IMR Press / RCM / Volume 25 / Issue 3 / DOI: 10.31083/j.rcm2503109
Open Access Review
The Upper Common Pathway in Atrioventricular Nodal Reentrant Tachycardia: A Comprehensive Review of Evidence and Current Perspectives
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1 Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
2 Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
*Correspondence: superstar@catholic.ac.kr (Young Choi)
Rev. Cardiovasc. Med. 2024, 25(3), 109; https://doi.org/10.31083/j.rcm2503109
Submitted: 24 October 2023 | Revised: 23 November 2023 | Accepted: 1 December 2023 | Published: 15 March 2024
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia, and its diagnostic and therapeutic approaches have been well-established. Traditionally, AVNRT is understood to be an intranodal reentry having two bystander pathways; the upper common pathway (UCP) which connects to the atrium and the lower common pathway which connects to the ventricle. However, the existence of the UCP remains a subject of ongoing debate. The assertion of the UCP’s presence is supported by electrophysiological evidence suggesting that the atrium is not essential for the perpetuation of AVNRT. Nonetheless, numerous anatomical studies have failed to identify any structure that could be conclusively designated as the UCP. The histological and electrophysiological characteristics of the slow and fast pathways, which are the core components of AVNRT, suggest the inclusion of atrial myocardium in the reentry circuit. While clear interpretation of these discrepancies remains elusive, potential explanations may be derived from existing evidence and recent research findings concerning the actual AVNRT circuit.

Keywords
atrioventricular nodal reentrant tachycardia
upper common pathway
anatomy
atrioventricular node
nodoventricular bypass tract
nodofascicular bypass tract
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