The mechanisms of spontaneous termination of reentrant supraventricular tachycardias

Pablo A. Chiale, Adrián Baranchuk, Mario D. González, Rubén A. Sánchez, Hugo A. Garro, Pablo A. Fernández, Carlos Quiroga Avalos, Andres Enriquez, Marcelo V. Elizari

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) often terminate spontaneously, presumably due to changes in the electrophysiological properties of the reentrant circuit. However, the mechanism of spontaneous termination of these arrhythmias is incompletely understood. Methods We included 70 consecutive patients with reentrant supraventricular tachycardias (35 AVNRT, 35 AVRT) in whom the arrhythmia ended spontaneously during the electrophysiologic study. We determined in each patient the duration of the induced arrhythmia, site of block, beat-to-beat oscillations in tachycardia cycle-length (CL), A-H, H-V, H-A and V-A intervals. Results In 21/34 (62%) patients with AVNRT and 19/30 (63%) with orthodromic AVRT, tachycardia termination was preceded by progressive increase in tachycardia CL due to prolongation of the A-H interval (Mobitz type-I pattern). In 13/34 patients with AVNRT (38%) and 11/30 with orthodromic AVRT (37%), termination occurred suddenly without a preceding change in CL, with block ensuing retrogradely either in the fast AV nodal pathway or the accessory pathway (Mobitz type-II pattern). In 4/5 patients with antidromic AVRT the tachycardia ended at the retrograde limb with previous prolongation of the VA interval. Conclusion Spontaneous termination of AVNRT and AVRT is a time-related phenomenon. Despite different pathways being involved in these two reentrant tachycardias, termination can follow antegrade or retrograde block in similar ratio (60% antegradely and 40% retrogradely). Antegrade block is preceded by prolongation of the AH interval (Mobitz type-I), whereas retrograde block occurs unexpectedly in the retrograde limb (Mobitz type-II). Fatigue of conduction appears to be involved in this phenomenon.

Original languageEnglish (US)
Pages (from-to)151-158
Number of pages8
JournalInternational Journal of Cardiology
Volume191
DOIs
StatePublished - Jul 15 2015

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'The mechanisms of spontaneous termination of reentrant supraventricular tachycardias'. Together they form a unique fingerprint.

  • Cite this

    Chiale, P. A., Baranchuk, A., González, M. D., Sánchez, R. A., Garro, H. A., Fernández, P. A., Avalos, C. Q., Enriquez, A., & Elizari, M. V. (2015). The mechanisms of spontaneous termination of reentrant supraventricular tachycardias. International Journal of Cardiology, 191, 151-158. https://doi.org/10.1016/j.ijcard.2015.04.239