Electrophysiological Manifestations of Rare Supra-ventricular
Tachycardias with Concealed Nodo-ventricular Fibers
Abstract
Background Nodo-ventricular(NV) fiber-related reentrant tachycardias are
so rare that most of them were reported by case, while few reports have
summarized their common and individual features. Objectives To clarify
the electrophysiological mechanism of supra-ventricular tachycardias
(SVT) related to concealed NV fibers. Methods and Results We studied the
intra-cardiac electrograms during electrophysiological study of 3 cases
of SVT concerning concealed NV fibers. Maneuvers including ventricular
entrainments, His bundle refractory period ventricular stimuli,
adenosine triphosphate injection and so on were done for differential
diagnosis before ablation. Among these patients, one had AVNRT with a
bystander NV fiber, the other 2 had NV fiber-mediated orthodromic
reentrant tachycardias (NVRT). VA dissociation were observed during SVT
in all with antegrade His bundle conduction sequence. His bundle
refractory period ventricular stimuli reset tachycardias with resetting
of the H-H interval advancing the V-V interval, suggesting the existence
of an accessory pathway. The cycle length of an NVRT prolonged during
the status of functional right bundle branch block. Multiple QRS fusion
morphologies during ventricular entrainments on a fixed site could be
observed. Conclusions Concealed NV fibers can mediate orthodromic SVT or
be a bystander of AVNRT. V-A dissociation usually occur during such
SVTs. An NV fiber not only expresses the characteristics of an AP, but
also the characteristics of the AV node. Multiple QRS fusion
morphologies during ventricular entrainments or His bundle refractory
period ventricular stimuli on a fixed site can discriminate NV fibers
from NF fibers.