Reappraisal of resetting response to locate the antegrade pathway in slow-fast atrio-ventricular nodal re-entrant tachycardia

Typical atrio-ventricular nodal re-entrant tachycardia (AVNRT) can occasionally remain easily inducible after slow pathway (SP) modification in lower Triangle of Koch (TOK). Analysis of resetting response by delivering atrial premature depolarizations (APD) from various sites (TOK, right atrium, cor...

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Published inIndian pacing and electrophysiology journal Vol. 20; no. 6; pp. 290 - 292
Main Authors Bera, Debabrata, Sarkar, Rakesh, Joshi, Radhey Shyam, Kar, Ayan, Mukherjee, Sanjeev S.
Format Journal Article
LanguageEnglish
Published Elsevier B.V 01.11.2020
Elsevier
Subjects
APD
Atrial extra-stimulus
AVNRT
Case Report
Resetting response
Slow pathway localization
Slow pathway localization
Resetting response
APD
Atrial extra-stimulus
AVNRT
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Summary:Typical atrio-ventricular nodal re-entrant tachycardia (AVNRT) can occasionally remain easily inducible after slow pathway (SP) modification in lower Triangle of Koch (TOK). Analysis of resetting response by delivering atrial premature depolarizations (APD) from various sites (TOK, right atrium, coronary sinus and left atrium) can pin-point the culprit SP serving as the antegrade limb of the tachycardia circuit. However, the maneuver is under-utilized by most centers. We describe a case where anatomical SP modification in TOK failed to cure the arrhythmia. The resetting maneuver performed subsequently, helped us to rule out leftward inferior extension of SP and suggested right inferior SP as essential part of AVNRT circuit. Further ablation was performed at M1-M2 region (on the right side) to achieve success.
ISSN:0972-6292
0972-6292
DOI:10.1016/j.ipej.2020.08.007