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

Loh, Peter; Ho, Siew Yen; Kawara, Tokuhiro; Hauer, Richard N.W.; Janse, Michiel J.; Breithardt, Günter; Bakker, Jacques M.T. de

doi:10.1161/01.cir.0000080286.87137.32

Cited by 21 publications

(5 citation statements)

References 37 publications

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“…Optical and multielectrode mapping data in a rabbit model have suggested that perinodal atrial tissue participates in the reentrant circuit. [11][12][13] We hypothesize that the AVR could form these inputs to the AV node, which in turn could serve in the adult as part of the perinodal reentrant circuit during AVNRT.…”

Section: Discussionmentioning

confidence: 99%

Atrioventricular Ring Reentry in Embryonic Mouse Hearts

et al. 2006

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Background-During development, AV conduction switches from base-to-apex to apex-to-base conduction after emergence of the conduction system. We hypothesize that after this transition, the bulk of the AV ring, although no longer required for AV conduction, remains transiently able to conduct, providing a potential arrhythmia substrate. We studied AV conduction during this transition and its sensitivity to autonomic modulation. Methods and Results-Simultaneous voltage and Ca2ϩ mapping with RH-237 and Rhod-2 was performed with 2 CCD cameras in embryonic mouse hearts (nϭ43). Additionally, isolated calcium mapping was performed in 309 hearts with fluo-3AM. Propagation patterns in voltage and Ca 2ϩ mapping coincided. Arrhythmias were uncommon under basal conditions, with AV block in 14 (4%) and junctional rhythms in 4 (1%). Arrhythmias increased after stimulation with isoproterenol-junctional rhythm in 9 (3%) and ventricular rhythms in 22 (6%)-although AV block decreased (3 hearts, 1%). Adding carbachol after isoproterenol caused dissociated antegrade and retrograde AV ring conduction in 30 (8.6%) of E10.5 and E11.5 hearts, occurring preferentially in the right and left sides of the ring, respectively. In 2 cases, reentry occurred circumferentially around the AV ring, perpendicular to normal propagation. Reentry persisted for multiple beats, lasting from 3 to 22 minutes. No episodes of AV ring reentry occurred in E9.5 hearts. Conclusions-AV ring reentry can occur by spatial dissociation of antegrade and retrograde conduction during combined adrenergic and muscarinic receptor stimulation. Critical maturation (ϾE9.5) seems to be required to sustain reentry.

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Section: Discussionmentioning

confidence: 99%

Atrioventricular Ring Reentry in Embryonic Mouse Hearts

et al. 2006

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“…Considering the anatomic models of the AVNRT circuit, our results provide further evidence in support of our proposed scheme of re-entry along the posterior nodal extension in all forms of atypical AVNRT. 12 Attempts to provide a functional circuit model have also been made by reference to contextual considerations, such as the anisotropic conduction properties of the transitional area between the atria and the AV node, 15 – 20 and variability in the space constant of tissue and poor gap junction connectivity because of differential expression of connexin isoforms in the nodal area. 21 , 22 Regardless of the nature of the re-entry circuit in AVNRT, our results suggest that anterograde fast conduction during atypical AVNRT is distinct from retrograde fast conduction during typical AVNRT.…”

Section: Discussionmentioning

confidence: 99%

Coexistent Types of Atrioventricular Nodal Re-Entrant Tachycardia

Katritsis

Marine

Latchamsetty

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background—There is evidence that atypical fast–slow and typical atrioventricular nodal re-entrant tachycardia (AVNRT) do not use the same limb for fast conduction, but no data exist on patients who have presented with both typical and atypical forms of this tachycardia. We compared conduction intervals during typical and atypical AVNRT that occurred in the same patient.Methods and Results—In 20 of 1299 patients with AVNRT, both typical and atypical AVNRT were induced at electrophysiology study by pacing maneuvers and autonomic stimulation or occurred spontaneously. The mean age of the patients was 47.6±10.9 years (range, 32–75 years), and 11 patients (55%) were women. Tachycardia cycle lengths were 368.0±43.1 and 365.8±41.1 ms, and earliest retrograde activation was recorded at the coronary sinus ostium in 60% and 65% of patients with typical and atypical AVNRT, respectively. Thirteen patients (65%) displayed atypical AVNRT with fast–slow characteristics. By comparing conduction intervals during slow–fast and fast–slow AVNRT in the same patient, fast pathway conduction times during the 2 types of AVNRT were calculated. The mean difference between retrograde fast pathway conduction during slow–fast AVNRT and anterograde fast pathway conduction during fast–slow AVNRT was 41.8±39.7 ms and was significantly different when compared with the estimated between-measurement error (P=0.0055).Conclusions—Our data provide further evidence that typical slow–fast and atypical fast–slow AVNRT use different anatomic pathways for fast conduction.

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“…These phenomena may be explained by a discrepancy in the anatomical substrate for the sustained AVNRT circuit and AV nodal echo beats. 19,20…”

Section: Ardashevmentioning

confidence: 99%

Atrioventricular Nodal Reentrant Tachycardia Treatment Using Novel Potential

Ардашев

Makarenko

Zhelyakov

et al. 2010

Asian Cardiovasc Thorac Ann

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Radiofrequency ablation of atrioventricular nodal reentrant tachycardia is commonly guided by slow and sharp bipolar potentials of the atrioventricular slow nodal pathway. We optimized the morphology of the guiding potential by unipolar mapping of the slow nodal pathway. We identified a novel unipolar dual-component atrial electrogram at the anterior limb of the coronary sinus ostium. The first component was a positive delta-wave type that corresponded to the isoelectric phase on a bipolar electrogram. The second component had fast biphasic morphology and corresponded to the R wave on a bipolar atrial electrogram. Of 104 consecutive patients with typical atrioventricular nodal reentrant tachycardia, 51 were treated with ablation guided by the novel potential, and 53 underwent ablation using the conventional technique. There was no recurrence of tachycardia in any of these patients. In those treated by the novel potential, there was significantly less radiofrequency power applied and a shorter duration of application than in patients treated by the traditional approach. The novel approach to mapping and ablation of the slow nodal pathway in atrioventricular nodal reentrant tachycardia guided by unipolar recording was safe and effective, and comparable to the traditional technique.

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

Cited by 21 publications

References 37 publications

Atrioventricular Ring Reentry in Embryonic Mouse Hearts

Atrioventricular Ring Reentry in Embryonic Mouse Hearts

Coexistent Types of Atrioventricular Nodal Re-Entrant Tachycardia

Atrioventricular Nodal Reentrant Tachycardia Treatment Using Novel Potential

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