Supraventricular Arrhythmia 2 - European Society of Cardiology

18 Pages·2011·0.7 MB·English

Supraventricular Arrhythmia 2:

AV Nodal Reentrant Tachycardia (AVNRT) and

Ectopic Atrial Tachycardia (EAT)

Prof. Dr. Hein Heidbuchel

Cardiology - Electrophysiology

University Hospital Gasthuisberg

University of Leuven, Belgium

EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
Typical Slow / Fast

FFPP
?
SSPP
Atypical ...
Fast / Slow /
Slow Slow
FP
?
SP
SP SP
EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
AVNRT Subtype Classification

• Based upon:
1. Pathway used for antegrade conduction (jump?),
2. Pathway used for retrograde conduction (mapping),

3. Values of AH and HA (tachycardia and pacing): LCP?
4. Other evidence for or against lower common pathway.
Heidbuchel & Jackman, Europace 6:316-329 (2004)
EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
Incremental Atrial Pacing: FP > SP

(with 1-to-1 antegrade SP conduction)

EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
Mapping the site of Earliest Atrial Activation

80 80
EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
Absence of lower common pathway

Slow/Fast: HA = HA - HA = 65 - 65 ms = 0 ms
p t
EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
Typical Slow/Fast AVNRT

FFPP
?
SSPP
AHt ≥200 ms (364
71; 245-510 ms)
Anteroseptal exit (site of earliest atrial activation)

HAt 45 15 (20-95 ms); HAp 45 18; (15-95 ms): HA -1 7 ms

Usually no other arguments for Lower Common Pathway (10%)
77%
Heidbuchel & Jackman, Europace 6:316-329 (2004)
EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
Atypical AVNRT Forms

Slow / Slow Posteroseptal exit
AHt ≥ 200 ms (323 52; 200-400 ms)
HAt 136 65 (60-315 ms)
HAp ≥70 ms (128 52; 60-215 ms)
Lower Common Pathway in 84%
Posteroseptal exit
Fast / Slow
AHt < 200 ms (135 32)
HAt always >150 ms
SP
HAp: no 1:1 retrograde
FP ??
LCP in all
?
SP
11%
?
Undetermined
SP
5%
N = 344
Heidbuchel & Jackman, Europace 2004
?
EHRA Invasive EP Course
7%
February 25th 2011– Hein Heidbuchel
Electrogram-guided, anatomical SP ablation

Mapping of potentials, indicating slow pathway activation.
Haïssaguerre et al. Circ 1992

Jackman et al. NEJM 1992

Due to activation of a discrete pathway,

or the functional result of non-uniform anisotropic conduction...?

EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel
Ablation Approach

RAA
CS
RAA
CS
HB
HB
?
Abl
Abl
RAO LAO
• during sinus rhythm, without isoproterenol administration, for optimal catheter stability
• ablation catheter: 4 mm tip; curve reaching the tricuspid annulus (2.5 inch or 3 inch)
• no temperature control
• start 20 W; maximal 40 W
• combined approach: electrogram-guided start (Asp); anatomy-based extensions
EHRA Invasive EP Course
February 25th 2011– Hein Heidbuchel