Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA.
J Cardiovasc Electrophysiol. 2022 Jun;33(6):1177-1182. doi: 10.1111/jce.15465. Epub 2022 Apr 12.
The surface electrocardiography 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 to 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.
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 atrial-His-atrial response, (3) short septal ventriculoatrial time, and (4) ventricular-atrial-ventricular (V-A-V) response to ventricular overdrive (VOD) pacing with corrected post pacing interval-tachycardia cycle length (cPPI-TCL) > 110 ms. JT was excluded by either termination or advancement of tachycardia by atrial extrastimuli (AES) or atrial overdrive (AOD) pacing.
We found 11 patients (age 20-78 years old, six female) who met the above-mentioned criteria. The TCL ranged from 560 to 782 ms. Except for one patient showing tachycardia termination, all patients demonstrated a V-A-V response and cPPI-TCL over 110 ms 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.
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.
典型房室结折返性心动过速（AVNRT）的体表心电图表现为心室-心房（RP）同时激活，V1 导联出现假性 R'，典型心率为 150-220 次/分。较慢的心率提示交界性心动过速（JT）。然而，我们偶尔会遇到典型 AVNRT 伴较慢的心室率。我们描述了一系列心率低于 110 次/分的典型 AVNRT 病例。
对 1972 例接受慢径消融的 AVNRT 患者进行分析。典型 AVNRT 的诊断标准为：（1）存在双房室结传导证据；（2）心动过速由心房驱动程序引发，心房-希氏束-心房反应；（3）短的间隔室房时间；（4）心室超速起搏（VOD）时出现心室-心房-心室（V-A-V）反应，校正后的起搏后间期-心动过速周期长度（cPPI-TCL）>110 毫秒。通过心房早搏（AES）或心房超速起搏（AOD）终止或提前心动过速可排除 JT。
我们发现符合上述标准的 11 例患者（年龄 20-78 岁，女性 6 例）。TCL 范围为 560-782 毫秒。除 1 例患者心动过速终止外，所有患者均表现出 V-A-V 反应和 cPPI-TCL 超过 110 毫秒，VOD 时表现出 V-A-V 反应和 cPPI-TCL 超过 110 毫秒。AES 或 AOD 起搏在 10 例患者中可使心动过速提前，在 1 例患者中可使心动过速终止，从而成功排除 JT。所有患者均成功消融慢径，且均不能诱发心动过速。
本病例系列描述了伴有缓慢心室率（小于 110 次/分）的典型 AVNRT 患者，其可能类似于 JT。我们强调使用起搏操作排除 JT 的重要性。
