Document Detail

Entrainment of typical AV nodal reentrant tachycardia using para-Hisian pacing: evidence for a lower common pathway within the AV node.
MedLine Citation:
PMID:  10355921     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Despite the ability to cure atrioventricular nodal reentrant tachycardia (AVNRT) by radiofrequency catheter ablation with a high success rate, the exact localization of the tachycardia circuit is still not well established. The presence of AV nodal tissue between the typical AVNRT circuit and the His bundle, constituting a lower common pathway (LCP), remains controversial. METHODS AND RESULTS: Entrainment of AVNRT during para-Hisian stimulation allows accurate measurement of the His- to- atrial (HA) interval which is part of the same circuit as that of the tachycardia. With an LCP, during tachycardia, there is simultaneous conduction from the low turnaround of the circuit to the atrium (via the fast pathway) and to the His bundle (via the LCP). However, during entrainment by para-Hisian pacing, the impulse has to retrogradely depolarize sequentially the LCP and the fast pathway. Therefore, in the presence of an LCP, the HA interval duration during tachycardia (HAt) should be shorter than that of during entrainment by para-Hisian stimulation (HAe). We considered an LCP present when Hae - HAt was > or = 10 msec. Entrainment of typical AVNRT with para-Hisian stimulation was performed in 23 consecutive patients (21 females) with a mean age of 45+/-17 years. LCP was considered to be present in 18 of 23 patients (78%). In addition, transient His-bundle dissociation from the ongoing tachycardia occurred in seven patients (30%). CONCLUSION: These results support the presence of a LCP during typical AVNRT.
F Anselme; H Poty; A Cribier; M E Josephson; N Saoudi
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  10     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-07-13     Completed Date:  1999-07-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  655-61     Citation Subset:  IM    
Cardiology Department, Rouen University Hospital, Rouen, France.
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MeSH Terms
Atrioventricular Node / abnormalities*,  physiopathology
Bundle of His / abnormalities*,  physiopathology
Cardiac Pacing, Artificial / methods*
Electrophysiology / methods
Heart Catheterization
Heart Rate
Reproducibility of Results
Tachycardia, Atrioventricular Nodal Reentry / diagnosis,  physiopathology,  therapy*
Comment In:
J Cardiovasc Electrophysiol. 1999 Dec;10(12):1691-2   [PMID:  10636201 ]

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