Why the study?
Typical AVNRT usually presents with heart rates of 150 to 220/min, while slower rates are suspicious for junctional tachycardia, but typical AVNRT with slow ventricular rates is occasionally encountered.
Can pacing maneuvers and slow pathway ablation successfully diagnose and treat very slow typical AVNRT mimicking junctional tachycardia?
Observational (n=11)
Yes
Can pacing maneuvers and slow pathway ablation successfully diagnose and treat very slow typical AVNRT mimicking junctional tachycardia?
Very slow typical AVNRT (<110 bpm) can mimic junctional tachycardia but can be accurately diagnosed using pacing maneuvers and safely treated with slow pathway ablation.
Pacing maneuvers differentiate slow AVNRT from junctional tachycardia; leaves open generalizability beyond this small case series.
INTRODUCTION: The surface electrocardiography of typical atrioventricular nodal reentrant tachycardia (AVNRT) shows simultaneous ventricular-atrial (RP) activation with pseudo R' in V1 and typical heart rates ranging from 150 to 220/min. Slower rates are suspicious for junctional tachycardia (JT). However, occasionally we encounter typical AVNRT with slow ventricular rates. We describe a series of typical AVNRT cases with heart rates under 110/min. METHODS: A total of 1972 patients with AVNRT who underwent slow pathway ablation were analyzed. Typical AVNRT was diagnosed when; (1) evidence of dual atrioventricular nodal conduction, (2) tachycardia initiation by atrial drive train with atrial-His-atrial response, (3) short septal ventriculoatrial time, and (4) ventricular-atrial-ventricular (V-A-V) response to ventricular overdrive (VOD) pacing with corrected post pacing interval-tachycardia cycle length (cPPI-TCL) > 110 ms. JT was excluded by either termination or advancement of tachycardia by atrial extrastimuli (AES) or atrial overdrive (AOD) pacing. RESULTS: We found 11 patients (age 20-78 years old, six female) who met the above-mentioned criteria. The TCL ranged from 560 to 782 ms. Except for one patient showing tachycardia termination, all patients demonstrated a V-A-V response and cPPI-TCL over 110 ms with VOD. AES or AOD pacing successfully excluded JT by either advancing the tachycardia in 10 patients or by tachycardia termination in one patient. Slow pathway was successfully ablated, and tachycardia was not inducible in all patients. CONCLUSIONS: This case series describes patients with typical AVNRT with slow ventricular rate (less than 110/min) who may mimic JT. We emphasize the importance of using pacing maneuvers to exclude JT.
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Higuchi et al. (2022) conducted an observational in Atrioventricular nodal reentrant tachycardia (AVNRT) with slow ventricular rate (n=11). Slow pathway ablation and pacing maneuvers was evaluated on Tachycardia non-inducibility after slow pathway ablation.
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