AV nodal reentrant tachycardia with unusual characteristics: lessons from radiofrequency catheter ablation

There are still some AV nodal reentrant tachycardias with unusual AV nodal properties that need further study to understand these complexities. Accordingly, the two-dimensional model with alpha and beta pathways in the AV nodal reentrant tachycardia circuit certainly is an oversimplification and does not explain adequately the anatomic and physiologic complexity of the AV junctional area. The modern concept suggests that this arrhythmia takes place in a highly complex three-dimensional model with nonuniform anisotropy and discontinuous conduction property in the AV junctional area. Application of radiofrequency energy within the AV junctional area should always be performed carefully to achieve a successful ablation procedure and to minimize possible injury of AV nodal conduction.