Ablation of Atrioventricular nodal "slow pathway" for simultaneous treatment of coexisting atrioventricular and nodal reciprocating tachycardias

Luigi Di Biase, Rong Bai, Massimo Tritto, Massimo Grimaldi, Maria Giuseppina Biasco

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: We report the case of a 49-year-old male patient with recurrent palpitations and two different supraventricular reciprocating tachycardias due to atrioventricular (AV) nodal reentry and orthodromic AV reentry sustained by a left-sided, concealed AV accessory pathway (AP). Methods and results: During the baseline electrophysiological study, dual AV nodal conduction (90 ms jump) and non-decremental, eccentric, ventriculo-atrial conduction due to a left-sided, unidirectional, postero-septal AP were documented. Both typical AV nodal reentrant and orthodromic AV reentrant tachycardias were induced by programmed electrical stimulation. In both cases, shift and sustained conduction over the AV "slow pathway" were required for tachycardia induction and maintenance, respectively. Accordingly, catheter ablation was performed by targeting the AV nodal "slow pathway" first with radiofrequency current applications delivered at the inferior portion of the Koch's triangle. Irritative, slow-rate junctional rhythm was observed during ablation. Afterward, programmed electrical stimulation demonstrated a continuous AV nodal conduction curve, persistent conduction over the AP, and only single orthodromic AV echo beat inducible under baseline condition and pharmacological stress (atropine 0.02 mg/kg i.v. bolus and continuous isoprenaline i.v. administration). Sustained reentrant tachycardias were not inducible any more. For these reasons, the procedure was stopped without any attempt to ablate the AP. After a 4 years follow-up the patient is still asymptomatic without antiarrhythmic drug usage. Conclusion: AV nodal "slow pathway" ablation may abolish both typical AV nodal reentry tachycardia and orthodromic AV reentry tachycardia induction when the latter arrhythmia is dependent from AV nodal "slow pathway" conduction for induction and maintenance. This ablation strategy could be considered, under some instances (e.g. right antero-septal accessory pathways, older patients, etc), in order to reduce the procedure risks due to multiple arrhythmia substrate ablations.

Original languageEnglish (US)
Pages (from-to)143-147
Number of pages5
JournalJournal of Interventional Cardiac Electrophysiology
Volume19
Issue number2
DOIs
StatePublished - Aug 2007
Externally publishedYes

Fingerprint

Reciprocating Tachycardia
Tachycardia
Electric Stimulation
Cardiac Arrhythmias
Maintenance
Accessory Atrioventricular Bundle
Atrioventricular Nodal Reentry Tachycardia
Supraventricular Tachycardia
Catheter Ablation
Anti-Arrhythmia Agents
Therapeutics
Atropine
Isoproterenol
Pharmacology

Keywords

  • Ablation
  • Accessory pathway
  • Slow pathway

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ablation of Atrioventricular nodal "slow pathway" for simultaneous treatment of coexisting atrioventricular and nodal reciprocating tachycardias. / Di Biase, Luigi; Bai, Rong; Tritto, Massimo; Grimaldi, Massimo; Biasco, Maria Giuseppina.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 19, No. 2, 08.2007, p. 143-147.

Research output: Contribution to journalArticle

@article{e35be0925d5c4c129cef15174792caf4,
title = "Ablation of Atrioventricular nodal {"}slow pathway{"} for simultaneous treatment of coexisting atrioventricular and nodal reciprocating tachycardias",
abstract = "Introduction: We report the case of a 49-year-old male patient with recurrent palpitations and two different supraventricular reciprocating tachycardias due to atrioventricular (AV) nodal reentry and orthodromic AV reentry sustained by a left-sided, concealed AV accessory pathway (AP). Methods and results: During the baseline electrophysiological study, dual AV nodal conduction (90 ms jump) and non-decremental, eccentric, ventriculo-atrial conduction due to a left-sided, unidirectional, postero-septal AP were documented. Both typical AV nodal reentrant and orthodromic AV reentrant tachycardias were induced by programmed electrical stimulation. In both cases, shift and sustained conduction over the AV {"}slow pathway{"} were required for tachycardia induction and maintenance, respectively. Accordingly, catheter ablation was performed by targeting the AV nodal {"}slow pathway{"} first with radiofrequency current applications delivered at the inferior portion of the Koch's triangle. Irritative, slow-rate junctional rhythm was observed during ablation. Afterward, programmed electrical stimulation demonstrated a continuous AV nodal conduction curve, persistent conduction over the AP, and only single orthodromic AV echo beat inducible under baseline condition and pharmacological stress (atropine 0.02 mg/kg i.v. bolus and continuous isoprenaline i.v. administration). Sustained reentrant tachycardias were not inducible any more. For these reasons, the procedure was stopped without any attempt to ablate the AP. After a 4 years follow-up the patient is still asymptomatic without antiarrhythmic drug usage. Conclusion: AV nodal {"}slow pathway{"} ablation may abolish both typical AV nodal reentry tachycardia and orthodromic AV reentry tachycardia induction when the latter arrhythmia is dependent from AV nodal {"}slow pathway{"} conduction for induction and maintenance. This ablation strategy could be considered, under some instances (e.g. right antero-septal accessory pathways, older patients, etc), in order to reduce the procedure risks due to multiple arrhythmia substrate ablations.",
keywords = "Ablation, Accessory pathway, Slow pathway",
author = "{Di Biase}, Luigi and Rong Bai and Massimo Tritto and Massimo Grimaldi and Biasco, {Maria Giuseppina}",
year = "2007",
month = "8",
doi = "10.1007/s10840-007-9145-6",
language = "English (US)",
volume = "19",
pages = "143--147",
journal = "Journal of Interventional Cardiac Electrophysiology",
issn = "1383-875X",
publisher = "Springer Netherlands",
number = "2",

}

TY - JOUR

T1 - Ablation of Atrioventricular nodal "slow pathway" for simultaneous treatment of coexisting atrioventricular and nodal reciprocating tachycardias

AU - Di Biase, Luigi

AU - Bai, Rong

AU - Tritto, Massimo

AU - Grimaldi, Massimo

AU - Biasco, Maria Giuseppina

PY - 2007/8

Y1 - 2007/8

N2 - Introduction: We report the case of a 49-year-old male patient with recurrent palpitations and two different supraventricular reciprocating tachycardias due to atrioventricular (AV) nodal reentry and orthodromic AV reentry sustained by a left-sided, concealed AV accessory pathway (AP). Methods and results: During the baseline electrophysiological study, dual AV nodal conduction (90 ms jump) and non-decremental, eccentric, ventriculo-atrial conduction due to a left-sided, unidirectional, postero-septal AP were documented. Both typical AV nodal reentrant and orthodromic AV reentrant tachycardias were induced by programmed electrical stimulation. In both cases, shift and sustained conduction over the AV "slow pathway" were required for tachycardia induction and maintenance, respectively. Accordingly, catheter ablation was performed by targeting the AV nodal "slow pathway" first with radiofrequency current applications delivered at the inferior portion of the Koch's triangle. Irritative, slow-rate junctional rhythm was observed during ablation. Afterward, programmed electrical stimulation demonstrated a continuous AV nodal conduction curve, persistent conduction over the AP, and only single orthodromic AV echo beat inducible under baseline condition and pharmacological stress (atropine 0.02 mg/kg i.v. bolus and continuous isoprenaline i.v. administration). Sustained reentrant tachycardias were not inducible any more. For these reasons, the procedure was stopped without any attempt to ablate the AP. After a 4 years follow-up the patient is still asymptomatic without antiarrhythmic drug usage. Conclusion: AV nodal "slow pathway" ablation may abolish both typical AV nodal reentry tachycardia and orthodromic AV reentry tachycardia induction when the latter arrhythmia is dependent from AV nodal "slow pathway" conduction for induction and maintenance. This ablation strategy could be considered, under some instances (e.g. right antero-septal accessory pathways, older patients, etc), in order to reduce the procedure risks due to multiple arrhythmia substrate ablations.

AB - Introduction: We report the case of a 49-year-old male patient with recurrent palpitations and two different supraventricular reciprocating tachycardias due to atrioventricular (AV) nodal reentry and orthodromic AV reentry sustained by a left-sided, concealed AV accessory pathway (AP). Methods and results: During the baseline electrophysiological study, dual AV nodal conduction (90 ms jump) and non-decremental, eccentric, ventriculo-atrial conduction due to a left-sided, unidirectional, postero-septal AP were documented. Both typical AV nodal reentrant and orthodromic AV reentrant tachycardias were induced by programmed electrical stimulation. In both cases, shift and sustained conduction over the AV "slow pathway" were required for tachycardia induction and maintenance, respectively. Accordingly, catheter ablation was performed by targeting the AV nodal "slow pathway" first with radiofrequency current applications delivered at the inferior portion of the Koch's triangle. Irritative, slow-rate junctional rhythm was observed during ablation. Afterward, programmed electrical stimulation demonstrated a continuous AV nodal conduction curve, persistent conduction over the AP, and only single orthodromic AV echo beat inducible under baseline condition and pharmacological stress (atropine 0.02 mg/kg i.v. bolus and continuous isoprenaline i.v. administration). Sustained reentrant tachycardias were not inducible any more. For these reasons, the procedure was stopped without any attempt to ablate the AP. After a 4 years follow-up the patient is still asymptomatic without antiarrhythmic drug usage. Conclusion: AV nodal "slow pathway" ablation may abolish both typical AV nodal reentry tachycardia and orthodromic AV reentry tachycardia induction when the latter arrhythmia is dependent from AV nodal "slow pathway" conduction for induction and maintenance. This ablation strategy could be considered, under some instances (e.g. right antero-septal accessory pathways, older patients, etc), in order to reduce the procedure risks due to multiple arrhythmia substrate ablations.

KW - Ablation

KW - Accessory pathway

KW - Slow pathway

UR - http://www.scopus.com/inward/record.url?scp=34548188211&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548188211&partnerID=8YFLogxK

U2 - 10.1007/s10840-007-9145-6

DO - 10.1007/s10840-007-9145-6

M3 - Article

C2 - 17668304

AN - SCOPUS:34548188211

VL - 19

SP - 143

EP - 147

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

SN - 1383-875X

IS - 2

ER -