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Europace Advance Access originally published online on May 3, 2007
Europace 2007 9(7):458-465; doi:10.1093/europace/eum067
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ELECTROPHYSIOLOGY

Retrograde slow pathway conduction in patients with atrioventricular nodal re-entrant tachycardia

Demosthenes G. Katritsis1,*, Kenneth A. Ellenbogen2, Anton E. Becker3 and A. John Camm4

1 Department of Cardiology, Athens Euroclinic, 9 Athanassiadou St., Athens 11521, Greece; 2 Division of Cardiology, Medical College of Virginia, Richmond, VA, USA; 3 Academic Medical Center, University of Amsterdam, Amsterdam, The, Netherlands; 4 Cardiac and Vascular Sciences, St George's, University of London, London, UK

Aims To study retrograde slow pathway conduction by means of right- and left-sided septal mapping.

Methods and results Nineteen patients with slow–fast atrioventricular nodal re-entrant tachycardia (AVNRT) were studied before and after slow pathway ablation. Simultaneous His bundle recordings from right and left sides of the septum, using trans-aortic and trans-septal electrodes, were made during right ventricular pacing. Pre-ablation, decremental retrograde ventriculo-atrial (VA) conduction without jumps or discontinuities was recorded in eight patients (group 1). In six patients, retrograde conduction jumps were demonstrated (group 2) and in the remaining four patients, there was minimal prolongation of stimulus to atrium (St-A) intervals (group 3). The maximal difference ({Delta}St-A) between St-A intervals obtained with pacing at a constant cycle length of 500 ms and at the cycle length with maximal retrograde VA prolongation was significantly longer measured from the right His compared with the left His (122 ± 25 vs. 110 ± 33 ms, P = 0.02, respectively) in group 1 and group 2 (140 ± 23 vs. 110 ± 35 ms, P = 0.03), but not in group 3 (10 ± 4 vs. 13 ± 8 ms, P = 0.35). Post-ablation, {Delta}St-A intervals were similar between right and left His recordings (77 ± 37 vs. 76 ± 33 ms, P = 0.53, respectively) in group 1, (100 ± 24 vs. 103 ± 21 ms, P = 0.35) group 2, and (63 ± 32 vs. 66 ± 33 ms, P = 0.35) group 3.

Conclusion In patients with typical AVNRT, retrograde conduction through the slow pathway results in earliest retrograde atrial activation on the left side of the septum and catheter ablation in the right inferoparaseptal area abolishes this pattern. These findings are compatible with the concept of slow pathway conduction by means of the inferior AV nodal extensions.

Key Words: Atrioventricular node, Slow pathway, Tachycardia, Ablation

* Corresponding author. Tel: +30 210 6416600; fax: +30 210 6819779/6416661. E-mail address: dkatritsis{at}euroclinic.gr

Manuscript submitted 22 February 2007. Revision received 21 March 2007.
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