What is the clinical evidence from this study?

Study design: Observational. Population: Atypical fast-slow atrioventricular nodal reentrant tachycardia (sup-F/S-AVNRT) (n=8). Intervention: Radiofrequency ablation. Primary outcome: Elimination of retrograde conduction and confirmation of AVNRT diagnosis.

November 6, 2015Circulation

Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a “Superior” Slow Pathway

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Key result

Radiofrequency ablation eliminates atypical fast-slow AVNRT with a superior slow pathway in 100% of cases.

Why the study?

Does radiofrequency ablation successfully eliminate atypical fast-slow atrioventricular nodal reentrant tachycardia incorporating a superior slow pathway?

Population

8 patients with atypical fast-slow atrioventricular nodal reentrant tachycardia

Design

Case_series

Authors

YKYoshiaki KanekoGunma University SNShigeto NaitoGunma Prefectural Cardiovascular Center KOKaoru OkishigeKanagawa Rehabilitation Hospital

Discussion

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Implication

Supports feasibility of targeted RFA for this rare AVNRT variant; leaves open need for larger prospective confirmation.

Key Points

To confirm the existence and electrophysiological characteristics of atypical fast-slow atrioventricular nodal reentrant tachycardia involving a retrograde superior slow pathway and evaluate catheter ablation outcomes.
Evaluated 8 patients (6 women and 2 men; mean age 74 ± 7 years) presenting with atypical fast-slow atrioventricular nodal reentrant tachycardia.
Performed programmed ventricular stimulation, overdrive pacing, and pharmacological testing with adenosine triphosphate to map retrograde conduction and exclude atrioventricular reentrant tachycardia.
Delivered radiofrequency catheter ablation targeting the superior slow pathway near the His bundle via the right perinodal region or the noncoronary cusp of Valsalva.
All 8 patients exhibited retrograde decremental conduction over a superior slow pathway with earliest atrial activation near the His bundle and a mean shortest spike-atrial interval of 378 ± 119 ms.
Electrophysiological maneuvers showed ventriculoatrial dissociation during ventricular overdrive pacing in 5 patients, atrioventricular block during tachycardia in 3 patients, and tachycardia termination via adenosine triphosphate.
Radiofrequency ablation successfully eliminated or modified superior slow pathway conduction via the right perinodal region (n=4) or the noncoronary cusp of Valsalva (n=4).

Study Design

Type

Observational (n=8)

Structured PICO

Does radiofrequency ablation successfully eliminate atypical fast-slow atrioventricular nodal reentrant tachycardia incorporating a superior slow pathway?

Population

8 patients (6 women, 2 men, mean age 74 ± 7 years) with atypical fast-slow atrioventricular nodal reentrant tachycardia (sup-F/S-AVNRT)

Intervention

Radiofrequency ablation near the His bundle (right perinodal region or noncoronary cusp of Valsalva)

Outcome

Elimination or modification of retrograde conduction over the superior slow pathway and confirmation of AVNRT diagnosis

Atypical fast-slow AVNRT incorporating a superior slow pathway is a distinct supraventricular tachycardia that can be successfully treated with targeted radiofrequency ablation.

Cite This Study

Kaneko et al. (2015) conducted an observational in Atypical fast-slow atrioventricular nodal reentrant tachycardia (sup-F/S-AVNRT) (n=8). Radiofrequency ablation was evaluated on Elimination of retrograde conduction and confirmation of AVNRT diagnosis. Radiofrequency ablation successfully eliminated atypical fast-slow atrioventricular nodal reentrant tachycardia incorporating a superior slow pathway in all 8 studied patients.

synapsesocial.com/papers/6a0ea8c806ecbe833447aaeb https://doi.org/10.1161/circulationaha.115.018443

Topics

AF ablation outcomes

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Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a “Superior” Slow Pathway

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a “Superior” Slow Pathway

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

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