Electrophysiological Mechanisms of Conversion of Typical to Atypical Atrioventricular Nodal Reentrant Tachycardia Occurring After Radiofrequency Catheter Ablation of the Slow Pathway

• FUJIKI Akira

  The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University

• USUI Masahiro

  The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University

• MIZUMAKI Koichi

  The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University

• HAYASHI Hideki

  The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University

• NAGASAWA Hidehiko

  The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University

• INOUE Hiroshi

  The Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University

Abstract

This report presents an adult patient with conversion of typical to atypical atrioventricular nodal reentrant tachycardia(AVNRT) after slow pathway ablation. Application of radiofrequency energy(3 times)in the posteroseptal region changed the pattern of the atrioventricular(AV) node conduction curve from discontinuous to continuous, but did not change the continuous retrograde conduction curve. After ablation of the slow pathway, atrial extrastimulation induced atypical AVNRT. During tachycardia, the earliest atrial activation site changed from the His bundle region to the coronary sinus ostium. One additional radiofrequency current applied 5 mm upward from the initial ablation site made atypical AVNRT noninducible. These findings suggest that the mechanism of atypical AVNRT after slow pathway ablation is antegrade fast pathway conduction along with retrograde conduction through another slow pathway connected with the ablated antegrade slow pathway at a distal site. The loss of concealed conduction over the antegrade slow pathway may play an important role in the initiation of atypical AVNRT after slow pathway ablation.

Journal

• Japanese circulation journal

  Japanese circulation journal 63 (12), 999-1001, 1999-12-01

  Japanese Circulation Society

Keywords

• Atrioventricular nodal reentrant tachycardia
• Concealed conduction
• Multiple slow pathways
• Slow pathway ablation

Details

• CRID: 1572824501954119168
• NII Article ID: 110002572820
• NII Book ID: AA00690731
• ISSN: 00471828
• Web Site: https://search.jamas.or.jp/link/ui/2000115387
• Text Lang: en
• Data Source:
  • CiNii Articles