Sustained slow pathway conduction: Superior to dual atrioventricular node physiology in young patients with atrioventricular nodal reentry tachycardia?

Background: Young patients with atrioventricular nodal reentry tachycardia (AVNRT) frequently do not display discrete dual AV node physiology (DAVNP) as classically defined. The purpose of the study was to investigate the prevalence of sustained slow pathway conduction (SSPC; PR > RR during atrial pacing) in young patients with AVNRT and compare it to dual atrioventricular node physiology. Methods: The presence of SSPC and DAVNP was prospectively assessed before and after radiofrequency catheter ablation in 61 young patients (age 4-23 years) with typical AVNRT. Results: Prior to ablation, 32 (52%) displayed DAVNP, while 46 (75%) displayed SSPC; 7 patients (11%) had neither marker. Patients with DAVNP were older than those without (15 +/- 3 vs 13 +/- 4, P = 0.027) and the prevalence increased with age (38% < 13 years, 50% 13-15, 70% > 15, P = 0.041), while SSPC showed no age predilection. Patients under 13 years displayed SSPC more commonly than DAVNP (81% vs 38%, P = 0.004). DAVNP persisted after ablation in 10/32 (31%) patients, compared to 6/46 (13%) with persistent SSPC after ablation. The ability to use loss of the marker (present before, absent after ablation) as a surrogate for successful ablation was greater for SSPC than for DAVNP (66% vs 36%, P = 0.001). Conclusion: SSPC is more common than DAVNP in young patients with AVNRT. SSPC is eliminated more frequently than DAVNP after acutely successful ablation, and appears to be a better indicator of the substrate for AVNRT. Elimination of SSPC may serve as a useful surrogate endpoint for slow pathway ablation.