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Implications of 2:1 atrioventricular block during typical atrioventricular nodal reentrant tachycardia

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Abstract

Objective

The effects of 2:1 AV block (AVB) on AV nodal reentrant tachycardia (AVNRT) remain to be elucidated. This study was performed to localize the site of 2:1 AVB and elucidate the effects of 2:1 AVB on typical AVNRT.

Methods

The His bundle (HB) electrograms during typical AVNRT with 2:1 AV block were reviewed in 24 patients. It was hypothesized that if 2:1 AVB at the HB or below changed tachycardia cycle length (TCL), the lower turnaround point of the reentrant circuit (RC) might be located within the HB and parts of the HB might be involved in the RC.

Results

A HB potential was absent in blocked beats during 2:1 AVB in four patients (supra-Hisian block), and the maximal amplitude of the HB potential in blocked beats was the same as that in conducted beats in four patients (infra-Hisian block), and was significantly smaller than that in conducted beats (0.1 ± 0.1 versus 0.5 ± 0.2 mV, P < 0.05) in 16 patients (intra-Hisian block). Eight patients (33%) with intra-Hisian block had a nearly identical prolongation of the H–A and A–A intervals in blocked beats (12 ± 3 and 13 ± 2 ms, respectively) with unchanged A–H intervals, while the remaining 16 patients (67%) exhibited invariable A–A and/or H–A intervals.

Conclusion

The site of 2:1 AVB during typical AVNRT was estimated to be at the HB or below in 83% of the cases. Two-to-one intra-Hisian block transiently prolonged TCL, possibly indicating involvement of the proximal HB in the RC in one-third of typical the AVNRT cases with 2:1 AVB.

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References

  1. Schmitt, C., Miller, J. M., & Josephson, M. E. (1988). Atrioventricular nodal supraventricular tachycardia with 2:1 block above the bundle of His. Pacing Clinical Electrophysiology, 11, 1018–1023.

    Article  CAS  Google Scholar 

  2. Wellens, H. J., Wesdorp, J. C., Duren, D. R., & Lie, K. I. (1976). Second degree block during reciprocal atrioventricular nodal tachycardia. Circulation, 53, 595–599.

    PubMed  CAS  Google Scholar 

  3. Man, K. C., Brinkman, K., Bogun, F., Knight, B., Bahu, M., Weiss, R., et al. (1996). 2:1 atrioventricular block during atrioventricular node reentrant tachycardia. Journal of the American College of Cardiology, 28, 1770–1774.

    Article  PubMed  CAS  Google Scholar 

  4. Lee, S. H., Tai, C. T., Chiang, C. E., Yu, W. C., Cheng, J. J., Ding, Y. A., et al. (2003). Spontaneous transition of 2:1 atrioventricular block to 1:1 atrioventricular conduction during atrioventricular nodal reentrant tachycardia: evidence supporting the intra-Hisian or infra-Hisian area as the site of block. Journal of Cardiovascular Electrophysiology, 14, 1337–1341.

    Article  PubMed  Google Scholar 

  5. Otomo, K., Suyama, K., Okamura, H., Noda, T., Satomi, K., Shimizu, W., et al. (2007). Participation of a concealed atrio-hisian tract in the reentrant circuit of the slow–fast type atrioventricular nodal reentrant tachycardia. Heart Rhythm, 4, 703–710.

    Article  PubMed  Google Scholar 

  6. Li, Y. G., Bender, B., Bogun, F., Gronefeld, G., & Hohnloser, S. H. (2000). Location of the lower turnaround point in typical AV nodal reentrant tachycardia: a quantitative model. Journal of Cardiovascular Electrophysiology, 11, 34–40.

    Article  PubMed  CAS  Google Scholar 

  7. Heidbuchel, H., Ector, H., & Van de Werf, F. (1998). Prospective evaluation of the length of the lower common pathway in the differential diagnosis of various forms of AV nodal reentrant tachycardia. Pacing Clinical Electrophysiology, 21, 209–216.

    Article  CAS  Google Scholar 

  8. Gomes, J. A., Dhatt, M. S., Damato, A. N., Akhtar, M., & Holder, C. A. (1979). Incidence, determinants and significance of fixed retrograde conduction in the region of the atrioventricular node. Evidence for retrograde atrioventricular nodal bypass tracts. American Journal of Cardiology, 44, 1089–1098.

    Article  PubMed  CAS  Google Scholar 

  9. Spurrell, R. A., Krikler, D. M., & Sowton, E. (1974). Concealed bypasses of the atrioventricular mode in patients with paroxysmal supraventricular tachycardia revealed by intracardiac electrical stimulation and verapamil. American Journal of Cardiology, 33, 590–595.

    Article  PubMed  CAS  Google Scholar 

  10. Kerr, C. R., Benson, D. W., & Gallagher, J. J. (1983). Role of specialized conducting fibers in the genesis of “AV nodal” re-entry tachycardia. Pacing Clinical Electrophysiology, 6, 171–184.

    Article  CAS  Google Scholar 

  11. Narula, O. S., ed. (1979). Paroxysmal supraventricular tachycardia due to reciprocation via concealed accessory pathways. Cardiac Arrhythmias. Electrophysiology, Diagnosis and Management. Baltimore: Williams & Wilkins, 318–546.

  12. Narula, O. S. (1974). Retrograde pre-excitation. Comparison of antegrade and retrograde conduction intervals in man. Circulation, 50, 1129–1143.

    PubMed  CAS  Google Scholar 

  13. Josephson, M. E., ed. (2002). Supraventricular tachycardias. Clinical Cardiac Electrophysiology. Techniques and Interpretations. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 168–271.

  14. Hirao, K., Otomo, K., Wang, X., Beckman, K. J., McClelland, J. H., Widman, L., et al. (1996). A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation, 94, 1027–1035.

    PubMed  CAS  Google Scholar 

  15. Knight, B. P., Zivin, A., Souza, J., Flemming, M., Pelosi, F., Goyal, R., et al. (1999). A technique for the rapid diagnosis of atrial tachycardia in the electrophysiology laboratory. Journal of the American College of Cardiology, 33, 775–781.

    Article  PubMed  CAS  Google Scholar 

  16. Heidbuchel, H., & Jackman, W. M. (2004). Characterization of subforms of AV nodal reentrant tachycardia. Europace, 6, 316–329.

    Article  PubMed  Google Scholar 

  17. Willems, S., Shenasa, M., Borggrefe, M., Hindricks, G., Chen, X., Rotman, B., et al. (1993). Atrioventricular nodal reentry tachycardia: electrophysiologic comparisons in patients with and without 2:1 infra-His block. Clinical Cardiology, 16, 883–888.

    Article  PubMed  CAS  Google Scholar 

  18. Miles, W. M., Hubbard, J. E., Zipes, D. P., & Klein, L. S. (1994). Elimination of AV nodal reentrant tachycardia with 2:1 VA block by posteroseptal ablation. Journal of Cardiovascular Electrophysiology, 5, 510–516.

    Article  PubMed  CAS  Google Scholar 

  19. Kantoch, M. J., & Kimber, S. K. (1996). Narrow QRS tachycardia with atrioventricular block. Pacing Clinical Electrophysiology, 19, 1386–1387.

    Article  CAS  Google Scholar 

  20. Lee, S. H., Chen, S. A., Tai, C. T., Chiang, C. E., Wen, Z. C., Ueng, K. C., et al. (1997). Electrophysiologic characteristics and radiofrequency catheter ablation in atrioventricular node reentrant tachycardia with second-degree atrioventricular block. Journal of Cardiovascular Electrophysiology, 8, 502–511.

    Article  PubMed  CAS  Google Scholar 

  21. Lee, D. T., Tai, C. T., Lin, Y. J., Lai, W. T., & Chen, S. A. (2004). Variation of HA intervals in atrioventricular nodal reentrant tachycardia with atrioventricular block: What is the machanism? Journal of Cardiovascular Electrophysiology, 15, 1103–1104.

    Article  PubMed  Google Scholar 

  22. Yagi, T., Yang, Y., Keung, E. C., Collins, K. K., & Scheinman, M. M. (2003). Significance of bundle branch block during atrioventricular nodal reentrant tachycardia. American Journal of Cardiology, 91, 1184–1189.

    Article  PubMed  Google Scholar 

  23. Lin, Y. J., Tai, C. T., & Chen, S. A. (2003). Unusual phenomenon of spontaneous termination of atrioventricular nodal reentrant tachycardia with 2:1 atrioventricular block. Journal of Cardiovascular Electrophysiology, 14, 437–438.

    Article  PubMed  Google Scholar 

  24. Miller, J. M., Rosenthal, M. E., Vassallo, J. A., & Josephson, M. E. (1987). Atrioventricular nodal reentrant tachycardia: studies on upper and lower ‘common pathways’. Circulation, 75, 930–940.

    PubMed  CAS  Google Scholar 

  25. Josephson, M. E., & Miller, J. M. (1993). Atrioventricular nodal reentry: evidence supporting an intranodal location. Pacin Clin Electrophysiol, 16, 599–614.

    Article  CAS  Google Scholar 

  26. Fishberger, S. B., Mehta, D., Rossi, A. F., Langan, M. N., Marx, S. O., & Gomes, J. A. (1998). Variable effects of adenosine on retrograde conduction in patients with atrioventricular nodal reentry tachycardia. Pacing Clinical Electrophysiology, 2, 1254–1257.

    Article  Google Scholar 

  27. Mewis, C., Kuhlkamp, V., Mermi, J., Bosch, R. F., & Seipel, L. (2000). High variability of retrograde fast pathway sensitivity to adenosine. Clinical Cardiology, 23, 576–578.

    PubMed  CAS  Google Scholar 

  28. Souza, J. J., Zivin, A., Flemming, M., Pelosi, F., Oral, H., Knight, B. P., et al. (1998). Differential effect of adenosine on anterograde and retrograde fast pathway conduction in patients with atrioventricular nodal reentrant tachycardia. Journal of Cardiovascular Electrophysiology, 9, 820–824.

    Article  PubMed  CAS  Google Scholar 

  29. Miyata, A., Kobayashi, Y., Jinbo, Y., Chiyoda, K., Nakagawa, H., Tanno, K., et al. (1997). Effects of adenosine triphosphate on ventriculoatrial conduction-usefulness and problems in assessment of catheter ablation of accessory pathways. Japanese Circulation Journal, 61, 323–330.

    Article  PubMed  CAS  Google Scholar 

  30. Brechenmacher, C. (1975). Atrio-His bundle tracts. British Heart Journal, 37, 853–855.

    PubMed  CAS  Google Scholar 

  31. Brechenmacher, C., Laham, J., Iris, L., Gerbaux, A., & Lenegre, J. (1974). Histological study of abnormal conduction pathways in the Wolff–Parkinson–White syndrome and Lown–Ganong–Levine syndrome. Archives des maladies du coeur et des vaisseaux, 67, 507–519.

    PubMed  CAS  Google Scholar 

  32. Patterson, E., & Scherlag, B. J. (2004). Fast pathway–His bundle connections in the rabbit heart. Journal of Interventional Cardiac Electrophysiology, 10, 121–129.

    Article  PubMed  Google Scholar 

  33. Patterson, E., & Scherlag, B. (2002). Anatomic and functional fast atrioventricular conduction pathway. Journal of Cardiovascular Electrophysiology, 13, 945–949.

    Article  PubMed  Google Scholar 

  34. Morady, F. (1996). Ventriculoatrial block during a narrow-QRS tachycardia: what is the mechanism? -IV. Journal of Cardiovascular Electrophysiology, 7, 174–177.

    Article  PubMed  CAS  Google Scholar 

  35. Solti, F., Vecsey, T., Kekesi, V., & Juhasz-Nagy, A. (1989). The effect of atrial dilatation on the genesis of atrial arrhythmias. Cardiovascular Research, 23, 882–886.

    Article  PubMed  CAS  Google Scholar 

  36. Stambler, B. S., & Ellenbogen, K. A. (1996). Elucidating the mechanisms of atrial flutter cycle length variability using power spectral analysis techniques. Circulation, 94, 2515–2525.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, National Cardiovascular Center, Suita, Japan

    Kiyoshi Otomo, Kazuhiro Suyama, Hideo Okamura, Takashi Noda, Kazuhiro Satomi, Wataru Shimizu, Takashi Kurita, Naohiko Aihara & Shiro Kamakura

  2. Division of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital, 11-7 Manabe-shin-machi, Tsuchiura, Ibaraki Prefecture, 300-0053, Japan

    Kiyoshi Otomo

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  1. Kiyoshi Otomo
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Otomo, K., Suyama, K., Okamura, H. et al. Implications of 2:1 atrioventricular block during typical atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 19, 109–119 (2007). https://doi.org/10.1007/s10840-007-9147-4

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  • DOI: https://doi.org/10.1007/s10840-007-9147-4

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