Arrhythmias Utilizing Concealed Nodoventricular or His-Ventricular Pathways
| Autor: | Jeffrey J. Goldberger, Aleksandr Voskoboinik, Thomas A. Dewland, Patrick J. Tchou, Babak Nazer, Bernard Belhassen, Melvin M. Scheinman, Asaf Danon, Satoshi Higuchi |
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| Rok vydání: | 2021 |
| Předmět: |
Tachycardia
medicine.medical_specialty Bundle branch block business.industry Left bundle branch block medicine.medical_treatment medicine.disease Ablation Basal (phylogenetics) medicine.anatomical_structure Ventricle Internal medicine cardiovascular system medicine Cardiology Sinus rhythm cardiovascular diseases Supraventricular tachycardia medicine.symptom business |
| Zdroj: | JACC: Clinical Electrophysiology. 7:1588-1599 |
| ISSN: | 2405-500X |
| DOI: | 10.1016/j.jacep.2021.05.010 |
| Popis: | Objectives This study sought to describe the electrophysiologic characteristics, diagnostic maneuvers, and treatment of a series of arrhythmias using concealed nodoventricular (cNV) or His-ventricular (cHV) pathways. Background Confirming the presence and participation of cNV or cHV pathways in tachyarrhythmias is challenging. Methods We present 4 cases of tachycardias with a participatory cNV or cHV pathway. Results The first patient had a narrow complex tachycardia with ventriculoatrial dissociation. Findings of an entrainment pacing from the right ventricle and fused premature ventricular complexes suggested cNV pathway involvement. The second patient had nonsustained narrow complex tachycardia with more ventricular than atrial complexes. The tachycardia exhibited an anterograde His-right bundle (RB) activation sequence and normal His-ventricular (HV) interval and consistently terminated with fused ventricular extra stimuli, suggesting cNV pathway participation. The third patient had a wide complex tachycardia (WCT) with either a right or left bundle branch block pattern. The WCT showed an eccentric His-RB activation sequence and short HV interval and terminated with fused premature ventricular complexes, suggesting a cHV (or concealed fasciculoventricular) pathway involvement. The fourth patient had a WCT with alternating bundle branch block morphologies with a short HV interval. Entrainment from the basal right ventricle demonstrated fusion and a short postpacing interval, suggesting cHV (or fasciculoventricular) pathway involvement. Ablation at the proximal RB rendered the tachycardia noninducible. Conclusions A structured approach can help diagnose and treat cNV or cHV pathways. We emphasize the importance of evaluating both the His-RB activation pattern and HV interval during sinus rhythm and tachycardia as well as the ventricular pacing study. |
| Databáze: | OpenAIRE |
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