Why the study?
The existence of the upper common pathway in AVNRT remains debated, as electrophysiological evidence suggests the atrium is not essential for perpetuation, while anatomical studies fail to identify such a structure.
The review challenges the traditional concept of the upper common pathway in AVNRT, suggesting that the reentry circuit likely involves the perinodal atrium rather than being strictly intranodal.
Questions upper common pathway targeting in most AVNRT; leaves open perinodal atrial involvement and requires prospective validation.
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia, and its diagnostic and therapeutic approaches have been well-established. Traditionally, AVNRT is understood to be an intranodal reentry having two bystander pathways; the upper common pathway (UCP) which connects to the atrium and the lower common pathway which connects to the ventricle. However, the existence of the UCP remains a subject of ongoing debate. The assertion of the UCP's presence is supported by electrophysiological evidence suggesting that the atrium is not essential for the perpetuation of AVNRT. Nonetheless, numerous anatomical studies have failed to identify any structure that could be conclusively designated as the UCP. The histological and electrophysiological characteristics of the slow and fast pathways, which are the core components of AVNRT, suggest the inclusion of atrial myocardium in the reentry circuit. While clear interpretation of these discrepancies remains elusive, potential explanations may be derived from existing evidence and recent research findings concerning the actual AVNRT circuit.
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Park et al. (2024) studied this question.
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