Properties and Substrate of Slow Pathway Exposed with a Compact Node Targeted Fast Pathway Ablation in Rabbit Atrioventricular Node

Lin, Long-Yau; Billette, Jacques; Medkour, Djamila; Reid, Marie Claude; Tremblay, Mélanie

doi:10.1046/j.1540-8167.2001.00479.x

Cited by 22 publications

(47 citation statements)

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“…10). ERPN is not significantly affected, either (44,60). Conduction then occurs through SP over all H 2 A 3 ranges including the long range.…”

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 89%

“…10, inset) consistently interrupt FP (44,60). FP ablation prolongs conduction time over the long and intermediate H 2 A 3 ranges by a 16-ms average during the control protocol but minimally affects conduction over the short H 2 A 3 range (filled circles and squares in Fig.…”

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 93%

“…However, the normal dual pathways yield a smoother recovery curve at the transition from FP to SP than that of these patients (36,50,60). They can nonetheless be interrupted with ablation lesions (4,26,36,43,44,60,71). The typical target of a SP ablation is the crista terminalis input to the AV node, while the target of FP ablation is the interatrial septum input.…”

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 99%

“…9, inset) as located from the timing and shape of endocardial surface unipolar electrograms (36,43,44,50,60). Such a SP ablation typically prevents conduction over the short H 2 A 3 range and prolongs ERPN during a control S 1 S 2 S 3 protocol (Fig.…”

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 99%

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Integrated rate-dependent and dual pathway AV nodal functions: principles and assessment framework

Billette

Tadros

2014

American Journal of Physiology-Heart and Circulatory Physiology

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The atrioventricular (AV) node conducts slowly and has a long refractory period. These features sustain the filtering of atrial impulses and hence are often modulated to optimize ventricular rate during supraventricular tachyarrhythmias. The AV node is also the site of a clinically common reentrant arrhythmia. Its function is assessed for a variety of purposes from its responses to a premature protocol (S 1S2, test beats introduced at different cycle lengths) repeatedly performed at different basic rates and/or to an incremental pacing protocol (increasingly faster rates). Puzzlingly, resulting data and interpretation differ with protocols as well as with chosen recovery and refractory indexes, and are further complicated by the presence of built-in fast and slow pathways. This problem applies to endocavitary investigations of arrhythmias as well as to many experimental functional studies. This review supports an integrated framework of rate-dependent and dual pathway AV nodal function that can account for these puzzling characteristics. The framework was established from AV nodal responses to S 1S2S3 protocols that, compared with standard S 1S2 protocols, allow for an orderly quantitative dissociation of the different factors involved in changes in AV nodal conduction and refractory indexes under rate-dependent and dual pathway function. Although largely based on data from experimental studies, the proposed framework may well apply to the human AV node. In conclusion, the rate-dependent and dual pathway properties of the AV node can be integrated within a common functional framework the contribution of which to individual responses can be quantitatively determined with properly designed protocols and analytic tools. atrioventricular node; functional assessment; conduction; refractory period; pretest cycle length; recovery; facilitation; fatigue THE ATRIOVENTRICULAR (AV) node generates a delay between atrial and His bundle activation that helps optimize ventricular filling and blood pumping. The AV node also has rate-dependent conduction and refractory properties accounting for the filtering of atrial impulses during supraventricular tachyarrhythmias. The optimization of this filtering to control the ventricular rate constitutes a cornerstone of atrial fibrillation therapy (3). Another consistent feature of the normal AV node is its built-in fast pathway (FP) and slow pathway (SP) (29,36,45,50,60,73). In some human hearts, SP and FP interplay to result in a clinical arrhythmia known as AV nodal reentrant tachycardia, the most common form of paroxysmal supraventricular tachycardia that can now be successfully cured by ablation therapy (24,34,59,61). These properties are obviously sensitive to autonomic tone (54 -57), itself modulated by conditions such as rest, exercise, pregnancy, stress, diseases, drugs, etc. However, the basic AV nodal physiology and its assessment tools remain debated. Their understanding is the primary goal of this review.The understanding of AV nodal function remains indeed challenging. Zip...

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“…10). ERPN is not significantly affected, either (44,60). Conduction then occurs through SP over all H 2 A 3 ranges including the long range.…”

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 89%

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 93%

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 99%

Section: Dual Pathway Origin Of Rate-dependent Av Nodal Functionmentioning

confidence: 99%

See 2 more Smart Citations

Integrated rate-dependent and dual pathway AV nodal functions: principles and assessment framework

Billette

Tadros

2014

American Journal of Physiology-Heart and Circulatory Physiology

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“…Also disagreement exists whether the fast pathway arises as a separate branch of the posterior nodal extension, 8 or originates from the compact AV node. 7,14 The objective of this study was to extend our previous study 10 that visualized reentry pathways during retrograde excitation (ventricular echo) to reentry produced by more physiological anterograde programmed stimulation. We aimed to identify the role and anatomical localization of the FP in AV nodal reentry.…”

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confidence: 93%

Cx43 and Dual-Pathway Electrophysiology of the Atrioventricular Node and Atrioventricular Nodal Reentry

Nikolski

Jones²,

Lancaster³

et al. 2003

Circulation Research

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Fluorescent imaging has revealed that posterior nodal extensions provide the anatomical substrate for the dual-pathway electrophysiology of the atrioventricular (AV) node during normal conduction and reentry. The reentry can be intranodal, or as well as the posterior nodal extensions, it can involve an endocardial layer of atrial/atrial-nodal (A/AN) cells as part of the AV nodal reentry (AVNR) circuit. Using fluorescent imaging with a voltage-sensitive dye and immunolabeling of Cx43, we mapped the electrical activity and structural substrate in 3 types of AVNR induced by premature atrial stimulation in 8 rabbit hearts. In 6 cases, the AVNR pathway involved (1) a fast pathway (FP), (2) the A/AN layer, and (3) a slow pathway (SP). In 4 cases, reentry took the path (1) SP, (2) A/AN layer, and (3) FP. In 2 cases, reentry was intranodal, propagating between the 2 posterior nodal extensions. Immunolabeling revealed that the FP and SP are formed by Cx43-expressing bundles surrounded by tissue without Cx43. Cx43-expressing posterior nodal extensions are the substrate of AVNR during both intranodal and extranodal reentry.

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Clinical Electrophysiological Mechanisms of Tachycardias Arising from the Atrioventricular Junction

Katritsis¹

2011

Cardiac Arrhythmias and Mapping Techniques

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Properties and Substrate of Slow Pathway Exposed with a Compact Node Targeted Fast Pathway Ablation in Rabbit Atrioventricular Node

Abstract: The posterior nodal extension can sustain effective atrial-His conduction at all cycle lengths and account for both the manifest and concealed portion of SP. Slow and FP conduction primarily arise from the posterior extension and compact node, respectively.

Cited by 22 publications

References 1 publication

Integrated rate-dependent and dual pathway AV nodal functions: principles and assessment framework

Integrated rate-dependent and dual pathway AV nodal functions: principles and assessment framework

Cx43 and Dual-Pathway Electrophysiology of the Atrioventricular Node and Atrioventricular Nodal Reentry

Clinical Electrophysiological Mechanisms of Tachycardias Arising from the Atrioventricular Junction

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