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Shortening of ventriculoatrial interval after ablation of an accessory pathway.

Alasti M, Alizadeh A, Haghjoo M, Emkanjoo Z, Sadr-Ameli MA - Indian Pacing Electrophysiol J (2006)

View Article: PubMed Central - PubMed

Affiliation: Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical Center, Vali-asr Avenue, Tehran, Iran. alastip@gmail.com

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A 21-year old man with history of 8 year palpitation was referred for electrophysiologic study and possible radiofrequency ablation... Physical examination and transthoracic echocardiographic study did not disclose any abnormality... Baseline ECG showed normal sinus rhythm with normal PR and QRS intervals and no evidence of preexcitation... Right ventricular apical pacing at a cycle length just shorter than the tachycardia cycle length showed the same retrograde atrial activation sequence as during the arrhythmia... Subsequently, the right atrioventricular annulus was mapped in the tachycardia and the shortest VA interval was noted at the posterolateral of tricuspid annulus... The radiofrequency current was delivered to this site at the ventricular aspect of tricuspid annulus and resulted in termination of the arrhythmia within 5 seconds... Based on the electrophysiologic findings, the patient had a slowly conducting right posterolateral accessory pathway and the arrhythmia was an orthdromic AVRT... Before ablation of the accessory pathway, retrograde atrial activation sequence had been eccentric and conduction had been via the accessory pathway with slowly conducting property but after that, retrograde atrial activation sequence was concentric with short VA interval... According to post-ablation study, VA conduction was decremental and no arrhythmia was inducible so the presence of another accessory pathway is unlikely and it seems that retrograde atrial conduction was via fast pathway... Although slowly conducting accessory pathways behave like AV node in many respects, they have quantitatively differing response to autonomic and pharmacologic manipulation... It is similar to different responses of slow and fast pathways to autonomic stimulation in patients with AVNRT... For example, adrenergic stimulation tends to shorten ERP of fast pathway (both antegrade and retrograde) to a greater extent that of the slow pathway... In conclusion, post-ablation retrograde atrial activation sequence was concentric and conduction was via AV node (fast pathway) so after ablation of the accessory pathway, VA interval was shortened and it seems that atrial and ventricular electrograms were fused.

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Related in: MedlinePlus

Surface leads and intracardiac electrograms during the arrhythmia are shown. HRA: high right atrium, CS: coronary sinus, His d: His distal, His p: His proximal, RVA: right ventricle apex. Recording speed: 100 mm/sec.
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Figure 1: Surface leads and intracardiac electrograms during the arrhythmia are shown. HRA: high right atrium, CS: coronary sinus, His d: His distal, His p: His proximal, RVA: right ventricle apex. Recording speed: 100 mm/sec.

Mentions: A 21-year old man with history of 8 year palpitation was referred for electrophysiologic study and possible radiofrequency ablation. Physical examination and transthoracic echocardiographic study did not disclose any abnormality. Baseline ECG showed normal sinus rhythm with normal PR and QRS intervals and no evidence of preexcitation. Antiarrhythmic drugs (propranolol and verapamil) were discontinued two days before the procedure. Baseline intervals in sinus rhythm were as follows: sinus cycle length=690 msec, AH=74 msec, HV=37 msec, QRS=90 msec, PR=133 msec. The minimal pacing cycle length maintaining 1:1 antegrade conduction (AVWP) was 320 msec and the minimal pacing cycle length maintaining 1:1 retrograde conduction (VAWP) was 400 msec. Single extrastimulus testing in the right atrium and the right ventricular apex leaded to a sustained narrow complex tachycardia. The arrhythmia was a short PR- long RP tachycardia with following characteristics: cycle length=376 msec, AH=141 msec, HV=42 msec, VA=200 msec, HA (HRA) =236 msec, HA (His) =243 msec and eccentric atrial activation during the arrhythmia (Figure 1). The arrhythmia was easily reproducible with stable hemodynamic.


Shortening of ventriculoatrial interval after ablation of an accessory pathway.

Alasti M, Alizadeh A, Haghjoo M, Emkanjoo Z, Sadr-Ameli MA - Indian Pacing Electrophysiol J (2006)

Surface leads and intracardiac electrograms during the arrhythmia are shown. HRA: high right atrium, CS: coronary sinus, His d: His distal, His p: His proximal, RVA: right ventricle apex. Recording speed: 100 mm/sec.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1586161&req=5

Figure 1: Surface leads and intracardiac electrograms during the arrhythmia are shown. HRA: high right atrium, CS: coronary sinus, His d: His distal, His p: His proximal, RVA: right ventricle apex. Recording speed: 100 mm/sec.
Mentions: A 21-year old man with history of 8 year palpitation was referred for electrophysiologic study and possible radiofrequency ablation. Physical examination and transthoracic echocardiographic study did not disclose any abnormality. Baseline ECG showed normal sinus rhythm with normal PR and QRS intervals and no evidence of preexcitation. Antiarrhythmic drugs (propranolol and verapamil) were discontinued two days before the procedure. Baseline intervals in sinus rhythm were as follows: sinus cycle length=690 msec, AH=74 msec, HV=37 msec, QRS=90 msec, PR=133 msec. The minimal pacing cycle length maintaining 1:1 antegrade conduction (AVWP) was 320 msec and the minimal pacing cycle length maintaining 1:1 retrograde conduction (VAWP) was 400 msec. Single extrastimulus testing in the right atrium and the right ventricular apex leaded to a sustained narrow complex tachycardia. The arrhythmia was a short PR- long RP tachycardia with following characteristics: cycle length=376 msec, AH=141 msec, HV=42 msec, VA=200 msec, HA (HRA) =236 msec, HA (His) =243 msec and eccentric atrial activation during the arrhythmia (Figure 1). The arrhythmia was easily reproducible with stable hemodynamic.

View Article: PubMed Central - PubMed

Affiliation: Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical Center, Vali-asr Avenue, Tehran, Iran. alastip@gmail.com

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 21-year old man with history of 8 year palpitation was referred for electrophysiologic study and possible radiofrequency ablation... Physical examination and transthoracic echocardiographic study did not disclose any abnormality... Baseline ECG showed normal sinus rhythm with normal PR and QRS intervals and no evidence of preexcitation... Right ventricular apical pacing at a cycle length just shorter than the tachycardia cycle length showed the same retrograde atrial activation sequence as during the arrhythmia... Subsequently, the right atrioventricular annulus was mapped in the tachycardia and the shortest VA interval was noted at the posterolateral of tricuspid annulus... The radiofrequency current was delivered to this site at the ventricular aspect of tricuspid annulus and resulted in termination of the arrhythmia within 5 seconds... Based on the electrophysiologic findings, the patient had a slowly conducting right posterolateral accessory pathway and the arrhythmia was an orthdromic AVRT... Before ablation of the accessory pathway, retrograde atrial activation sequence had been eccentric and conduction had been via the accessory pathway with slowly conducting property but after that, retrograde atrial activation sequence was concentric with short VA interval... According to post-ablation study, VA conduction was decremental and no arrhythmia was inducible so the presence of another accessory pathway is unlikely and it seems that retrograde atrial conduction was via fast pathway... Although slowly conducting accessory pathways behave like AV node in many respects, they have quantitatively differing response to autonomic and pharmacologic manipulation... It is similar to different responses of slow and fast pathways to autonomic stimulation in patients with AVNRT... For example, adrenergic stimulation tends to shorten ERP of fast pathway (both antegrade and retrograde) to a greater extent that of the slow pathway... In conclusion, post-ablation retrograde atrial activation sequence was concentric and conduction was via AV node (fast pathway) so after ablation of the accessory pathway, VA interval was shortened and it seems that atrial and ventricular electrograms were fused.

No MeSH data available.


Related in: MedlinePlus