© 2002 by European Society of Cardiology
Multiple AV nodal pathways in patients with AV nodal reentrant tachycardia — more common than expected?
1Department of Cardiology and Angiology, Ruhr-University Bochum Hölkeskampring 40, 44625, Herne, Germany; 2Department of Cardiology and Angiology, University of Halle-Wittenberg Ernst-Grube-Straße 40, 06097, Halle, Germany
AIMS: It was the purpose of this study to determine the incidence of more than two AV nodal pathways in patients with AVNRT.
METHODS AND RESULTS: In 78 consecutive patients with AV-nodal reentrant tachycardias (AVNRT) (50 females, 28 males, mean age 52·8±14·6 years), the number of sudden AH increases by 50 ms or more (AH-jump) was analysed during atrial extrastimulation. The incidence of two AV nodal pathways was accepted to be present in patients with AVNRT without an AH-jump (‘smooth curve’).
The following forms of tachycardia were induced: a typical AVNRT (slow–fast) in 67 patients, an atypical AVNRT (fast–slow) in 12 patients and a slow–slow-AVNRT in 4 patients. Five patients had two forms of AVNRT. 47 patients (60·3%) showed two AV nodal pathways, 27 patients (34·6%) had three AV-nodal pathways and 4 patients (5·1%) exhibited four AV-nodal pathways.
For successful catheter ablation of AVNRT in patients with more than two pathways, more radiofrequency energy applications were required (9·2±6·3) compared with patients with only two pathways (6·7±4·8). Furthermore, in patients with more than two AV-nodal pathways, the catheter intervention resulted more frequently in a modulation of slow pathway conduction than in an ablation of the slow pathway(s).
CONCLUSION: The incidence of more than two AV-nodal pathways in patients with AVNRT was unexpectedly high at about 40%. Thus, these tachycardias require a meticulous electrophysiological evaluation for successful ablation.
Key Words: AVNRT, multiple AV-nodal pathways, catheter ablation
Correspondence: Drs K. M. Heinroth, I. Stabenow, Department of Cardiology and Angiology, University of Halle-Wittenberg, Ernst-Grube-Stra&(e 40, 06097 Halle, Germany. Tel.: +49 (345) 557 4938; Fax: +49 (345) 557 4943; E-mail: konstantin.heinroth{at}medizin.uni-halle.de Prof. Dr H.-J. Trappe, PD, Dr P. Weismüller, Dr K. Kattenbeck, Department of Cardiology and Angiology, University of Bochum, Hölkeskampring 40, 44625 Herne, Germany. Tel.: +49 (2323 ) 499 1601; Fax: +49 (2323) 499 301; E-mail: peter.weismueller{at}ruhr-uni-bochum.de
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