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Celebration of the 150th birthday of Professor Sunao Tawara. J Arrhythm 2024; 40:397-403. [PMID: 38939769 PMCID: PMC11199831 DOI: 10.1002/joa3.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 06/29/2024] Open
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Zhang Y. A jump in the atrioventricular conduction curve is not caused by a switch from fast pathway to slow pathway conduction. Front Physiol 2024; 15:1367509. [PMID: 38617058 PMCID: PMC11009421 DOI: 10.3389/fphys.2024.1367509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/29/2024] [Indexed: 04/16/2024] Open
Abstract
Background: A jump in the atrioventricular (AV) conduction curve is the current clinical criterion of dual-pathway electrophysiology. However, the assumption that a jump indicates a switch from fast pathway (FP) to slow pathway (SP) conduction remains unconfirmed. This study was carried out to investigate whether a jump indeed indicates a transition from FP to SP conduction, and if not, what the potential cause is. Methods: Eighty-one experimental records from rabbit AV nodal preparations containing the following data were analyzed: 1) had at least one AV conduction curve and 2) had recording of His electrogram alternans (a validated new index of dual-pathway conduction). Most cases also had intracellular action potential recordings from the AV nodal fibers. Results: Of the 81 preparations, 11 (13%) showed a jump in the AV conduction curve. The jumps always occurred after the FP to SP transition. The FP-SP transition occurred at prematurity at 196 ± 39 ms versus the jump at 114 ± 13 ms (p < 0.001). The beat with a jump showed an SP-FP pattern in seven and an SP-SP pattern in four preparations. The jumps were always associated with and most likely caused by the formation of intranodal/nodal-atrial reentry and its subsequent conduction, rather than a switch from FP to SP conduction. Conclusion: Contrary to what has been assumed, a transition from FP to SP conduction does not produce a jump in the AV conduction curve. A jump in the AV conduction curve is most likely caused by the formation of intranodal/nodal-atrial reentry and its subsequent conduction.
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Affiliation(s)
- Youhua Zhang
- Departments of Cardiovascular Medicine and Molecular Cardiology, The Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
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González-Casal D, Pérez-Castellanos A, Flores NS, Carta-Bergaz A, González-Torrecilla E, Bruña Fernández V, Ávila P, Atienza F, Arenal Á, González-Panizo J, Fernández-Avilés F, Cabrera JA, Datino T. Cannon A wave validation as a diagnostic tool in paroxysmal supraventricular tachycardias. Pacing Clin Electrophysiol 2024; 47:383-391. [PMID: 38348921 DOI: 10.1111/pace.14946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The presence of cannon A waves, the so called "frog sign", has traditionally been considered diagnostic of atrioventricular nodal re-entrant tachycardia (AVNRT). Nevertheless, it has never been systematically evaluated. The aim of this study is to assess the independent diagnostic utility of cannon A waves in the differential diagnosis of supraventricular tachycardias (SVTs). METHODS We prospectively included 100 patients who underwent an electrophysiology (EP) study for SVT. The right jugular venous pulse was recorded during the study. In 61 patients, invasive central venous pressure (CVP) was registered as well. CVP increase is thought to be related with the timing between atria and ventricle depolarization; two groups were prespecified, the short VA interval tachycardias (including typical AVNRT and atrioventricular reciprocating tachycardia (AVRT) mediated by a septal accessory pathway) and the long VA interval tachycardias (including atypical AVNRT and AVRT mediated by a left free wall accessory pathway). RESULTS The relationship between cannon A waves and AVNRT did not reach the statistical significance (OR: 3.01; p = .058); On the other hand, it was clearly associated with the final diagnosis of a short VA interval tachycardia (OR: 10.21; p < .001). CVP increase showed an inversely proportional relationship with the VA interval during tachycardia (b = -.020; p < .001). CVP increase was larger in cases of AVNRT (4.0 mmHg vs. 1.2 mmHg; p < .001) and short VA interval tachycardias (3.9 mmHg vs. 1.2 mmHg; p < .001). CONCLUSION The presence of cannon A waves is associated with the final diagnosis of short VA interval tachycardias.
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Affiliation(s)
- David González-Casal
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alberto Pérez-Castellanos
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nina Soto Flores
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alejandro Carta-Bergaz
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Pablo Ávila
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe Atienza
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Arenal
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge González-Panizo
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | | | - José Angel Cabrera
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
| | - Tomás Datino
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
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Karlsson M, Platonov PG, Ulimoen SR, Sandberg F, Wallman M. Model-based estimation of AV-nodal refractory period and conduction delay trends from ECG. Front Physiol 2024; 14:1287365. [PMID: 38283279 PMCID: PMC10811553 DOI: 10.3389/fphys.2023.1287365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction: Atrial fibrillation (AF) is the most common arrhythmia, associated with significant burdens to patients and the healthcare system. The atrioventricular (AV) node plays a vital role in regulating heart rate during AF by filtering electrical impulses from the atria. However, it is often insufficient in regards to maintaining a healthy heart rate, thus the AV node properties are modified using rate-control drugs. Moreover, treatment selection during permanent AF is currently done empirically. Quantifying individual differences in diurnal and short-term variability of AV-nodal function could aid in personalized treatment selection. Methods: This study presents a novel methodology for estimating the refractory period (RP) and conduction delay (CD) trends, and their uncertainty in the two pathways of the AV node during 24 h using non-invasive data. This was achieved by utilizing a network model together with a problem-specific genetic algorithm and an approximate Bayesian computation algorithm. Diurnal variability in the estimated RP and CD was quantified by the difference between the daytime and nighttime estimates, and short-term variability was quantified by the Kolmogorov-Smirnov distance between adjacent 10-min segments in the 24-h trends. Additionally, the predictive value of the derived parameter trends regarding drug outcome was investigated using several machine learning tools. Results: Holter electrocardiograms from 51 patients with permanent AF during baseline were analyzed, and the predictive power of variations in RP and CD on the resulting heart rate reduction after treatment with four rate control drugs was investigated. Diurnal variability yielded no correlation to treatment outcome, and no prediction of drug outcome was possible using the machine learning tools. However, a correlation between the short-term variability for the RP and CD in the fast pathway and resulting heart rate reduction during treatment with metoprolol (ρ = 0.48, p < 0.005 in RP, ρ = 0.35, p < 0.05 in CD) were found. Discussion: The proposed methodology enables non-invasive estimation of the AV node properties during 24 h, which-indicated by the correlation between the short-term variability and heart rate reduction-may have the potential to assist in treatment selection.
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Affiliation(s)
- Mattias Karlsson
- Department of Systems and Data Analysis, Fraunhofer-Chalmers Centre, Gothenburg, Sweden
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Pyotr G. Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Sara R. Ulimoen
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | - Frida Sandberg
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Mikael Wallman
- Department of Systems and Data Analysis, Fraunhofer-Chalmers Centre, Gothenburg, Sweden
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Ryzhii M, Ryzhii E. A compact multi-functional model of the rabbit atrioventricular node with dual pathways. Front Physiol 2023; 14:1126648. [PMID: 36969598 PMCID: PMC10036810 DOI: 10.3389/fphys.2023.1126648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
The atrioventricular node (AVN) is considered a “black box”, and the functioning of its dual pathways remains controversial and not fully understood. In contrast to numerous clinical studies, there are only a few mathematical models of the node. In this paper, we present a compact, computationally lightweight multi-functional rabbit AVN model based on the Aliev-Panfilov two-variable cardiac cell model. The one-dimensional AVN model includes fast (FP) and slow (SP) pathways, primary pacemaking in the sinoatrial node, and subsidiary pacemaking in the SP. To obtain the direction-dependent conduction properties of the AVN, together with gradients of intercellular coupling and cell refractoriness, we implemented the asymmetry of coupling between model cells. We hypothesized that the asymmetry can reflect some effects related to the complexity of the real 3D structure of AVN. In addition, the model is accompanied by a visualization of electrical conduction in the AVN, revealing the interaction between SP and FP in the form of ladder diagrams. The AVN model demonstrates broad functionality, including normal sinus rhythm, AVN automaticity, filtering of high-rate atrial rhythms during atrial fibrillation and atrial flutter with Wenckebach periodicity, direction-dependent properties, and realistic anterograde and retrograde conduction curves in the control case and the cases of FP and SP ablation. To show the validity of the proposed model, we compare the simulation results with the available experimental data. Despite its simplicity, the proposed model can be used both as a stand-alone module and as a part of complex three-dimensional atrial or whole heart simulation systems, and can help to understand some puzzling functions of AVN.
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Affiliation(s)
- Maxim Ryzhii
- Department of Computer Science and Engineering, University of Aizu, Aizu-Wakamatsu, Japan
- *Correspondence: Maxim Ryzhii ,
| | - Elena Ryzhii
- Department of Anatomy and Histology, Fukushima Medical University, Fukushima, Japan
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Pandozi C, Matteucci A, Galeazzi M, Russo M, Lavalle C, Ficili S, Malacrida M, Colivicchi F. New insights into atrioventricular nodal anatomy, physiology, and immunochemistry: A comprehensive review and a proposed model of the slow-fast atrioventricular nodal reentrant tachycardia circuit in agreement with direct potential recordings in the Koch's triangle area. Heart Rhythm 2023; 20:614-626. [PMID: 36634901 DOI: 10.1016/j.hrthm.2023.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent regular tachycardia in humans. In this review, we describe the most recent discoveries regarding the anatomical, physiological, and molecular biological features of the atrioventricular junction that could underlie the typical slow-fast AVNRT mechanisms, as these insights could lead to the proposal of a new theory concerning the circuit of this arrhythmia. Despite several models have been proposed over the years, the precise anatomical site of the reentrant circuit and the pathway involved in the slow-fast AVNRT have not been conclusively defined. One possible way to evaluate all the hypotheses regarding the nodal tachycardia circuit in humans is to map this circuit. Thus, we tried to identify the slow potential of nodal and inferior extension structures by using automated mapping of atrial activation during both sinus rhythm and typical slow-fast AVNRT. This constitutes a first step toward the definition of nodal area activation in sinus rhythm and during slow-fast AVNRT. Further studies and technical improvements in recording the potentials of the atrioventricular node structures are necessary to confirm our initial results.
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Affiliation(s)
- Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy.
| | | | - Marco Galeazzi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy
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Althoff TF, Mont L. Catheter ablation of supraventricular tachycardias-a success story. Europace 2022; 25:4-5. [PMID: 36305555 PMCID: PMC9907505 DOI: 10.1093/europace/euac180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lluís Mont
- Corresponding author. E-mail addresses: ;
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Serra JL, Figueroa JA. Nonreentrant atrioventricular nodal tachycardia: The great simulator. J Electrocardiol 2022; 74:20-25. [PMID: 35914347 DOI: 10.1016/j.jelectrocard.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/18/2022] [Accepted: 07/11/2022] [Indexed: 12/13/2022]
Abstract
We present the case of a healthy 12-year-old boy without structural heart disease who was followed for several years for an arrhythmia with diverse and incorrect initial diagnoses, refractory to flecainide, metoprolol and verapamil. Thorough reevaluation of the electrocardiographic recordings led to a presumptive diagnosis of a non-reentrant atrioventricular nodal tachycardia, subsequently confirmed with electrophysiology study. Radiofrequency ablation was performed during the procedure and the arrhythmia resolved. Double conduction through the atrioventricular node often simulates other arrhythmias, leading to misdiagnosis.
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Affiliation(s)
- Jose Luis Serra
- Cardiology, Arrhythmia Unit, Sanatorio Allende, Córdoba, Argentina.
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Higuchi K, Higuchi S, Baranowski B, Wazni O, Scheinman MM, Tchou P. A Case Series of Very Slow Atrioventricular Nodal Reentrant Tachycardia Resembling Junctional Tachycardia. J Cardiovasc Electrophysiol 2022; 33:1177-1182. [PMID: 35348267 PMCID: PMC9324822 DOI: 10.1111/jce.15465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
Introduction The surface electrocardiography of typical atrioventricular nodal reentrant tachycardia (AVNRT) shows simultaneous ventricular‐atrial (RP) activation with pseudo R′ in V1 and typical heart rates ranging from 150 to 220/min. Slower rates are suspicious for junctional tachycardia (JT). However, occasionally we encounter typical AVNRT with slow ventricular rates. We describe a series of typical AVNRT cases with heart rates under 110/min. Methods A total of 1972 patients with AVNRT who underwent slow pathway ablation were analyzed. Typical AVNRT was diagnosed when; (1) evidence of dual atrioventricular nodal conduction, (2) tachycardia initiation by atrial drive train with atrial‐His‐atrial response, (3) short septal ventriculoatrial time, and (4) ventricular‐atrial‐ventricular (V‐A‐V) response to ventricular overdrive (VOD) pacing with corrected post pacing interval‐tachycardia cycle length (cPPI‐TCL) > 110 ms. JT was excluded by either termination or advancement of tachycardia by atrial extrastimuli (AES) or atrial overdrive (AOD) pacing. Results We found 11 patients (age 20−78 years old, six female) who met the above‐mentioned criteria. The TCL ranged from 560 to 782 ms. Except for one patient showing tachycardia termination, all patients demonstrated a V‐A‐V response and cPPI‐TCL over 110 ms with VOD. AES or AOD pacing successfully excluded JT by either advancing the tachycardia in 10 patients or by tachycardia termination in one patient. Slow pathway was successfully ablated, and tachycardia was not inducible in all patients. Conclusions This case series describes patients with typical AVNRT with slow ventricular rate (less than 110/min) who may mimic JT. We emphasize the importance of using pacing maneuvers to exclude JT.
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Affiliation(s)
- Koji Higuchi
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Satoshi Higuchi
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Bryan Baranowski
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Oussama Wazni
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
| | - Melvin M. Scheinman
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Patrick Tchou
- Section of Cardiac Electrophysiology and Pacing, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland ClinicClevelandOhioUSA
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Chatzidou S, Kontogiannis C, Georgiopoulos G, Kosmopoulos M, Pateras K, Spartalis M, Stamatelopoulos K, Rokas S. Wenckebach cycle length: A novel predictor for AV block in AVNRT patients treated with ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1497-1503. [PMID: 34287980 DOI: 10.1111/pace.14322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/07/2021] [Accepted: 06/27/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation remains the most effective management option for atrioventricular nodal reentry tachycardia (AVNRT). The risk of atrioventricular (AV) block requiring permanent pacemaker is substantial, but, currently, a reliable method to predict this complication is lacking. METHODS The electrophysiologic studies (EPS) and baseline characteristics of patients who underwent catheter ablation for the treatment of AVNRT were retrospectively analyzed to investigate predisposing factors for AV block after treatment. Patients were followed for AV block at one month and one year after hospital discharge. RESULTS Among 784 patients treated with catheter ablation for AVNRT between 1999 to 2019, 15 developed AV block. Patients with AV block were older (p = .001). Among the recorded EPS parameters, patients with AV block had significantly higher Atrial His interval (120 vs. 110 ms, p = .049), Wenckebach cycle length (WCL) (400 vs. 353 ms, p < .001) and tachycardia CL (400 vs. 387 ms, P = .01) during the ablation compared to their peers without AV block. Additionally, only WCL (OR = 1.1, 95% CI 1.02-1.19, p = .017) remained significant after adjustment for age, gender, ERP, AH interval, and HR. This association was confirmed by comparing patients with (n = 15) and without (n = 15) AV block using propensity score-matching. A WCL≥400ms was associated with a 4-fold higher incidence of AV block (4.79% vs. 1.25%). CONCLUSION Increased pre-procedural WCL was associated with a high risk for AV block after catheter ablation treatment for AVNRT. These findings suggest that this readily available EPS-derived parameter may be a novel marker of risk for severe complications in these patients.
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Affiliation(s)
- Sofia Chatzidou
- Department of Clinical Therapeutics, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, 11528, Greece
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, 11528, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, 11528, Greece.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE5 9NU, UK
| | | | - Konstantinos Pateras
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3508 GA, The Netherlands
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, 11528, Greece
| | - Stelios Rokas
- Department of Clinical Therapeutics, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, 11528, Greece
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Duman D, Ertuğrul İ, Yıldırım Baştuhan I, Aykan HH, Karagöz T. Empiric slow-pathway ablation results for presumed atrioventricular nodal reentrant tachycardia in pediatric patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1200-1206. [PMID: 34080209 DOI: 10.1111/pace.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/29/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In pediatric patients with documented narrow QRS tachycardia that is suggestive of atrioventricular nodal reentrant tachycardia (AVNRT) and not inducible in electrophysiological study (EPS), empiric slowpathway ablation (ESPA) may be considered. There is limited data in children about this topic. METHODS Seventy-nine patients who underwent cryoablation and/or radiofrequency ablation (RFA) for presumed AVNRT between January 2010 and January 2020, with no inducible tachycardia and no other tachycardia mechanisms during EPS, were included in this study. RESULTS The age was between 6 and 18 years. All patients had no structural heart disease. Preablation exhibited sustained SP conduction for all patients. In all cases, the ablation end points were prolongation in wenckebach cycle length (WBCL) with loss of cross and/or jump, and/or echo beat. The end points were not achieved in two patients. Overall, the mean basal WBCL increased to 351 ms (240-500 ms) from 301.3 ms (180-420 ms), evident in the non-recurrence group. Nine patients had a transient AV block that improved. We followed the patients without medication for about 46.9 months (8 months to 10 years). Palpitations occurred again in 9 of 77 patients (clinical recurrence rate 9/79 - 11.3%). The documented ECG recurrence rate was 1.2% (1/79). In the non-recurrence group, WBCL prolongation was higher and mean age was lower than in the recurrence group (13.075 vs. 15.33 years). CONCLUSION In cases with presumed AVNRT, ESPA seems to be a reasonable and safe way. In our study, we found our procedural success rate as 97.4% and follow-up recurrence rate as 12.6% (9+1/79).
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Affiliation(s)
- Derya Duman
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - İlker Ertuğrul
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - Işıl Yıldırım Baştuhan
- Division of Pediatric Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Dalian
| | - Hayrettin Hakan Aykan
- Department of Pediatrics, Division of Pediatric Cardiology, University of Hacettepe, Ankara, Turkey
| | - Tevfik Karagöz
- Department of Pediatrics, University of Hacettepe, Ankara, Turkey
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Catheter ablation via the left atrium for atrioventricular nodal reentrant tachycardia: A narrative review. Heart Rhythm O2 2021; 2:187-200. [PMID: 34113921 PMCID: PMC8183875 DOI: 10.1016/j.hroo.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Since 1996, it has been recognized that catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) may require an approach through the left atrium. Objective The purposes are to present a case report and to provide a comprehensive narrative review on this topic. Methods A literature review of all articles that provided detailed information on patients who underwent catheter ablation via the left atrium for AVNRT was performed. The primary search queried PubMed using Medical Subject Headings (MeSH) terms "atrioventricular nodal reentrant tachycardia" and "left." The secondary search was performed by manual review of reference lists and Google Scholar citations of manuscripts retrieved by the primary search. The review was limited to the English language. Results The searches yielded 30 articles that described 79 patients. A case report was added. Therefore, the final review consisted of 80 patients. The prevalence of left atrial ablation for patients with AVNRT undergoing catheter ablation at tertiary care centers was approximately 1%. Failed right atrial ablation, with or without coronary sinus ablation, was the most common indication for left atrial ablation. Pooled data from 3 cohort studies estimated the acute success rate for radiofrequency ablation of the slow pathway at the septal or inferoparaseptal segments of the mitral valve annulus after failed right-sided ablation to be 90%. There were no reports of atrioventricular block requiring permanent pacemaker implantation. Conclusion Catheter ablation of the slow pathway via the left atrium is an important technique for AVNRT cases that are refractory to conventional ablation.
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Sugumar H, Chieng D, Prabhu S, Voskoboinik A, Anderson RD, Al-Kaisey A, Lee G, McLellan AJ, Morton JB, Taylor AJ, Ling LH, Kalman JM, Kistler PM. A prospective evaluation of the impact of individual RF applications for slow pathway ablation for AVNRT: Markers of acute success. J Cardiovasc Electrophysiol 2021; 32:1886-1893. [PMID: 33855753 DOI: 10.1111/jce.15045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/25/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Catheter ablation is highly effective for atrioventricular nodal re-entrant tachycardia (AVNRT). Generally junctional rhythm (JR) is an accepted requirement for successful ablation however there is a lack of detailed prospective studies to determine the characteristics of JR and the impact on slow pathway conduction. METHODS Multicentre prospective observational study evaluating the impact of individual radiofrequency (RF) applications in typical AVNRT (slow/fast). Characteristics of JR during ablation were documented and detailed testing was performed after every RF application to determine outcome. Procedural success was defined as ≤1 AV nodal echo. RESULTS Sixty-seven patients were included (mean age 53 ± 18years, 57% female and a history of SVT 2.9 ± 4.7 years). RF (50w, 60°) ablation for AVNRT was applied in 301 locations with JR in 178 (59%). Successful slow pathway modification was achieved in 66 (99%) patients with slow pathway block in 30 (46%). Success was associated with JR in all patients. Success was achieved in six patients with RF < 10 s. There was no significant difference in the CL of JR during RF between effective (587 ± 150 ms) versus ineffective (611 ± 193 ms, p = .4) applications. Inadvertent junctional beat-atrial (JA) block with immediate termination of RF was observed in 19 (28%) patients with AVNRT no longer inducible in 14 (74%). Freedom from SVT was achieved in 66 (99%) patients at a mean follow up of 15 ± 6 months. CONCLUSION In this prospective study, JR was required during RF for acute success in AVNRT. Cycle length of JR during RF was not predictive of success. Although unintended JA block during faster JR was associated with slow pathway block, this is a precursor to fast pathway block and should not be intentionally targeted.
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Affiliation(s)
- Hariharan Sugumar
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David Chieng
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Sandeep Prabhu
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Alex J McLellan
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Joseph B Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrew J Taylor
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Liang-Han Ling
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Peter M Kistler
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
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14
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Raines DL, Adler DG. The Role of Provocative Testing and Localization of the Video Capsule Endoscope in the Management of Small Intestinal Bleeding. Gastrointest Endosc Clin N Am 2021; 31:317-330. [PMID: 33743928 DOI: 10.1016/j.giec.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The cause of small intestinal bleeding (SIB) may be elusive despite exhaustive testing. This article describes the current understanding of SIB regarding evaluation, with emphasis on the use of video capsule endoscopy (VCE) as a diagnostic procedure. This article addresses the utility of provocative testing in challenging cases and the performance of endoscopic procedures on active antithrombotic therapy. Specific recommendations accompany this article, including use of antithrombotic agents to stimulate bleeding when clearly indicated; performance of endoscopic procedures on active antithrombotic therapy; and progressive adoption of VCE and device-assisted enteroscopy in the inpatient setting.
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Affiliation(s)
| | - Douglas G Adler
- University of Utah School of Medicine, 30 North 1900 East 4R118, Salt Lake City, UT 84132, USA
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15
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Verbeet T, Almorad A, Nguyen T, Jottrand M, Castro J. Uncommon presentation of a common arrhythmia. Clin Case Rep 2021; 9:1321-1324. [PMID: 33768836 PMCID: PMC7981656 DOI: 10.1002/ccr3.3763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 11/06/2022] Open
Abstract
This case report demonstrates that atrioventricular and ventricular atrial conduction at rest may be unreliable in assessing the presence of reentrant atrioventricular nodal tachycardia.
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Affiliation(s)
- Thierry Verbeet
- University Hospital BrugmannFree University of BrusselsBrusselsBelgium
| | - Alexandre Almorad
- University Hospital BrugmannFree University of BrusselsBrusselsBelgium
| | - Thomas Nguyen
- University Hospital BrugmannFree University of BrusselsBrusselsBelgium
| | - Maurice Jottrand
- University Hospital BrugmannFree University of BrusselsBrusselsBelgium
| | - José Castro
- University Hospital BrugmannFree University of BrusselsBrusselsBelgium
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16
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Gorgels APM. An unusual mechanism of accelerated rhythms in inferior stemi. J Electrocardiol 2020; 63:51-53. [PMID: 33080446 DOI: 10.1016/j.jelectrocard.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Anton P M Gorgels
- Department of Cardiology, Maastricht School of Cardiovascular Diseases, Maastricht University Medical Centre+, Cardiology Centres Netherlands, Utrecht, the Netherlands.
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17
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18
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Scholman KT, Meijborg VMF, Gálvez-Montón C, Lodder EM, Boukens BJ. From Genome-Wide Association Studies to Cardiac Electrophysiology: Through the Maze of Biological Complexity. Front Physiol 2020; 11:557. [PMID: 32536879 PMCID: PMC7267057 DOI: 10.3389/fphys.2020.00557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022] Open
Abstract
Genome Wide Association Studies (GWAS) have provided an enormous amount of data on genomic loci associated with cardiac electrophysiology and arrhythmias. Clinical relevance, however, remains unclear since GWAS do not provide a mechanistic explanation for this association. Determining the electrophysiological relevance of variants for arrhythmias would aid development of risk stratification models for patients with arrhythmias. In this review, we give an overview of genetic variants related to ECG intervals and arrhythmogenic pathologies and discuss how these variants may influence cardiac electrophysiology and the occurrence of arrhythmias.
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Affiliation(s)
- Koen T Scholman
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Veronique M F Meijborg
- Department of Experimental Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Carolina Gálvez-Montón
- ICREC Research Program, Germans Trias i Pujol Health Science Research Institute, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabeth M Lodder
- Department of Experimental Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Bastiaan J Boukens
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Department of Experimental Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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19
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Dasgupta S, Kelleman M, Whitehill R, Fischbach P. Recurrent single echo beats after cryoablation of atrioventricular nodal reentrant tachycardia: The pediatric population. Indian Pacing Electrophysiol J 2020; 20:173-177. [PMID: 32311435 PMCID: PMC7517539 DOI: 10.1016/j.ipej.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/08/2020] [Accepted: 04/11/2020] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is effective and safe with a reported limitation of lower success and higher recurrence rates. We have observed cases in which slow pathway conduction was eliminated as demonstrated by atrial extra-stimulus testing within 1 min of cryo-energy delivery but returned following tissue rewarming. Frequently, slow pathway conduction persisted despite multiple acutely successful lesions over a broad anatomic region. We aimed to determine if return of slow pathway conduction after elimination during cryoablation represents a risk for recurrent AVNRT with the same intermediate term results as slow pathway ablation. We hypothesize that remnant single echo beats in the absence of sustained slow pathway conduction and inducible AVNRT is an acceptable end point after clear slow pathway elimination during cryoablation. METHODS Retrospective chart review of patients undergoing attempted slow pathway ablation for AVNRT using solely cryoablation between January 2015-January 2018. RESULTS Forty-four patients met inclusion criteria with at-least 2 features of dual AVN physiology. 19 patients had return of slow pathway conduction shortly after clear elimination during cryoablation (Group A) while 25 did not (Group B). All in Group A had recurrent single echo beats but none had sustained slow pathway conduction at the end of the procedure nor AVNRT recurrence at 1 year. CONCLUSION Recurrent single echo beats with absent sustained slow pathway conduction and non-inducible AVNRT may be an acceptable endpoint for slow pathway ablation of AVNRT using cryoablation when there is elimination of slow pathway demonstrated during energy delivery.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | | | - Robert Whitehill
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Peter Fischbach
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
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20
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Chin CG, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Vicera JJB, Chen CC, Chuang CM, Cheng WH, Liu SH, Hsieh MH, Chen SA. Extremely late recurrences (≥3 years) of atrioventricular nodal reentrant tachycardia: Electrophysiological characteristics of the index and repeat ablation procedures. Int J Cardiol 2020; 305:70-75. [PMID: 32059994 DOI: 10.1016/j.ijcard.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/26/2020] [Accepted: 02/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter ablation is an effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). However, the characteristics of extremely late (>3 years) recurrences of AVNRT after a successful initial ablation are not fully elucidated. We aimed to explore the electrophysiological characteristics of extremely late recurrences of AVNRT after a successful ablation. METHODS From 1991 to 2018, 3311 patients (mean age: 48.7 ± 17.4 years; men: 1328 [40.1%]) who underwent catheter ablation for AVNRT were investigated. Baseline characteristics of the patients, recurrence status, and detailed electrophysiological parameters of the index and repeat ablation procedures were obtained for analysis. RESULTS After a mean follow-up period of 129.5 ± 58.0 months, 65 (2.0%) patients underwent repeat ablation for recurrences of AVNRT, of whom 17 (0.5%) presented with extremely late recurrences. The incidence of transient AV block was significantly higher in patients with extremely late recurrences (5.9%) than in those without recurrences (1.9%) but lower than that in patients with recurrences within <3 years (12.5%, P < .001). In addition, among patients with extremely late recurrences of AVNRT, the atrial-His bundle interval was significantly longer (99.1 ± 23.4 vs. 76.5 ± 13.1 ms, P < .01) and the need for intravenous isoproterenol and/or atropine for the induction of AVNRT (88.2% vs. 47.1%, P = .03) was higher in the repeat ablation procedure than in the index ablation procedure. CONCLUSION Recurrences of AVNRT can occur 3 years after a successful initial ablation. The electrophysiological features of the index and repeat ablation procedures differed between patients with extremely late recurrences of AVNRT and those with recurrences within <3 years.
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Affiliation(s)
- Chye-Gen Chin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; University of Santo Tomas Hospital, Manila, Philippines
| | - Chun-Chao Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Mao Chuang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan; Department of Pediatric Cardiology, Chinese Medical University Children's Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Hsiung Hsieh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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21
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Tchou P. A novel method of demonstrating dual atrioventricular nodal physiology in the clinical electrophysiology laboratory. Heart Rhythm 2020; 17:965-966. [PMID: 32036024 DOI: 10.1016/j.hrthm.2020.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Patrick Tchou
- Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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22
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Billette J, Tadros R. An integrated overview of AV node physiology. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:805-820. [DOI: 10.1111/pace.13734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/10/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jacques Billette
- Département de Physiologie, Faculté de MédecineUniversité de Montréal Montréal Canada
| | - Rafik Tadros
- Département de Physiologie, Faculté de MédecineUniversité de Montréal Montréal Canada
- Electrophysiology ServiceMontreal Heart Institute Montreal Canada
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23
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Cunha Guerra M, Lokhandwala Y, Oyarzun R, Vyas A, Soares Correa F, Cruz Filho FE, J Wellens H, Back Sternick E. When and how does a single ventricular premature beat initiate and terminate supraventricular tachycardia? Ann Noninvasive Electrocardiol 2019; 24:e12650. [PMID: 30993813 DOI: 10.1111/anec.12650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re-entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). METHODS Three hundred and thirty-seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V-A conduction. In this cross-sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB. RESULTS Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p < 0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, (p < 0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT (p < 0.001). CONCLUSION Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording.
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Affiliation(s)
| | | | | | | | | | | | - Hein J Wellens
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Faculdade Ciências Médicas, Ciências Médicas-MG, Belo Horizonte, Brazil.,Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil
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24
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Wang NC, Lahiri MK, Thosani AJ, Shen S, Goldberger JJ. Reflections on the early invasive clinical cardiac electrophysiology era through fifty manuscripts: 1967-1992. J Arrhythm 2019; 35:7-17. [PMID: 30805039 PMCID: PMC6373646 DOI: 10.1002/joa3.12143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023] Open
Abstract
In 1967, researchers in The Netherlands and France independently reported a new technique, later called programmed electrical stimulation. The ability to reproducibly initiate and terminate arrhythmias heralded the beginning of invasive clinical cardiac electrophysiology as a medical discipline. Over the next fifty years, insights into the pathophysiologic basis of arrhythmias would transform the field into an interventional specialty with a tremendous armamentarium of procedures. In 2015, the variety and complexity of these procedures were major reasons that led to the recommendation for an increase in the training period from one year to two years. The purpose of this manuscript is to present fifty manuscripts from the early invasive clinical cardiac electrophysiology era, between 1967 and 1992, to serve as an educational resource for current and future electrophysiologists. It is our hope that reflection on the transition from a predominantly noninvasive discipline to one where procedures are commonly utilized will lead to more thoughtful patient care today and to inspiration for innovation tomorrow. In the words of the late Dr. Mark E. Josephson, "It is only by getting back to the basics that the field of electrophysiology will continue to grow instead of stagnate."
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Affiliation(s)
- Norman C. Wang
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Marc K. Lahiri
- Heart and Vascular InstituteHenry Ford Health SystemDetroitMichigan
| | - Amit J. Thosani
- Cardiovascular InstituteAllegheny Health NetworkPittsburghPennsylvania
| | - Sharon Shen
- Cardiovascular DivisionVanderbilt University Medical CenterNashvilleTennessee
| | - Jeffrey J. Goldberger
- Division of Cardiovascular MedicineUniversity of Miami Miller School of MedicineMiamiFlorida
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25
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Siebels H, Sohns C, Nürnberg JH, Siebels J, Langes K, Hebe J. Value of an old school approach: safety and long-term success of radiofrequency current catheter ablation of atrioventricular nodal reentrant tachycardia in children and young adolescents. J Interv Card Electrophysiol 2018; 53:267-277. [DOI: 10.1007/s10840-018-0367-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
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26
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Bayraktarova IH, Stoyanov MK, Kunev BT, Shalganov TN. Correlation between the sudden jump-like increases of the atrio-Hisian interval induced during burst atrial pacing and during programmed atrial stimulation in patients with atrioventricular nodal reentrant tachycardia. Indian Pacing Electrophysiol J 2017; 18:49-53. [PMID: 29183712 PMCID: PMC5998202 DOI: 10.1016/j.ipej.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/01/2017] [Accepted: 11/23/2017] [Indexed: 11/28/2022] Open
Abstract
Purpose To study the correlation between the sudden prolongations of the atrio-Hisian (AH) interval with ≥50 ms during burst and programmed atrial stimulation, and to define whether the AH jump during burst atrial pacing is a reliable diagnostic criterion for dual AV nodal physiology. Methods Retrospective data on 304 patients with preliminary ECG diagnosis of AV nodal reentrant tachycardia (AVNRT), confirmed during electrophysiological study, was analyzed for the presence of AH jump during burst and programmed atrial stimulation, and for correlation between the pacing modes for inducing the jump. Wilcoxon signed-ranks test and Spearman's bivariate correlation coefficient were applied, significant was P-value <0.05. Results The population was aged 48.5 ± 15.7 (12-85) years; males were 38.5%. AH jump occurred during burst atrial pacing in 81% of the patients, and during programmed stimulation – in 78%, P = 0.366. In 63.2% AH jump was induced by both pacing modes; in 17.8% – only by burst pacing; in 14.8% – only by programmed pacing; in 4.2% there was no inducible jump. There was negative correlation between both pacing modes, ρ = –0.204, Р<0.001. Conclusion Burst and programmed atrial stimulation separately prove the presence of dual AV nodal physiology in 81 and 78% of the patients with AVNRT, respectively. There is negative correlation between the two pacing modes, allowing the combination of the two methods to prove diagnostic in 95.8% of the patients.
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Affiliation(s)
| | - Milko K Stoyanov
- Department of Cardiology, National Heart Hospital, Sofia, Bulgaria
| | - Boyan T Kunev
- Department of Cardiology, National Heart Hospital, Sofia, Bulgaria
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27
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Atrioventricular Nodal Non Re-Entrant Tachycardia (AVNNT). Heart Lung Circ 2017; 26:524-525. [DOI: 10.1016/j.hlc.2016.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 07/26/2016] [Indexed: 11/18/2022]
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28
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Zipes DP. Catheter ablation of supraventricular tachycardias: where we have been, where we are, and where we are going. Eur Heart J 2017; 38:1327-1328. [PMID: 28329357 DOI: 10.1093/eurheartj/ehx112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Douglas P Zipes
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA
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Raines DL, Jex KT, Nicaud MJ, Adler DG. Pharmacologic provocation combined with endoscopy in refractory cases of GI bleeding. Gastrointest Endosc 2017; 85:112-120. [PMID: 27343413 DOI: 10.1016/j.gie.2016.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The source of GI bleeding may elude us despite exhaustive testing in some cases. Bleeding in these cases is often related to a vascular lesion that is discernible only when actively bleeding. The objective of this study was to determine the efficacy and safety of endoscopy combined with the administration of antiplatelet and/or anticoagulant agents to stimulate bleeding in order to define a source. METHODS A retrospective review of a database of device-assisted enteroscopy (DAE) procedures was completed to identify cases in which provocation with antiplatelet or anticoagulant agents was used as part of a GI bleeding evaluation. Procedures were divided into 3 groups based on the method of provocation: patients with a history of bleeding associated with an antiplatelet/anticoagulant (provocation-experienced); patients naïve to these medications (provocation-naïve); and cases of recurrent, overt GI bleeding in which a combination of clopidogrel and intravenous heparin was administered for provocation (Lousiana State University [LSU] protocol). RESULTS A review of 824 DAE procedures was completed to identify a total of 38 instances in which provocation was attempted in 27 patients. These cases were subdivided into 13 provocation-experienced procedures, 18 provocation-naïve procedures, and 7 LSU protocol procedures. The diagnostic yield of provocative testing per procedure was 53% in the provocation-experienced group, 27% in the provocation-naïve group, and 71% in the full protocol group. Provocative testing was revealing in 15 of 27 patients; angioectasias and Dieulafoy lesions were the most common pathologies. Provocative testing was not beneficial in 4 patients who were eventually diagnosed with bleeding caused by intestinal angioectasias (3) and an aorto-enteric fistula (1). There were no adverse events. CONCLUSIONS Provocative testing combined with endoscopy can be justified as an option in the diagnostic algorithm of complex cases of GI bleeding when intermittent bleeding related to a vascular lesion, such as an angioectasia or Dieulafoy, is suspected. However, this novel technique should be considered only after standard management has failed to define a bleeding source, and bleeding continues to recur. This is the first reported case series of provocative testing combined with endoscopy.
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Affiliation(s)
| | - Kellen T Jex
- LSU Health Sciences Center, New Orleans, Louisiana
| | | | - Douglas G Adler
- University of Utah School of Medicine, Salt Lake City, Utah, USA
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Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation. J Interv Card Electrophysiol 2016; 48:333-341. [DOI: 10.1007/s10840-016-0208-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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31
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Pulmonary vein duality: A new encounter with an old friend. Int J Cardiol 2016; 224:18-19. [DOI: 10.1016/j.ijcard.2016.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/07/2016] [Indexed: 11/21/2022]
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32
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Kawamura M, Scheinman MM, Vedantham V, Marcus GM, Tseng ZH, Badhwar N. Clinical and Electrophysiological Characteristics of Incessant Atrioventricular Nodal Re-Entrant Tachycardia. JACC Clin Electrophysiol 2016; 2:596-602. [DOI: 10.1016/j.jacep.2016.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 11/16/2022]
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Yin X, Xi Y, Zhang S, Xia Y, Gao L, Liu J, Cheng N, Chen Q, Cheng J, Yang Y. Atrioventricular Node Slow-Pathway Ablation Reduces Atrial Fibrillation Inducibility: A Neuronal Mechanism. J Am Heart Assoc 2016; 5:e003083. [PMID: 27287698 PMCID: PMC4937257 DOI: 10.1161/jaha.115.003083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) for atrioventricular nodal reentrant tachycardia appears to reduce atrial tachycardia, which might relate to parasympathetic denervation at cardiac ganglionated plexuses. METHODS AND RESULTS Compared to 7 control canines without RFA, in 14 canines, RFA at the bottom of Koch's triangle attenuated vagal stimulation-induced effective refractory periods prolongation in atrioventricular nodal and discontinuous atrioventricular conduction curves but had no effect on the sinoatrial node. RFA attenuated vagal stimulation-induced atrial effective refractory periods shortening and vulnerability window of atrial fibrillation widening in the inferior right atrium and proximal coronary sinus but not in the high right atrium and distal coronary sinus. Moreover, RFA anatomically impaired the epicardial ganglionated plexuses at the inferior vena cava‒inferior left atrial junction. This method was also investigated in 42 patients who had undergone ablation of atrioventricular nodal reentrant tachycardia, or 12 with an accessory pathway (AP) at the posterior septum (AP-PS), and 34 patients who had an AP at the free wall as control. In patients with atrioventricular nodal reentrant tachycardia and AP-PS, RFA at the bottom of Koch's triangle prolonged atrial effective refractory periods and reduced vulnerability windows of atrial fibrillation widening at the inferior right atrium, distal coronary sinus and proximal coronary sinus but not the high right atrium. In patients with AP-free wall, RFA had no significant atrial effects. CONCLUSIONS RFA at the bottom of Koch's triangle attenuated local autonomic innervation in the atrioventricular node and atria, decreased vagal stimulation-induced discontinuous atrioventricular nodal conduction, and reduced atrial fibrillation inducibility due to impaired ganglionated plexuses. In patients with atrioventricular nodal reentrant tachycardia or AP-PS, RFA prolonged atrial effective refractory periods, and narrowed vulnerability windows of atrial fibrillation.
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Affiliation(s)
- Xiaomeng Yin
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yutao Xi
- Texas Heart Institute, Houston, TX
| | - Shulong Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunlong Xia
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Lianjun Gao
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jinqiu Liu
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Nancy Cheng
- CHI St. Luke's Health - Baylor St. Luke's Medical Center, Houston, TX University of Texas Medical Branch, Galveston, TX
| | - Qi Chen
- CHI St. Luke's Health - Baylor St. Luke's Medical Center, Houston, TX
| | - Jie Cheng
- CHI St. Luke's Health - Baylor St. Luke's Medical Center, Houston, TX
| | - Yanzong Yang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Zhang Y. His electrogram alternans (Zhang's phenomenon) and a new model of dual pathway atrioventricular node conduction. J Interv Card Electrophysiol 2015; 45:19-28. [PMID: 26614299 DOI: 10.1007/s10840-015-0079-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND In contrast to the current textbook model and the current clinical index of dual pathway atrioventricular (AV) nodal conduction, here we summarize the discovery and validation of Zhang's phenomenon (originally His electrogram alternans) as a new index of dual pathway conduction. We also describe the new findings of transverse-versus-longitudinal electrical propagation within the AV node as the electrophysiological basis underlining this new index. Thus, a new index and a new model of dual pathway AV conduction are being developed. METHODS We have reviewed current literature and provided evidence supporting a new index and a new model of dual pathway AV conduction. RESULTS Recent data revealed that during fast pathway conduction, electrical excitation in the AV node propagates in a superior to inferior direction across AV conduction axis and fiber orientation to reach first the superior His bundle fibers. However, this transverse conduction can fail easily within the superior nodal domain at fast rates. The failing of transverse propagation permits electrical excitation formed at the posterior/inferior nodal region to propagate longitudinally along fiber orientation in a posterior to anterior direction through the inferior nodal domain to reach the inferior His bundle (slow pathway conduction). This transverse-versus-longitudinal electrical propagation within the AV node results in a functional dissociation in the distal node and formation of dual inputs into the His bundle, providing the electrophysiological basis for the formation of Zhang's phenomenon (His electrogram alternans). CONCLUSIONS Based on strong experimental data, a new index and a new model of dual pathway AV nodal conduction are emerging, although they are still awaiting clinical validation.
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Affiliation(s)
- Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Room 208, Rockefeller Building, Northern Boulevard, P.O. Box 8000, Old Westbury, NY, 11568-8000, USA.
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Kaneko Y, Nakajima T, Irie T, Ota M, Iijima T, Iizuka T, Kurabayashi M. An Abrupt Change in the Atrio-His Interval during Long RP Tachycardia: What Is the Underlying Mechanism? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:190-3. [PMID: 26449818 DOI: 10.1111/pace.12763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/01/2015] [Accepted: 10/04/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Yoshiaki Kaneko
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadanobu Irie
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masaki Ota
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takafumi Iijima
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Iizuka
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Xu G, Hlaing HH, Boesche L, Deneke T, Li Y, Muegge A. Cryoablation versus radiofrequency catheter ablation for AV nodal re-entrant tachycardia. Hippokratia 2015. [DOI: 10.1002/14651858.cd010303.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ge Xu
- Guangxi Medical University; Department of Cardiovascular Medicine; 1st Affiliated Hospital 22 Shuang Yong Rd Nanning Guangxi China 530021
| | - Hnin Hnin Hlaing
- Guangxi Medical University; Department of Cardiovascular Medicine; 1st Affiliated Hospital 22 Shuang Yong Rd Nanning Guangxi China 530021
| | - Leif Boesche
- Berufsgenossenschaftliche Universitaetsklinik Bergmannsheil; Department of Cardiology; Buerkle de la Camp Platz Bochum Germany 44789
| | - Thomas Deneke
- Heart Center Bad Neustadt; Department for Electrophysiologs; Salzbuergerstrasse 1 Bad Neustadt Germany 97616
| | - Yanning Li
- Guangxi Medical University; Department of Social Medicine and Health Management; 22 Shuan Yong Rd Nanning Guangxi China 530021
| | - Andreas Muegge
- Berufsgenossenschaftliche Universistaetsklinik Bergmannsheil; Department of Cardiology; Buerkle de la Camp Platz Bochum Germany 44789
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37
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Leila R, Raluca P, Yves DG, Dirk S, Bruno S. Cryoablation Versus Radiofrequency Ablation in AVNRT: Same Goal, Different Strategy. J Atr Fibrillation 2015; 8:1220. [PMID: 27957174 DOI: 10.4022/jafib.1220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 11/10/2022]
Abstract
Catheter ablation is nowadays the first therapeutic option for AVNRT, the most common benign supraventricular tachycardia. Both cryotherapy and radiofrequency energy may be used to ablate the slow pathway. This paper compares both techniques, evaluates results published in literature and gives feedback on some typical aspects of cryo- and RF ablation. Although both techniques have satisfying success rates in AVNRT ablation, with a higher safety profile of cryoablation towards creation of inadvertent atrioventricular block, it remains paramount that the operator respects the distinctive traits of each technique in order to obtain an optimal result in every patient.
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Peiker C, Pott C, Eckardt L, Kelm M, Shin DI, Willems S, Meyer C. Dual atrioventricular nodal non-re-entrant tachycardia. Europace 2015; 18:332-9. [DOI: 10.1093/europace/euv056] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/19/2015] [Indexed: 11/14/2022] Open
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39
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Alihanoglu YI, Yildiz BS, Kilic DI, Evrengul H, Kose S. Clinical and electrophysiological characteristics of typical atrioventricular nodal reentrant tachycardia in the elderly - changing of slow pathway location with aging. Circ J 2015; 79:1031-6. [PMID: 25739340 DOI: 10.1253/circj.cj-14-1320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the clinical and electrophysiological characteristics of elderly patients with typical atrioventricular nodal reentrant tachycardia (AVNRT), and to assess the acute safety and efficacy of slow-pathway radiofrequency (RF) ablation in this specific group of patients. METHODS AND RESULTS The present study retrospectively included a total of 1,290 patients receiving successful slow-pathway RF ablation for typical slow-fast AVNRT. Patients were divided into 2 groups: group I included 1,148 patients aged <65 years and group II included 142 patients aged >65 years. The required total procedure duration and total fluoroscopy exposure time were significantly higher in group II vs. group I (P=0.005 and P=0.0001, respectively). The number of RF pulses needed for a successful procedural end-point was significantly higher in group II than in group I (4.4 vs. 7.2, P=0.005). While the ratio of the anterior location near to the His-bundle region was significantly higher in group II, the ratio of posterior and midseptal locations were significantly higher in group I (P=0.0001). The overall procedure success rates were similar. There was no significant difference between the 2 groups in respect of the complications rates. CONCLUSIONS This experience demonstrates that RF catheter ablation, targeting the slow pathway, could be considered as first-line therapy for typical AVNRT patients older than 65 years as well as younger patients, as it is very safe and effective in the acute period of treatment.
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González M, Quiroga C, Fernández P, Garro H, Chiale P. Diferentes tiempos de conducción auriculoventricular y fenómeno de alternancia en los intervalos del ciclo en taquicardia por reentrada nodal AV de la variedad común. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 85:87-90. [DOI: 10.1016/j.acmx.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/16/2013] [Accepted: 04/22/2014] [Indexed: 11/28/2022] Open
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41
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Arrhythmia and thyroid dysfunction. Herz 2014; 40 Suppl 2:101-9. [DOI: 10.1007/s00059-014-4123-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
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42
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Kirmanoglou K, Peiker C, Clasen L, Shin DI, Kelm M, Meyer C. [Dual AV nodal nonreentry tachycardia (DAVNNT): unrecognized differential diagnosis with far-reaching consequences]. Herzschrittmacherther Elektrophysiol 2014; 25:109-115. [PMID: 24830917 DOI: 10.1007/s00399-014-0310-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The dual atrioventricular nodal nonreentry tachycardia (DAVNNT) is a rare form of tachycardia which occurs due to a time delayed double antegrade conduction via the slow and fast atrioventricular nodal pathways. Its epidemiology is not known so far. The aim of this article is to present the clinical findings in a series of patients with DAVNNT. MATERIALS AND METHODS We retrospectively analyzed our database of patients who successfully underwent radiofrequency catheter ablation between January 2012 and March 2013 due to diagnosed supraventricular tachycardia. RESULTS In 3 out of 231 patients DAVNNT could be successfully treated by slow pathway modulation/ablation. Patients presented with widely varying symptoms including syncope, palpitations which had been mistaken as atrial fibrillation, and inappropriate defibrillator shocks due to suspected ventricular tachycardia. CONCLUSIONS The DAVNNT seems to be more common than previously thought. This important differential diagnosis needs to be taken into consideration as slow pathway modulation can be curative while a misdiagnosis, such as atrial fibrillation or ventricular tachycardia might result in over-treatment in patients with this arrhythmia.
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Affiliation(s)
- Kiriakos Kirmanoglou
- Abteilung für Rhythmologie, Klinik für Kardiologie Pneumologie und Angiologie, Heinrich-Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Clinical and electrophysiological characteristics of the patients with relatively slow atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2014; 40:117-23. [PMID: 24793102 DOI: 10.1007/s10840-014-9901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study is to retrospectively investigate clinical and electrophysiologic characteristics of typical AVNRT with relatively slow tachycardia rates below the average value compared to faster ones, in patients without structural heart disease. METHODS The present study retrospectively included a total of 1,150 patients receiving successful slow-pathway radio frequency ablation for typical slow-fast AVNRT. Patients were divided into two groups according to their tachycardia cycle length: group I included 1,018 patients with tachycardia cycle length < 400 msn and group II included 132 patients with cycle length > 400 msn. Patients with another form of arrhythmia other than typical AVNRT, the existence of structural heart disease, preexisting prolonged PR interval, history of clinically documented AF, and reasons capable of causing AF were accepted as exclusion criterias. RESULTS The patients in group II were older than those in group 1 (p=0.039), and male ratio was significantly higher in group II compared to group I (p=0.02). Wenckebach cycle length and AV node antegrade effective refractory period values before the RF ablation were significantly higher in group II compared to group I (p=0.0001 and 0.01, respectively). Right atrium effective refractory period values in both pre- and post-ablation period were significantly higher in group I compared to group II (p=0.0001 and 0.004, respectively). The existence of atrial vulnerability before ablation was significantly higher in group II compared to group I (p=0.007); however, there was no difference between the two groups in terms of atrial vulnerability after the ablation. In addition, while the ratio of anterior location as an ablation site near the His-bundle region was significantly higher in group II, the ratio of posterior location was significantly higher in group I (p=0.0001 for both). CONCLUSION Our experience demonstrates that clinical and electrophysiologic characteristics of AVNRT patients with relatively slower tachycardia rates were quite different compared to the faster AVNRT cases.
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SUZUKI ATSUSHI, YOSHIDA AKIHIRO, TAKEI ASUMI, FUKUZAWA KOJI, KIUCHI KUNIHIKO, TANAKA SATOKO, ITOH MITSUAKI, IMAMURA KIMITAKE, FUJIWARA RYUDO, NAKANISHI TOMOYUKI, YAMASHITA SOICHIRO, MATSUMOTO AKINORI, KONISHI HIROKI, ICHIBORI HIROTOSHI, HIRATA KENICHI. Visualization of the Antegrade Fast and Slow Pathway Inputs in Patients with Slow-Fast Atrioventricular Nodal Reentrant Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:874-83. [DOI: 10.1111/pace.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/30/2013] [Accepted: 01/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- ATSUSHI SUZUKI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - AKIHIRO YOSHIDA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
- Section of Arrhythmia; Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Chuo-ku Kobe Japan
| | - ASUMI TAKEI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - KOJI FUKUZAWA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
- Section of Arrhythmia; Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Chuo-ku Kobe Japan
| | - KUNIHIKO KIUCHI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - SATOKO TANAKA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - MITSUAKI ITOH
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - KIMITAKE IMAMURA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - RYUDO FUJIWARA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - TOMOYUKI NAKANISHI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - SOICHIRO YAMASHITA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - AKINORI MATSUMOTO
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - HIROKI KONISHI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - HIROTOSHI ICHIBORI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - KEN-ICHI HIRATA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
- Section of Arrhythmia; Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Chuo-ku Kobe Japan
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Evertz R, Merschón F, Berruezo A, Mont L. Doble respuesta ventricular: otra vía a la taquicardia supraventricular en fisiología doble del nódulo. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dual Ventricular Response: Another Road to Supraventricular Tachycardia in Dual Atrioventricular Nodal Physiology. ACTA ACUST UNITED AC 2013; 66:145-6. [DOI: 10.1016/j.rec.2012.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 05/18/2012] [Indexed: 11/24/2022]
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Von Bergen NH, Law IH. AV nodal reentrant tachycardia in children: Current approaches to management. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Liao Z, Chang Y, Ma J, Fang P, Zhang K, Ren X, Yang P, Yu B, Hu J, Yang Q, Ouyang F, Zhang S. Atrioventricular Node Reentrant Tachycardia in Patients With Congenitally Corrected Transposition of the Great Arteries and Results of Radiofrequency Catheter Ablation. Circ Arrhythm Electrophysiol 2012; 5:1143-8. [PMID: 23159417 DOI: 10.1161/circep.112.976597] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zili Liao
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Yu Chang
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Jian Ma
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Pihua Fang
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Kuijun Zhang
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Xiaoqing Ren
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Pingzhen Yang
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Bo Yu
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Jiqiang Hu
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Qian Yang
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Feifan Ouyang
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
| | - Shu Zhang
- From the Arrhythmia Center and Clinical Electrophysiological Laboratory, FuWai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (Z.L., J.M., P.F., K.Z., X.R., J.H., Q.Y., F.O., S.Z.); Department of Cardiology, Qingdao Fuwai Hospital, Qingdao, China (Y.C.); Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangzhou, China (P.Y.); Department of Cardiology, First Affiliated Hospital of China Medical
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Masè M, Glass L, Disertori M, Ravelli F. Nodal recovery, dual pathway physiology, and concealed conduction determine complex AV dynamics in human atrial tachyarrhythmias. Am J Physiol Heart Circ Physiol 2012; 303:H1219-28. [DOI: 10.1152/ajpheart.00228.2012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The genesis of complex ventricular rhythms during atrial tachyarrhythmias in humans is not fully understood. To clarify the dynamics of atrioventricular (AV) conduction in response to a regular high-rate atrial activation, 29 episodes of spontaneous or pacing-induced atrial flutter (AFL), covering a wide range of atrial rates (cycle lengths from 145 to 270 ms), were analyzed in 10 patients. AV patterns were identified by applying firing sequence and surrogate data analysis to atrial and ventricular activation series, whereas modular simulation with a difference-equation AV node model was used to correlate the patterns with specific nodal properties. AV node response at high atrial rate was characterized by 1) AV patterns of decreasing conduction ratios at the shortening of atrial cycle length (from 236.3 ± 32.4 to 172.6 ± 17.8 ms) according to a Farey sequence ordering (conduction ratio from 0.34 ± 0.12 to 0.23 ± 0.06; P < 0.01); 2) the appearance of high-order alternating Wenckebach rhythms, such as 6:2, 10:2, and 12:2, associated with ventricular interval oscillations of large amplitude (407.7 ± 150.4 ms); and 3) the deterioration of pattern stability at advanced levels of block, with the percentage of stable patterns decreasing from 64.3 ± 35.2% to 28.3 ± 34.5% ( P < 0.01). Simulations suggested these patterns to originate from the combined effect of nodal recovery, dual pathway physiology, and concealed conduction. These results indicate that intrinsic nodal properties may account for the wide spectrum of AV block patterns occurring during regular atrial tachyarrhythmias. The characterization of AV nodal function during different AFL forms constitutes an intermediate step toward the understanding of complex ventricular rhythms during atrial fibrillation.
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Affiliation(s)
- Michela Masè
- Department of Physics and BioTech, University of Trento, Povo-Trento, Italy
| | - Leon Glass
- Department of Physiology, McGill University, Montreal, Québec, Canada; and
| | | | - Flavia Ravelli
- Department of Physics and BioTech, University of Trento, Povo-Trento, Italy
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Kaese S, Verheule S. Cardiac electrophysiology in mice: a matter of size. Front Physiol 2012; 3:345. [PMID: 22973235 PMCID: PMC3433738 DOI: 10.3389/fphys.2012.00345] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/09/2012] [Indexed: 12/27/2022] Open
Abstract
Over the last decade, mouse models have become a popular instrument for studying cardiac arrhythmias. This review assesses in which respects a mouse heart is a miniature human heart, a suitable model for studying mechanisms of cardiac arrhythmias in humans and in which respects human and murine hearts differ. Section I considers the issue of scaling of mammalian cardiac (electro) physiology to body mass. Then, we summarize differences between mice and humans in cardiac activation (section II) and the currents underlying the action potential in the murine working myocardium (section III). Changes in cardiac electrophysiology in mouse models of heart disease are briefly outlined in section IV, while section V discusses technical considerations pertaining to recording cardiac electrical activity in mice. Finally, section VI offers general considerations on the influence of cardiac size on the mechanisms of tachy-arrhythmias.
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Affiliation(s)
- Sven Kaese
- Division of Experimental and Clinical Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster Münster, Germany
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