The electrophysiologic characteristics of atrioventricular nodal reentry tachycardia with eccentric retrograde activation.
BACKGROUND
The occurrence of eccentric retrograde atrial activation has been demonstrated to be from 6 to 8% in patients with atrioventricular nodal reentrant tachycardia (AVNRT) by several previous reports. However, most of those reports were limited by the absence of coronary sinus venography to confirm if the retrograde activation was truly left sided. The purposes of this study were to 1) determine the incidence of left sided retrograde atrial activation in our center, 2) determine the specific electrophysiologic characteristics of eccentric and concentric atrial activation and 3) determine the outcome of radiofrequency catheter ablation for AVNRT with eccentric retrograde atrial activation.


METHODS
From November 2001 to July 2004, 290 consecutive patients with AVNRT who underwent an electrophysiologic study and radiofrequency ablation were included. Group 1 consisted of AVNRT patients with eccentric retrograde atrial activation; group 2 consisted of AVNRT patients with concentric retrograde atrial activation. The electrophysiologic characteristics of the group 1 and group 2 patients were then compared.


RESULTS
The incidence of AVNRT with eccentric retrograde activation confirmed by CS venography was 6.5%. There were more females and atypical AVNRT in patients with retrograde eccentric conduction. There was more VA block after ablation and tachycardia induction by right ventricular pacing/extrastimuli in eccentric rather than concentric retrograde atrial activation. A shorter antegrade fast functional refractory period of the AV node was demonstrated in the atypical eccentric group as compared to the atypical concentric group.


CONCLUSIONS
This study demonstrated the different electrophysiologic characteristics between the AVNRT patients with eccentric and concentric retrograde atrial activation. Successful ablation sites were similar to the standard RA ablation sites in patients with retrograde eccentric conduction.
Ong
Mary Gertrude Y
MG
Division of Cardiology and Pediatric Cardiology, National Yang-Ming University and Taipei Veterans General Hospital, Taiwan.
Lee
Pi-Chang
PC
Tai
Ching-Tai
CT
Lin
Yenn-Jiang
YJ
Hsieh
Ming-Hsiung
MH
Chen
Yi-Jen
YJ
Lee
Kun-Tai
KT
Tsao
Hsuan-Ming
HM
Kuo
Jen-Yuan
JY
Chang
Shih-Lin
SL
Chen
Shih-Ann
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D015331:Cohort Studies; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004594:Electrophysiology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome