Unusual Variant Forms of AV Nodal Reentrant Tachycardia

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Background: AV nodal reentrant tachycardias (AVNRT) are conventionally classified into one of slow-fast (S/F), slow-slow (S/S) and fast-slow forms (F/S) according to the atrial-His (A-H) and His-atrial (H-A) intervals and the site of the earliest retrograde atrial activation during the tachycardia. Each form is usually amenable to the slow pathway (SP) ablation at the right inferoseptal area. However, exceptional cases are rarely observed. Methods and Results: The electrophysiological data of a total of 1252 AVNRTs induced during the electrophysiological study were reviewed. Among them, a total of 4 types of variant forms were observed; (1) left-variant forms (6.0%; F/S and S/S) requiring SP ablation inside the coronary sinus (11 +⁄− 5 mm from the ostium); (2) irregular forms (3.6%) continuously exhibiting variable A-H and H-A intervals and Wenckebach type 2nd-degree AV block because of the decremental conduction over the longer lower common pathway and mimicking atrial tachycardia; (3) superior atypical forms (2.5%; S/S and F/S) exhibiting the long H-A interval during the tachycardia and earliest atrial activation at the right superoseptal area and requiring SP ablation at right supero- to midseptal areas; and (4) fast-fast or fast-intermediate forms (0.5%) exhibiting a short A-H interval with the earliest atrial activation at supero- to midseptal areas. Conclusions: Unusual variant forms of AVNRT were observed in approximately 13%. Conventional concepts for the mechanisms of AVNRT were not valid for those variant forms; which suggests that the tachycardia mechanisms and anatomical substrates of the different forms of AVNRT would not be uniform.

Unusual Variant Forms of AV Nodal Reentrant Tachycardia

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