Mechanism of ventricular rate control after radiofrequency modification of atrioventricular conduction in patients with atrial fibrillation

Circulation
S M MarkowitzB B Lerman

Abstract

Modification of atrioventricular (AV) conduction during atrial fibrillation (AF) may be achieved by radiofrequency ablation in the posteroseptal region of the tricuspid annulus. We tested the hypothesis that elimination of the posterior atrionodal input rather than direct damage to the compact AV node accounts for the decrease in ventricular rate after AV nodal modification. Twenty-four patients with the typical form of AV nodal reentrant tachycardia (AVNRT) underwent selective radiofrequency ablation of the slow AV nodal pathway in the posteroseptal tricuspid annulus. AF was induced before ablation (phase 1), 30 minutes after ablation (phase 2), and during follow-up 24 hours after ablation (phase 3), both with and without concurrent infusion of isoproterenol (4 micrograms/min). Successful elimination of AVNRT was achieved in all patients. During phase 3, 11 patients (46%) had residual dual pathway physiology. AV nodal Wenckebach cycle length (AVNW-CL) increased progressively during each phase of the protocol (356 +/- 72 versus 371 +/- 78 ms versus 432 +/- 104 ms, P < .0001), as did the effective refractory period of the AV node (279 +/- 60 versus 304 +/- 67 ms versus 372 +/- 56 ms, P < .0001). Minimal, mean, and maximal RR int...Continue Reading

References

Sep 1, 1995·Journal of Cardiovascular Electrophysiology·J TebbenjohannsB Lüderitz
Apr 1, 1996·Pacing and Clinical Electrophysiology : PACE·G Fenelon, P Brugada

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Citations

Aug 6, 2000·Current Problems in Cardiology·J SraM Akhtar
Nov 18, 1997·Journal of Cardiovascular Electrophysiology·B B Lerman
Jan 22, 1998·Journal of Cardiovascular Electrophysiology·T N Mazgalev
Mar 6, 2007·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Gregory K Feld
Dec 22, 1999·The American Journal of Cardiology·S RokasS Stamatelopoulos
Mar 19, 2004·Journal of Cardiovascular Electrophysiology·Shaowen LiuShiwen Yuan
Sep 5, 2006·Journal of Cardiovascular Electrophysiology·Steven M Markowitz
Dec 23, 2004·Pacing and Clinical Electrophysiology : PACE·Steven M MarkowitzBruce B Lerman
Jun 18, 2018·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Steven M Markowitz, Bruce B Lerman
Aug 13, 1999·The American Journal of Physiology·K M SteinB B Lerman
Jun 1, 1997·Journal of Cardiovascular Electrophysiology·S A Strickberger, F Morady

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