P-173 Unexpected High Prevalence of Left Nodal Extension Breakthrough in Patients with Slow fast Atrioventricular Nodal Reentry Tachycardia

Chih-Chieh Yu, Bui The Dung, Liang-Yu Lin, Fu-Chun Chiu, Chia-Ti Tsai, Ling-Ping Lai, Jiunn-Lee Lin

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Background: Dual pathways inside atrioventricular node (AVN) have been postulated as the critical component of the circuit of AVN re-entry tachycardia (AVNRT). However, detailed electroanatomical mapping is lacking so far.
Methods: To investigate the 3-dimensional circuit incorporating both right and left AVN extensions, we studied 17 pts of slow-fast AVNRT by a duodecapolar electrode positioned along the tendon of Todaro, a decapolar electrode placed
along the high septum of left ventricle, and a decapolar one in the coronary sinus. The fast pathway of AVN was recorded as the earliest retrograde atrial activation site (RAA) during right ventricular pacing (RVP) and slow-fast
AVNRT. Ventricular extrastimuli were recruited during AVNRT to demonstrate the atrial activation sequence. Results: The RAAs in AVNRT were at right septum in 6 pts (35.3%), left in 4 (23.5%), simultaneous in 7 (41.2%). In the 13 patients whose RAAs involved right septum, the RAA was mainly at anteroseptal area in 10 pts (77%), less at middle and posterior septum (2 pts, 15%), and one patient
showed broad breakthrough. During RVP at comparable cycle length, RAA was at right septum in 7 pts (41.2%), left in 3 (17.6%), simultaneous in 7 (41.2%). The RAAs were concordant between AVNRT and RVP in most of the pts
(15 pts, 88.2%). Conclusion: This electroanatomical mapping study showed
unexpected high prevalence of left nodal extensionn breakthrough and the pattern of retrograde fast pathway atrial breakthrough could be variable in each patient.
頁(從 - 到)S101
期刊Global Heart
出版狀態已發佈 - 5月 1 2009