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Posterior fast atrioventricular node pathways: implications for radiofrequency catheter ablation of atrioventricular node reentrant tachycardia.
J Am Coll Cardiol. 1996 Apr; 27(5):1098-105.JACC

Abstract

OBJECTIVES

This study sought to present evidence that fast atrioventricular (AV) node pathways with posterior exit sites may participate in typical AV node reentry.

BACKGROUND

Catheter ablation of the slow AV node pathway in the posteroseptal right atrium is the preferred therapeutic approach in patients with AV node reentrant tachycardia. Despite the success achieved with this approach, electrophysiologic changes consistent with fast pathway ablation are occasionally observed. One potential explanation is the presence of an aberrant posterior fast pathway.

METHODS

The location of fast and slow AV node pathways was determined by atrial activation mapping along the tricuspid valve annulus during tachycardia and was further confirmed by the effect of radiofrequency catheter ablation.

RESULTS

Seven patients with AV node reentrant tachycardia had evidence of a posterior fast pathway near the coronary sinus os. Abolition of anterograde and retrograde fast pathway conduction followed radiofrequency ablation in the posteroseptal region in six patients. Consistent with fast pathway ablation, the AH interval increased from 70 +/- 24 to 195 +/- 35 ms (mean +/- SD), and tachycardia was no longer inducible. Selective slow pathway ablation was performed in one other patient with a posterior fast pathway.

CONCLUSIONS

Functionally fast AV node pathways may be located in the posteroseptal right atrium, where slow pathway modification is performed. These data delineate the limitation of an anatomically guided slow pathway ablative approach and emphasize the importance of detailed mapping and localization of the retrograde fast pathway exit site before ablation. Failure to recognize the presence of posterior fast AV node pathways may account for sporadic examples of AV block, complicating posteroseptal ablation in patients with AV node reentry.

Authors+Show Affiliations

Department of Medicine, New York Hospital-Cornell University Medical Center, New York, NY 10021, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8609327

Citation

Engelstein, E D., et al. "Posterior Fast Atrioventricular Node Pathways: Implications for Radiofrequency Catheter Ablation of Atrioventricular Node Reentrant Tachycardia." Journal of the American College of Cardiology, vol. 27, no. 5, 1996, pp. 1098-105.
Engelstein ED, Stein KM, Markowitz SM, et al. Posterior fast atrioventricular node pathways: implications for radiofrequency catheter ablation of atrioventricular node reentrant tachycardia. J Am Coll Cardiol. 1996;27(5):1098-105.
Engelstein, E. D., Stein, K. M., Markowitz, S. M., & Lerman, B. B. (1996). Posterior fast atrioventricular node pathways: implications for radiofrequency catheter ablation of atrioventricular node reentrant tachycardia. Journal of the American College of Cardiology, 27(5), 1098-105.
Engelstein ED, et al. Posterior Fast Atrioventricular Node Pathways: Implications for Radiofrequency Catheter Ablation of Atrioventricular Node Reentrant Tachycardia. J Am Coll Cardiol. 1996;27(5):1098-105. PubMed PMID: 8609327.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior fast atrioventricular node pathways: implications for radiofrequency catheter ablation of atrioventricular node reentrant tachycardia. AU - Engelstein,E D, AU - Stein,K M, AU - Markowitz,S M, AU - Lerman,B B, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 1098 EP - 105 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 27 IS - 5 N2 - OBJECTIVES: This study sought to present evidence that fast atrioventricular (AV) node pathways with posterior exit sites may participate in typical AV node reentry. BACKGROUND: Catheter ablation of the slow AV node pathway in the posteroseptal right atrium is the preferred therapeutic approach in patients with AV node reentrant tachycardia. Despite the success achieved with this approach, electrophysiologic changes consistent with fast pathway ablation are occasionally observed. One potential explanation is the presence of an aberrant posterior fast pathway. METHODS: The location of fast and slow AV node pathways was determined by atrial activation mapping along the tricuspid valve annulus during tachycardia and was further confirmed by the effect of radiofrequency catheter ablation. RESULTS: Seven patients with AV node reentrant tachycardia had evidence of a posterior fast pathway near the coronary sinus os. Abolition of anterograde and retrograde fast pathway conduction followed radiofrequency ablation in the posteroseptal region in six patients. Consistent with fast pathway ablation, the AH interval increased from 70 +/- 24 to 195 +/- 35 ms (mean +/- SD), and tachycardia was no longer inducible. Selective slow pathway ablation was performed in one other patient with a posterior fast pathway. CONCLUSIONS: Functionally fast AV node pathways may be located in the posteroseptal right atrium, where slow pathway modification is performed. These data delineate the limitation of an anatomically guided slow pathway ablative approach and emphasize the importance of detailed mapping and localization of the retrograde fast pathway exit site before ablation. Failure to recognize the presence of posterior fast AV node pathways may account for sporadic examples of AV block, complicating posteroseptal ablation in patients with AV node reentry. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/8609327/Posterior_fast_atrioventricular_node_pathways:_implications_for_radiofrequency_catheter_ablation_of_atrioventricular_node_reentrant_tachycardia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0735-1097(95)00609-5 DB - PRIME DP - Unbound Medicine ER -