scholarly journals Differentiating Atrioventricular Reentry Tachycardia and Atrioventricular Node Reentry Tachycardia Using Premature His Bundle Complexes

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Benzy J. Padanilam ◽  
Asim S. Ahmed ◽  
Brad A. Clark ◽  
Jasen L. Gilge ◽  
Parin J. Patel ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Atrioventricular Node ◽  
Conduction Time ◽  
His Bundle ◽  
Specificity And Sensitivity ◽  
Atrioventricular Reentry Tachycardia ◽  
Supraventricular Tachycardias ◽  
Reentry Tachycardia ◽  
High Output ◽  
Atrioventricular Node Reentry Tachycardia

Background: Current maneuvers for differentiation of atrioventricular node reentry tachycardia (AVNRT) and atrioventricular reentry tachycardia (AVRT) lack sensitivity and specificity for AVRT circuits located away from the site of pacing. We hypothesized that a premature His complex (PHC) will always perturb AVRT because the His bundle is obligatory to the circuit. Further, AVNRT could not be perturbed by a late PHC (≤20 ms ahead of the His) due to the retrograde His conduction time. Earlier PHCs can advance the AVNRT circuit but only by a quantity less than the prematurity of the PHC. Methods: High-output pacing at the distal His location delivered PHCs. AVRT was predicted when late PHCs perturbed tachycardia or when earlier PHCs led to atrial advancement by an amount equal or greater than the degree of PHC prematurity. Results: Among the 73 supraventricular tachycardias, the test accurately predicted AVRT (n=29) and AVNRT (n=44) in all cases. Late PHC advanced the circuit in all 29 AVRTs and none of the AVNRTs (sensitivity and specificity, 100%). With earlier PHCs, the degree of atrial advancement was equal or greater than the PHC prematurity in 26/29 AVRTs and none of the AVNRTs (90% sensitivity and 100% specificity). The mean prematurity of the PHC required to perturb AVNRT was 48 ms (range, 28–70 ms) and the advancement less than the prematurity of the PHC (mean, 32 ms; range, 18–54 ms). Conclusions: The responses to PHCs distinguished AVRT and AVNRT with 100% specificity and sensitivity.

Abstract 15612: Force, Power, and Temperature Settings in Slow Pathway Modification Utilizing an Irrigated Force Sensing Ablation Catheter

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amit Blumfield ◽  
Jay Chudow ◽  
John D Fisher ◽  
Luigi DiBiase ◽  
Kevin J Ferrick ◽  
...  
Keyword(s):  
Atrioventricular Node ◽  
Force Sensing ◽  
Slow Pathway ◽  
Target Temperature ◽  
Ablation Catheter ◽  
Electrophysiologic Study ◽  
Junctional Rhythm ◽  
Reentry Tachycardia ◽  
Atrioventricular Node Reentry Tachycardia ◽  
Catheter Location

Introduction: Atrioventricular node reentry tachycardia (AVNRT) ablation is typically performed with solid tip catheters set to temperature control (TC) mode. Radiofrequency (RF) output, tip temperature (T), and junctional rhythm response (JRR) during RF application have been well defined. JRR in an intermittent burst, sinus-junction-junction, or sinus-junction-sinus pattern is associated with successful modification of the AV nodal slow pathway (SP). Irrigated force-sensing catheters (IFSC) are often utilized for mapping and ablation of the SP. Despite this, parameters for IFSC used in TC mode resulting in JRR have not been well described. Hypothesis: Parameters predicting JRR and successful SP modification with IFSC include power (P), force (F), impedance drop (I), and target temperature (T). Methods: Consecutive patients that underwent electrophysiologic study and successful ablation of typical AVNRT with an IFSC were studied. Lesion parameters including P, T, F, time and I change were analyzed. Lesions producing JRR were considered efficacious. Independent T-Test and ANOVA were used to determine significance between the two groups (efficacious and non-efficacious lesions). Results: 296 lesions in 39 patients (age 52+/-14) were analyzed. All patients had successful SP modification without complication. Average F producing JRR was 8g, average T producing JRR was 41 o C, average I drop producing JRR was 9 Ohms, and average P producing JRR was 28W. Only RF lesion time was a significant predictor of JRR (p=0.009). (Table 1). Conclusions: Successful SP modification with IFSC was accomplished with catheter contact force as low as 2g. Lower average tip T, and lower average P settings compared to parameters typically used with solid tip catheters were observed. Parameters including P, F, T, and I change were not predictive of JRR. Additional studies controlling for catheter location while varying parameters are indicated.

scholarly journals Radiofrequency Catheter Ablation for Atrioventricular Node Reentry Tachycardia with Multiple Slow Atrioventricular Node Pathways.

1995 ◽  
Vol 59 (4) ◽  
pp. 224-230
Author(s):  
Muneshige Kaibara ◽  
Atsushi Konoe ◽  
Shojiro Isomoto ◽  
Osmar A. Centurion ◽  
Tetsuya Hirata ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Atrioventricular Node ◽  
Reentry Tachycardia ◽  
Atrioventricular Node Reentry Tachycardia

Morphology and electrophysiology of the mammalian atrioventricular node

1988 ◽  
Vol 68 (2) ◽  
pp. 608-647 ◽  
Author(s):  
F. L. Meijler ◽  
M. J. Janse
Keyword(s):  
Mammalian Species ◽  
Conduction Block ◽  
Atrioventricular Node ◽  
Conduction Delay ◽  
Conduction Time ◽  
Av Node ◽  
Crista Terminalis ◽  
His Bundle ◽  
Transitional Cells ◽  
Av Bundle

The AV node of those mammalian species in which it has been thoroughly investigated (rabbit, ferret, and humans) consists of various cell types: transitional cells, midnodal (or typical nodal cells), lower nodal cells, and cells of the AV bundle. There are at least two inputs to the AV node, a posterior one via the crista terminalis and an anterior one via the interatrial septum, where atrial fibers gradually merge with transitional cells. The role of a possible third input from the left atrium has not been investigated. Since the transition from atrial fibers to nodal fibers is gradual, it is very difficult to define the "beginning" of the AV node, and gross measurements of AV nodal length may be misleading. Histologically, the "end" of the AV node is equally difficult to define. At the site where macroscopically the AV node ends, at the point where the AV bundle penetrates into the membranous septum, typical nodal cells intermingle with His bundle cells. A conspicuous feature, found in all species studied, is the paucity of junctional complexes, most marked in the midnodal area. The functional counterpart of this is an increased coupling resistance between nodal cells. An electrophysiological classification of the AV nodal area, based on transmembrane action potential characteristics during various imposed atrial rhythms (rapid pacing, trains of premature impulses), into AN (including ANCO and ANL), N, and NH zones has been described by various authors for the rabbit heart. In those studies in which activation patterns, transmembrane potential characteristics, and histology have been compared, a good correlation has been found between AN and transitional cells, N cells and the area where transitional cells and cells of the beginning of the AV bundle merge with midnodal cells, and NH cells and cells of the AV bundle. Dead-end pathways correspond to the posterior extension of the bundle of lower nodal cells and to anterior overlay fibers. During propagation of a normal sinus beat, activation of the AN zone accounts for at least 25% of conduction time from atrium to His bundle, the small N zone being the main source of AV nodal delay. Cycle length-dependent conduction delay is localized in the N zone. Conduction block of premature atrial impulses can occur both in the N zone and in the AN zone, depending on the degree of prematurity. Several factors determining AV nodal conduction delay have been identified.(ABSTRACT TRUNCATED AT 400 WORDS)

scholarly journals Surgery for atrioventricular node reentry tachycardia

1992 ◽  
Vol 104 (4) ◽  
pp. 1035-1044 ◽  
Author(s):  
Yousuf Mahomed ◽  
Robert D. King ◽  
Douglas Zipes ◽  
William M. Miles ◽  
Lawrence S. Klein ◽  
...  
Keyword(s):  
Atrioventricular Node ◽  
Reentry Tachycardia ◽  
Atrioventricular Node Reentry Tachycardia
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