loading page

A Case Series of Very Slow Atrioventricular Nodal Reentrant Tachycardia Resembling Junctional Tachycardia
  • +3
  • Koji Higuchi,
  • Satoshi Higuchi,
  • Bryan Baranowski,
  • Oussama Wazni,
  • Melvin M. Scheinman,
  • Patrick Tchou
Koji Higuchi
Cleveland Clinic Miller Family Heart and Vascular Institute
Author Profile
Satoshi Higuchi
University of California San Francisco Division of Cardiology
Author Profile
Bryan Baranowski
Cleveland Clinic Miller Family Heart and Vascular Institute
Author Profile
Oussama Wazni
Cleveland Clinic Miller Family Heart and Vascular Institute
Author Profile
Melvin M. Scheinman
University of California San Francisco Division of Cardiology
Author Profile
Patrick Tchou
Cleveland Clinic Miller Family Heart and Vascular Institute
Author Profile

Abstract

Introduction: The surface EKG of typical atrioventricular nodal reentrant tachycardia (AVNRT) shows simultaneous ventricular-atrial (RP) activation with pseudo R’ in V1 and typical heart rates ranging from 150-220/min. Slower rates are suspicious for junctional tachycardia (JT). However, occasionally we encounter typical AVNRT with slow ventricular rates. We describe a series of typical AVNRT cases with heart rates under 110/min. Methods: A total of 1972 patients with AVNRT who underwent slow pathway ablation were analyzed. Typical AVNRT was diagnosed when; 1) evidence of dual atrioventricular nodal conduction, 2) tachycardia initiation by atrial drive train with A-H-A response, 3) septal ventriculoatrial (VA) time < 70 ms, and 4) ventricular-atrial-ventricular (V-A-V) response to ventricular overdrive (VOD) pacing with post pacing interval-tachycardia cycle length (PPI-TCL) > 115ms. JT was excluded by either termination or advancement of tachycardia by atrial extrastimuli (AES) or atrial overdrive (AOD) pacing. Results: We found 11 patients (Age 20-78 years old, 6 female) who met the above-mentioned criteria. The TCL ranged from 560ms to 782ms. Except for one patient showing tachycardia termination, all patients demonstrated a V-A-V response and PPI-TCL over 115ms with VOD. AES or AOD pacing successfully excluded JT by either advancing the tachycardia in 10 patients or by tachycardia termination in one patient. Slow pathway was successfully ablated, and tachycardia was not inducible in all patients. Conclusions: This case series describes patients with typical AVNRT with slow ventricular rate (less than 110/min) who may mimic JT. We emphasize the importance of using pacing maneuvers to exclude JT.
12 Jan 2022Submitted to Journal of Cardiovascular Electrophysiology
12 Jan 2022Submission Checks Completed
12 Jan 2022Assigned to Editor
16 Jan 2022Reviewer(s) Assigned
01 Feb 2022Review(s) Completed, Editorial Evaluation Pending
07 Feb 2022Editorial Decision: Revise Minor
16 Mar 20221st Revision Received
17 Mar 2022Submission Checks Completed
17 Mar 2022Assigned to Editor
17 Mar 2022Reviewer(s) Assigned
18 Mar 2022Review(s) Completed, Editorial Evaluation Pending
19 Mar 2022Editorial Decision: Accept
12 Apr 2022Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15465