Revealing the Origin of Typical and Atypical Forms of Atrioventricular Nodal Reentrant Tachycardia with a Compact Computer Model of Rabbit AV Node

Maxim Ryzhii1 and Elena Ryzhii2
1University of Aizu, 2Fukushima Medical University


Abstract

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of regular supraventricular arrhythmia. The AVNRT is electrophysiologically classified as typical (slow-fast) and much more rare atypical (fast-slow, and also slow-slow for humans) forms corresponding to anterograde-retrograde conduction sequence through the dual (fast, FP and slow, SP) pathway structure. The exact nature of the pathways interaction has yet to be established, despite numerous attempts to explain the mechanism of AVNRT. We have recently proposed a compact, multi-functional rabbit AV node model based on the Aliev-Panfilov cardiac cell model. The one-dimensional model includes dual pathways, primary pacemaking in the sinoatrial node, and subsidiary pacemaking in the slow pathway. Being tuned to the available experimental data, the AV node model demonstrates wide functionality, such as filtering high-rate atrial rhythms during atrial fibrillation and atrial flutter with Wenckebach periodicity. In addition, implementing the FP and SP ablation allows each pathway to be considered separately, which is suitable for AVNRT studies. As demonstrated experimentally, in mammalian hearts in the case of anterograde conduction, the FP has a significantly longer effective refractory period (ERP) than the SP. This may be a substrate for typical AVNRT at premature stimulation periods shorter than the ERP of the FP. On the other hand, the origin of atypical AVNRT is attributed to the retrograde stimulations from ventricles or His bundle. In this work, along with the typical AVNRT with the anterograde atrial origin, we simulated scenarios of both typical and atypical AVNRT originated by retrograde conduction from His bundle. The interaction of electrical conduction between SP and FP was visualized in the form of AV nodal ladder diagrams. The simulations demonstrated that difference in ERP between the FP and SP determines the type of AVNRT. Also, the study may explain why atypical AVNRT occurs much less frequently.