Longitudinal Dissociation Within the Posterior AV Nodal Input of the Rabbit

Patterson, Eugene; Scherlag, Benjamin J.

doi:10.1161/01.cir.99.1.143

Cited by 23 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, this observation is perfectly compatible with both longitudinal dissociation theories of AV nodal function, 9 in addition to separate inputs into a lower common pathway. In our observations, interactive pathways have a lower common pathway giving identical decremental properties, consistent with the slope of unity in Figure 3.…”

Section: Discussionsupporting

confidence: 85%

Insights Into Atrioventricular Nodal Function From Patients Displaying Dual Conduction Properties

Mendenhall

Voigt

Saba

2013

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Two patients with suspected and subsequently confirmed diagnosis of double firing were studied in the electrophysiology laboratory at University of Pittsburgh Medical Center Shadyside Hospital. All exhibited spontaneous episodic 1:2 tachycardia under baseline conditions, with minimal difference between all conducted QRS complexes on surface electrocardiogram recording.During electrophysiological study, standard quadripolar recording catheters were placed in the right ventricular apex, His bundle, and high right atrial positions. A decapolar catheter was placed into the coronary sinus. Spontaneous recording of A1A1 intervals and A1H1, A1H2 (for double firing), and A1H (single conduction) were © 2013 American Heart Association, Inc. Background-There is a significant variability observed in the conduction properties of the atrioventricular node. In a subset of hearts, impulse transmission tends to fall into two distinct conduction regions, termed the slow and fast pathway, and a further subset are capable of dual conduction of a single input stimulus, termed double firing. Methods and Results-In this article, we closely characterize two distinct responses in patients with double firing properties of the atrioventricular node, separating these into discrete types: those with slow and fast pathway interaction and interdependence (interactive), and those with independent pathway properties (orthogonal). We use novel mathematical techniques to evaluate the relative decrement and unique properties of conduction during the overlapping slow and fast pathway conduction zones. Conclusions-Our analysis demonstrates two distinct patterns of pathway conduction in double firing patients, termed interactive and orthogonal. We show parallel overlapping segments of slow and fast pathway decremental conduction curves in interactive pathways, with no such findings with orthogonal conduction. These findings suggest anatomic correlates of pathway conduction, with interactive pathways likely having a common distal segment and orthogonal pathways able to independently activate downstream structures. (Circ Arrhythm Electrophysiol. 2013;6:364-370.) Circ Arrhythm Electrophysiol

show abstract

Section: Discussionsupporting

confidence: 85%

Insights Into Atrioventricular Nodal Function From Patients Displaying Dual Conduction Properties

Mendenhall

Voigt

Saba

2013

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…It has been known for more than 30 years that longitudinal dissociation within the posterior AV nodal region is the main mechanism, which gives rise to localized reentry and AVNRT [ 12 ]. Despite this, the signal characteristics of the HB potentials in human beings with an SP have not been scrutinized in depth to date.…”

Section: Discussionmentioning

confidence: 99%

Distinctive characteristics of His bundle potentials in patients with atrioventricular nodal reentrant tachycardia

Guan

Saguner²,

Höfer³

et al. 2023

Cardiol J.

View full text Add to dashboard Cite

Background: His bundle (HB) potentials vary in amplitude and duration in patients with and without slow pathways. The aim of this study was to determine the characteristics of HB potentials and to elucidate whether they can provide clues for identification of slow pathway (SP). Methods:The present research prospectively studied the electrophysiological findings of 162 patients with symptomatic atrioventricular nodal reentrant tachycardia (AVNRT) due to slow-fast or fast-slow type and atrioventricular reentrant tachycardia (AVRT).Maximal HB potential (HBmax, HB with the highest amplitude) among HB cloud was recorded in both groups. For AVNRT patients, the following were measured: (1) AH interval at the "jump" during programmed atrial stimulation (A2H2, taken as a reflection of SP conduction time); (2) Distance from HBmax to the successful SP ablation site (HBmax-ABL) and from HBmax to the ostium of coronary sinus (HBmax-CSO).Results: HBmax was 0.29 ± 0.10 mV in AVNRT patients, whereas it was 0.17 ± 0.05 mV in AVRT group (p < 0.0001). Likewise, the HBmax duration was 22 ± 5 ms in AVNRT group and 16 ± 3 ms in AVRT group (p < 0.0001). The area under the ROC curve of HBmax amplitude in AVNRT patients was 0.86 and the optimal HBmax cut-off to predict AVNRT was ≥ 0.22 mV with a sensitivity of 0.78 and specificity of 0.84.HBmax-CSO was positively correlated with HBmax-ABL, and HBmax-ABL was positively correlated with A2H2.Conclusions: HBmax amplitudes were higher and durations longer in patients with AVNRT, as compared to those with AVRT. Moreover, the distance between HBmax and successful ablation site was positively correlated with the SP conduction time and with the distance from HBmax to the CS ostium.

show abstract

“…These findings suggest that the atrial insertions of the antegrade and retrograde slow pathways may be anatomically different. [7][8][9] The radiofrequency modification of vagal fibers to the posteroseptal region could enhance the retrograde slow pathway conduction, resulting in the critical delay required for reentry to occur. However, we could not confirm this hypothesis because the retrograde conduction over the slow pathway could not be demonstrated before the slow pathway ablation.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological Mechanisms of Conversion of Typical to Atypical Atrioventricular Nodal Reentrant Tachycardia Occurring After Radiofrequency Catheter Ablation of the Slow Pathway

et al. 1999

View full text Add to dashboard Cite

here have been several reports of the occurrence of atypical varieties of atrioventricular nodal reentrant tachycardia (AVNRT) after catheter ablation of the typical AVNRT using either a fast or slow pathway approach. [1][2][3] However, the mechanism of this conversion is still unclear, particularly in adult patients having slow pathway ablation.We describe an adult patient with conversion of typical to atypical AVNRT after slow pathway ablation and we propose the electrophysiological mechanisms of this conversion. Case ReportThe patient was a 63-year-old male with the primary complaint of palpitation, and typical AVNRT was suspected from the 12-lead surface ECG. Atypical AVNRT was not observed before the slow pathway ablation. An electrophysiological study was performed using standard electrophysiologic methods after informed consent was obtained. All antiarrhythmic agents were discontinued for at least 5 half-lives before the study. Bipolar intracardiac electrograms filtered between 30 and 500 Hz were recorded and stored digitally on a Cardiolab system (Prucka Engineering) simultaneously with the 12-lead surface ECG.Japanese Circulation Journal Vol.63, December 1999 Stimulation was performed with a programmable stimulator (Nihon-Kohden SEC3102). The antegrade and retrograde conduction properties were evaluated using incremental pacing and extrastimulus pacing from atrial and ventricular sites.After determination of AVNRT as the mechanism of tachycardia, a 7F-diameter deflectable catheter with a 4-mm ablation tip (EP Technologies) was inserted. The ostium of the coronary sinus (CSos) and the posteromedial tricuspid annulus were explored in an attempt to record a slow pathway potential during sinus rhythm. 4,5 Ablation was performed with a 550-kHz unmodulated radiofrequency current from a generator with temperature monitoring (EP Technologies). During ablation, the radiofrequency energy was adjusted to obtain a catheter tip temperature between 50 and 60°C. The current was applied for 30 s if junctional tachycardia was observed during ablation.Typical AVNRT with an His-atrial (HA) interval of 40 ms and AH/HA of 8.0 was induced by atrial extrastimulation (Fig 1). During tachycardia, the atrial activation at the His bundle region preceded atrial activation at the CSos and the ventricular premature beat did not preexcite the atrium while the His bundle was refractory from the antegrade impulse. Before ablation, the antegrade atrioventricular (AV) node conduction curve was discontinuous and the retrograde AV node conduction curve was continuous. Application of radiofrequency energy (3 times) in the posteroseptal region changed the AV node conduction curve from discontinuous to continuous, but did not change the retrograde conduction curve. The antegrade fast AV node pathway effective refractory period (ERP) shortened slightly from 310 ms to 290 ms. Atrial extrastimulation Jpn Circ J 1999; 63: 999 -1001 (Received June 17, 1999; revised manuscript received August 10, 1999; accepted August 27, 1999 This report pres...

show abstract

Longitudinal Dissociation Within the Posterior AV Nodal Input of the Rabbit

Cited by 23 publications

References 28 publications

Insights Into Atrioventricular Nodal Function From Patients Displaying Dual Conduction Properties

Insights Into Atrioventricular Nodal Function From Patients Displaying Dual Conduction Properties

Distinctive characteristics of His bundle potentials in patients with atrioventricular nodal reentrant tachycardia

Electrophysiological Mechanisms of Conversion of Typical to Atypical Atrioventricular Nodal Reentrant Tachycardia Occurring After Radiofrequency Catheter Ablation of the Slow Pathway

Contact Info

Product

Resources

About