Patterns of Ventriculo-Atrial Conduction in the Wolff-Parkinson-White Syndrome

Wellens, Hein J.J.; Durrer, D

doi:10.1161/01.cir.49.1.22

Cited by 115 publications

(13 citation statements)

References 13 publications

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“…Klein et al14 recently observed decremental retrograde conduction via anomalous bypass tracts in three of their 30 patients with the Wolff-Parkinson-White syndrome. However, the magnitude of conduction delay during retrograde conduction over the slow pathway as demonstrated in this study was much greater than that reported by Klein et al, 1 as evidenced by recordings of atrial electrograms far apart from those of ventricular electrograms during retrograde slow pathway conduction (ventriculoatrial -intervals ranged from 290-525 msec) (figs. [4][5][6].…”

Section: Resultscontrasting

confidence: 63%

Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways.

Sung¹,

Waxman²,

Saksena³

et al. 1981

Circulation

185

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SUMMARY To characterize the sequence of retrograde atrial activation in the presence of dual atrioventricular (AV) nodal pathways, we analyzed electrophysiologic data from seven patients in whom discontinuous AV nodal and ventriculoatrial conduction curves could be induced with programmed electrical stimulation. In all patients, electrograms of the high right atrium (HRA), lateral right atrium (LRA), low septal right atrium (SRA) and proximal coronary sinus (PCS) near the coronary sinus ostium were simultaneously recorded at a paper speed of 150-250 mm/sec. During programmed ventricular extrastimulation and incremental ventricular pacing, ventriculoatrial conduction via the fast AV nodal pathway resulted in SRA activation before PCS, HRA and LRA activation. However, the sequence of retrograde atrial activation abruptly changed with a shift from retrograde fast to retrograde slow AV nodal pathway conduction. Characteristically, during ventriculoatrial conduction via the slow AV nodal pathway, activation of the PCS preceded SRA activation by 5-20 msec and was accompanied by an alteration of the temporal relationship between HRA and LRA activation in all patients. These observations suggest that anatomically, the proximal common AV nodal pathway is a broad area that permits the slow AV nodal pathway to have a retrograde exit located posteriorly, inferiorly and to the left of that of the fast AV nodal pathway, and that the retrograde atrial activation sequence recorded during tachyarrhythmias should be determined with caution while attempting to differentiate retrograde normal AV pathway from retrograde anomalous bypass tract conduction.IN DIFFERENTIATING retrograde conduction via the normal atrioventricular (AV) pathway from an anomalous bypass tract, one must evaluate ventriculoatrial conduction properties during an electrophysiologic study.'-" Ventriculoatrial conduction over the normal AV pathway is characterized by the earliest activation of the low septal right atrium (SRA) recorded in the His bundle electrographic lead and progressive prolongation of ventriculoatrial conduction time with increasing prematurity of ventricular extrastimulation. In contrast, ventriculoatrial conduction over an anomalous bypass tract has the earliest atrial activation at the site of its atrial insertion, and, characteristically, there is a lack of refractory-dependent ventriculoatrial conduction delay despite progressively premature ventricular extrastimulation.1 3 Dual AV nodal pathways are generally believed to be intranodal structures.4"8 Both fast and slow AV nodal pathways possess AV nodal properties with refractory-dependent conduction delay in both antegrade and retrograde directions.6-8 However, studies on the sequence of retrograde atrial activation have been limited to the fast AV nodal pathway.9' 10 In the present study, we characterize and compare retrograde atrial activation sequences that result from ventriculoatrial conduction via the fast and the slow AV nodal pathways. Materials and MethodsElectrophysiologic evid...

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Section: Resultscontrasting

confidence: 63%

Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways.

Sung¹,

Waxman²,

Saksena³

et al. 1981

Circulation

185

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“…2a) (Narula, 1974;Wellens and Durrer, 1974). The small but equal increase in V-RA and V-LA intervals in 1 patient was attributed to intraventricular delay.…”

Section: Resultsmentioning

confidence: 99%

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

De¹,

Aj²,

Spurrell³

1979

Heart

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“…The use of retrograde atrial sequence and of functional bundle-branch block has been described in detail in recent publications (Coumel and Attuel, 1974;Spurrell et al, 1974;Zipes et al, 1974;Svenson et al, 1974;Wellens and Durrer, 1974;Gallagher et al, 1975;Neuss et al, 1975;Tonkin al., 1975). The use of atrial stimulation at multiple sites has received less attention.…”

Section: Discussionmentioning

confidence: 99%

Atrial pacing at multiple sites in the Wolff-Parkinson-White syndrome.

Denes¹,

Wyndham²,

Amat-y-Leon³

et al. 1977

Heart

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Atrial pacing at multiple sites was used in an attempt to predict the site of pre-excitation in 5 patients with Wolff-Parkinson-White syndrome with 5 different anomalous pathway locations (right anterior, right posterior, septal, left posterior, and left lateral). At least 3 atrial pacing sites were tested in each patient. Pacing sites tested included high right atrium, low lateral right atrium, low septal right atrium, proximal coronary sinus, and distal coronary sinus. Atrial stimulation sites with shortest and longest stimulus-delta intervals could be identified in each patient, the shortest stimulus-delta interval in each case ranging from 60 to 80 ms. The difference between the shortest and longest stimulus-delta interval in each case ranged from 60 to 110 ms. It was suggested that the site with the shortest stimulus-delta interval corresponded to a site close to the atrial insertion of the anomalous pathway. This hypothesis was confirmed in all cases (3 with epicardial mappitng and 2 with retrograde atrial activation data). In conclusion, atrial pacing at multiple sites is helpful in predicting the site of anterogradely conducting anomalous pathways, and appears particularly usefulfor differentiation of right posterior, left posterior, and septal pre-excitation.

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Patterns of Ventriculo-Atrial Conduction in the Wolff-Parkinson-White Syndrome

Cited by 115 publications

References 13 publications

Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways.

Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways.

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

Atrial pacing at multiple sites in the Wolff-Parkinson-White syndrome.

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