F. Anselme et al., Entrainment of typical AV nodal reentrant tachycardia using para-Hisian pacing: Evidence for a lower common pathway within the AV node, J CARD ELEC, 10(5), 1999, pp. 655-661
Citations number
13
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Lower Common Pathway Within the AV Node. Introduction: Despite the ability
to cure atrioventricular nodal reentrant tachycardia (AVNRT) by radiofreque
ncy catheter ablation with a high success rate, the exact localization of t
he tachycardia circuit is still not well established. The presence of AV no
dal tissue between the typical AVNRT circuit and the His bundle, constituti
ng a lower common pathway (LCP), remains controversial.
Methods and Results: Entrainment of AVNRT during para-Hisian stimulation al
lows accurate measurement of the His- to- atrial (HA) interval which is par
t of the same circuit as that of the tachycardia. With an LCP, during tachy
cardia, there is simultaneous conduction from the low turnaround of the cir
cuit to the atrium (via the fast pathway) and to the His bundle (via the LC
P). However, during entrainment by para-Hisian pacing, the impulse has to r
etrogradely depolarize sequentially the LCP and the fast pathway. Therefore
, in the presence of an LCP, the HA interval duration during tachycardia (H
At) should lye shorter than that of during entrainment by para-Hisian stimu
lation (HAe). We considered an LCP present when Hae - HAt was greater than
or equal to 10 msec. Entrainment of typical AVNRT with para-Hisian stimulat
ion was performed in 23 consecutive patients (21 females) with a mean age o
f 45 +/- 17 years. LCP was considered to be present in 18 of 23 patients (7
8%). In addition, transient His-bundle dissociation from the ongoing tachyc
ardia occurred in semen patients (30%).
Conclusion: These results support the presence of a LCP during typical AVNR
T. (J Cardiovasc Electrophysiol, Vol. 10, pp. 655-661, May 1999).