Progressive Atrial Exit Shift in Fast‐Slow Atrioventricular Nodal Reentrant Tachycardia With Right Inferior Extension of the Slow Pathway: Insights From High‐Density Mapping
Key result
High-density mapping during fast-slow AVNRT ablation reveals progressive atrial exit shifts requiring posteroseptal ablation.
- n=1
Why the study?
The optimal ablation target in fast-slow AV nodal reentrant tachycardia with a long right inferior extension remains controversial, and previous reports did not clearly depict atrial exit shifts using three-dimensional mapping.
Population
A 15-year-old male patient with fast-slow AVNRT
Design
Case report
Authors
Discussion
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Member takes
Implication
May warrant repeated high-density mapping if exit sites shift in fast-slow AVNRT; leaves open whether this strategy improves outcomes in atypical nodal reentry.
Study Design
Type
Case Report (n=1)
Structured PICO
P
Population
15-year-old male patient with narrow QRS tachycardia, specifically fast-slow atrioventricular nodal reentrant tachycardia (F-S AVNRT) with a right inferior extension (RIE) of the slow pathway.
I
Intervention
Radiofrequency catheter ablation guided by repeated high-density 3D activation mapping (Ensite X EP with Advisor HD Grid).
O
Outcome
Termination of supraventricular tachycardia (SVT) and non-inducibility.
In cases of fast-slow AVNRT with a long right inferior extension, repeated high-density mapping can reveal dynamic changes in the atrial exit site, demonstrating that successful ablation may require targeting the conventional posteroseptal area.
Limitations
- Diagnostic features of the upper common pathway, such as V-A block during tachycardia, could not be clearly observed.
Cite This Study
Oda et al. (2025) conducted a case report in Fast-slow atrioventricular nodal reentrant tachycardia with right inferior extension (n=1). High-density activation mapping and radiofrequency catheter ablation was evaluated. High-density activation mapping during radiofrequency ablation of fast-slow AVNRT visualized progressive shifts in the atrial exit site, ultimately requiring ablation at the posteroseptal area.