Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy.

Haı̈ssaguerre, Michel; Gaïta, Fiorenzo; Fischer, Bruno; Commenges, Daniel; Montserrat, P; d'Ivernois, C; Lemétayer, P; Warin, J F

doi:10.1161/01.cir.85.6.2162

Cited by 545 publications

(292 citation statements)

References 47 publications

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“…These SPs showed a low amplitude with a slow rate of rise morphology and they were observed along the tricuspid annulus. McGuire et al20, 21 previously reported that high‐frequency deflection followed by a low‐frequency deflection, which is similar to that described by Haissaguerre et al,1 were found during sinus rhythm along the tricuspid annulus. These potentials were caused by asynchronous activation of 2 cell layers, a high‐frequency component was caused by depolarization of atrial‐type cells in the deep subendocardial layer and the low‐frequency component was caused by depolarization of cells with nodal characteristics close to the endocardium 20, 21.…”

Section: Discussionsupporting

confidence: 76%

“…The SP was defined as a discrete and low amplitude deflection with a slow rate of rise occupying the interval between the atrial and ventricular potentials 1, 3. The electrogram amplitude and width of the atrial electrogram and the SP were measured during sinus rhythm and compared between the successful and unsuccessful ablation sites.…”

Section: Methodsmentioning

confidence: 99%

“…Slow potential (SP) has been found to be helpful in identifying target sites for radiofrequency catheter ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia 1, 2, 3. 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.…”

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: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

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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“…[1][2][3][4][5] Mapping of the cardiac chambers is performed with relatively stiff manually deflectable catheters with unidirectional or bidirectional deflection radius. Steering of those electrodes is performed via a pull-wire mechanism integrated in the handle of the catheter, allowing a reliable and reproducible deflection.…”

mentioning

confidence: 99%

Initial Experience With Remote Catheter Ablation Using a Novel Magnetic Navigation System

et al. 2004

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Background-Catheters are typically stiff and incorporate a pull-wire mechanism to allow tip deflection. While standing at the patient's side, the operator manually navigates the catheter in the heart using fluoroscopic guidance. Methods and Results-A total of 42 patients (32 female; mean age, 55Ϯ15 years) underwent ablation of common-type (slow/fast) or uncommon-type (slow/slow) atrioventricular nodal reentrant tachycardia (AVNRT) with the use of the magnetic navigation system Niobe (Stereotaxis, Inc). It consists of 2 computer-controlled permanent magnets located on opposite sides of the patient, which create a steerable external magnetic field (0.08 T). A small magnet embedded in the catheter tip causes the catheter to align and to be steered by the external magnetic field. A motor drive advances or retracts the catheter, enabling complete remote navigation. Radiofrequency current was applied with the use of a remote-controlled 4-mm, solid-tip, magnetic navigation-enabled catheter (55°C, maximum 40 W, 60 seconds) in all patients. The investigators, who were situated in the control room, performed the ablation using a mean of 7.2Ϯ4.7 radiofrequency current applications (mean fluoroscopy time, 8.9Ϯ6.2 minutes; procedure duration, 145Ϯ43 minutes). Slow pathway ablation was achieved in 15 patients, whereas slow pathway modulation was the end point in the remaining patients. There were no complications. Conclusions-The Niobe magnetic navigation system is a new platform technology allowing remote-controlled navigation of an ablation catheter. In conjunction with a motor drive unit, this system was used successfully to perform completely remote-controlled mapping and ablation in patients with AVNRT.

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“…4 Indeed, several investigators provided evidence that slow, low-amplitude waves could be recorded between atrial and His bundle potentials. [5][6][7] In the process of developing radiofrequency catheter ablation for the termination and cure of AVN reentrant tachycardia, potentials recorded in the inferior-posterior portion of Koch's triangle, both in animals 8 and in man, 5,6 served as the targets for successful ablation of slow AVN input. However, it remains unclear if surface potentials from the AVN can carry the distinctive signatures of "slow" and "fast" wavefronts that form the foundation of dual AVN physiology.…”

mentioning

confidence: 99%

Surface Potentials From the Region of the Atrioventricular Node and Their Relation to Dual Pathway Electrophysiology

Mazgalev

Tchou

2000

Circulation

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Background-Clinical applications of the principles of dual atrioventricular nodal (AVN) electrophysiology in the treatment of AVN reentrant tachycardias rely on empirical findings, such as discontinued conduction curves or the presence of specific catheter-recorded signals. However, neither the shape of the conduction curve nor the surface electrograms have been validated as functionally related to the presence of slow or fast wavefronts. Methods and Results-We performed in vitro studies using 10 rabbit atrial-AVN preparations. A bipolar roving electrode was used to explore the endocardial surface of the triangle of Koch during programmed electrical stimulation. Microelectrodes were impaled in AVN cells to correlate surface and intracellular responses. In 7 preparations, a specific area near the compact cell region produced surface electrograms that were dissociated in 2 distinct components, with progressive shortening of prematurity. Similar dissociation was demonstrated during Wenckebach periodicity and increased vagal tone. Cellular recordings supported the presence of early ("fast") and late ("slow") wavefronts, with different refractory properties. Although the fast-slow transition was a basis for discontinued propagation, the AVN conduction curves were smooth in the majority of cases. Conclusions-Exploration of the triangle of Koch during programmed pacing reveals the presence of dual-wavefront surface potentials. Clinical confirmation of these AVN potentials could provide a new, sensitive tool in defining dual

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Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy.

Cited by 545 publications

References 47 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

Initial Experience With Remote Catheter Ablation Using a Novel Magnetic Navigation System

Surface Potentials From the Region of the Atrioventricular Node and Their Relation to Dual Pathway Electrophysiology

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