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Atypical atrioventricular node reciprocating tachycardia masquerading as tachycardia using a left-sided accessory
C Hwang1, D J Martin, J S Goodman
1Central Utah Valley Medical Clinic, Utah Valley Cardiology, Provo 84604, USA.
Journal of the American College of Cardiology
|July 1, 1997
Summary
Atrioventricular node reentrant tachycardia (AVNRT) can mimic left accessory pathway tachycardia with eccentric left-sided activation. Ablating the slow pathway in the right atrial septum successfully treated these atypical AVNRT cases.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Eccentric retrograde left-sided activation during tachycardia typically suggests a left free wall accessory pathway.
- The occurrence of this activation pattern in atrioventricular node reentrant tachycardia (AVNRT) has not been previously established.
Purpose of the Study:
- To document that AVNRT can present with eccentric retrograde left-sided activation.
- To differentiate this presentation from tachycardia utilizing a left accessory pathway.
Main Methods:
- Analysis of 356 patients with AVNRT undergoing catheter ablation.
- Intracardiac recordings, including coronary sinus catheterization, to determine retrograde atrial activation patterns during tachycardia and ventricular pacing.
Main Results:
- Eccentric retrograde atrial activation was observed in 6% (20/356) of AVNRT patients.
- These cases involved fast-slow or slow-slow AVNRT, with earliest activation in lateral or posterior coronary sinus leads.
- Slow pathway ablation in the right atrial septum was successful in all patients, preventing recurrence.
Conclusions:
- Atypical AVNRT can manifest with eccentric retrograde left-sided activation, mimicking left accessory pathway tachycardia.
- Successful catheter ablation of the slow pathway at the posterior right atrial septum provides a curative treatment for these patients.