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High-resolution mapping of the circuit of typical atrioventricular nodal reentrant tachycardia

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Abstract

Background

Recent anatomic and electrophysiologic evidence has provided new insight into the anatomic substrate. Previous reports on electroanatomic mapping (EAM) of the circuit of atrioventricular nodal reentrant tachycardia (AVNRT) have been limited by mapping only the triangle of Koch on the right side of the septum and by the use of conventional mapping tools. The objectives are to obtain comprehensive high-resolution mapping of typical AVNRT and to investigate the role of the atrioventricular ring tissues in the circuit.

Methods

We employed EAM with the use of novel modules and algorithms for studying typical AVNRT from the right and the left sides of the septum.

Results

We performed extensive mapping of both the atrial septum and the septal vestibule of the tricuspid valve during typical AVNRT in 9 (6 females) patients, aged 49.6 ± 12.1 years. In two of these, left septal mapping was also obtained through the aorta. The earliest initial activation was variable, emanating from the superior or medial septum. The impulse consistently appeared below the orifice of the coronary sinus, at the site where its inferoanterior margin merged with the septal vestibule of the tricuspid valve at its entrance to the right atrium. It then returned to the initial activation site, presumably through the septal vestibular myocardium. The left septal activation area corresponded to that recorded on the right side.

Conclusions

Typical AVNRT uses a circuit confined within the pyramid of Koch from the AV node to the septal isthmus, involving the myocardial walls of the pyramidal space.

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Modified from: Katritsis DG, Anderson RH. New insights into the mechanisms of fast and slow conduction in the atrioventricular node. Heart Rhythm. 2022. 10.1016/j.hrthm.2022.08.025

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Acknowledgements

We are grateful to Theodoros Xenos and Stylianos Tsakiroglou for their incredible technical help.

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Authors and Affiliations

  1. Hygeia Hospital, 4 Erythrou Stavrou Str, 15123, Athens, Greece

    Demosthenes G. Katritsis & Vasileios Doukas

  2. Johns Hopkins Hospital, Baltimore, MD, USA

    Demosthenes G. Katritsis, Joseph E. Marine & Hugh Calkins

  3. Aristotelian University of Thessaloniki, Thessaloniki, Greece

    Nikolaos Fragakis

  4. Imperial College Healthcare NHS Trust, London, UK

    George Katritsis

  5. University of Michigan Medical School, Ann Arbor, MI, USA

    Amrish Desmukh & Rakesh Latchamsetty

  6. Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK

    Robert H. Anderson

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  1. Demosthenes G. Katritsis
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Correspondence to Demosthenes G. Katritsis.

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Katritsis, D.G., Fragakis, N., Katritsis, G. et al. High-resolution mapping of the circuit of typical atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 67, 599–607 (2024). https://doi.org/10.1007/s10840-023-01632-7

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