Atypical atrioventricular nodal reentrant tachycardia: prevalence, electrophysiologic characteristics, and tachycardia circuit
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AIMS: This study aimed at assessing the prevalence, electrophysiologic characteristics, and mechanism of atypical atrioventricular nodal reentrant tachycardia (AVNRT). METHODS AND RESULTS: We studied 925 consecutive patients with AVNRT. Atrial-His (AH) and His-atrial (HA) intervals were measured during atypical AVNRT (HA > 70 ms), and compared with measurements in 34 patients with typical (slow-fast) AVNRT. Assuming that conduction velocity over the fast pathway is similar in the anterograde and retrograde directions, the AH interval during the fast-slow form should be smaller than the HA during slow-fast. Atypical AVNRT was diagnosed in 59 patients (6.4%), median age 50 years (range 19-79 years), and 37 (59.7%) of them female. Fast-slow AVNRT was diagnosed in 44 patients (74.5%), and slow-slow AVNRT in 9 patients (15.2%). The remaining six patients (10.2%) could not be reliably classified due to inconsistent AH, and HA/AH patterns or variable intervals. Tachycardia induction with anterograde conduction jumps was seen in two patients with the fast-slow, and in three patients with slow-slow or intermediate forms. Atrial-His in the fast-slow group was significantly longer than HA in the slow-fast group, 99.7 ± 40.5 ms vs. 45.8 ± 7.7 ms, P < 0.001. Tachycardia cycle length was longer in fast-slow compared with slow-fast, 379.1 ± 68.5 ms vs. 317.1 ± 42.8 ms, P < 0.001. CONCLUSION: Of AVNRT cases, 6.4% are atypical and may display patterns that do not necessarily correspond to the fast-slow or slow-slow conventional types. Atypical fast-slow and typical AVNRT do not appear to utilize the same limb for fast conduction.
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There is considerable histologic and electrophysiologic evidence that the right and left inferior extensions of the human AV node and the atrio-nodal inputs they facilitate may provide the anatomic substrate of the slow pathway.
“Regarding the slow pathway, there has now been considerable histologic and electrophysiologic evidence that the right and left inferior extensions of the human AV node and the atrio-nodal inputs they facilitate may provide its anatomic substrate.29,221”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [221]
Mathematical modelling and numerical analyses have been employed in the investigation of the circuit of atrioventricular nodal reentrant tachycardia.
“Mathematical modelling and numerical analyses have also been employed in the investigation of the circuit of AVNRT.221,232”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [221]
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- Authors
- Katritsis, D. G., Sepahpour, A., Marine, J. E., Katritsis, G. D., Tanawuttiwat, T., Calkins, H., Rowland, E., & Josephson, M. E.
- Affiliations
- Athens Euroclinic (GR)
- University College Hospital at Westmoreland Street (GB)
- Johns Hopkins Hospital (US)
- University of Oxford (GB)
- Beth Israel Deaconess Medical Center (US)
- ORCID
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-02-01
- Volume
- 17
- Issue
- 7
- Pages
- 1099.1-1106
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- OpenAlex
- W2098992067
- Cited by
- 58
- References
- 29
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 8 · 2023: 4 · 2022: 5 · 2021: 8 · 2020: 3 · 2019: 6 · 2018: 3 · 2017: 3 · 2016: 5 · 2015: 6
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- 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
- atrioventricular nodal reentrant tachycardia, slow-fast AVNRT, tachycardia cycle length, conduction velocity, prevalence, tachycardia induction
- MeSH terms
- Adult, Aged, Electrocardiography, Female, United Kingdom, Greece, Humans, Male, Middle Aged, Tachycardia, Atrioventricular Nodal Reentry, United States, Prevalence, Age Distribution, Sex Distribution, Risk Assessment, Young Adult
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