Surgical procedure for the cure of atrioventricular junctional (“AV node”) reentrant tachycardia: Anatomic and electrophysiologic effects of dissection of the anterior atrionodal connections in a canine model

Abstract

The atrionodal connections closest to the His bundle are the preferred route of conduction through the AV node during normal AV or VA conduction. Destruction of these connections modifies AV node conduction. The surgical procedure selectively interrupts these connections, and this interruption is likely to be the mechanism of cure.

Paroxysmal Supraventricular Tachycardia: A Century of Progress

“…Accordingly, the effects of anterior (type A) and posterior (type B) dissection were examined in experimental animals. 62,63 These studies showed some degree of damage to the AV node in animals undergoing type A dissection but in more than 40% of cases this damage was minor. Moreover, there was only mild impairment of anterograde AV conduction.…”

Noncontact three-dimensional mapping guides catheter ablation of difficult atrioventricular nodal reentrant tachycardia

“…Some investigators arbitrarily divided these nondiscrete AV nodal inputs into the so-called fast pathway, slow pathway, and intermediate pathway. McGuire et al suggested that the atrionodal connection closest to the His bundle was the preferred route of conduction through the AV node during normal AVor VA conduction, and that part of slow AV nodal pathway may lie outside the compact AV node [12,13]. Previous animal studies demonstrated that the antegrade conduction over the slow pathway existed in all normal hearts with or without AVNRT, but did not become manifest because propagation over the fast pathway reached the AV node first [11,14].…”

“…However, the propagation of the wavefronts in the other two cases could not spread directly toward the apex of Koch's triangle during atrial pacing with shorter CLs, but instead appeared to approach the AV nodal region via the posterior "slow" pathway input. This particular phenomenon may be caused by: 1) previous ablation lesions, 2) local fibrosis due to the older age or, 3) local functional block due to a negative balance of the source and sink [12,13,16].…”

Atypical Form of the Fourth Criterion for Transient Entrainment

“…Stimulation from the distal coronary sinus was often associated with pacing failure (due to the high stimulation threshold) or simultaneous pacing of the left atrium and the left ventricle.' Thus, selective left atrial pacing from the distal coronary sinus was possible in only 6 cases (9)(10)(11)(12)19, and 20).…”