Shift in the earliest retrograde atrial activation site during the fast–slow form of atrioventricular nodal reentrant tachycardia after the radiofrequency modification of the atrioventricular node: is the atrium a necessary link?

摘要

Whether or not the perinodal atrium forms an upper link in the tachycardia circuit of the atypical form of AV nodal reentrant tachycardia (AVNRT) is controversial. We report a case with the fast–slow form of AVNRT in whom the earliest retrograde atrial activation site during the tachycardia changed from the right inferoseptum to the right superoseptum close to the His bundle without a change in the tachycardia cycle length following the radiofrequency energy applications to the earliest retrograde atrial activation site. It was speculated that a sub-atrial reentry with multiple atrial breakthroughs was the possible tachycardia mechanism in the present case.