Physiology of “Atypical” Atrioventricular Junctional Reentrant Tachycardia Occurring Following Radiofrequency Catheter Modification of the Atrioventricular Node

JEFFREY GOLDBERGER, RODNEY BROOKS, ALAN KADISH

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38 Scopus citations

Abstract

The physiology of atypical atrioventricular junctional reentrant (achycardia (AVJRT) occurring following catheter modification of the AV node is poorly defined. Six patients undergoing radiofrequency current catheter modification of the AV node had inducible atypical AVJRT before or after AV nodal modification. Typical AVJRT was differentiated from atypical AVJRT by a ventriculoatrial (VA) time < 60 msec in the His‐bundle electrogram recording. Five of six patients had typical AVJRT and two had atypical AVJRT prior to AV nodal modification. Following anterior approach AV nodal modification, previously undetected atypical AVJRT was induced in four patients. Earliest retrograde atrial activation in the posterior septum was documented in all patients with atypical AVJRT prior to modification and in three four patients with atypical AVJRT following modification. The AH intervals during tachycardia were 320 ± 52 msec in typical AVJRT, 88 ± 33 msec in the premodification atypical AVJRTs, and 172 ± 12 msec in the postmodification atypical AVJRTs (P − 0.0001). The AHJRA ratios were 4.1 ± 0.9 in typical AVJRT, 0.5 ± 0.2 in the premodification atypical AVJRTs, and 0.9 ± 0.2 in the postmodification atypical AVJRTs (P = 0.0001). Two patients with postmodificafion atypical AVJRT underwent further posterior approach AV node modification that resulted in VA block. One patient with postmodification atypical AVJRT had further anterior approach AV nodal modification that resulted in heart block. The retrograde limb of the atypical AVJRT seen following anterior approach AV nodal modification is a posterior, slow pathway.

Original languageEnglish (US)
Pages (from-to)2270-2282
Number of pages13
JournalPacing and Clinical Electrophysiology
Volume15
Issue number12
DOIs
StatePublished - Dec 1992

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Keywords

  • atrioventricular nodal modification
  • atrioventricular node reentry
  • radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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