Slow/Fast Atrioventricular Nodal Reentrant Tachycardia Using the Inferolateral Left Atrial Slow Pathway: Role of the Resetting Response to Select the Ablation Target
| Autor: | Sunny S. Po, Stavros Stavrakis, Hiroshi Nakagawa, Karen J. Beckman, Khaled Elkholey, Warren M. Jackman, Zulu Wang, Deborah Lockwood |
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| Rok vydání: | 2018 |
| Předmět: |
Tachycardia
Adult Male medicine.medical_specialty Time Factors Adolescent Slow pathway medicine.medical_treatment Action Potentials Catheter ablation 030204 cardiovascular system & hematology Bundle of His 03 medical and health sciences 0302 clinical medicine Left atrial Heart Rate Physiology (medical) Internal medicine Medicine Humans Tachycardia Atrioventricular Nodal Reentry cardiovascular diseases 030212 general & internal medicine Coronary sinus Aged Retrospective Studies business.industry Middle Aged Ablation Accessory Atrioventricular Bundle medicine.anatomical_structure Treatment Outcome cardiovascular system Cardiology Atrioventricular Node Catheter Ablation Female medicine.symptom Cardiology and Cardiovascular Medicine business NODAL Electrophysiologic Techniques Cardiac |
| Zdroj: | Circulation. Arrhythmia and electrophysiology. 11(9) |
| ISSN: | 1941-3084 |
| Popis: | Background We describe a technique to localize the ablation target in patients with an unusual variant of slow/fast atrioventricular nodal reentrant tachycardia (AVNRT) using a slow pathway connecting to the basal inferolateral left atrium. Methods Consecutive patients with slow/fast AVNRT were included. During stable slow/fast AVNRT, a single late atrial extrastimulus (AES) was delivered at the inferolateral left atrium near the mitral annulus. Advancing the next His bundle potential by ≥5 ms, followed by resetting of the tachycardia cycle length, indicated that the AES engaged the anterograde slow pathway. The latest AES resetting AVNRT was considered to be in close proximity to the atrial end of the anterograde slow pathway and was selected as the ablation target. Results In 10 of 843 (1.2%) patients, ablation at the inferolateral left atrium was required. All patients had had failed ablation at the inferior triangle of Koch and roof of the coronary sinus. In all 10 patients, a late AES advanced the His bundle potential by ≥10 ms and reset the tachycardia. Ablation at that site eliminated slow pathway conduction and terminated the tachycardia. Ablation was successful at the site of the latest AES, delivered 49±12 ms after the onset of the His bundle potential. No recurrent tachycardia was noted at 1 year of follow-up. Conclusions The inferolateral left atrium slow pathway is used in a small subset of patients with slow/fast AVNRT. Accurate localization of the ablation target can be achieved by delivering late AES during AVNRT (resetting response). |
| Databáze: | OpenAIRE |
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