Yoshiaki Kaneko1, Shigeto Naito2, Kaoru Okishige2, Itsuro Morishima2, Takeshi Tobiume2, Tadashi Nakajima2, Tadanobu Irie2, Masaki Ota2, Takafumi Iijima2, Takashi Iizuka2, Mio Tamura2, Shuntaro Tamura2, Akihiro Saito2, Osamu Igawa2, Ritsushi Kato2, Kazuo Matsumoto2, Fumio Suzuki2, Masahiko Kurabayashi2. 1. From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.). kanekoy@gunma-u.ac.jp. 2. From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.).
Abstract
BACKGROUND: The existence of an atypical fast-slow (F/S) atrioventricular nodal reentrant tachycardia (AVNRT) including a superior (sup) pathway with slow conductive properties and an atrial exit near the His bundle has not been confirmed. METHODS AND RESULTS: We studied 6 women and 2 men (age, 74 ± 7 years) with sup-F/S-AVNRT who underwent successful radiofrequency ablation near the His bundle. Programmed ventricular stimulation induced retrograde conduction over a superior SP with an earliest atrial activation near the His bundle, a mean shortest spike-atrial interval of 378 ± 119 milliseconds, and decremental properties in all patients. sup-F/S-AVNRT was characterized by a long-RP interval; a retrograde atrial activation sequence during tachycardia identical to that over a sup-SP during ventricular pacing; ventriculoatrial dissociation during ventricular overdrive pacing of the tachycardia in 5 patients or atrioventricular block occurring during tachycardia in 3 patients, excluding atrioventricular reentrant tachycardia; termination of the tachycardia by ATP; and a V-A-V activation sequence immediately after ventricular induction or entrainment of the tachycardia, including dual atrial responses in 2 patients. Elimination or modification of retrograde conduction over the sup-SP by ablation near the right perinodal region or from the noncoronary cusp of Valsalva eliminated and confirmed the diagnosis of AVNRT in 4 patients each. CONCLUSIONS: sup-F/S-AVNRT is a distinct supraventricular tachycardia, incorporating an SP located above the Koch triangle as the retrograde limb, that can be eliminated by radiofrequency ablation.
BACKGROUND: The existence of an atypical fast-slow (F/S) atrioventricular nodal reentrant tachycardia (AVNRT) including a superior (sup) pathway with slow conductive properties and an atrial exit near the His bundle has not been confirmed. METHODS AND RESULTS: We studied 6 women and 2 men (age, 74 ± 7 years) with sup-F/S-AVNRT who underwent successful radiofrequency ablation near the His bundle. Programmed ventricular stimulation induced retrograde conduction over a superior SP with an earliest atrial activation near the His bundle, a mean shortest spike-atrial interval of 378 ± 119 milliseconds, and decremental properties in all patients. sup-F/S-AVNRT was characterized by a long-RP interval; a retrograde atrial activation sequence during tachycardia identical to that over a sup-SP during ventricular pacing; ventriculoatrial dissociation during ventricular overdrive pacing of the tachycardia in 5 patients or atrioventricular block occurring during tachycardia in 3 patients, excluding atrioventricular reentrant tachycardia; termination of the tachycardia by ATP; and a V-A-V activation sequence immediately after ventricular induction or entrainment of the tachycardia, including dual atrial responses in 2 patients. Elimination or modification of retrograde conduction over the sup-SP by ablation near the right perinodal region or from the noncoronary cusp of Valsalva eliminated and confirmed the diagnosis of AVNRT in 4 patients each. CONCLUSIONS: sup-F/S-AVNRT is a distinct supraventricular tachycardia, incorporating an SP located above the Koch triangle as the retrograde limb, that can be eliminated by radiofrequency ablation.