March 1, 1993
View Full PaperAtrioventricular Nodal Reentry: Evidence Supporting an Intranodal Location
Structured PICO
P
Population
Patients with AV nodal reentry / supraventricular tachycardia (SVT)
O
Outcome
Location of the reentrant circuit in AV nodal reentry
This review provides pathophysiological and clinical evidence supporting that the reentrant circuit in AV nodal reentry is located entirely within the AV node.
Abstract
The exact site of the reentrant circuit in AV nodal reentry remains controversial. While recent ablative techniques have yielded information, the interpretation of which suggests that the atrium is required, other explanations for these interpretations are available. Prior pathophysiological studies with three-dimensional reconstruction of the node suggest that it is a highly anisotropic structure and extends through Koch's Triangle. Data from humans suggesting the atria are not necessary include the presence of AV dissociation during supraventricular tachycardia (SVT), depolarization of atrial tissue surrounding the node without affecting SVT, pacing induced AH intervals exceeding those during SVT, and site dependency of a critical AH interval (exceeding atrial refractoriness) that is required for initiation of AV nodal reentry.