Abstract:
Objective To summarize the electrophysiological characteristics, differential diagnosis and ablation methods of atypical atrioventricular nodal reentry tachycardia (AVNRT) with eccentric activation in coronary sinus (CS).
Methods The clinical data of 524 patients with AVNRT who underwent ablation in the Department of Cardiology, Zhongshan Hospital from January 2014 to December 2018 were collected retrospectively.Among them, there were 16 atypical AVNRT patients with eccentric activation in CS, including 6 males and 10 females, with an average age of (56.6±11.4) years.The electrocardiogram (ECG) and intracardiac eletrogram (IEGM) features, induction mode, differential diagnosis and ablation strategy were analyzed.
Results Generally, the ECG of AVNRT with eccentric activation pattern in the CS electrical signals demonstrated a negative P waves in lead Ⅱ, Ⅲ, AVF and a longer RP interval than PR interval.During the occurrence of an arrhythmia, 12 patients exhibited 1:1 atrioventricular conduction, 4 patients exhibited AV dissociation with 2:1 or 3:1 conduction.Additionally, 13 patients could be easily identified by apical ventricular entrainment, 2 patients needed multiple ventricular entrainments to succeed, and 1 patient had occurred atrioventricular dissociation during multiple ventricular entrainments.14 patients could be successfully ablated at the posterior septum of right atrium near the tricuspid annulus, whilst 3 patients required CS ablation.
Conclusion Atypical AVNRT with eccentric activation in CS can be differentiated by ventricular entrainments.Most patients can be treated safely and effectively by conventional ablation strategy, whilst a few patients need CS ablation to be successfully treated.
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