Adenosine‐Sensitive Atrial Reentrant Tachycardia Originating from the Atrioventricular Nodal Transitional Area

Iesaka, Yoshito; Takahashi, Atsushi; Goya, Masahiko; Soejima, Yohkoh; Okamoto, Yoshihiro; Fujiwara, Hideomi; Aonuma, Kazutaka; Nogami, Akihtko; Hiroe, Michiaki; Marumo, Fumiaki; Hiraoka, Masayasu

doi:10.1111/j.1540-8167.1997.tb00846.x

Cited by 125 publications

(160 citation statements)

References 27 publications

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“…Since this form of AT was sensitive to adenosine and verapamil, a calcium channel–dependent tissue has been suggested to be involved in the reentry circuit 4, 5, 6, 7, 8, 9. Indeed, cells with atrioventricular nodal or transitional‐type action potentials have been shown to be present in the atrioventricular valve 16, 17, 18.…”

Section: Discussionmentioning

confidence: 99%

“…These SPs, which were observed in the region along the septal tricuspid annulus close to the coronary sinus (CS) ostium, can be a marker for successful slow pathway ablation, suggesting that the SP reflects a substrate of slow pathway composed of calcium channel–dependent tissue. Meanwhile, it has also been shown that calcium channel–dependent tissue is involved in the tachycardia circuit of verapamil‐sensitive atrial tachycardia (AT) arising from the atrioventricular annulus 4, 5. We have recently shown that the underlying mechanism of the verapamil‐sensitive AT arising from the atrioventricular annulus is caused by reentry with a slow conduction zone (SCZ) involved in the circuit 6, 7.…”

Section: Introductionmentioning

confidence: 99%

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Slow Potential at the Entrance of the Slow Conduction Zone in the Reentry Circuit of a Verapamil‐Sensitive Atrial Tachycardia Originating From the Atrioventricular Annulus

Yamabe

Kanazawa

Ito

et al. 2018

JAHA

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BackgroundSlow conduction zone in a verapamil‐sensitive reentrant atrial tachycardia originating from atrioventricular annulus is composed of calcium channel–dependent tissue. We examined whether there was a slow potential (SP) at the entrance of the slow conduction zone.Methods and ResultsWe first identified the pacing site from where manifest entrainment and orthodromic capture of the earliest atrial activation site were demonstrated in 40 atrioventricular annulus patients with atrioventricular annulus. Radiofrequency energy was then delivered 2 cm proximal to the earliest atrial activation site in the direction of entrainment pacing site and gradually advanced toward the earliest atrial activation site until atrial tachycardia termination to localize the entrance of the slow conduction zone. Electrogram characteristics were analyzed at successful and unsuccessful ablation sites. During sinus rhythm, SP was observed at all 40 successful sites, but was observed at only 12 unsuccessful sites (P<0.0001). During sinus rhythm, there was no significant difference in electrogram amplitude nor width of atrial electrogram between successful and unsuccessful sites (0.407±0.281 versus 0.487±0.447 mV [P=0.1989] and 37.0±9.2 versus 38.9±8.0 ms [P=0.1773]); however, SP amplitude and width at successful sites were significantly greater than those at unsuccessful sites (0.110±0.049 versus 0.025±0.046 mV [P<0.0001] and 38.8±13.4 versus 8.1±13.2 ms [P<0.0001]). During atrial tachycardia, SP amplitude was significantly attenuated (0.088±0.042 versus 0.110±0.049 mV, P<0.001) and SP width was significantly prolonged (47.8±14.1 versus 38.8±13.4 ms, P<0.0001) at successful sites.Conclusions SP was observed during sinus rhythm at the entrance of the slow conduction zone; however, SP amplitude was attenuated and SP width was prolonged during atrial tachycardia, suggesting that SP reflects the characteristics of calcium channel–dependent tissue involved in atrioventricular annulus reentry circuit.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Slow Potential at the Entrance of the Slow Conduction Zone in the Reentry Circuit of a Verapamil‐Sensitive Atrial Tachycardia Originating From the Atrioventricular Annulus

Yamabe

Kanazawa

Ito

et al. 2018

JAHA

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“…[1][2][3][4][5][6][7][8] More recently, Ino et al described a case with a 2:1 exit block of repetitive focal activity in a SVC focus manifesting as a high right AT. 13 Furthermore, we found that AT can occur focally from different parts of the SVC, which was confirmed by the SVC angiogram showing the location of the successful ablation sites at various distances above the atriocaval junction and different positions within the SVC (Fig 7).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Focal AT is distinguished from macroreentrant AT by its electrophysiological characteristics and electropharmacological responses, and by the approaches to mapping and ablation of the tachycardia. 7,8 The underlying mechanism of focal AT is thought to be automaticity, triggered activity or atrial microreentry.…”

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confidence: 99%

Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena Cava.

Chang¹,

Lin²,

Chen³

et al. 2001

Jpn Circ J

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trial tachycardia (AT) originating focally from diverse anatomical structures in both atria has been well described. [1][2][3][4][5][6][7][8] Focal AT is distinguished from macroreentrant AT by its electrophysiological characteristics and electropharmacological responses, and by the approaches to mapping and ablation of the tachycardia. 7,8 The underlying mechanism of focal AT is thought to be automaticity, triggered activity or atrial microreentry. 7,8 Recently, Tsai et al reported an unusual form of focal atrial fibrillation (AF) triggered by ectopic beats originating from the superior vena cava (SVC), and radiofrequency (RF) ablation of the triggering SVC focus was safe and highly effective in eliminating the focal AF. 9 Theoretically, it is possible that focal electrical firing in the SVC could initiate AT in addition to AF; however, the mechanism of this type of focal AT remains unclear. In this study, we describe the distinct electrocardiograms and electrophysiological characteristics in 3 patients with focal AT originating from various parts of the SVC. The location of the successful RF site in the SVC was proven by multi-plane SVC angiography. All 3 patients underwent uneventful ablations of their SVC foci within a few seconds of RF current application. Methods PatientsThe study group were 3 patients with drug-refractory atrial tachyarrhythmias who were admitted for electrophysiological study and RF ablation therapy. Each patient had a focal AT originating from the SVC that had been diagnosed and confirmed by the electrophysiological study, SVC angiography and RF ablation. Two (cases 1 and 2) of the 3 patients did not have significant organic heart diseases detectable by physical examination, chest roentgenograms, echocardiography, and coronary angiography. The other patient (case 3) had one-vessel coronary artery disease. The definition of focal AT was based on previously established criteria. 7,10-12 Electrophysiological Study and RF AblationThe electrophysiological study was performed in a postabsorptive state after each patient gave written informed consent. All antiarrhythmic drugs except amiodarone were discontinued for at least 5 half-lives before the study. Two 6F quadripolar electrode catheters with a 5-mm interelectrode spacing were positioned at the high right atrium and the right ventricular apex, respectively, for pacing and recording. Another 6F quadripolar electrode catheter with a 10-mm interelectrode spacing was positioned across the tricuspid annulus to record the His bundle potential. A 6F decapolar electrode catheter with a 2-10-2-mm interelectrode spacing (Daig Corp) was positioned in the coronary sinus for recording and pacing. A 7F deflec- Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena CavaKuan-Cheng Chang, MD; Yu-Chin Lin, MD; Jan-Yow Chen, MD; Hsiang-Tai Chou, MD, PhD; Jui-Sung Hung, MDThe initiation of focal atrial tachycardia (AT) from the superior vena cava (SVC) remains unclear. In 3 patients (2...

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“…13,14 These ATs resemble the fast/slow form of AV node reentry with respect to ECG characteristics and electrophysiological properties. Earliest atrial activation is recorded from the low anteroseptal RA, and these tachycardias are sensitive to adenosine and verapamil.…”

Section: Focal Atrial Tachycardia: "Ring Of Fire"mentioning

confidence: 99%

Response to Adenosine Differentiates Focal From Macroreentrant Atrial Tachycardia

et al. 2002

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Background-We previously proposed that adenosine has mechanism-specific effects on atrial tachycardia (AT), such that adenosine terminates AT attributable to triggered activity, transiently suppresses automatic rhythms, and has no effect on macroreentrant AT. This, however, remains controversial, because other studies have reported that adenosine terminates reentrant AT. To clarify this issue, we used 3D electroanatomic mapping to delineate the tachycardia circuit and thereby determine whether the response to adenosine differentiates focal from macroreentrant AT. Methods and Results-We examined the effect of adenosine on 43 ATs in 42 consecutive patients (59Ϯ15 years of age; 26 female) who received adenosine during tachycardia and whose mechanism of AT was characterized by pharmacological perturbation, entrainment, 3D electroanatomic mapping, and results of radiofrequency ablation. Eight tachycardias were macroreentrant (noncavotricuspid isthmus-dependent), and 35 ATs were focal (either triggered or automatic). Adenosine administered during AT (at doses sufficient to result in AV block) terminated or transiently suppressed focal AT in 33 of 35 cases, whereas 8 of 8 macroreentrant ATs were adenosine insensitive (PϽ0.001). Twenty-eight of 35 focal ATs were located along the crista terminalis or tricuspid annulus. Conclusions-The response of AT to adenosine can immediately differentiate atrial tachycardia arising from a focal source from that attributable to macroreentry. This finding can be exploited to facilitate developing a focused, strategic ablative approach at the onset of a procedure.

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Adenosine‐Sensitive Atrial Reentrant Tachycardia Originating from the Atrioventricular Nodal Transitional Area

Abstract: There may be an entity of adenosine-sensitive atrial tachycardia probably due to focal reentry within the AV node or its transitional tissues without involvement of the AV nodal pathways. This tachycardia can be ablated without disturbing AV nodal conduction from the right atrial septum.

Cited by 125 publications

References 27 publications

Slow Potential at the Entrance of the Slow Conduction Zone in the Reentry Circuit of a Verapamil‐Sensitive Atrial Tachycardia Originating From the Atrioventricular Annulus

Slow Potential at the Entrance of the Slow Conduction Zone in the Reentry Circuit of a Verapamil‐Sensitive Atrial Tachycardia Originating From the Atrioventricular Annulus

Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena Cava.

Response to Adenosine Differentiates Focal From Macroreentrant Atrial Tachycardia

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