Why the study?
What are the electrophysiological determinants of double ventricular response during transient entrainment in a patient with slow-fast AV nodal reentrant tachycardia?
What are the electrophysiological determinants of double ventricular response during transient entrainment in a patient with slow-fast AV nodal reentrant tachycardia?
This case report identifies specific electrophysiological mechanisms, including slow pathway conduction delay and activation collision, that determine a double ventricular response during transient entrainment in AVNRT.
Identifies AVNRT double-response mechanisms; hypothesis-generating and should not yet change practice.
We report a patient with slow-fast atrioventricular (AV) nodal reentrant tachycardia, in which double ventricular response was demonstrated during rapid pacing at cycle length of 300 msec or less from the high right atrium. The determinants of double ventricular response during transient entrainment in the present case were: (1) a crucial conduction delay in the slow pathway; (2) the collision between the activation via the antegrade fast pathway (antidromically) of the last paced beat and the activation via the antegrade slow pathway (orthodromically) of the previous paced beat, instead of the unidirectional block in the slow pathway; and (3) the enhanced AV nodal conduction over the antegrade fast pathway.
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Shimizu et al. (1993) studied this question.
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