Atrioventricular Node Anatomy and Physiology: What Have We Learned from Catheter Ablation?
Atrioventricular (AV) nodal reentrant tachycardia (AVNRT) is the most frequent form of supraventricular tachycardia. Its electrophysiologic mechanism has been known for many years. In 1913 Mines (1) first performed experiments on the AV connections of the heart and explained the mechanism of this arrhythmia as follows:
“A slight difference in the rate of recovery of two divisions of the AV connexion might determine that an extrasystole of the ventricle, provoked by a stimulus applied to the ventricle shortly after activity of the AV connexion, should spread up to the auricle by that part of the AV connexion having the quicker recovery process and not by the other part. In such a case, when the auricle became excited by this impulse, the other portion of the AV connexion would be ready to take up the transmission again back to the ventricle. Provided the transmission in each direction was slow, the chamber at either end would be ready to respond and thus the condition once established would tend to continue.”
KeywordsCatheter Ablation Versus Node Slow Pathway Reentrant Tachycardia Versus Block
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