Author + information
- Received March 15, 2017
- Revision received June 22, 2017
- Accepted July 13, 2017
- Published online December 18, 2017.
- Frederick T. Han, MD∗ (, )
- Eric M. Riles, MD, MPH,
- Nitish Badhwar, MD and
- Melvin M. Scheinman, MD
- Department of Medicine, University of Utah Health Sciences Center, Division of Cardiovascular Medicine, Salt Lake City, Utah
- ↵∗Address for correspondence:
Dr. Frederick T. Han, University of Utah Health Sciences Center, Division of Cardiovascular Medicine, 30 North 1900 East, Room 4A-100 SOM, Salt Lake City, Utah 84132.
Objectives This study sought to describe the clinical features and sites of successful ablation for incessant nodofascicular (NF) and nodoventricular (NV) tachycardias.
Background Incessant supraventricular tachycardias have been associated with tachycardia-induced cardiomyopathies and have been previously attributed to permanent junctional reciprocating tachycardias, atrial tachycardias, and atrioventricular nodal re-entrant tachycardias. Incessant concealed NF and NV tachycardias have not been described previously.
Methods Three cases of incessant concealed NF and NV re-entrant tachycardias were identified from 2 centers.
Results The authors describe 3 cases with incessant supraventricular tachycardia resulting from NV (2 cases) and NF (1 case) pathways. Atrioventricular nodal re-entrant tachycardia was excluded by His synchronous premature ventricular complexes that either delayed or terminated the tachycardia. Ventricular pacing showed constant and progressive fusion in cases 1 and 3. In 2 cases, there was spontaneous initiation with a 1:2 response (cases 1 and 3); the presence of retrograde longitudinal dissociation or marked decremental pathway conduction in cases 1 and 3 sustains these tachycardias. The NV pathway was successfully ablated in the slow pathway region in case 3 and at the right bundle branch in case 1. The NF pathway was successfully ablated within the proximal coronary sinus in case 2.
Conclusions This is the first report of incessant supraventricular tachycardia using concealed NF or NV pathways. These tachycardias demonstrated spontaneous initiation from sinus rhythm with a 1:2 response and retrograde longitudinal dissociation or marked decremental pathway conduction. Successful ablation was achieved at either right-sided sites or within the coronary sinus.
Dr. Han has received research support from Boston Scientific and Abbott; and honoraria from Biotronik. Dr. Scheinman is a speaker for St Jude Medical, Boston Scientific, Medtronic, Biosense-Webster, and Biotronik at Fellows Programs. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 15, 2017.
- Revision received June 22, 2017.
- Accepted July 13, 2017.
- 2017 American College of Cardiology Foundation
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