Document Detail


Electrophysiologic characteristics of diverse accessory pathway locations of antidromic reciprocating tachycardia.
MedLine Citation:
PMID:  11113408     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study assessed antidromic reciprocating tachycardia (ART) in patients with paraseptal accessory pathways (APs). Previous clinical experience suggests that paraseptal APs are unable to serve as the anterograde limb during ART. Based on the reentry wavelength concept, we hypothesized that anatomic location of a paraseptal AP may not preclude occurrence of ART. If wavelength criteria were met due to prolonged conduction time retrogradely in the atrioventricular node or anterogradely in the AP, ART may be sustained. All patients who had ART in the electrophysiologic laboratory at our institution (1991 to 1998) were studied. Based on fluoroscopically guided electrophysiologic mapping and radiofrequency ablation, AP location was classified as paraseptal, posterior, or lateral. Conduction time and refractoriness measurements were made for all components of the ART circuit. Of 24 patients with ART, 5 (21%) had ART utilizing a paraseptal AP. Anterograde conduction time through the AP and retrograde atrioventricular nodal conduction time were significantly longer in patients with paraseptal versus lateral pathways. Isoproterenol was required for ART induction in 38% of patients with a posterior AP, 36% with lateral AP location, but not in patients with a paraseptal AP. There were no significant differences in tachycardia cycle length or refractoriness of anterograde and/or retrograde components of the macroreentry circuit between the 3 pathway locations. Thus, ART can occur in patients with a paraseptal AP. Slower anterograde pathway conduction, or retrograde atrioventricular nodal conduction renders the wavelength critical for completion of the antidromic re-entrant circuit.
Authors:
D M Luria; S S Chugh; T M Munger; P A Friedman; R F Rea; D L Packer; A Jahangir; S C Hammill; W K Shen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  86     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2000 Dec 
Date Detail:
Created Date:  2001-01-15     Completed Date:  2001-02-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1333-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Agonists / diagnostic use
Adult
Analysis of Variance
Atrioventricular Node / physiopathology
Body Surface Potential Mapping
Bundle-Branch Block / physiopathology
Catheter Ablation
Electrocardiography
Electrophysiology
Female
Fluoroscopy
Heart Conduction System / drug effects,  physiopathology*,  surgery
Heart Septum / physiopathology
Humans
Isoproterenol / diagnostic use
Male
Radiography, Interventional
Refractory Period, Electrophysiological / physiology
Retrospective Studies
Tachycardia / physiopathology*,  surgery
Time Factors
Chemical
Reg. No./Substance:
0/Adrenergic beta-Agonists; 7683-59-2/Isoproterenol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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