IMR Press / RCM / Volume 23 / Issue 11 / DOI: 10.31083/j.rcm2311369
Open Access Review
Atrioventricular Ring Tachycardias: Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia and Atrial Tachycardia Share a Common Arrhythmogenic Substrate—A Unifying Proposal
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1 Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, 371-8511 Gunma, Japan
*Correspondence:; (Yoshiaki Kaneko)
Academic Editor: Giacomo Mugnai
Rev. Cardiovasc. Med. 2022, 23(11), 369;
Submitted: 16 August 2022 | Revised: 17 September 2022 | Accepted: 9 October 2022 | Published: 28 October 2022
(This article belongs to the Special Issue Clinical Electrophysiology: Diagnosis and Treatment)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Our understanding of the variants of slow pathway (SP) and associated atypical atrioventricular (AV) nodal reentrant tachycardia (NRT) is still growing. We have identified variants extending outside Koch’s triangle along the tricuspid annulus, including superior, superoanterior and inferolateral right atrial SP and associated atypical, fast-slow AVNRT. We review the history of each variant, their electrophysiological characteristics and related atypical AVNRT, and their treatment by catheter ablation. We focused our efforts on organizing the published information, as well as some unpublished, reliable data, and show the pitfalls of electrophysiological observations, along with keys to the diagnosis of atypical AVNRT. The superior-type of fast-slow AVNRT mimics adenosine-sensitive atrial tachycardia originating near the AV node and can be successfully treated by ablation of a superior SP form the right side of the perihisian region or from the non-coronary sinus of Valsalva. Fast-slow AVNRT using a superoanterior or inferolateral right atrial SP also mimics atrial tachycardia originating from the tricuspid annulus. We summarize the similarities among these variants of SP, and the origin of the atrial tachycardias, including their anatomical distributions and electrophysiological and pharmacological characteristics. Moreover, based on recent basic research reporting the presence of node-like AV ring tissue encircling the annuli in adult hearts, we propose the term “AV ring tachycardia” to designate the tachycardias that share the AV ring tissue as a common arrhythmogenic substrate. This review should help the readers recognize rare types of SP variants and associated AVNRT, and diagnose and cure these complex tachycardias. We hope, with this proposal of a unified tachycardia designation, to open a new chapter in clinical electrophysiology.

atrioventricular nodal reentrant tachycardia
slow pathway
tricuspid annulus
atrial tachycardia
atrioventricular ring
adenosine sensitivity
21K08022/a Grant-in-Aid for Scientific Research from the Japanese Society for the Promotion of Science
Fig. 1.
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