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. 2020 Nov-Dec;20(6):269-272.
doi: 10.1016/j.ipej.2020.06.005. Epub 2020 Jun 14.

The HAV pattern in pediatric patients with atrioventricular node reentrant tachycardia

Jose M Moltedo  1 , Mauricio S Abello  2 , David Doiny  2 , Estela Falconi  2 , María G Majdalani  2 , Carlos J Diaz  2 , Guillermo Macias  3 , Christopher S Snyder  4
Affiliations

The HAV pattern in pediatric patients with atrioventricular node reentrant tachycardia

Jose M Moltedo et al. Indian Pacing Electrophysiol J. 2020 Nov-Dec.

Abstract

Objectives: The purpose of this study is to assess the prevalence of a His-Atrial-Ventricular (HAV) pattern, i.e. the atrial electrogram following the His bundle -HB- electrogram and preceding the ventricular one, on the catheter placed in the His position in pediatric patients during typical atrioventricular node reentry (AVNRT).

Materials and methods: The pediatric electrophysiology databases of two separate institutions were queried for patients with a diagnosis of AVNRT. Demographic, clinical data and the electrophysiology study (EPS) information were assessed.

Results: Thirty-nine consecutive patients were included. Twenty-five were female. The average age at the time of the EPS was 12 ± 3.7 years. Induction was achieved with atrial pacing in 23, with a single atrial extra stimulus in 8 and with dual atrial extra stimuli in 8. Isoproterenol was needed to induce tachycardia in 21. Tachycardia cycle length averaged 320 ± 50 ms. An HAV pattern was present in 35 (74%) of the patients, and in 100% of the patients younger than 8.

Conclusions: An HAV pattern on the catheter placed in the His position, is common in pediatric patients with AVNRT, occurring in up to 74% of the patients in this population, being more common in younger patients.

Keywords: Supraventricular tachycardia- AV nodal Reentry tachycardia-children.

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Conflict of interest statement

Declaration of competing interest The authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
A. In sinus rhythm, the first four channels show the surface ECG. There are catheters positioned in the high right atrium (HRA), the coronary sinus (CS) and in the His position (HBE). In the HB channel (HBE 1–2 and 3–4) three electrograms can be identified, the atrial (A), the His bundle (H) and the ventricular (V) electrograms. B. During AVNRT, the H-A-V pattern is observed, with the atrial (A) electrogram following the His bundle (H) electrogram and preceding the ventricular one (V).
Fig. 2
Fig. 2
A. In sinus rhythm, the first four channels show the surface ECG. There are catheters positioned in the His position (HBE), in the coronary sinus (CS) and in the right ventricular apex (RVA). In the HBE three electrograms can be identified, the atrial (A), the His bundle (H) and the ventricular (V) electrograms. The atrial component in the HBE is larger than in Fig. 1. B. During AVNRT, the H-A-V pattern is observed, with the atrial (A) electrogram following the His bundle (H) electrogram and preceding the ventricular one (V).
Fig. 3
Fig. 3
The first four channels show the surface ECG. There are catheters positioned in the His position (HBE), in the coronary sinus (CS) and in the right ventricular apex (RVA). One atrial extra stimulus at 270 ms is placed, pacing from the proximal dipole of the catheter placed in the CS, there is a prolongation of the AH interval and tachycardia is induced. In the atrial extra stimulus, the HBE channel shows the atrial (A) electrogram, followed by the His (H) electrogram and then the ventricular (V) one. When tachycardia is induced the H-A-V pattern is observed.
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