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Atrioventricular Nodal Re-entry Tachycardia in Identical Twins: A Case Report and Literature Review.

Barake W, Caldwell J, Baranchuk A - Indian Pacing Electrophysiol J (2013)

Bottom Line: Successful but technically challenging slow pathway ablation was performed in both twins.This is the first reported case of confirmed AVNRT in identical twins which adds strong evidence to heritability of the dual AV node physiology and AVNRT.A review of the current literature regarding PSVT in monozygotic twins is provided.

View Article: PubMed Central - PubMed

Affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.

ABSTRACT
This report details the case of 17 year old identical twins who both presented with paroxysmal supraventricular tachycardia (PSVT). Electrophysiological studies revealed atrioventricular nodal reentry tachycardia (AVNRT) in both twins. Successful but technically challenging slow pathway ablation was performed in both twins. This is the first reported case of confirmed AVNRT in identical twins which adds strong evidence to heritability of the dual AV node physiology and AVNRT. A review of the current literature regarding PSVT in monozygotic twins is provided.

No MeSH data available.


Related in: MedlinePlus

The four panels show intracardiac tracings during ventricular pacing. A jump in VA conduction time was observed in both twins with similar jumps at similar pacing intervals i.e. a VA jump of 84ms from S2=380ms to S2=360ms (drive chain 600ms) in twin A, and a jump of 102ms from S2=400ms to S2=390ms in twin B (drive chain 600ms).
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Figure 1: The four panels show intracardiac tracings during ventricular pacing. A jump in VA conduction time was observed in both twins with similar jumps at similar pacing intervals i.e. a VA jump of 84ms from S2=380ms to S2=360ms (drive chain 600ms) in twin A, and a jump of 102ms from S2=400ms to S2=390ms in twin B (drive chain 600ms).

Mentions: Twin A: Basic intervals were within normal limits (Table 1). Retrograde properties were assessed at pacing cycle length of 600 ms and 400 ms. At both cycle lengths, retrograde activation was concentric and decremental but with demonstrable dual nodal physiology as seen by a VA jump (Figure 1). At 600 ms, the fast pathway effective refractory period (FPERP) was 360 ms, and slow pathway ERP (SPERP) 320 ms. At pacing cycle length of 400 ms, FPERP was 330 ms and SPERP 290 ms. Assessment of the antegrade properties was performed at pacing cycle length of 600 ms. Again dual pathway physiology was demonstrated with FPERP 300 ms and SPERP of less than 210 ms. The antegrade Wenckebach cycle length was less than 240 ms. Tachycardia was easily induced with the administration of 1 mcg/min of Isoproterenol.


Atrioventricular Nodal Re-entry Tachycardia in Identical Twins: A Case Report and Literature Review.

Barake W, Caldwell J, Baranchuk A - Indian Pacing Electrophysiol J (2013)

The four panels show intracardiac tracings during ventricular pacing. A jump in VA conduction time was observed in both twins with similar jumps at similar pacing intervals i.e. a VA jump of 84ms from S2=380ms to S2=360ms (drive chain 600ms) in twin A, and a jump of 102ms from S2=400ms to S2=390ms in twin B (drive chain 600ms).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539401&req=5

Figure 1: The four panels show intracardiac tracings during ventricular pacing. A jump in VA conduction time was observed in both twins with similar jumps at similar pacing intervals i.e. a VA jump of 84ms from S2=380ms to S2=360ms (drive chain 600ms) in twin A, and a jump of 102ms from S2=400ms to S2=390ms in twin B (drive chain 600ms).
Mentions: Twin A: Basic intervals were within normal limits (Table 1). Retrograde properties were assessed at pacing cycle length of 600 ms and 400 ms. At both cycle lengths, retrograde activation was concentric and decremental but with demonstrable dual nodal physiology as seen by a VA jump (Figure 1). At 600 ms, the fast pathway effective refractory period (FPERP) was 360 ms, and slow pathway ERP (SPERP) 320 ms. At pacing cycle length of 400 ms, FPERP was 330 ms and SPERP 290 ms. Assessment of the antegrade properties was performed at pacing cycle length of 600 ms. Again dual pathway physiology was demonstrated with FPERP 300 ms and SPERP of less than 210 ms. The antegrade Wenckebach cycle length was less than 240 ms. Tachycardia was easily induced with the administration of 1 mcg/min of Isoproterenol.

Bottom Line: Successful but technically challenging slow pathway ablation was performed in both twins.This is the first reported case of confirmed AVNRT in identical twins which adds strong evidence to heritability of the dual AV node physiology and AVNRT.A review of the current literature regarding PSVT in monozygotic twins is provided.

View Article: PubMed Central - PubMed

Affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.

ABSTRACT
This report details the case of 17 year old identical twins who both presented with paroxysmal supraventricular tachycardia (PSVT). Electrophysiological studies revealed atrioventricular nodal reentry tachycardia (AVNRT) in both twins. Successful but technically challenging slow pathway ablation was performed in both twins. This is the first reported case of confirmed AVNRT in identical twins which adds strong evidence to heritability of the dual AV node physiology and AVNRT. A review of the current literature regarding PSVT in monozygotic twins is provided.

No MeSH data available.


Related in: MedlinePlus