Atrioventricular node anatomy and physiology: implications for ablation of atrioventricular nodal reentrant tachycardia

PURPOSE OF REVIEW: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common arrhythmia in patients with regular supraventricular tachycardia. Selective radio frequency catheter ablation of the slow pathway has afforded an ideal method to treat most patients with AVNRT. However, there are still some controversies and recent developments concerning the ablation for patients with AVNRT. The purpose of this review is to elucidate the anatomy and physiology of the atrioventricular node and implications for the ablation of AVNRT. RECENT FINDINGS: The sequential ablation sites for slow pathway ablation are suggested as the isthmus between tricuspid annulus and coronary sinus ostium, the tricuspid edge of coronary sinus ostium by moving the ablation catheter tip slightly in and out of the coronary sinus, the septum lower than coronary sinus ostium, moving higher up on the half of Koch's triangle along the septum, one or two burns inside the first centimeter of the coronary sinus, left side of the septum. SUMMARY: It is imperative to recognize the detailed anatomy and physiology of the atrioventricular node in every individual patient before the ablation of AVNRT.