Dixit Sanjay, Callans David J, Gerstenfeld Edward P, Marchlinski Francis E
Cardiac Electrophysiology Section, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
J Cardiovasc Electrophysiol. 2006 Mar;17(3):312-6. doi: 10.1111/j.1540-8167.2006.00410.x.
Atrial fibrillation (AF) manifests disorganized atrial activity and irregular R-R intervals on electrocardiogram (ECG). Variation in R-R intervals can also be seen with other supraventricular tachycardias that may mimic AF.
We report our observations on three patients who were referred to our center to undergo pulmonary vein (PV) isolation for erroneously diagnosed AF in the setting of dual atrio-ventricular (AV) nodal pathways manifesting as AV nodal reentrant tachycardia (AVNRT) and/or double response during sinus rhythm.
These three subjects (two females) were derived from a group of 456 consecutive patients undergoing AF ablation at our center over a 3-year period. All three patients had been symptomatic for over 2 years, having failed two or more antiarrhythmic medications. In each case AF was initially diagnosed on ECG and/or recordings from ambulatory monitoring. However, in all three cases the correct diagnosis was established during the invasive electrophysiologic study. In one patient during the stimulation protocol, two narrow complex tachycardias were serially induced (cycle lengths: 305 and 360 msecs; VA time: 60 and 240 msecs). The latter was confirmed to be atypical AVNRT and during this tachycardia, block in upper pathway was observed. In the other two patients, sinus rhythm with repetitive runs of double response and isolated junctional beats were observed in the absence of retrograde conduction. Successful slow pathway modification was performed in each subject and all three patients have remained arrhythmia free over a mean follow-up of 31 +/- 16 months off antiarrhythmic medications.
AF can be erroneously diagnosed in patients with dual AV nodal pathways manifesting double response and/or AVNRT. Incorporating a stimulation protocol as a part of the AF ablation procedure may help in diagnosing these rare clinical presentations that can be cured by slow pathway modification alone.
心房颤动（AF）在心电图（ECG）上表现为心房活动紊乱和R-R间期不规则。其他可能模拟AF的室上性心动过速也可见R-R间期变化。
我们报告了3例转诊至我院的患者的观察结果，这些患者因在双房室（AV）结径路表现为房室结折返性心动过速（AVNRT）和/或窦性心律时的双反应的情况下被错误诊断为AF而接受肺静脉（PV）隔离。
这3例患者（2例女性）来自我院3年内连续接受AF消融的456例患者。所有3例患者症状持续超过2年，两种或更多抗心律失常药物治疗无效。在每例患者中，AF最初通过ECG和/或动态监测记录诊断。然而，在所有3例患者中，正确诊断是在有创电生理研究中确定的。1例患者在刺激方案中，先后诱发了两种窄QRS波心动过速（周期长度：305和360毫秒；VA时间：60和240毫秒）。后者被证实为非典型AVNRT，在此心动过速期间，观察到上部径路阻滞。在另外2例患者中，在无逆行传导的情况下观察到窦性心律伴反复双反应发作和孤立性交界性搏动。对每例患者成功进行了慢径路改良，所有3例患者在停用抗心律失常药物平均随访31±16个月期间均未再发生心律失常。
在表现为双反应和/或AVNRT的双AV结径路患者中，AF可能被错误诊断。将刺激方案纳入AF消融手术的一部分可能有助于诊断这些罕见的临床表现，这些表现仅通过慢径路改良即可治愈。
