Characterization of the distal insertion of atriofascicular accessory pathways and mechanisms of QRS patterns in atriofascicular antidromic tachycardia

Gandhavadi, Maheer; Sternick, Eduardo B.; Jackman, Warren M.; Wellens, Hein J.J.; Josephson, Mark E.

doi:10.1016/j.hrthm.2013.07.009

Cited by 38Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasCardiac pacing and defibrillation studies

Characterization of the distal insertion of atriofascicular accessory pathways and mechanisms of QRS patterns in atriofascicular antidromic tachycardia

Gandhavadi, Maheer, Sternick, Eduardo B., Jackman, Warren M., Wellens, Hein J.J., Josephson, Mark E.·2013·Heart Rhythm

DOI 10.1016/j.hrthm.2013.07.009

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Abstract

Background The distal insertion of right atriofascicular pathways remains a source of debate. Moreover, there are various morphologies of preexcited QRS complexes involving atriofascicular pathways that have been poorly characterized.Objective To characterize the distal insertion of atriofascicular accessory pathways and to provide a mechanism for the change in QRS morphology observed between short and long ventriculo-His (V-H) antidromic atrioventricular reentrant tachycardias (AVRTs) in the same patient.Methods Thirteen patients with atriofascicular pathways and preexcited AVRT with short V-H and long V-H intervals were studied. For each patient, the tachycardia cycle length, V-H interval, QRS width, and axis were compared. A baseline His-ventricular interval was also recorded.Results The baseline His-ventricular interval was significantly longer than the V-H interval during antidromic AVRT (median 50 ms vs. 10 ms; P < .0001). Retrograde right bundle branch block increased the V-H interval (median 10 ms vs. 85 ms; P < .0001), the tachycardia cycle length (median of 302.5 ms vs. 350 ms; P < .0001), and the QRS width (median 120 ms vs. 140 ms; P < .0002). At least subtle changes in QRS morphology, axis, or QRS width were seen in all patients.Conclusions The distal insertion of right atriofascicular pathways fuses with the right bundle branch. The various QRS morphologies seen during the change from short V-H to long V-H antidromic AVRT can be explained by fusion, particularly over the left anterior fascicle.

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Authors: Gandhavadi, M., Sternick, E. B., Jackman, W. M., Wellens, H. J. J., & Josephson, M. E.
Affiliations: Biocor Institute (BR)
University of Oklahoma Health Sciences Center (US)
Maastricht University (NL)
Beth Israel Deaconess Medical Center (US)
Corresponding author: Josephson, Mark E.
ORCID: Sternick, Eduardo B.
Jackman, Warren M.
Venue: Heart Rhythm
Publisher: Elsevier BV
Published: 2013-09
Volume: 10
Issue: 9
Pages: 1385-1392
ISSN: 1547-5271 (ISSN-L)
DOI: 10.1016/j.hrthm.2013.07.009
OpenAlex: W1967761857
Cited by: 38
References: 24
Citations by year: 2026: 3 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 4 · 2017: 5 · 2016: 2 · 2015: 1 · 2014: 3
FWCI: 1.36
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Heart Rhythm (publishedVersion)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion)
Research Publications (Maastricht University) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords: antidromic tachycardia, QRS morphology, right bundle branch block, His-ventricular interval, tachycardia cycle length
MeSH terms: Bundle-Branch Block, Heart Conduction System, Humans, Tachycardia, Atrioventricular Nodal Reentry, Catheter Ablation, Accessory Atrioventricular Bundle

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Characterization of the distal insertion of atriofascicular accessory pathways and mechanisms of QRS patterns in atriofascicular antidromic tachycardia

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