Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia

Yamabe, Hiroshige; Shimasaki, Yukio; Honda, Osamu; Kimura, Yuichi; Hokamura, Youichi

doi:10.1161/hc3601.096995

Cited by 37 publications

(34 citation statements)

References 36 publications

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“…Hence, in this study we observed a significant difference between the numbers of patients with typical and atypical forms. According to what had been noted in previous studies 9,[11][12][13][14][15] , atypical NAVT is infrequent, and even in light of modern electrophysiology knowledge, varied and/or multiple circuits of the atypical forms are still poorly understood, unlike the typical tachycardia circuit which is already well-established 1,2,5 .…”

Section: Resultsmentioning

confidence: 97%

“…In some of these studies, patients with the atypical form presented a higher incidence of some degree of nodal damage after RF emission (detected by analysis of A-H interval lengthening, increase of the A-V node refractory period or of Wenckebach point) resulting from RF catheter ablation in the posteroseptal region of the RA 11,14,15 . In any case, in every NAVT (typical or atypical) the presence of risk-predicting events during JET is considered an important marker for a permanent A-V block 3,[8][9][10][11][12]14 , much more than for transient TAVB.…”

Section: Discussionmentioning

confidence: 99%

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Contribuição da análise eletrofisiológica e anatômica do circuito atípico da taquicardia atrioventricular nodal

Silva¹,

Sá²,

Fagundes³

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjective: To analyze retrograde conduction during junctional ectopic tachycardia (JET) episodes and investigate the existence of a relationship between the presence of a retrograde block and the risk of atrioventricular block (AVB) development during radiofrequency ablation procedures in patients with nodal atrioventricular tachycardia (NAVT).Methods: 145 male and female patients aged 16-84 years, with NAVT who had undergone radiofrequency catheter ablation in the posteroseptal region of the right atrium were studied. Evaluation criteria were anatomical location and electrophysiological behavior of retrograde conduction during NAVT, in order to understand the nodal reentrant circuit (classifying the tachycardia as typical or atypical), and monitoring of retrograde conduction during JET episodes for riskpredicting AVB events.Results: Of the 145 patients studied, 132 (91%) met electrophysiological and anatomical criteria of the typical form of NAVT, and 13 (9%) of atypical form. During the ablation, 5.3% with the typical form and 30.8% of the atypical form presented risk events for AVB. After the ablation, complications were a total AVB episode in one patient and a firstdegree AVB episode in another in the typical group, and one first-degree AVB in the atypical group. All three episodes were preceded by risk events and resulted in permanent nodal injury. Conclusion:Patients with atypical NAVT presented higher percentages of risk events for atrioventricular block than did patients with the typical form (p=0.021).A careful observation of retrograde conduction during JET episodes is vital in order to avoid permanent damage in AV nodal conduction, such as TAVB, after the ablation procedure.

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Contribuição da análise eletrofisiológica e anatômica do circuito atípico da taquicardia atrioventricular nodal

Silva¹,

Sá²,

Fagundes³

et al. 2007

Arq. Bras. Cardiol.

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“…13,14 During constant stimulation from the distal coronary sinus (S1-S1ϭ600 ms), late atrial extrastimuli (S2) were delivered every eighth paced beat at the anterior approach (nϭ46), posterior approach (nϭ46), and inferoparaseptal mitral annulus (nϭ20). Stimulation of the anterior approach was obtained by positioning a pacing catheter just posterior and to the left of the catheter recording the His bundle at the level of the tendon of Todaro.…”

Section: Late Extrastimuli Delivered During Coronary Sinus Stimulationmentioning

confidence: 99%

“…This technique is frequently used to identify sites that participate in reentrant tachycardias. 13,14 In the present study, the same concept was applied to determine the wavefront path reaching the AV node during coronary sinus stimulation. Using this technique, the posterior and anterior approaches, but not the mitral annulus, could be dissociated from His bundle activation in most patients, consistent with a left-sided input to the AV node.…”

Section: Use Of Late Extrastimuli To Identify a Left Input To The Av mentioning

confidence: 99%

Demonstration of a Left Atrial Input to the Atrioventricular Node in Humans

et al. 2002

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Background-During right atrial stimulation, the anterior and posterior approaches provide inputs to the atrioventricular (AV) node. The purpose of the present study was to determine how activation proceeding from the left atrium reaches the AV node. Methods and Results-We studied AV nodal conduction during right and left atrial (coronary sinus) stimulation in 46 patients (27 women and 19 men; mean age, 46Ϯ4 years) who had structurally normal hearts. At an identical cycle length (600 ms), left atrial stimulation resulted in shorter A-H intervals than right atrial stimulation (73Ϯ3 ms versus 99Ϯ3 ms; PϽ0.05). In addition, atrial electrograms recorded close to the His bundle changed from near to far field potentials when stimulation was shifted to the left atrium. The A-H interval prolonged as the site of pacing was progressively moved from the distal to the proximal coronary sinus. During constant pacing from the distal coronary sinus, atrial activation close to the His bundle could be advanced by late extrastimuli delivered at the anterior and posterior approaches (up to 11Ϯ2 ms and 9Ϯ1 ms, respectively), without altering His bundle activation time. In contrast, late extrastimuli delivered at the inferoparaseptal mitral annulus advanced both the A and H electrograms in 19 of 20 patients, which is consistent with a left-sided input to the AV node. Right and left atrial stimulation resulted in similar AV nodal function. Conclusion-The mitral annulus provides a left atrial input to the human AV node.

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“…Experimental and clinical data suggest intranodal reentry or reentry circuits outside the nodal area. [3][4][5][6][7] Part of this controversy may be ascribed to an inconsistent definition of the AV node. The term "AV node" is often used for the compact node alone.…”

mentioning

confidence: 99%

Reentrant Circuits in the Canine Atrioventricular Node During Atrial and Ventricular Echoes

Loh

Kawara

et al. 2003

Circulation

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Background-The anatomic-electrophysiological correlation of AV nodal reentry is unclear. To localize reentrant circuits during atrial and ventricular echoes and to characterize sites of slow conduction and block, we correlated histology with electrophysiology of the AV node. Methods and Results-In 10 isolated dog hearts, extracellular electrical activity was recorded in Koch's triangle at 208 or 247 sites (interelectrode distance, 0.5 and 0.3 mm) after removal of 0.7 to 1.5 mm of overlying atrial tissue. Resection did not affect refractory periods. Five hearts were subjected to histology. Complete atrial echoes were induced in 1 heart, incomplete atrial echoes in 5 hearts. Unidirectional conduction block occurred at the atrial-transitional cell junction in the superior area. Zones of slow conduction arose at the atrial-transitional or the transitional-compact node junction in the inferior area. Complete reentrant circuits of ventricular echoes were obtained in 5 hearts. Unidirectional conduction block occurred at the compact node-transitional cell junction in the superior area. Localized zones of slow conduction arose at the junctions between the different types of tissue in the inferior area. Conclusions-In the dog heart, tissue architecture and functional dissociation between the inferior and the superior region of the AV node enable dual physiology and reentry. Slow conduction and functional conduction block occur at the junctions between the different types of tissue in the AV nodal area. Atrial echoes were enabled by conduction block at the atrial-transitional cell junction, whereas during ventricular echoes conduction block occurred at the compact node-transitional cell junction.

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Demonstration of the Exact Anatomic Tachycardia Circuit in the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia

Cited by 37 publications

References 36 publications

Contribuição da análise eletrofisiológica e anatômica do circuito atípico da taquicardia atrioventricular nodal

Contribuição da análise eletrofisiológica e anatômica do circuito atípico da taquicardia atrioventricular nodal

Demonstration of a Left Atrial Input to the Atrioventricular Node in Humans

Reentrant Circuits in the Canine Atrioventricular Node During Atrial and Ventricular Echoes

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