{"title":"Slow/Fast Atrioventricular Nodal Reentrant Tachycardia Catheter Ablation Guided by Atrial Resetting: The New Insight.","authors":"Saer Abu-Alrub, Finet Florian, Antoine Boudias, Pierre-Antoine Catalan, Frédéric Jean, Guillaume Clerfond, Romain Eschalier, Grégoire Massoullié","doi":"10.1016/j.hrthm.2025.03.1940","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Atrial resetting can be used for discerning the anterograde pathway in slow/fast atrioventricular nodal reentrant tachycardia (AVNRT).</p><p><strong>Objectives: </strong>Assess the prevalence of right inferior extension (RIE) and left extension (LE) and the potential impact on the ablation approach.</p><p><strong>Methods: </strong>During the electrophysiological study of patients with slow/fast AVNRT, a decremental supraventricular extrastimulus was delivered within the vulnerability window of the tachycardia cycle at two distinct sites: the infero-paraseptal area of the Koch triangle (near the RIE) and the proximal few centimeters of the coronary sinus (near the LE). The site with the latest extrastimulus (longest H-Stim) that could reset the tachycardia was defined as the site of the anterograde slow pathway.</p><p><strong>Results: </strong>Thirty-six patients were enrolled over a 1-year period. Resetting couldn't be performed in 10 patients (28%) due to non-sustained tachycardia and one patient due to failed atrial capture. Among the remaining 25 patients (69%), 18 (72%) had the best resetting from the RIE, 5 (20%) from the LE, and 2 (8%) had two alternating AVNRT. The mean H-Stim value in the RIE position was longer when resetting favored RIE compared to LE (46±13 vs 16±21ms; p<0.001); a similar pattern was observed in the LE position (59±20 vs 15±18ms; p<0.001). Ablation of the left inferior extension could be performed from the right side but significantly closer to the His bundle compared to the RIE (9.6±3 vs. 18.5±4mm, p<0.001).</p><p><strong>Conclusion: </strong>Left extension AVNRT is a common finding and can be ablated by a right-sided approach in most cases.</p>","PeriodicalId":12886,"journal":{"name":"Heart rhythm","volume":" ","pages":""},"PeriodicalIF":5.6000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart rhythm","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hrthm.2025.03.1940","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Atrial resetting can be used for discerning the anterograde pathway in slow/fast atrioventricular nodal reentrant tachycardia (AVNRT).
Objectives: Assess the prevalence of right inferior extension (RIE) and left extension (LE) and the potential impact on the ablation approach.
Methods: During the electrophysiological study of patients with slow/fast AVNRT, a decremental supraventricular extrastimulus was delivered within the vulnerability window of the tachycardia cycle at two distinct sites: the infero-paraseptal area of the Koch triangle (near the RIE) and the proximal few centimeters of the coronary sinus (near the LE). The site with the latest extrastimulus (longest H-Stim) that could reset the tachycardia was defined as the site of the anterograde slow pathway.
Results: Thirty-six patients were enrolled over a 1-year period. Resetting couldn't be performed in 10 patients (28%) due to non-sustained tachycardia and one patient due to failed atrial capture. Among the remaining 25 patients (69%), 18 (72%) had the best resetting from the RIE, 5 (20%) from the LE, and 2 (8%) had two alternating AVNRT. The mean H-Stim value in the RIE position was longer when resetting favored RIE compared to LE (46±13 vs 16±21ms; p<0.001); a similar pattern was observed in the LE position (59±20 vs 15±18ms; p<0.001). Ablation of the left inferior extension could be performed from the right side but significantly closer to the His bundle compared to the RIE (9.6±3 vs. 18.5±4mm, p<0.001).
Conclusion: Left extension AVNRT is a common finding and can be ablated by a right-sided approach in most cases.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.