scholarly journals “Nodoventricular” accessory pathway: Evidence for a distinct accessory atrioventricular pathway with atrioventricular node-like properties

1988 ◽  
Vol 11 (5) ◽  
pp. 1035-1040 ◽  
Author(s):  
George J Klein ◽  
Gerard M Guiraudon ◽  
Charles R Kerr ◽  
Arjun D Sharma ◽  
Raymond Yee ◽  
...  
Keyword(s):  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Accessory Atrioventricular Pathway

Sevoflurane Has No Effect on Sinoatrial Node Function or on Normal Atrioventricular and Accessory Pathway Conduction in Wolff-Parkinson-White Syndrome during Alfentanil/Midazolam Anesthesia 

1999 ◽  
Vol 90 (1) ◽  
pp. 60-65 ◽  
Author(s):  
Michael D. Sharpe ◽  
Daniel J. Cuillerier ◽  
John K. Lee ◽  
Magdi Basta ◽  
Andrew D. Krahn ◽  
...  
Keyword(s):  
Cycle Length ◽  
Sinoatrial Node ◽  
Sinus Node ◽  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Conduction Time ◽  
White Syndrome ◽  
The Right ◽  
Ablative Procedures ◽  
Wolff Parkinson White Syndrome

Background The effects of sevoflurane on the electrophysiologic properties of the human heart are unknown. This study evaluated the effects of sevoflurane on the electrophysiologic properties of the normal atrioventricular conduction system, and on the accessory pathways in patients with Wolff-Parkinson-White syndrome, to determine its suitability as an anesthetic agent for patients undergoing ablative procedures. Methods Fifteen patients with Wolff-Parkinson-White syndrome undergoing elective radiofrequency catheter ablation were studied. Anesthesia was induced with alfentanil (20-50 microg/kg) and midazolam (0.15 mg/kg), and vecuronium (20 mg) and maintained with alfentanil (0.5 to 2 microg x kg(-1) x min(-1)) and midazolam (1 or 2 mg every 10-15 min, as required). An electrophysiologic study measured the effective refractory period of the right atrium, atrioventricular node, and accessory pathway; the shortest conducted cycle length of the atrioventricular node and accessory pathway during atrial pacing; the effective refractory period of the right ventricle and accessory pathway; and the shortest retrograde conducted cycle length of the accessory pathway during ventricular pacing. Parameters of sinoatrial node function included sinus node recovery time, corrected sinus node recovery time, and sinoatrial conduction time. Intraatrial conduction time and the atrial-His interval were also measured. Characteristics of induced reciprocating tachycardia, including cycle length, atrial-His, His-ventricular, and ventriculoatrial intervals, also were measured. Sevoflurane was administered to achieve an end-tidal concentration of 2% (1 minimum alveolar concentration), and the study measurements were repeated. Results Sevoflurane had no effect on the electrophysiologic parameters of conduction in the normal atrioventricular conduction system or accessory pathway, or during reciprocating tachycardia. However, sevoflurane caused a statistically significant reduction in the sinoatrial conduction time and atrial-His interval but these changes were not clinically important. All accessory pathways were successfully identified and ablated. Conclusions Sevoflurane had no effect on the electrophysiologic nature of the normal atrioventricular or accessory pathway and no clinically important effect on sinoatrial node activity. It is therefore a suitable anesthetic agent for patients undergoing ablative procedures.

Wolff–Parkinson–White syndrome: lessons learnt and lessons remaining

2017 ◽  
Vol 27 (S1) ◽  
pp. S62-S67 ◽  
Author(s):  
D. Woodrow Benson ◽  
Mitchell I. Cohen
Keyword(s):  
Atrial Fibrillation ◽  
Sudden Death ◽  
Accessory Pathway ◽  
Minimal Risk ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
High Negative Predictive Value ◽  
Patients At Risk ◽  
Accessory Atrioventricular Pathway

AbstractThe Wolff–Parkinson–White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope – the “delta wave”. It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation <250 ms. Owing to the relatively high prevalence of asymptomatic Wolff–Parkinson–White pattern and availability of catheter ablation, there has been a need to identify risk among asymptomatic patients. Recent guidelines recommend invasive evaluation for such patients where pre-excitation clearly does not disappear during exercise testing. This strategy has a high negative predictive value only. The accuracy of this approach is under continued investigation, especially in light of other considerations: Patients having intermittent pre-excitation, once thought to be at minimal risk may not be, and the role of isoproterenol in risk assessment.

scholarly journals Mahaim-mediated tachycardia using at times the atrioventricular node and other times a left lateral accessory pathway

2021 ◽  
Vol 7 (10) ◽  
pp. 641-649
Author(s):  
Zakariyya Vali ◽  
G. André Ng ◽  
Mervat Aboulmaaty ◽  
Mokhtar Ibrahim
Keyword(s):  
Accessory Pathway ◽  
Atrioventricular Node

scholarly journals Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway and Atrial Flutter: A Case Report

2022 ◽  
Vol 1 ◽  
Author(s):  
Jogendra Singh ◽  
Dibyasundar Mahanta ◽  
Rudra Pratap Mahapatra ◽  
Debasis Acharya ◽  
Ramachandra Barik
Keyword(s):  
Case Report ◽  
Atrial Flutter ◽  
Mitral Stenosis ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Rheumatic Mitral Stenosis ◽  
Percutaneous Balloon ◽  
Mitral Valvotomy ◽  
The Right

A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had higher refractory period than atrioventricular node.

Supraventricular (narrow complex) tachycardias

2019 ◽  
pp. 209-220
Author(s):  
Julio Martí-Almor
Keyword(s):  
Antiarrhythmic Drugs ◽  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Term Treatment ◽  
Qrs Complex ◽  
Emergency Situations ◽  
Narrow Qrs ◽  
Long Term Treatment ◽  
Narrow Qrs Complex ◽  
Excitation Pattern

Supraventricular tachycardia (SVT) includes all tachycardia rhythms (more than 100 bpm), of which the mechanism involves the His Bundle or tissues above it. Usually, these tachyarrhythmias present a narrow QRS complex (except in the presence of a bundle branch block or a manifest accessory pathway which conducts anterogradely to cause a ventricular pre-excitation pattern on the electrocardiogram). This chapter only focuses on narrow QRS complex SVT involving the atrial tissue, the atrioventricular node, and accessory pathways. Atrial fibrillation and atrial flutter are excluded because they are specifically covered in other chapters. The role of antiarrhythmic drugs in SVTs is mainly restricted to acute situations because ablative therapy has surrogate pharmacotherapy and ablation is considered the best long-term treatment for most cases. Nevertheless, it is very important to know how to deal with antiarrhythmic drugs in emergency situations.

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