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- W2486560906 abstract "neuvers were elegant, and the informed discussion provided a nice review of differential diagnosis in this setting. However, I beg to differ regarding the conclusion of the authors. The presented case is compatible with atypical atrioventricular nodal reentrant tachycardia (AVNRT), provided that the model of reentry through the inferior right and left nodal extensions is taken into account. 2 First, true nodoventricular pathways are rare, and concealed ones extremely rare. Second, it is of interest that the earliest retrograde atrial activation was mapped inside the coronary sinus ostium and not the proximal His. This is against a concealed nodoventricular pathway, but compatible with a relatively short left inferior nodal extension. Third, resetting of the tachycardia (ie, advancing the next atrial electrogram) with His-synchronous extrastimuli is considered a strong diagnostic criterion to exclude AVNRT. Paradoxical delay may also indicate an operating pathway although data are few. Both rules are subject to exceptions. We have previously demonstrated that resetting of typical AVNRT may occur with almost His-synchronous left inferoparaseptal pacing. 3 Atypical AVNRT may also be reset in this way: In Figure 3, a ventricular extrastimulus is delivered before the expected His bundle depolarization; thus, it may well have captured the antidromic slow pathway, conducted with a decrement, and resulted in delayed retrograde activation of the atrium. The A-A-V response may be compatible with fast-slow AVNRT as the authors state. In addition, although unusual, atypical AVNRT can be induced by atrial pacing in the presence of a relatively slow fast pathway, as expected in a 71-year-old patient." @default.
- W2486560906 created "2016-08-23" @default.
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- W2486560906 date "2013-01-01" @default.
- W2486560906 modified "2023-09-24" @default.
- W2486560906 title "To the Editor—Resetting atrioventricular nodal reentrant tachycardia: The impact of nodal extensions I really enjoyed reading the recent case presentation of a long RP tachycardia by Ho and Fischman. 1 Diagnostic ma-" @default.
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