Shortcut Link Between the Fast and Slow Pathways and the Mechanism of Cure in Atrioventricular Nodal Reentrant Tachycardia by Catheter Ablation

The mechanism of cure in AV nodal reentrant tachycardia (AVNRT) by catheter ablation has not been fully clarified. We hypothesized that disruption of a shortcut link between the fast and slow pathways is responsible for the elimination of tachycardia. Results: AVNRT was eliminated in 20 patients by catheter ablation. In five patients (25%; group 1) slow pathway conduction disappeared 1 week after ablation. In six patients (30%; group II), the effective refractory period of the slow pathway was prolonged by more than 50 ms (212 ± 81 ms vs 340 ± 81 ms; P < 0.05). In the remaining nine patients (45%; group III), there was no change in the refractory period (270 ± 65 ms vs 273 ± 74 ms), although tachycardia was not inducible. A shortcut link between the fast and slow pathways was examined by comparing the A-H intervals over the slow pathway during the tachycardia and during atrial pacing at the tachycardia cycle length. Prior to ablation, a shortcut link was assumed in 1 of group I patients, 2 of group II patients, and 8 of group III patients. Of the 9 patients in whom the slow pathway was not impaired after ablation (group III), 8 patients were found to have a shortcut link, while 8 of 11 patients with impairment of the slow pathway after ablation (groups I and II) had no shortcut link between the fast and slow pathways (P < 0.05). Conclusion: In patients with a shortcut link between the fast and slow pathways, slow pathway conduction itself does not need to be impaired to eliminate the AVNRT, whereas in patients without this shortcut link, slow pathway conduction must be impaired.