Advertisement

Physiology of AV Junction: What Have We Learnt from Radiofrequency Ablation?

  • F. Gaita
  • R. Riccardi
  • M. Scaglione
  • L. Calò
  • E. Richiardi
  • L. Garberoglio
  • P. Di Donna

Abstract

The atrioventricular (AV) junction is a rather complex structure involved in the genesis of the atrioventricular junctional reentrant tachycardia (AVJRT), which is the most frequent supraventricular arrhythmia. The advent of radiofrequency (RF) catheter ablation, that has been developed in the recent years, has provided a new therapeutic tool for the radical cure of this arrhythmia. In the meantime the more precise and extensive mapping of the septal region has provided new insight in the physiology and anatomy of the AV junction. This has led to questioning of some previously accepted concepts on its electrophysiology, and rekindled the interest of anatomists and experimental and clinical electrophysiologists, particularly in relation to the mechanism of reentry in humans.

Keywords

Catheter Ablation Slow Pathway Slow Potential Reentrant Circuit Fast Pathway 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Mines GR (1913) On dynamic equilibrium of the heart. J Physiol 46: 349–382PubMedGoogle Scholar
  2. 2.
    Denes P, Wu D, Dhingra RC, Chuquimia R, Rosen KM (1973) Demonstration of dual AV nodal pathways in patients with paroxysmal supraventricular tachycardia. Circulation 48: 549–555PubMedCrossRefGoogle Scholar
  3. 3.
    Rosen KM, Mehta A, Miller RA (1974) Demonstration of dual atrioventricular nodal pathways in man. Am J Cardiol 33: 291–294PubMedCrossRefGoogle Scholar
  4. 4.
    Ross DL, Johnson DC, Denniss AR, Cooper MJ, Richards DA, Uther JB (1985) Curative surgery for atrioventricular junctional (“AV nodal”) reentrant tachycardia. J Am Coll Cardiol 6: 1383–1392PubMedCrossRefGoogle Scholar
  5. 5.
    Haïssaguerre M, Warin JF, Lemetayer P, Saoudi N, Guikkem JP, Blanchot P (1989) Closed chest ablation of retrograde conduction in patients with atrioventricular nodal reentrant tachycardia. N Engl J Med 320: 426–433PubMedCrossRefGoogle Scholar
  6. 6.
    Lee MA, Morady F, Kadish A, Schamp DJ, Chin MC, Scheinman MM, Griffin JC, Lesh MD, Pederson D, Goldberg J, Calkins H, de Buitler M, Kou WH, Rosennheck S, Sousa J, Langberg JJ (1991) Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation 83: 827–835PubMedCrossRefGoogle Scholar
  7. 7.
    Jazayeri MH, Hempe SL, Sra JS, Dhala AA, Blanck Z, Desphande SS, Avital B, Krum DP, Gilbert CJ, Akhtar M (1992) Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. Circulation 85: 1318–1328PubMedCrossRefGoogle Scholar
  8. 8.
    Haïssaguerre M, Gaita F, Fisher B, Commenges D, Montserrat P, d’Ivernois C, Lemetayer P, Warin JF (1992) Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation 85: 2162–2175PubMedCrossRefGoogle Scholar
  9. 9.
    Gaita F, Haïssaguerre M, Di Donna P, Scaglione M, Riccardi R, Bocchiardo M, Richiardi E, Warin JF (1993) Tachicardia da rientro nodale: efficacia e sicurezza a breve e lungo termine di una tecnica di ablazione selettiva della via lenta. G Ital Cardiol 23: 563–574PubMedGoogle Scholar
  10. 10.
    Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ, Roman CA, Moulton KP, Twidale N, Hazlitt A, Prior MI, Oren J, Ovrholt E, Lazzara R (1992) Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow pathway conduction. N Engl J Med 327: 313–318PubMedCrossRefGoogle Scholar
  11. 11.
    Ho SY, Kilpatrick L, Kanai T, Germorth PG, Thompson RP, Anderson RH (1995) The architecture of the atrioventricular conduction axis in dog compared to man. J Cardiovasc Electrophysiol 6: 26–39PubMedCrossRefGoogle Scholar
  12. 12.
    Hazlit HA, Beckman KJ, McClelland JH, Wang X, Arruda M, Santoro I, Abdalla I, Singh A, Sweidan R, Nakagawa H, Hirao K, Lazzara R, Jackman WM (1993) Prevalence of slow A-V nodal pathway potentials in patients without A-V nodal reentrant tachycardia. J Am Coll Cardiol 21: 281A (abstr)Google Scholar
  13. 13.
    Sung RJ Waxman HL, Saksena S, Juma Z (1981) Sequence of retrograde atrial activation in patients with dual atrioventricular nodal pathways. Circulation 64: 1059–1067CrossRefGoogle Scholar
  14. 14.
    McGuire MA, Bourke JP, Robotin MC, Johnson DC, Meldrum-Hanna W, Nunn GR, Uther JB, Ross DL (1993) High resolution mapping of Koch’s triangle using sixty electrodes in humans with atrioventricular junctional (“AV nodal”) reentrant tachycardia. Circulation 88: 2315–2328PubMedCrossRefGoogle Scholar
  15. 15.
    Racker DK (1991) Sinoventricular transmission in 10 mM K+ by canine atrioventricular nodal inputs. Superior atrionodal bundle and proximal atrioventricular bundle. Circulation 83: 1738–1753PubMedCrossRefGoogle Scholar
  16. 16.
    Racker DK (1993) Transmission and reentrant activity in the sinoventricular conducting system and in the circumferential lamina of the tricuspid valve. J Cardiovasc Electrophysiol 4: 513–522PubMedCrossRefGoogle Scholar
  17. 17.
    de Bakker JMT, Coronel L, McGuire MA, Vermeulen JT, Opthof T, Tasseron S, van Hemel NM, Defauw JJAM (1994) Slow potentials in the atrioventricular junctional area of patients operated for atrioventricular nodal tachycardias and in isolated porcine hearts. J Am Coll Cardiol 23: 709–715PubMedCrossRefGoogle Scholar
  18. 18.
    McGuire MA, de Bakker JMT, Vermeulen JT, Opthof T, Becker AE, Janse MJ (1994) Origin and significance of double potentials near the atrioventricular node. Correlation of extracellular potentials, intracellular potentials and histology. Circulation 89: 2351–2360PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • F. Gaita
    • 1
  • R. Riccardi
    • 1
  • M. Scaglione
    • 1
  • L. Calò
    • 1
  • E. Richiardi
    • 1
  • L. Garberoglio
    • 1
  • P. Di Donna
    • 1
  1. 1.Divisione di CardiologiaOspedale Civile di AstiItaly

Personalised recommendations