Arrhythmias & electrophysiology
Pitfalls in diagnosis of atypical atrioventricular nodal reentrant tachycardia by a conventional electrophysiological study
Authors' conclusion
Conventionally placed electrode catheter mapping in atypical AVNRT was able to identify 100% of LIEs but only 64% of RIEs. It is critical to place a catheter on the TA.
Study context
- Population
- Patients with atypical atrioventricular nodal reentrant tachycardia (AVNRT)patients (9 female, age 59 ± 17 years), 19 atypical AVNRTs (15 fast/slow, 4 slow/slow)
- Participants
- 14 patients
- Exposure
- Conventional 2-catheter (His bundle and coronary sinus (CS)) mapping method for localizing the atrial ends of these extensions, validated by electroanatomic 3-dimensional (3D) mapping
- Left inferior extension (LIE)n = 8
- Right inferior extension (RIE)n = 11
- Outcome
- Localization of LIE exits
Methodological detailselectroanatomic 3-dimensional (3D) mapping validation
- Electroanatomic 3-dimensional (3D) mapping validation
Main finding
As reported in the abstract
- The 8 LIE exits were inside the CS, and localization by 3D mapping and CS electrode catheter matched in all
Observational data: associations, not effects.
Further findings
Localization of RIE exits
- RIE exits were on the posterior tricuspid annulus (TA) where electrode catheters are conventionally not placed, requiring 3D mapping for accurate localization
Activation sequence during retrograde RIE conduction
- CS ostium activated earlier than His-bundle electrogram (HBE) (RIEs)
- 7
- HBE earlier
- 1
- Simultaneous
- 3
- RIE missed using current diagnostic criteria
- 4 of 11 AVNRTs (36%)
Determinants of CS ostium and His-bundle activation times
- Determined by their relative closeness to the RIE exit
Original publication
Pitfalls in diagnosis of atypical atrioventricular nodal reentrant tachycardia by a conventional electrophysiological study. Heart Rhythm. Published 31 March 2025. doi:10.
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