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(Circulation. 1999;99:659-665.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Characterization of Atrioventricular Nodal Reentry With Continuous Atrioventricular Node Conduction Curve by Double Atrial Extrastimulation

Chi-Tai Kuo, MD; Kuo-Hung Lin, MD; Nye-Jan Cheng, MD; Po-Hsien Chu, MD; Tsu-Shiu Hsu, MD; Cheng-Wen Chiang, MD; Ying-Shiung Lee, MD

From the Department of Cardiology, Chang Gung University, and Chang Gung Memorial Hospital–Linkou, Taiwan.

Correspondence to Chi-Tai Kuo, MD, Chang Gung Memorial Hospital, 199 Tun Hwa N Rd, Taipei, Taiwan. E-mail chitai{at}adm. cgmh.com.tw

Background—Characterization of typical atrioventricular nodal reentrant tachycardia (AVNRT) with continuous AVN conduction (A₁A₂/A₂H₂) curves by double atrial extrastimulation (A₁A₂A₃) has never been systematically studied.

Methods and Results—This study was composed of 33 patients with typical AVNRT and continuous AVN conduction curves (group 1) and 103 patients with AVNRT and discontinuous AVN conduction curves (group 2). Using A₁A₂A₃ with predefined fast pathway–conducted A₂, we examined the effects of slow pathway ablation on the A₂A₃/A₃H₃ curves in both groups. In group 1, anterograde AVN effective refractory period (272±33 versus 277±47 ms, P>0.05) and AVN Wenckebach block cycle length (320±45 versus 343±59 ms, P>0.05) remained unchanged after ablation. A₂H₂max was shorter in group 1 than group 2 (237±89 versus 395±72 ms, P<0.05) at baseline. It shortened in group 2 (395±72 versus 221±78 ms, P<0.001) but remained unchanged in group 1 (237±89 versus 214±59 ms, P>0.05) after ablation. A₁A₂A₃ could further disclose discontinuous A₂A₃/A₃H₃ curves in 29 patients of group 1. A₃H₃max shortened in both groups (375±81 versus 238±82 ms, P<0.001, and 419±104 versus 220±78 ms, P<0.001, respectively) in a similar fashion. Successful ablation resulted in loss of the left portion of the A₂A₃/A₃H₃ curves in the 4 patients of group 1 with continuous A₂A₃/A₃H₃ curves.

Conclusions—Use of A₁A₂A₃ could expose discontinuous A₂A₃/A₃H₃ curves in most patients with continuous A₁A₂/A₂H₂ curves. Significant shortening of A₃H₃max after ablation may be indicative of successful elimination of AVNRT.

Key Words: atrioventricular node • catheter ablation • tachycardia • electrophysiology

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