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Updated: Jul 22, 2025

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
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Antidromic AVRT with changing His activation. What is the mechanism?

Anand Manickavasagam1, Sirish Chandra Srinath Patloori1, Hariharan Narasaiyan1

  • 1Department of Cardiology, Christian Medical College, Vellore, Tamilnadu, India.

Journal of Electrocardiology
|July 23, 2023
PubMed

Insights

This study details a rare case of antidromic atrioventricular reentrant tachycardia (AVRT) linked to an atriofascicular pathway. A unique finding was transient VA dissociation during tachycardia in a patient with impaired heart function.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Electrophysiology

Background:

  • Atrioventricular reentrant tachycardia (AVRT) can involve various accessory pathways.
  • Atriofascicular pathways are less common causes of AVRT.
  • Coronary sinus anomalies can influence cardiac electrophysiology.

Observation:

  • A patient with an atretic coronary sinus os presented with antidromic AVRT.
  • The patient exhibited left ventricular dysfunction and rate-related left bundle branch block aberrancy.
  • Electrophysiology study revealed transient VA dissociation during antidromic tachycardia.

Findings:

  • The case highlights an unusual presentation of antidromic AVRT associated with an atriofascicular pathway.
  • The presence of an atretic coronary sinus os was a significant anatomical finding.
  • Transient VA dissociation during tachycardia suggests complex electrophysiological interactions.

Implications:

  • This case expands the understanding of AVRT mechanisms involving atriofascicular pathways.
  • It underscores the importance of considering anatomical variations in diagnosing arrhythmias.
  • Further research into the mechanisms of VA dissociation in AVRT is warranted.

Keywords:
Atretic CSAtriofascicular pathwayBBRVTDual AV nodal physiologyLBBB

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