Among patients with Wolff-Parkinson-White syndrome, atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) can coexist in a single patient. Direct transition of both tachycardias is rare; however, it can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. Furthermore, persistent atrial activation by an accessory pathway (AP) located outside of the AV node during ongoing AVNRT is also rare. This article describes a case of uncommon atrial activation by an AP during AVNRT and gradual transition of the two supraventricular tachycardias without any preceding atrial or ventricular activity in a patient with preexcitation syndrome.
Atrioventricular Node ; Humans ; Pre-Excitation Syndromes ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Paroxysmal ; Tachycardia, Reciprocating ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome*

OBJECTIVES: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. METHODS: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. RESULTS: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9 +/- 17.3 years in AVNRT, 25.5 +/- 13.3 years in WPW and 26.3 +/- 15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6 +/- 23.9 per minute and AVRT was 186.7 +/- 38.0 per minute, which were faster than that of AVNRT(161.7 +/- 28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. CONCLUSION: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.
Catheter Ablation ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Korea ; Male ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinoatrial Nodal Reentry ; Tachycardia, Supraventricular* ; Tertiary Care Centers ; Wolff-Parkinson-White Syndrome

Since its initial description in 1930, the preexcitation or Wolff-Parkinson-White(W-P-W) syndrome is characterized by a special electrocardiographic pattern and various paroxysmal tachyarrhythmia, which was found to have reciprocating tachycardia frequently. The W-P-W syndrome develops when some part of a ventricle is activated earlier than normal conduction pathway, and described as one type of ventricular preexcitation syndromes by Durrer (1974). The diagnostic criteria of the W-P-W syndrome are 1) initial slurring (delta wave) of the QRS complex, 2) short P-R interval, 3) widened QRS complex and 4) secondary T wave change. The initial slurring of the QRS complex (delta wave) which is the most important finding of preexcitation syndrome results from a premature activation of a portion of the ventricle through an accessary pathway which bypasses the A-V node and bundle. These accessary conduction fiber includes Kent's bundle, Jame's fibers, Mahaim's fibers and its combination. Recent developments in the field of electrophysiology and surgical therapy became to support the concept of anomalous pathways and the possible determination of the re-entry circuit of paroxysmal tachycardia. Total 12 cases including 9 cases of classical W-P-W syndromes and 3 cases of L-G-L syndromes were followed with special interest of pre-excitation phenomenon and paroxysmal tachyarrhythmia at the National medical Center during the period of Jan. 1975 to Feb. 1979 and found to have paroxysmal tachyarrhythmia in 8 cases out of 12 cases. His bundle electrogram (HBE) and right atrial pacing were recoded in 2 cases of W-P-W type B to support the existance of an anomalous pathway. Treatment was instituted in accordance with recent advanced knowledge for the paroxysmal tachyarrhymia and pre-excitation and references were reviewed.
Atrioventricular Node ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Electrophysiology ; Pre-Excitation Syndromes ; Tachycardia ; Tachycardia, Paroxysmal ; Tachycardia, Reciprocating ; Wolff-Parkinson-White Syndrome*

Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of reentrant supraventricular tachycardia. This tachycardia usually occurs in children and young adults and may be associated with tachycardiainduced cardiomyopathy. It is virtually incessant, at a rate ranging from 120 to 250 beats/minute. The characteristic electrocardiogram shows inverted P waves in the inferior leads with a long RP interval (RP greater than PR) during tachycardia. During tachycardia, the cardiac impulse conducts antegradely through the atrioventricular node and His-Purkinje system, returning retrogradely through the slowly conducting accessory pathway. The location of the accessory pathway is usually, but not always, near the ostium of the coronary sinus. Since the advent of radiofrequency catheter ablation (RFCA), several reports have emphasized the usefulness of RFCA for the treatment of PJRT. We report a case of PJRT in a 33-year-old male, successfully treated with RFCA.
Adult ; Atrioventricular Node ; Cardiomyopathies ; Catheter Ablation* ; Child ; Coronary Sinus ; Electrocardiography ; Humans ; Male ; Tachycardia ; Tachycardia, Reciprocating* ; Tachycardia, Supraventricular ; Young Adult

Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Humans ; Male ; Middle Aged ; Recurrence ; Tachycardia, Reciprocating ; etiology ; surgery

Adult ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; adverse effects ; Humans ; Tachycardia, Reciprocating ; etiology ; Tachycardia, Ventricular ; etiology

Radiofrequency catheter ablation (RFCA) has been established as an effective and safe treatment modality for atrioventricular nodal reentrant tachycardia and WPW syndrome. Surgical ablation or direct current catheter ablation had been performed to cure focal atrial tachycardia (AT), however, these treatments had limitations such as the need of open thoracotomy or the risk of barotrauma. RFCA could be an effective treatment modality for cure of AT. We performed RFCA for AT in 22 patients (male 13, mean age 38.1+/-15.4 years) among 831 patients who underwent electrophysiologic study between Jul. 1996 and May. 1999. Clinical pattern of tachycardia was paroxysmal (17 patients) or incessant (mean duration of symptoms, 41.1+/-42.3 months). Associated cardiac diseases were tachycardia-mediated cardiomyopathy (3 patients), aortic stenosis (1 patient) and ventricular septal defect with pulmonic stenosis (1 patient). AT was induced by programmed electrical stimulation in 17 patients: AT in the other 5 patients was incessant. The RFCA was successful in 17 patients (77.3%). The mean interval between atrial electrogram of mapping catheter and P wave of surface ECG was -53.5+/-24.9msec in 17 successful sites. Fractionated atrial activities were invariably found in the successful sites. Successful sites of RFCA for right AT were around coronary sinus ostium (5), crista terminalis (4), lower portion of sinus node (1), inferior portion of tricuspid annulus (1), and His area (1), respectively. In left AT, lateral portion near atrioventricular groove (2), inferoposterior portion (2) and near left atrial appendage (1) were successful site. During follow-up (mean 23 months), one patient had recurrence (recurrence rate 5.9%). RFCA for AT is an effective and curative treatment in selected cases.
Aortic Valve Stenosis ; Atrial Appendage ; Barotrauma ; Cardiomyopathies ; Catheter Ablation* ; Catheters ; Coronary Sinus ; Electric Stimulation ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Follow-Up Studies ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Pulmonary Valve Stenosis ; Recurrence ; Sinoatrial Node ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Thoracotomy ; Wolff-Parkinson-White Syndrome

BACKGROUND: Antidromic reentrant tachycardia(ART), in which an accessory atrioventricular pathway is used as the anterograde limb of an atrioventricular reentrant tachycardia, has been documented clinically in less than 10% of patients with the Wolff-Parkinson-White(WPW) syndrome. The wide QRS complex makes the distinction between antidromic AV reentrant tachycardia and ventricular tachycardia somewhat difficult. The purpose of this study is to evaluate the clinical and eoectrophysiologic characteristics of the antidromic reentrant tachycardia. METHODS AND RESULTS: During the electrophysiologic study of 355 patients, from December 1986 to April 1995, referred for evaluation of Wolff-Parkinson-White syndrome, 18(5.1%) patients had preexcited reciprocating tachycardia. 1) The age of the antidromic reentrant rnchycardia patients ranged from 15 to 53 years(28+/-12) and the mean age was younger than that of orthodromic reentrant tachycardia(ORT)patients(p<0.05). 2) Thirteen were male patients, five were females. 3) There were associated heart diseases in 3 cases. Two patients had Egstein's anomaly and ond had valvular heart disease. 4) The locations of accessory pathways(APs) documented on surface ECG were 7 left side(39%), 9 right side(50%)< 1 posteroseptal side(5.5%), and 1 anteroseptal side. 5) Nultiple bypass tracts were documented by electrophysiologic study in 7/18(38.9%) cases with ART, more common than cases with ORT(20/337(5.9%))(p<0.05). 6) 25 accessory pathways were documented by EPS in 18 patients(10 ;eft side, 11 right side, 2 posteroseptal side and 2 anteroseptal side). ART patients had more right sided AP(11/25,44%) than those with ORT(98/357, 27.5%), but ART patients had less posteroseptal AP(2/25, 8%)than those with ORT(63/357, 17.6%). 7) The types of ECG patterns naturally occurred were LBBB(11 cases), RBBB(6cases), and atrial fibrillation(4 cases). 8) The types of induced tachycardia in electrophysiologic study were 11 antidronic reentrant tachycardia, 10 orthodromic reentrant tachycardia, 7 reentrant tachycardia using two accessory bypass tracts, 3 AVnodal reentrant tachycardia, and 5 atrial fibrillations. CONCLUSION: ART patients were younger and had more multiple tracts than those with ORT. ART patients had less posteroseptal AP than ORT patients and more right sided AP than ORT patients. The posteroseptal AP was used as retrograde limb only.
Accessory Atrioventricular Bundle ; Atrial Fibrillation ; Electrocardiography ; Extremities ; Female ; Heart Diseases ; Heart Valve Diseases ; Humans ; Male ; Tachycardia ; Tachycardia, Reciprocating ; Tachycardia, Ventricular ; Wolff-Parkinson-White Syndrome

The delivery of single His-refractory ventricular extra-stimulus during supraventricular tachycardia is useful to identify the mechanism of the tachycardia. We present the different responses based on the ventricular extra-stimulus site. Our findings demonstrate that the atrial activation via an accessory pathway was not advanced based on the ventricular pacing site. Therefore, atrioventricular tachycardia could masquerade as atrioventricular nodal reentrant tachycardia.
Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular*

Anterograde and retrograde conduction properties of dual AV nodal pathways were analyzed in 15 patients having no accessory pathway and showing dual AV nodal pathways during extrastimulation. Four patients in whom the supraventricular tachycardia of common type (common type SVT) was induced during electrophysiological study were classified into group A. The remained 11 patients in whom the common type SVT was not induced were classified into group B. There was a history of paroxysmal supraventricular tachycardia(PSVT) in all of group A but none of group B. Among the properties of dual AV nodal pathways, effective refractory period (ERP) of anterograde fast pathway (FP) and retrograde FP were not different in both group. Maximal AH interval of anterograde slow pathway (SP) was significantly shorter in group A than in group B (P<0.01). In group A, all patients had intact ventriculoatrial (VA) conduction, but in group B, 5 patients had no VA conduction. The paced atrial cycle length producing Wenckebach block (WBCL) and the paced ventricular cycle length producing retrograde VA block (VABCL) were significantly shorter in group A the in group B (p<0.05). There were two patients showing retrograde dual AV nodal pathways. The common type SVT was not induced in both of them probably due to long ERP of retrograde FP. In conclusion, in patients with anterograde dual AV nodal pathways, the occurrence of common type SVT is highly related to anterograde slow pathway refractoriness (WBCL) and retrograde fast patway refactoriness (VABCL).
Humans ; Tachycardia, Atrioventricular Nodal Reentry* ; Tachycardia, Supraventricular