Patterns of atrial activation during right ventricular pacing in patients with concealed left-sided Kent pathways.

De, Ward; Aj, Camm; Spurrell, R. A. J.

doi:10.1136/hrt.42.2.192

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Shortening of the pacing cycle length from 1,000 down to 600 msec prolonged the effective refractory period but slowed the conduction in the cell sheet at the pre-drug control ( Figs. 2A and 2B), which were opposite to the previous observation in the intact human heart (Josephson, 1993;Ward et al, 1979). V 1/2 for steadystate inactivation of cardiac Na + channel (Nav1.5) has been reported to be −84 mV (Wang et al, 2015).…”

Section: Relationship Between Na + Channel Availability and Conductioncontrasting

confidence: 45%

Characterization of human iPS cell-derived cardiomyocyte sheets as a model to detect drug-induced conduction disturbance

et al. 2017

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-In order to characterize human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) sheets as a model for detecting drug-induced conduction disturbance, we examined their electrophysiological and electropharmacological properties by using the multi-electrode array system with a programmed electrical stimulation protocol. At pre-drug control, the conduction speed, effective refractory period and field potential duration were 0.14 ± 0.01 m/sec, 453 ± 10 msec and 361 ± 9 msec, respectively at a cycle length of 1,000 msec (n = 18). Shortening the pacing cycle length from 1,000 to 600 msec decreased the conduction speed and field potential duration, but prolonged the effective refractory period. Disopyramide, lidocaine and flecainide decreased the conduction speed but prolonged the effective refractory period and field potential duration, whereas the reverse was true for verapamil. Thus, conduction properties of the cell sheet may largely depend on the extent of Na + channel availability as is the case in the human ventricle. Importantly, there was no relationship between the conduction delay and 1 st spike amplitude reduction after the treatment of Na + channel blockers. These findings may provide crucial guide on future application of this new technology for early phase safety pharmacological screening of new chemical entities.

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Section: Relationship Between Na + Channel Availability and Conductioncontrasting

confidence: 45%

Characterization of human iPS cell-derived cardiomyocyte sheets as a model to detect drug-induced conduction disturbance

et al. 2017

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“…This suggested that retrograde conduction of late ventricular premature systoles occurred through the atrioventricular node." 13 The shortest coupling time of V2 showing this retrograde activation sequence was 430 ms (Fig. 6A).…”

Section: Case Reportsmentioning

confidence: 84%

Limitation of tachycardia zone resulting from longitudinal dissociation of the atrioventricular node in concealed pre-excitation.

Littmann¹,

Svenson²

1981

Heart

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SUMMARY Two cases with a concealed left-sided accessory atrioventricular bypass tract are described. In both, functional longitudinal dissociation of the atrioventricular node narrowed the range of atrial premature beat coupling intervals which could initiate re-entry using the accessory pathway. In case 1 early premature atrial beats were followed by an atrioventricular nodal re-entrant echo. The atrial echo pre-empted retrograde conduction over the Kent bundle and thus limited the development of paroxysmal supraventricular tachycardia. In case 2 atrioventricular nodal conduction showed typical features ascribed to dual atrioventricular nodal pathways. In addition there was a bradycardia-related retrograde block in the concealed accessory pathway. Early premature atrial beats, because of exclusive "slow pathway" anterograde conduction, arrived at the ventricles during the period of bradycardia-dependent retrograde block and failed to initiate a macro re-entrant tachycardia. This study shows that (1) longitudinal dissociation within the atrioventricular node may limit the ability to initiate tachycardia in patients with concealed pre-excitation; and (2) discontinuous atrioventricular nodal conduction curves occasionally help to reveal bradycardia-related retrograde block in a concealed accessory pathway.Discontinuous atrioventricular nodal conduction curves and atrioventricular nodal re-entry are common electrophysiological responses to premature atrial stimulation in man.' The former are believed to reflect dual atrioventricular nodal pathways and the latter dual pathways, functional longitudinal dissociation, or reflection within the atrioventricular node.' 2 These phenomena have recently been described in a few patients who also had manifest35 or concealed pre-excitation.69 In most of these reported cases the atrioventricular nodal conduction characteristics were unrelated to the initiation or maintenance of the paroxysmal supraventricular tachycardia.68 In some, the critical atrioventricular conduction delay required for macro re-entry was achieved by block in the fast atrioventricular nodal pathway, and thus initiation of the tachycardia was enhanced by "duality" of atrioventricular conduction.5 9 In a few patients with an accessory pathway, atrioventricular nodal re-entry itself proved to be the mechanism of the tachycardia.4 8 10The purpose of the following report is (1) to present * Dr Littmann is a research fellow of the Heineman Medical Research Center. Parent Institution: Semmelweis University Medical School, Budapest, Hungary. Received for publication 10 December 1980 302 two unusual cases of concealed pre-excitation where atrioventricular nodal re-entry and dual atrioventricular nodal conduction limited rather than enhanced initiation of paroxysmal supraventricular tachycardia with early atrial extrasystoles, and (2) to show for the first time, a bradycardia-related retrograde block in a concealed accessory pathway. Case reportsCase 1, a 57-year-old man, and case 2, a 54-year-old woman, were stud...

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“…Several methods have been reported 1–4 ; however, the atrial insertion site is sometimes the only target when the AP only exhibits retrograde conduction. Mapping of the AP atrial insertion site is widely performed during ventricular pacing; however, the fusion of atrial activation caused by simultaneous retrograde conduction of the AV node and AP has been reported 5–7 . A fusion of atrial activation can lead to misleading the mapping results; however, it can be dissociated by prolonging retrograde conduction via the AV node by ventricular extrastimulus, 6 overdrive pacing at a high rate, 7 or the pharmacologic block 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Mapping of the AP atrial insertion site is widely performed during ventricular pacing; however, the fusion of atrial activation caused by simultaneous retrograde conduction of the AV node and AP has been reported. 5 , 6 , 7 A fusion of atrial activation can lead to misleading the mapping results; however, it can be dissociated by prolonging retrograde conduction via the AV node by ventricular extrastimulus, 6 overdrive pacing at a high rate, 7 or the pharmacologic block. 5 These approaches were discovered before catheter ablation became widely accepted.…”

Section: Introductionmentioning

confidence: 99%

Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node

Kinjo,

Kimura,

Kaname

et al. 2023

Journal of Arrhythmia

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IntroductionDuring ventricular pacing, a fusion of atrial activation may occur owing to the simultaneous retrograde conduction of the atrioventricular (AV) node and accessory pathway (AP), potentially leading to an inaccurate mapping of the atrial AP insertion site.ObjectiveWe tested the hypothesis that landiolol, an ultra‐short‐acting intravenous β1‐blocker, could dissociate a fusion of atrial activation.MethodsWe conducted a prospective before‐and‐after study to investigate the effect of landiolol on retrograde conduction via the AV node and AP. We enrolled 21 consecutive patients with orthodromic AV reciprocating tachycardia who underwent electrophysiological studies at our hospital between January 1, 2018, and August 31, 2020.ResultsSix patients exhibited a fusion of atrial activation. After landiolol administration (10 μg/kg/min), the effective refractory period was unchanged in AP (280 [240–290] ms vs. 280 [245–295] ms, p = .91), whereas that of the AV node was prolonged (275 [215–380] ms vs. 332 [278–445] ms, p = .03). The Wenckebach pacing rate via retrograde AV node decreased after landiolol administration (180 [140–200] beats per minute [bpm] vs. 140 [120–180] bpm, p = .02). Thus, landiolol decreased the minimum ventricular pacing rate required to dissociate a fusion of atrial activation (180 [160–200] bpm vs. 140 [128–155] bpm, p = .007). Radiofrequency catheter ablation under landiolol administration successfully eliminated AP in all patients during ventricular pacing without complications or recurrence.ConclusionLandiolol inhibited the AV node without affecting the AP and helped dissociate a fusion of atrial activation at a lower ventricular pacing rate.

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Patterns of atrial activation during right ventricular pacing in patients with concealed left-sided Kent pathways.

Cited by 7 publications

References 17 publications

Characterization of human iPS cell-derived cardiomyocyte sheets as a model to detect drug-induced conduction disturbance

Characterization of human iPS cell-derived cardiomyocyte sheets as a model to detect drug-induced conduction disturbance

Limitation of tachycardia zone resulting from longitudinal dissociation of the atrioventricular node in concealed pre-excitation.

Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node

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