Atrioventricular Reentrant Tachycardia

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Atrioventricular reentrant tachycardia, or atrioventricular reciprocating tachycardia, is a type of supraventricular tachycardia in which an accessory pathway provides an abnormal connection between the atria and ventricles. Patients with an accessory pathway are at risk for developing antidromic (wide complex, anterograde conduction through the accessory pathway and retrograde conduction through the atrioventricular node) or orthodromic (narrow complex, anterograde conduction through the atrioventricular node and retrograde conduction through the accessory pathway) reentrant rhythms. When dysrhythmias occur involving the accessory pathway, it is referred to as the Wolf-Parkinson-White syndrome.

 

Depiction of orthodromic and antidromic atrioventricular reentrant tachycardias possible with the Wolf-Parkinson-White syndrome. The red bars in panel A represent possible locations of the accessory pathway (type A, between LA and LV; type B, between RA and RV). The blue line in panel B represents orthodromic conduction (narrow complex) and the blue line in panel C represents antidromic conduction (wide complex). RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle.

Examples

ECG Showing Atrioventricular Reentrant Tachycardia

Orthodromic Atrioventricular Reentrant Tachycardia

This narrow complex tachycardia converted to sinus rhythm with adenosine. She was subsequently discovered to have a left-sided lateral accessory pathway with retrograde conduction that was successfully ablated (i.e., orthodromic atrioventricular reentrant tachycardia or orthodromic reciprocating tachycardia). This tachycardia is virtually indistinguishable from atrioventricular nodal reentrant tachycardia and can be safely treated with atrioventricular nodal blocking agents. It is important to keep orthodromic accessory conduction on the differential for narrow complex tachycardia and always obtain a post-conversion ECG to look for evidence of pre-excitation.
ECG Showing Antidromic Atrioventricular Reentrant Tachycardia

Antidromic Atrioventricular Reentrant Tachycardia

This wide complex tachycardia is essentially indistinguishable from ventricular tachycardia. Antidromic atrioventricular tachycardia is a macro reentrant circuit in which the signal travels anterograde through accessory pathway and retrograde through the atrioventricular node. Antidromic conduction was subsequently confirmed via an electrophysiology study.

References

  1. Wagner GS, Strauss DG. Marriott’s Practical Electrocardiography. 12th ed. Lippincott Williams & Wilkins; 2014.
  2. Moore EN, Spear JF, Boineau JP. Recent Electrophysiologic Studies on the Wolff-Parkinson-White Syndrome. New England Journal of Medicine. 1973;289(18):956-963.
  3. Benson DW, Cohen MI. Wolff-Parkinson-White syndrome: Lessons learnt and lessons remaining. Cardiology in the Young. 2017;27(S1):S62-S67.