Effect of slow pathway ablation in atrioventricular nodal reentrant tachycardia on the electrophysiologic characteristics of the inferior atrial inputs to the human atrioventricular node
Abstract
The inferior atrial extensions of the atrioventricular (AV) node have been related to the anatomic substrate of the slow pathway, but their role in AV nodal reentrant tachycardia (AVNRT) is unknown. Ten patients with slow-fast AVNRT were studied before and after successful slow pathway ablation. Simultaneous His bundle recordings from the right and left sides of the septum were made during right and left inferoparaseptal pacing. Longer stimulus to His (St-H) intervals were measured during right inferoparaseptal pacing than during left inferoparaseptal pacing (284 +/- 55 vs 246 +/- 46 ms, p = 0.005 for right His recordings and 283 +/- 56 vs 244 +/- 46 ms, p = 0.005 for left His recordings) at similar coupling intervals during AVNRT induction. After ablation, the St-H intervals at the maximum AV nodal conduction decrement were similar during right inferoparaseptal and left inferoparaseptal pacing (217 +/- 32 vs 207 +/- 21 ms, p = 0.10 for right His and 215 +/- 32 vs 206 +/- 20 ms, p = 0.13 for left His) at similar coupling intervals. The difference (DeltaSt-H) between St-H intervals during AVRNT induction or at the maximum conduction decrement and during constant pacing for right His recordings with right inferoparaseptal pacing were significantly greater than DeltaSt-H measured with left His during left inferoparaseptal pacing (173 +/- 64 vs 137 +/- 55 ms, p = 0.005) before ablation, but not after (117 +/- 39 vs 100 +/- 40 ms, p = 0.44). Resetting of AVNRT with delivery of left inferoparaseptal extrastimuli was achieved in 7 of 10 patients. In conclusion, the electrophysiologic characteristics of the right and left inferior atrial inputs to the human AV node in patients with AVNRT and their response to slow pathway ablation provide further evidence that the inferior nodal extensions represent the anatomic substrate of the slow pathway.
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There is considerable histologic and electrophysiologic evidence that the right and left inferior extensions of the human AV node and the atrio-nodal inputs they facilitate may provide the anatomic substrate of the slow pathway.
“Regarding the slow pathway, there has now been considerable histologic and electrophysiologic evidence that the right and left inferior extensions of the human AV node and the atrio-nodal inputs they facilitate may provide its anatomic substrate.29,221”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [29]
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Self-citation
- Authors
- Katritsis, D. G., Becker, A. E., Ellenbogen, K. A., Giazitzoglou, E., Korovesis, S., & Camm, A. J.
- Affiliations
- Athens Euroclinic (GR)
- Amsterdam UMC Location University of Amsterdam (NL)
- Virginia Commonwealth University Medical Center (US)
- St George's, University of London (GB)
- Corresponding author
- Katritsis, Demosthenes G.
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2006-03
- Volume
- 97
- Issue
- 6
- Pages
- 860-865
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2081894634
- Cited by
- 35
- References
- 22
- Citations by year
- 2026: 1 · 2025: 2 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2016: 4 · 2015: 3 · 2013: 2 · 2012: 2
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrioventricular nodal reentrant tachycardia, slow pathway ablation, slow-fast AVNRT, His bundle recording, catheter ablation outcomes, atrioventricular node
- MeSH terms
- Adult, Atrioventricular Node, Bundle of His, Cardiac Pacing, Artificial, Electrocardiography, Female, Humans, Male, Middle Aged, Tachycardia, Atrioventricular Nodal Reentry, Catheter Ablation
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