Electrophysiological manifestations of rare supra-ventricular tachycardias with concealed nodo-ventricular fibers

Wei Wei, Caihua Sang, Sulin Zheng, Roderick Tung, Xunzhang Wang, Yumei Xue, Yuanhong Liang, Shangming Song, Tongbao Liu, Deyong Long, Yang Liu, Jianzeng Dong, Changsheng Ma, Shulin Wu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: To clarify the electrophysiological mechanism of supra-ventricular tachycardias (SVT) with concealed nodo-ventricular (NV) fibers. Methods: We studied the intra-cardiac electrograms during electrophysiological study (EPS) of three cases of SVT which concerned concealed NV fibers. Electrophysiological maneuvers including right ventricular apex entrainments, RS2 stimuli, adenosine triphosphate injection and so on were done for differential diagnosis before ablation. Results: Among these patients, one had atrio-ventricular nodal reentrant tachycardia (AVNRT) with a bystander NV fiber; the other 2 had NV fiber mediated orthodromic reentrant tachycardias (NVRT). VA dissociation was observed during SVT in all 3 cases with an antegrade His bundle conduction sequence. Ventricular stimulation at His refractory period reset the H-H intervals and the V-V intervals sequentially, suggesting the existence of a retrogradely conductive accessory pathway. Adenosine injection could terminate these tachycardias. The cycle length of an NVRT prolonged during the status of functional right bundle branch block, suggesting that the fiber located on the right side. Multiple QRS fusion morphologies during ventricular entrainments or ventricular stimulation at His refractory period at a fixed position could be observed in these cases. Conclusions: Concealed NV fibers can either mediate orthodromic reentrant tachycardia or be a bystander of AVNRT. V-A dissociation usually occur during such SVTs. Dissociation of H and V due to entrainment of right ventricular apex is a newly discovered maneuver to differentiate AVNRT from NVRT.

Original languageEnglish (US)
Pages (from-to)31-38
Number of pages8
JournalJournal of Interventional Cardiac Electrophysiology
Issue number1
StatePublished - Oct 2021
Externally publishedYes


  • Ablation
  • Differential diagnosis
  • Electrophysiological mechanism
  • Nodo-ventricular fiber

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


Dive into the research topics of 'Electrophysiological manifestations of rare supra-ventricular tachycardias with concealed nodo-ventricular fibers'. Together they form a unique fingerprint.

Cite this