Effect of adenosine on atrioventricular conduction in children and young patients with supraventricular tachycardia

1996 ◽  
Vol 6 (4) ◽  
pp. 308-314
Author(s):  
Parvin C. Dorostkar ◽  
Macdonald Dick ◽  
Gerald A. Serwer ◽  
Sarah LeRoy ◽  
Brian Armstrong
Keyword(s):  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
Young Patients ◽  
Atrioventricular Node ◽  
Atrioventricular Conduction ◽  
Ventricular Pacing ◽  
Accessory Pathways ◽  
Before And After ◽  
Ventricular Activation ◽  
Retrograde Conduction

AbstractAdenosine, when given as an intravenous bolus, has been shown to produce atrioventricular nodal block in humans. To examine the effect of adenosine on conduction across both accessory pathways and the atrioventricular node in children, we reviewed our experience with adenosine administered during both atrial and ventricular pacing in 42 patients with atrioventricular resting tachycardia and in eight patients with atrioventricular nodal reentry tachycardia. Adenosine was administered as a mean bolus of 195 μg/kg/dose during both atrial and ventricular pacing, examining antegrade and retrograde conduction before and after radiofrequency ablation. In those patients with persistent or intermittent pre-excitation, anomalous ventricular activation was either unchanged (n=8) or increased (n=11). Retrograde conduction (either through the accessory pathway alone in three, or across both the accessory pathway and the atrioventricular node in 19) persisted in 92% of the 24 patients studied. Adenosine produced either first or third degree antegrade heart block in all patients studied without pre-excitation (those with either dual atrioventricular nodal pathways or concealed accessory pathways). Adenosine produced retrograde block in all of the eight patients with dual atrioventricular nodal pathways. In contrast, retrograde conduction persisted in 82% (14/17) of patients with concealed accessory pathways (p=0.001). When used to examine retrograde conduction, adenosine was a sensitive (82%) and highly specific (producing retrograde atrioventricular block in all patients with dual atrioventricular nodal pathways) predictor of tachycardia supported by a concealed accessory pathway. Adenosine yielded a sensitivity and specificity of 96% and a positive predictive value of 99.5% for the success of ablation of accessory pathways. These data indicate that the pattern of adenosine-induced changes in either antegrade or retrograde atrioventricular conduction, or conduction in both directions, in young patients with supraventricular tachycardia is related to the mechanism of the tachycardia. Adenosine, therefore, is a useful adjunct in the electrophysiologic evaluation of supraventricular tachycardia in children.

Characteristics of antegrade-only accessory pathways in children and adolescents

2021 ◽  
pp. 1-5
Author(s):  
Minh B. Nguyen ◽  
Allison C. Hill ◽  
Yaniv Bar-Cohen ◽  
Michael J. Silka
Keyword(s):  
High Risk ◽  
Refractory Period ◽  
Accessory Pathway ◽  
Young Patients ◽  
Atrioventricular Node ◽  
Effective Refractory Period ◽  
Accessory Pathways ◽  
Electrophysiology Study ◽  
Minimal Data ◽  
Subsequent Comparison

Abstract There is minimal data regarding antegrade-only accessory pathways in young patients. Given evolving recommendations and treatments, retrospective analysis of the clinical and electrophysiologic properties of antegrade-only pathways in patients <21 years old was performed, with subsequent comparison of electrophysiology properties to age-matched controls with bidirectional pathways. Of 522 consecutive young patients with ventricular pre-excitation referred for electrophysiology study, 33 (6.3%) had antegrade-only accessory pathways. Indications included palpitations (47%), chest pain (25%), and syncope (22%). The shortest value for either the accessory pathway effective refractory period or the pre-excited R-R interval was taken for each patient, with the median of the antegrade-only group significantly greater than shortest values for the bidirectional group (310 [280–360] ms versus 270 [240–302] ms, p < 0.001). However, the prevalence of pathways with high-risk properties (effective refractory period or shortest pre-excited R-R interval <250 ms) was similar in both study patients and controls (13% versus 21%) (p = 0.55). Sixteen patients had a single antegrade-only accessory pathway and no inducible arrhythmia. Six patients had Mahaim fibres, all right anterolateral with inducible antidromic reciprocating tachycardia. However, 11 patients with antegrade-only accessory pathways and 3 with Mahaim fibres had inducible tachycardia due to a second substrate recognised at electrophysiology study. These included concealed accessory pathways (7), bidirectional accessory pathways (5), and atrioventricular node re-entry (2). Antegrade-only accessory pathways require comprehensive electrophysiology evaluation as confounding factors such as high-risk conduction properties or inducible Supraventricular Tachycardia (SVT) due to a second substrate of tachycardia are often present.

scholarly journals The Anatomy, Development, and Evolution of the Atrioventricular Conduction Axis

2018 ◽  
Vol 5 (3) ◽  
pp. 44 ◽  
Author(s):  
Robert Anderson ◽  
Shumpei Mori ◽  
Diane Spicer ◽  
Damian Sanchez-Quintana ◽  
Bjarke Jensen
Keyword(s):  
Atrioventricular Node ◽  
Atrioventricular Conduction ◽  
Significant Part ◽  
Current Understanding ◽  
Ventricular Activation ◽  
Mechanisms Of Development ◽  
Development And Evolution

It is now well over 100 years since Sunao Tawara clarified the location of the axis of the specialised myocardium responsible for producing coordinated ventricular activation. Prior to that stellar publication, controversies had raged as to how many bundles crossed the place of the atrioventricular insulation as found in mammalian hearts, as well as the very existence of the bundle initially described by Wilhelm His Junior. It is, perhaps surprising that controversies continue, despite the multiple investigations that have taken place since the publication of Tawara’s monograph. For example, we are still unsure as to the precise substrates for the so-called slow and fast pathways into the atrioventricular node. Much has been done, nonetheless, to characterise the molecular make-up of the specialised pathways, and to clarify their mechanisms of development. Of this work itself, a significant part has emanated from the laboratory coordinated for a quarter of a century by Antoon FM Moorman. In this review, which joins the others in recognising the value of his contributions and collaborations, we review our current understanding of the anatomy, development, and evolution of the atrioventricular conduction axis.

Anomalous Atrioventricular Excitation (Wolff-Parkinson-White Syndrome)

PEDIATRICS ◽  
1959 ◽  
Vol 23 (5) ◽  
pp. 902-902
Keyword(s):  
Atrioventricular Node ◽  
Atrial Arrhythmias ◽  
White Syndrome ◽  
Pr Interval ◽  
Ventricular Activation ◽  
Excitation Pattern ◽  
Retrograde Conduction ◽  
Wolff Parkinson White Syndrome

Vectorcardiographic and electrocardiographic data in 4 patients with the Wolff-Parkinson-White syndrome are presented. These studies support the concept that the mechanism responsible for the pre-excitation pattern is a functioning accessory neuromuscular bridge that by-passes the atrioventricular node. Early delivery of the impulse from the sino-auricular node to the lower chambers initiates premature ventricular activation with consequent shortening of the PR interval and lengthening of the QRS interval. Retrograde conduction through the accessory tract may be observed, and is a possible explanation of the atrial arrhythmias that occur in this syndrome.

Concealed accessory pathways and related tachycardias

ESC CardioMed ◽  
2018 ◽  
pp. 2091-2092
Author(s):  
Carlo Pappone ◽  
Vincenzo Santinelli
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Atrioventricular Node ◽  
Tricuspid Annulus ◽  
Atrioventricular Reentrant Tachycardia ◽  
Accessory Pathways ◽  
Purkinje System ◽  
Electrical Impulses ◽  
Supraventricular Tachycardias ◽  
Retrograde Conduction

Conduction from the atria to the ventricles normally occurs via the atrioventricular node–His–Purkinje system. Accessory pathways (APs) directly connect the atrium and ventricle and bypass the atrioventricular node, bridging the mitral or, less commonly, the tricuspid annulus. Concealed APs conduct electrical impulses retrogradely from the ventricles to the atria, but not antegradely from the atria to the ventricles. Approximately 40% of all APs are concealed, and orthodromic atrioventricular reentrant tachycardia due to concealed APs is present in up to 15% of patients with supraventricular tachycardias referred for catheter ablation. Most concealed APs are left-sided, exhibiting non-decremental retrograde conduction. Tachyarrhythmias due to concealed APs are managed similarly to those supraventricular tachycardias associated with manifest APs, and symptomatic tachyarrhythmias are successfully treated by radiofrequency catheter ablation in the majority of patients.

Quality of life assessment in children before and after a successful ablation for supraventricular tachycardia

2020 ◽  
Vol 30 (3) ◽  
pp. 413-417 ◽  
Author(s):  
M Cecilia Gonzalez Corcia ◽  
Laura Peters ◽  
Thierry Sluysmans ◽  
Stephane Moniotte ◽  
Karlien Carbonez ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Negative Impact ◽  
Accessory Pathway ◽  
Young Patients ◽  
Life Assessment ◽  
Percutaneous Ablation ◽  
Supraventricular Arrhythmias ◽  
Ectopic Atrial Tachycardia ◽  
Before And After

ABSTRACTBackground and Objectives:Young patients suffering from rhythm disorders have a negative impact in their quality of life. In recent years, ablation has become the first-line therapy for supraventricular arrhythmias in children. In the light of the current expertise and advancement in the field, we decided to evaluate the quality of life in young patients with supraventricular arrhythmias before and after a percutaneous ablation procedure.Methods:The prospective cohort consisted of patients <18 years with structurally normal hearts and non-pre-excited supraventricular arrhythmias, who had an ablation in our centre from 2013 to 2018. The cohort was evaluated with the PedsQL™ 4.0 Generic Core Scales self-questionnaire prior to and post-ablation.Results:The final cohort included 88 patients consisted of 52 males (59%), with a mean age at ablation of 12.5 ± 3.3 years. Forty-two patients (48%) had a retrograde-only accessory pathway mediating the tachycardia, 38 (43%) had atrio-ventricular nodal re-entrant tachycardia, 7 (8%) had ectopic atrial tachycardia, and 1 (1%) had atrial flutter. The main reason for an ablation was the patient’s choice in 53%. There were no severe complications. Comparison between the baseline and post-ablation assessments showed that patients reported significant improvement in the scores for physical health, emotional and social functioning, as well as in the total scores.Conclusions:The present study demonstrates that the successful treatment of supraventricular arrhythmias by means of an ablation results in a significant improvement in the quality of self-reported life scores in young patients.

Effect of radiofrequency catheter ablation of accessory pathways on autonomic tone in children

1999 ◽  
Vol 9 (4) ◽  
pp. 377-383 ◽  
Author(s):  
Ruchir Sehra ◽  
Joyce E. Hubbard ◽  
Susan P. Straka ◽  
Naomi S. Fineberg ◽  
Douglas P. Zipes ◽  
...  
Keyword(s):  
Heart Rate ◽  
Catheter Ablation ◽  
Supraventricular Tachycardia ◽  
Radiofrequency Catheter Ablation ◽  
Autonomic Function ◽  
Accessory Pathways ◽  
Non Invasive ◽  
Autonomic Changes ◽  
Before And After ◽  
Autonomic Blockade

AbstractBackgroundRadiofrequency catheter ablation is standard treatment for children with re-entrant supraventricular tachycardias. Autonomic changes have been noted after such ablation for atrioventricular nodal re-entry tachycardia, but not as well documented with atrioventricular re-entry over an accessory pathway.Methods and resultsIn 10 normal paediatric volunteers and 12 children referred for electrophysiologic testing and radiofrequency ablation of supraventricular tachycardia, non-invasive autonomic function tests and tilt-table testing were performed, and the variability in 24-h heart rate was analysed. Patients with supraventricular tachycardia underwent these tests both 24–72 h before and 24 h after ablation. Patients with tachycardia underwent additional autonomic testing to assess the sensitivity of baroreceptors and the intrinsic heart rate with autonomic blockade immediately before and after ablation. One non-invasive autonomic function test, namely handgrip, demonstrated significant differences (p < 0.05) in diastolic blood pressure before and after ablation, though these values did not differ from controls. Significant decreases were noted in two indexes of the variability of heart rate before and after ablation (p < 0.05). Certain tilt test variables also demonstrated significant differences between controls and those with tachycardia subsequent to ablation. Intracardiac testing demonstrated changes (p < 0.05) in sinus cycle lengths, effective refractory periods and/or blood pressures at baseline and during testing of the sensitivity of baroreceptors before and after ablation. These changes were consistent with increased sympathetic or decreased parasympathetic tone. With autonomic blockade, these differences were abolished.ConclusionsCatheter ablation of accessory pathways in children was associated with changes consistent with increased sympathetic or decreased parasympathetic tone. These autonomic changes persisted 24 h after the ablation procedure.

scholarly journals Radio Frequency Ablation of right sided accessory pathway - 8 years experience at SGNHC

2013 ◽  
Vol 8 (1) ◽  
pp. 19-22
Author(s):  
R Raut ◽  
MB KC ◽  
S Rajbhandari ◽  
M Dhungana ◽  
R Shah ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Radio Frequency ◽  
Success Rate ◽  
Recurrence Rate ◽  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
Demographic Characteristics ◽  
Radio Frequency Ablation ◽  
Accessory Pathways

Background Radiofrequency ablation has been established as the curative treatment for most of supraventricular tachycardia since 1987. In SGNHC, ablation has been done routinely since 2003. In our experience, right sided accessory pathway (AP) has been technically difficult and challenging with low success rate as mentioned in literature outside. So, the objective of this article was to analyze the demographic characteristics, success and recurrence rate and complication of right sided AP ablation in our centre. Methods and Materials From 13th Oct 2003 to 9th Sept. 2011, altogether 768 patients who underwent ablation were analyzed. Result Among 768 patients, 416(54.2%) were accessory pathways out of which 72(17.3%) were right sided AP. Majority of right sided accessory pathway were manifest (WPW) comprising 77.1%, significantly higher compare to left sided pathway where manifest AP was only 44.1 % (p< 0.001). Among all attempted ablation of right sided AP, 11 ablations failed so that the success rate was 84.7% lower than that of left sided pathway where success rate was 98.4% (p<0.001). Among 61 successful ablations, 2 relapsed during follow up period, recurrence rate being 3.3%. Although there were few complications in the ablation of other tachyarrhythmia, there was no complication noted during the ablation of 72 right sided AP. Conclusion Right sided pathway are mostly manifest. The success rate of right sided pathway is lower in comparison to left sided pathway. Our success rate is comparable to the result in the literature which indicates that ablation of right sided accessory pathway in our centre is reasonably good. DOI: http://dx.doi.org/10.3126/njh.v8i1.8332 Nepalese Heart Journal Vol.8(1) 2011 pp.19-22

Radiofrequency catheter ablation for supraventricular tachycardia in a paediatric population: characteristics of tachycardia mechanisms in a subpopulation with early onset

2020 ◽  
Vol 30 (10) ◽  
pp. 1383-1388
Author(s):  
Yamina Schibli ◽  
Matthias Gass ◽  
Florian Berger ◽  
Christian Balmer
Keyword(s):  
Supraventricular Tachycardia ◽  
Early Onset ◽  
Late Onset ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Population Characteristics ◽  
Common Mechanism ◽  
Accessory Pathways ◽  
Onset Group ◽  
Early Onset Group

AbstractBackground:In children, the first episode of supraventricular tachycardia occurs at various ages. The aim of this study is to describe age-specific tachycardia mechanisms, clinical findings, and outcome in a contemporary cohort of paediatric patients with supraventricular tachycardia.Methods:Retrospective analysis of 531 consecutive patients with structurally normal hearts under the age of 18 years who underwent invasive electrophysiological study for supraventricular tachycardia. The study population was divided into two groups, early-onset group (n = 57) and late-onset group (n = 474), according to the age of the occurrence of the first tachycardia before or after the age of 12 months.Results:Accessory pathway-mediated tachycardia was more common (82.5 versus 50.1%, p < 0.001) and the proportion of left-sided accessory pathways was more pronounced (74.5 versus 53.7%, p = 0.01) in the early-onset group than in the late-onset group. The antegrade and retrograde refractory periods of the accessory pathways were similar in both groups, but pre-excitation was more common in the early-onset group (50.9 versus 31.9%, p = 0.007). Typical atrioventricular nodal re-entrant tachycardia was more common (36.7 versus 7.0%, p < 0.001) in the late-onset group. There was no difference among the two groups regarding overall outcome.Conclusion:Accessory pathway-mediated re-entrant tachycardia is the most common mechanism of recurrent supraventricular tachycardia in infants with structurally normal hearts who are later referred to an electrophysiological study. These pathways often cause pre-excitation and tend to be located on the left side whereas their refractory period is not different from that of patients with late-onset tachycardia.

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