Peiker Christiane, Pott Christian, Eckardt Lars, Kelm Malte, Shin Dong-In, Willems Stephan, Meyer Christian
Department of Cardiology - Electrophysiology, University Heart Centre, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner site Hamburg, Kiel, Lübeck, Germany Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Duesseldorf, Germany.
Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Muenster, Germany.
Europace. 2016 Mar;18(3):332-9. doi: 10.1093/europace/euv056. Epub 2015 Apr 16.
Dual atrioventricular nodal non-re-entrant tachycardia (DAVNNT), also known as 'double fire', has recently received more attention since it was demonstrated to mimic more common arrhythmias such as atrial premature beats, atrial fibrillation, and ventricular tachycardia. This is important, since mistaken differential diagnoses and the resulting therapeutic decisions have severe consequences for affected patients. DAVNNT is characterized by conduction characteristics of the atrioventricular (AV) node that leads to a double antegrade conduction of one sinoatrial nodal activity via the slow and fast AV nodal pathways. As a result, the most significant hint from an electrocardiogram (ECG) is a P wave followed by two narrow QRS complexes. Although DAVNNT is rather a rare arrhythmia, it now appears to be more common than previously thought. To date, 68 cases including 3 small single-centre observational studies accumulated over the last 5 years have demonstrated the feasibility and safety of radiofrequency catheter ablation for DAVNNT. Catheter ablation treats this arrhythmia effectively by modifying or eliminating slow pathway function. Here, we review the current state of DAVNNT knowledge systematically and address current challenges presented by this 'ECG chameleon from the AV node'.
双房室结非折返性心动过速（DAVNNT），也被称为“双重激动”，自从被证实可模拟更常见的心律失常，如房性早搏、心房颤动和室性心动过速以来，最近受到了更多关注。这一点很重要，因为错误的鉴别诊断以及由此产生的治疗决策会给受影响的患者带来严重后果。DAVNNT的特征是房室（AV）结的传导特性，导致一次窦房结活动通过慢径和快径房室结通路进行双重前向传导。因此，心电图（ECG）最显著的提示是一个P波后跟随两个窄QRS波群。尽管DAVNNT是一种相当罕见的心律失常，但现在看来它比以前认为的更为常见。迄今为止，过去5年积累的包括3项小型单中心观察性研究在内的68例病例已经证明了射频导管消融治疗DAVNNT的可行性和安全性。导管消融通过改变或消除慢径功能有效地治疗这种心律失常。在此，我们系统地回顾了DAVNNT的现有知识，并探讨了这种“来自房室结的心电图变色龙”目前所带来的挑战。
