PDF(Pubmed)
Abstract：
Our understanding of the variants of slow pathway (SP) and associated atypical atrioventricular (AV) nodal reentrant tachycardia (NRT) is still growing. We have identified variants extending outside Koch\'s triangle along the tricuspid annulus, including superior, superoanterior and inferolateral right atrial SP and associated atypical, fast-slow AVNRT. We review the history of each variant, their electrophysiological characteristics and related atypical AVNRT, and their treatment by catheter ablation. We focused our efforts on organizing the published information, as well as some unpublished, reliable data, and show the pitfalls of electrophysiological observations, along with keys to the diagnosis of atypical AVNRT. The superior-type of fast-slow AVNRT mimics adenosine-sensitive atrial tachycardia originating near the AV node and can be successfully treated by ablation of a superior SP form the right side of the perihisian region or from the non-coronary sinus of Valsalva. Fast-slow AVNRT using a superoanterior or inferolateral right atrial SP also mimics atrial tachycardia originating from the tricuspid annulus. We summarize the similarities among these variants of SP, and the origin of the atrial tachycardias, including their anatomical distributions and electrophysiological and pharmacological characteristics. Moreover, based on recent basic research reporting the presence of node-like AV ring tissue encircling the annuli in adult hearts, we propose the term \"AV ring tachycardia\" to designate the tachycardias that share the AV ring tissue as a common arrhythmogenic substrate. This review should help the readers recognize rare types of SP variants and associated AVNRT, and diagnose and cure these complex tachycardias. We hope, with this proposal of a unified tachycardia designation, to open a new chapter in clinical electrophysiology.
摘要：
我们对慢通路（SP）和相关的非典型房室（AV）结折返性心动过速（NRT）的变体的理解仍在增长。我们已经确定了沿着三尖瓣环延伸到科赫三角形之外的变体，包括上级,上前和下外侧右心房SP和相关的非典型，快慢AVNRT。我们回顾了每个变体的历史，它们的电生理特征和相关的非典型AVNRT，以及通过导管消融治疗。我们集中力量整理发布的信息,以及一些未发表的，可靠的数据,并显示了电生理观察的陷阱，以及非典型AVNRT诊断的关键。上型的快慢AVNRT模拟了源自房室结附近的腺苷敏感性房性心动过速，可以通过消融周围区域右侧或Valsalva非冠状窦的上SP来成功治疗。使用上前或下外侧右心房SP的快慢AVNRT也模拟了源自三尖瓣环的房性心动过速。我们总结了SP的这些变体之间的相似性，房性心动过速的起源,包括它们的解剖分布和电生理和药理学特征。此外，根据最近的基础研究报告，在成人心脏中存在结节样房室环组织，我们提出术语“房室环心动过速”来指定共享房室环组织作为常见致心律失常底物的心动过速。这篇评论应该帮助读者认识到罕见类型的SP变异和相关的AVNRT，诊断和治愈这些复杂的心动过速。我们希望,有了这个统一的心动过速名称的建议，开启临床电生理学的新篇章.
