Para-Hisian Pacing

Hirao, Kazuyuki; Otomo, Kenichiro; Wang, Xunzhang; Beckman, Karen J.; McClelland, James H.; Widman, Lawrence E.; González, Mario D.; Arruda, Maurício; Nakagawa, Hiroshi; Lazzara, Ralph; Jackman, Warren M.

doi:10.1161/01.cir.94.5.1027

Cited by 238 publications

(46 citation statements)

References 18 publications

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“…[11][12][13] Retrograde CS angiography was performed in all patients suspected of having a CSAP on the basis of the presence of a negative delta wave in ECG lead II 14 or mapping results from the present or previous electrophysiological study. Before 1994, CS angiography was performed using an 8F guiding catheter and rapid injection of 20 mL of contrast media.…”

Section: Electrophysiological Study and Cs Angiographymentioning

confidence: 99%

“…Programmed stimulation of the right atrial appendage, posterolateral CS, anterobasal right ventricular septum (para-Hisian pacing), 12 and posterobasal ventricular septum (close to the accessory pathway) 13 was performed, verifying the presence of a posteroseptal or left posterior accessory pathway. Mapping of the tricuspid anulus, CS, and venous branches, and in selected patients, the mitral anulus (transseptal or retrograde transaortic approach) was performed during antegrade and retrograde accessory pathway conduction.…”

Section: Electrophysiological Study and Cs Angiographymentioning

confidence: 99%

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Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways

et al. 2002

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Background-The coronary sinus (CS) has a myocardial coat (CSMC) with extensive connections to the left and right atria. We postulated that some posteroseptal and left posterior accessory pathways (CSAPs) result from connections between a cuff of CSMC extending along the middle cardiac vein (MCV) or posterior coronary vein (PCV) and the ventricle. The purpose of the present study was to use CS angiography and mapping to define and determine the incidence of CSAPs and determine the relationship to CS anatomy. Methods and Results-CSAP was defined by accessory pathway (AP) potential or earliest activation in the MCV or PCV and late activation at anular endocardial sites. A CSAP was identified in 171 of 480 patients undergoing ablation of a posteroseptal or left posterior AP. CS angiography revealed a CS diverticulum in 36 (21%) and fusiform or bulbous enlargement of the small cardiac vein, MCV, or CS in 15 (9%) patients. The remaining 120 (70%) patients had an angiographically normal CS. A CSMC extension potential (CSE), like an AP potential, was recorded in the MCV in 98 (82%), in the PCV in 13 (11%), in both the MCV and PCV in 6 (5%), and in the CS in 3 (2%) of 120 patients. CSMC potentials were recorded between the timing of atrial and CSE potentials. Conclusions-CSAPs result from a connection between a CSMC extension (along the MCV or PCV) and the ventricle.The CS is angiographically normal in most patients.

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Section: Electrophysiological Study and Cs Angiographymentioning

confidence: 99%

Section: Electrophysiological Study and Cs Angiographymentioning

confidence: 99%

Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways

et al. 2002

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“…Usually, a combined anatomical and mapping approach is employed with ablation lesions delivered at the inferior or mid part of the triangle of Koch. 60,61 Multicomponent atrial electrograms or low amplitude potentials, although not specific for identification of slow pathway -SA-VA and cPPI-TCL intervals [44][45][46][47] -Differential entrainment or cessation 48 Cumbersome Delta HA during V Pre-excitation index 49 Differential entrainment 58 pacing and tachycardia 36 Entrainment VHA pattern 37 -Anterograde His capture 50 Para-Hisian pacing 38 -Progressive fusion during or after the transition zone 51,52 Induction of retrograde Delta HA during entrainment RBBB 39 and tachycardia 53 SA init -VA and cPPI init --Para-Hisian entrainment [54][55][56] TCL conduction, are successfully used to guide ablation at these areas.…”

Section: Ablationmentioning

confidence: 99%

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Katritsis

Josephson

2016

Arrhythmia &Amp; Electrophysiology Review

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Atrioventricular nodal reentrant tachycardia (AVNRT) denotes re-entry in the area of the AV node, and represents the most common regular arrhythmia in the human.1 Although several models have been proposed to explain the mechanism of the arrhythmia in the context of the complex anatomy and the anisotropic properties of the atrioventricular (AV) node and its atrial extensions (see Figure 1), 2 the actual circuit of AVNRT still remains elusive. Recent studies suggest a three-dimensional AV node with greater variability in the space constant of tissue and poor gap junction connectivity due to differential expression of connexin isoforms, that provide an explanation of dual conduction and nodal reentrant arrhythmogenesis. 3,4 AV junctional arrhythmias are presented in Table 1. Classification schemes for AVNRT have been mainly based on the conventional concept of longitudinally dissociated dual AV nodal pathways that conduct around a central obstacle (see Table 2).In typical slow-fast AVNRT the onset of atrial activation appears prior to, at the onset, or just after the QRS complex, thus maintaining an atrial-His/His-atrial ratio, AH/HA >1. The HA interval is usually <70 ms, measured from earliest deflection of the His bundle activation to the earliest rapid deflection of the atrial activation in the His bundle electrogram, and the VA interval, measured from the onset of ventricular activation on surface ECG to the earliest rapid deflection of the atrial activation on the His bundle electrogram, is <60 ms. 1,5,6 In atypical, fast-slow form of atypical AVNRT, the retrograde atrial electrogram begins after ventricular activation with an AH/HA ratio <1. The HA interval is prolonged, ≥70 msec, and the VA interval is ≥60 msec. 5,6 The atypical, slow-slow form, represents, by definition, an arrhythmia utilising two slow pathways. The AH/HA ratio is ≥1 but the HA interval is ≥70 msec, and the AH interval exceeds 200 ms. [7][8][9] There are several inherent limitations of this classification. The distinction between fast-slow and slow-slow atypical AVNRT is often arbitrary in view of the lack of a unanimously accepted definition. In order to establish the diagnosis of a truly fast-slow form, it has been proposed that the AH interval should be less than 185 ms 10 or 200 ms. 6 This criterion, however, has not been adopted by other investigators. 11-13Thus, tachycardias with a relatively prolonged AH interval but an AH/ HA ratio <1 cannot be reliably classified as either fast-slow or slow-slow (see Figure 2). Furthermore, the term 'fast-slow' implies that the fast component of slow-fast AVNRT is the same as the fast in the fast-slow type. There is now evidence that this is not the case in patients who present with both types of tachycardia.14,15 Typical slow-fast and atypical fast-slow AVNRT appear to utilise different anatomical pathways for fast conduction. In addition, electrophysiological behaviour compatible with multiple pathways may also be seen, and in some patients, several forms of AVNRT may be inducible at electrophy...

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“…5,6 Decremental but eccentric (free wall early) atrial activation may be seen with less common decremental accessory pathways, with AV nodal activation, or with unusual variance of AV nodal activation. 3 Retrograde AV node fast pathway activation Bystander Nodoventricular Tract may present with an eccentric CS activation sequence, even though the fast pathway site is the first to activate, as a result of trans-Eustachian ridge block that requires the AV node reentrant tachycardia wavefront to enter the left atrium and then propagate via CS myocardium-left atrial connections to return to the AV node.…”

Section: Retrograde Limbmentioning

confidence: 99%

His Bundle Refractoriness

Asirvatham

Stevenson

2016

Circ: Arrhythmia and Electrophysiology

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Para-Hisian Pacing

Abstract: Para-Hisian pacing reliably identifies retrograde conduction over septal and right free wall APs, but AVN conduction may mask APs located far from the pacing site or with a long retrograde conduction time.

Cited by 238 publications

References 18 publications

Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways

Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

His Bundle Refractoriness

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