21. New Insights into Reentry Circuits from Mapping and Ablation of Atrioventricular Nodal Reentrant Tachycardia

  1. Mohammad Shenasa MD3,
  2. Gerhard Hindricks MD4,
  3. Martin Borggrefe MD5,
  4. Günter Breithardt MD6 and
  5. Mark E. Josephson MD7
  1. Tomos Walters1 and
  2. Jonathan M. Kalman2

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch21

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Walters, T. and Kalman, J. M. (2013) New Insights into Reentry Circuits from Mapping and Ablation of Atrioventricular Nodal Reentrant Tachycardia, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch21

Editor Information

  1. 3

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 4

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 5

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 6

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 7

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. 1

    Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia

  2. 2

    Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

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Keywords:

  • atrioventricular nodal reentrant tachycardia;
  • cardiac arrhythmia;
  • atrioventricular node;
  • catheter ablation;
  • triangle of Koch;
  • atrial myocardial cells;
  • optical mapping;
  • coronary sinus

Summary

Atrioventricular nodal reentrant tachycardia (AVNRT) is a very common cardiac arrhythmia and is due to reentry within the region of the atrioventricular junction. The anatomy of the atrioventricular (AV) node, including inferior extensions within the triangle of Koch and a transitional zone of cells interposed between the compact node and atrial myocardial cells, has been extensively investigated. The functional inputs to the AV node have been revealed to be multiple, from both sides of the interatrial septum. Despite this knowledge the precise nature of the reentry circuit and its variants remains elusive, with a variety of proposed models. Regardless, catheter ablation of the slowly conducting pathway inferior to the compact node, within the triangle of Koch or anterior to the ostium of the coronary sinus, is a highly effective method by which the circuit can be disrupted and AVNRT eliminated.