Dual Atrioventricular Nodal Nonreentrant Tachycardia: A Systematic Review

Background: Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT) is a relatively uncommon supraventricular tachycardia. The clinical characteristics and optimal management strategies are not well described. Methods: A systematic review of all reported cases of DAVNNT was performed. Articles were included if they described spontaneous tachycardias resulting from 1: 2 atrioventricular (AV) conduction as a result of two AV nodal pathways. Data sources included PubMed from 1950 to January 2011, article bibliographies, and the Google internet search engine. Results: Ultimately, 44 citations that reported 49 cases met inclusion criteria. DAVNNT is being reported with increasing frequency. Clinical characteristics were assessed using the 44 cases reported in the English language. Palpitations were the most common presenting symptom (89%). The majority of patients had a significant delay until the correct diagnosis was made (77%). The most common specific mistaken diagnosis was atrial fibrillation (32%) and five patients were diagnosed after referral for pulmonary vein isolation. Nine reports described association with a tachycardia-mediated cardiomyopathy. Catheter ablation has successfully treated all reported cases since 1994. Conclusions: DAVNNT is an uncommon arrhythmia being reported with increasing frequency. It is commonly mistaken for atrial fibrillation and is associated with a reversible tachycardia- mediated cardiomyopathy. Catheter ablation of the slow AV nodal pathway is curative and appears to be the therapy of choice, although more systematic study is required. (PACE 2011; 34: 1671-1681)