Teaching by illustrating — A classical case of AVNRT

Abstract

This editorial refers to ‘Diagnosis and treatment of atrioventricular nodal reentrant tachycardia: a case report illustrating clinical management and ablation strategy’, by J. Ector et al., doi: 10.1093/ehjcr/ytaa129. Atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common regular paroxysmal supraventricular tachycardia observed in adults. Unsurprisingly, after the development of percutaneous ablation techniques with adequate safety profiles late during the last century, it became a first-line target for treatment most notably through radiofrequency (RF) ablation. Perhaps more surprising are the remaining uncertainties regarding underlying mechanisms, more than 50 years after the first pathophysiological observations by Moe et al. 1 While the underlying re-entry mechanism of AVNRT is often used as a model to teach fundamentals of re-entrant tachycardia in general, both the exact anatomical substrate of the circuit pathways as well as its precise anatomical boundaries remain elusive. 2 Colloquially the treatment of AVNRT by catheter ablation is known as an ‘easy difficult’ procedure by early learners and expert operators alike. In the preceeding issue of the journal, Ector et al. 3 present a clinical case of AVNRT with careful documentation of relevant challenges related to diagnosis and acute treatment, while providing insights on guideline implementation and long-term management. The report serves as the inaugural manuscript for a new ‘Classical Case Reports’ series that aims to provide readers with didactic illustrations of classical findings, discussion of contemporary management guidelines, and teaching points in common clinical scenarios. In their report, the authors illustrate relevant anatomy through the use of conventional as well as innovative imaging approaches and discuss approaches for mitigation of procedural risk—in particular, the risk of complete AV block which is all but eliminated through the use of careful mapping and novel approaches to catheter manipulation. The editorial team hopes you will find educational value in this and forthcoming publications. Lead author biography Dr Tom De Potter leads the electrophysiology unit of the Heart Center in Aalst, Belgium where he has practiced cardiology since 2009. He currently holds an executive board position in the European Heart Academy, and is the EHRA scientific program committee co-chair for 2021-2022. He has joined the European Heart Journal – Case Reports editorial team since its inception as an associate editor, and became deputy editor for the ‘Classical Case Reports’ in 2019. Conflict of interest: none declared.