhanced automaticity from ≥1 sites in the AV nodal transitional zone. The ensuing atrial activation pattern results from anisotropic spread from these sites. In addition, these data imply that the original concept of the AV node comprising 2 anatomically defined pathways may not be valid, and that a functionally defined pathway model may be a more accurate representation.

Multiple supraventricular tachycardia mechanisms in a single patient treated with radiofrequency catheter ablation

The incidence of atrioventricular (AV) nodal reentrant tachycardia in patients with accessory AV connection is 5 % or 1ess.l The occurrence of either accessory AV pathways or AV nodal reentrant tachycardia with ectopic atria1 tachycardias is even more uncommon.” This article reports the previously undocumented occurrence of sustained ectopic atria1 tachycardia, AV nodal reentry, and AV reciprocating tachycardia in a single patient. The successful treatment of all three tachycardia mechanisms with radiofrequency catheter ablation techniques is described. A 20-year-old man from Turkey was referred for treatment of medically refractory paroxysmal tachycardia. Symptoms of paroxysmal palpitations with dyspnea had been present for 4 years. These episodes occurred almost every evening in the absence of medical therapy. His symptoms were inadequately controlled by digoxin, metoprolol, propafenone, and amiodarone (200 mg/day). Ambulatory ECG monitor tracings suggested a diagnosis of ectopic atria1 tachycardia. Amiodarone therapy was discontinued 10 days before admission to the hospital. His echocardiogram and ECG were normal. According to electrophysiologic testing there was no evidence of antegrade ventricular preexcitation with atria1 pacing. Retrograde AV conduction was eccentric and nondecremental, with the earliest site of atria1 activation in the distal coronary sinus (CS), which was consistent with a concealed left lateral accessory pathway. No tachycardias were induced until after a continuous isoproterenol infusion at 2 pg/min was started. Single atria1 and ventricular extrastimuli induced both sustained orthodromic AV reciprocating tachycardia, utilizing the concealed left lateral accessory pathway, and sustained AV nodal reentrant tachycardia. The AV reciprocating tachycardia had a cycle length of 320 msec with local ventriculoatrial conduction times as follows: distal CS = 90 msec, mid CS = 100 msec, proximal CS = 130 msec, His atrium = 160 msec, and right atria1 appendage = 188 msec (Figs. 1 and 2). With the use of the retrograde transaortic approach, the reciprocating tachycardia

Initiation of atrioventricular nodal reentrant tachycardia in patients with discontinuous anterograde atrioventricular nodal conduction curves with and without documented supraventricular tachycardia: Observations on the role of a discontinuous retrograde conduction curve

To evaluate factors playing a role in initiation of atrioventricular (AV) nodal reentrant tachycardia utilizing anterogradely a slow and retrogradely a fast conducting AV nodal pathway, 38 patients having no accessory pathways and showing discontinuous anterograde AV nodal conduction curves during atrial stimulation were studied. Twenty-two patients (group A) underwent an electrophysiologic investigation because of recurrent paroxysmal supraventricular tachycardia (SVT) that had been electrocardiographically documented before the study. Sixteen patients (group B) underwent the study because of a history of palpitations (15 patients) or recurrent ventricular tachycardia (one patient); in none of them had SVT ever been electrocardiographically documented before the investigation. Twenty-one of the 22 patients of group A demonstrated continuous retrograde conduction curves during ventricular stimulation. In 20 tachycardia was initiated by either a single atrial premature beat (18 patients) or by two atrial premature beats. Fifteen of the 16 patients of group B had discontinuous retrograde conduction curves during ventricular stimulation, with a long refractory period of their retrograde fast pathway. Tachycardia was initiated by multiple atrial premature beats in one patient. Thirteen out of the remaining 15 patients received atropine. Thereafter tachycardia could be initiated in three patients by a single atrial premature beat, by two atrial premature beats in one patient, and by incremental atrial pacing in another patient. In the remaining eight patients tachycardia could not be initiated. Our observations indicate that the pattern of ventriculoatrial conduction found during ventricular stimulation is a marker for ease of initiation of AV nodal tachycardia in patients with discontinuous anterograde AV nodal conduction curves.

Initiation of atrio-ventricular nodal re-entrant tachycardia in patients with discontinuous antegrade conduction curves. Importance of a discontinuous retrograde conduction curve

Initiation of atrio-ventricular nodal re-entrant tachycardia in patients with discontinuous antegrade conduction curves. Importance of a discontinuous retrograde conduction curve