Curative surgery for atrioventricular junctional (“AV Nodal”) reentrant tachycardia
- 1 December 1985
- journal article
- research article
- Published by Elsevier BV in Journal of the American College of Cardiology
- Vol. 6 (6), 1383-1392
- https://doi.org/10.1016/s0735-1097(85)80229-1
Abstract
A new surgical approach was studied prospectively in 10 consecutive patients with atrioventricular (AV) junctional reentrant tachycardia. The aim was to abolish tachycardia yet preserve normal AV conduction. On the basis of electrophysiologic study before operation, patients were classified as type A (ventriculoatrial IVA] intervals during tachycardia ≤40 ms) (seven patients) or type B (VA intervals >40 ms) (three patients). Dual AV junctional pathways were demonstrable with single extrastimulus testing in seven patients before operation. Endocardial mapping during tachycardia at surgery revealed earliest atrial activation anteromedial to the AV node in type A patients and posterior to the node in the type B patients. The perinodal atrium in the region of earliest atrial activation during tachycardia was carefully disconnected from the AV node. After operation, AV junctional reentrant tachycardia was not inducible at comprehensive electrophysiologic study in any patient, and no clinical recurrences have occurred during a follow-up period of 2 to 14 months (mean 8 ± 4). Normal AV conduction was preserved in all cases. Anterograde slow AV junctional pathway conduction was abolished in five of seven cases. Retrograde His to atrium conduction time was prolonged in type A patients but the capacity for retrograde VA conduction remained excellent. Retrograde His to atrium conduction was interrupted or severely compromised in the type B patients. These data show that there are at least two types of AV junctional reentry. Perinodal atrium appears to be part of the reentrant circuit in human AV junctional reentry. Although the most consistent effect of surgery was on the retrograde limb of the circuit, anterograde slow pathway conduction was also modified. AV junctional reentry is surgically curable with a high success rate.This publication has 37 references indexed in Scilit:
- Role of the perinodal region in atrioventricular nodal reentry: Evidence in an isolated rabbit heart preparationJournal of the American College of Cardiology, 1983
- Incidence, determinants and significance of fixed retrograde conduction in the region of the atrioventricular node: Evidence for retrograde atrioventricular nodal bypass tractsThe American Journal of Cardiology, 1979
- Electrophysiologic evidence for selective retrograde utilization of a specialized conducting system in atrioventricular nodal reentrant tachycardiaThe American Journal of Cardiology, 1979
- Concealed bypasses of the atrioventricular node in patients with paroxysmal supraventricular tachycardia revealed by intracardiac electrical stimulation and verapamilThe American Journal of Cardiology, 1974
- An In Vitro Model of Paroxysmal Supraventricular TachycardiaCirculation, 1971
- Circus Movement within the AV Node as a Basis for Supraventricular Tachycardia as Shown by Multiple Microelectrode Recording in the Isolated Rabbit HeartCirculation Research, 1971
- Ventricular EchoesCirculation Research, 1966
- Demonstration of a Dual A-V Nodal Conduction System in the Isolated Rabbit HeartCirculation Research, 1966
- The physiologic basis of reciprocal rhythmProgress in Cardiovascular Diseases, 1966
- Some Characteristics of Ventricular EchoesCirculation Research, 1965