Can accelerated atrioventricular junctional escape rhythms be explained by delayed afterdepolarizations?

Rosen, Michael R.; Fisch, Charlés; Hoffman, Brian F.; Danilo, Peter; Lovelace, D. Eugene; Knoebel, Suzanne B.

doi:10.1016/0002-9149(80)90489-0

Cited by 90 publications

(28 citation statements)

References 24 publications

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“…19 The evidence to date suggests that nonparoxysmal junctional tachycardia appears to be related to delayed afterdepolarizations. [20][21] Care must be taken to differentiate junctional ectopic tachycardia from other arrhythmias. The typical appearance of a rapid, irregularly irregular tachycardia with atrioventricular dissociation excludes an atrial or atrioventricular reentrant tachycardia and is strong evidence against a reentrant supraventricular arrhythmia involving the atrioventricular node.…”

Section: Discussionmentioning

confidence: 99%

Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults.

Ruder¹,

Davis²,

Eldar³

et al. 1986

Circulation

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Junctional ectopic tachycardia has been described in infants but not in adults. Five adults with rapid symptomatic paroxysmal junctional tachycardia, distinct from the more common slower nonparoxysmal junctional tachycardia, were recently evaluated. The tachycardia was irregular (rate 120 to 250) and accompanied by periods of atrioventricular dissociation and narrow QRS complexes. A junctional origin was documented during electrophysiologic study in four of the five patients. Analysis of Holter recordings; the response to exercise, isoproterenol, and propranolol; and the effects of atrial and ventricular stimulation appeared to implicate abnormal automaticity of a high junctional focus that was catecholamine sensitive or dependent as the tachycardia mechanism. All patients responded somewhat to /3-blockers, although a combination of procainamide and propranolol proved to be the most effective therapy in one patient and another chose electrode catheter ablation of the atrioventricular junction rather than continued drug therapy. Thus, junctional ectopic tachycardia may occur in adults and its mechanism appears to be related to abnormal automaticity that is catecholamine sensitive or dependent. Initial therapy should include fl-blockers but selected patients may require more aggressive management.Circulation 73, No. 5, 930-937, 1986.

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Section: Discussionmentioning

confidence: 99%

Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults.

Ruder¹,

Davis²,

Eldar³

et al. 1986

Circulation

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“…In so doing, we were aware of the limitations inherent in attempting to extrapolate from any given model to the intact heart but were nevertheless encouraged by the results of a similar approach used to quantify rhythms induced by digitalis toxicity.' [22][23][24][25] We have found that there are some similarities between the triggered rhythms induced by catecholamines in atrial fibers of the coronary sinus and those caused by digitalis in Purkinje fibers, but there are important differences as well. These must be considered carefully in attempting to define the behavior of triggered activity in experimental animals and in the clinic.…”

mentioning

confidence: 98%

“…22 23 It has been tempting to apply these observations of digitalisinduced triggered activity more generally to predict the behavior of other types of triggered activity that might occur clinically. However, observations made to date in atrial fibers of the coronary sinus6 7 suggest that such extrapolation might be inappropriate.…”

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confidence: 99%

Characteristics of initiation and termination of catecholamine-induced triggered activity in atrial fibers of the coronary sinus.

Johnson¹,

Danilo²,

Wit³

et al. 1986

Circulation

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We studied epinephrine-induced delayed afterdepolarizations and triggered activity in atrial fibers from the canine coronary sinus to determine whether their responses to cardiac pacing would aid in formulating a uniform set of guidelines for differentiating this triggered activity from other arrhythmogenic mechanisms. We used standard microelectrode techniques and compared the delayed afterdepolarizations and triggered activity with those occurring in ouabain-superfused Purkinje fibers. Like Purkinje fibers, the frequency of triggering in the coronary sinus and the coupling interval of the first triggered beat were related directly to the basic drive cycle length, and the delayed afterdepolarization amplitude and frequency of triggering were related to the coupling interval of premature stimuli (S2). However, unlike Purkinje fibers, the coupling interval of the delayed afterdepolarization and of the first triggered beat were independent of the S2. Once initiated, triggered activity in the coronary sinus followed one of four rhythm patterns: in all four, the minimum and equilibrium cycle lengths were independent of the initiating cycle length. Triggered activity was terminated by overdrive and S2 pacing, especially by long episodes of overdrive at short cycle length. The first escape beat after overdrive was linearly related to the overdrive cycle length, resulting in overdrive acceleration. The return cycle length after S2 was linearly related to the S2 coupling interval. Because delayed afterdepolarizations and triggered activity in the coronary sinus respond differently to pacing from those in ouabain-superfused Purkinje fibers, triggered activity in general may not be identified by a uniform set of guidelines.

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“…Among 16-19 year old males, 0.21% had premature junctional complexes on 12-lead ECG and similar in other age groups (Hiss and Lamb 1962). 3.3.3 Mechanism: PJCs arise due to increased automaticity or triggered activity due to after depolarizations within the AV junction (Hoffman and Cranefield 1964;Rosen et al 1980). PJCs may predispose the patient to ventricular tachycardia.…”

Section: Work-upmentioning

confidence: 95%

Arrhythmias in Children and Young Adults

Singh¹

2012

Advances in Electrocardiograms - Clinical Applications

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Can accelerated atrioventricular junctional escape rhythms be explained by delayed afterdepolarizations?

Cited by 90 publications

References 24 publications

Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults.

Clinical and electrophysiologic characterization of automatic junctional tachycardia in adults.

Characteristics of initiation and termination of catecholamine-induced triggered activity in atrial fibers of the coronary sinus.

Arrhythmias in Children and Young Adults

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