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Electrophysiological Manifestations of Rare Supra-ventricular Tachycardias with Concealed Nodo-ventricular Fibers
  • +11
  • Wei Wei,
  • Caihua Sang,
  • Sulin Zheng,
  • Roderick Tung,
  • Xunzhang Wang,
  • yumei xue,
  • Yuanhong Liang,
  • Sangming Song,
  • Tongbao Liu,
  • Deyong Long,
  • Yang Liu,
  • Jian zeng Dong,
  • Chang Sheng Ma,
  • Shulin Wu
Wei Wei
Guangdong Cardiovascular Institute
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Caihua Sang
Beijing An Zhen Hospital
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Sulin Zheng
The First People’s Hospital of Shunde
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Roderick Tung
University of Chicago Medical Center
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Xunzhang Wang
Cedars-Sinai Health System
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yumei xue
Guangdong Cardiovascular Institute
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Yuanhong Liang
Guangdong Cardiovascular Institute
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Sangming Song
Shandong Provincial Hospital
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Tongbao Liu
Shandong Provincial Hospital
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Deyong Long
Capital Medical University
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Yang Liu
Guangdong Cardiovascular Institute
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Jian zeng Dong
Beijing Anzhen Hospital Capital Medical University
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Chang Sheng Ma
Beijing An Zhen Hospital
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Shulin Wu
Guangdong Cardiovascular Institute
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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.