Circulation, Vol 85, 2162-2175, Copyright © 1992 by American Heart Association
M Haissaguerre, F Gaita, B Fischer, D Commenges, P Montserrat, C d'Ivernois, P Lemetayer and JF Warin
BACKGROUND. Ablation of the slow pathway has been performed to eliminate
atrioventricular (AV) nodal reentrant tachycardia (AVNRT) either by a
surgical approach or by using radiofrequency catheter technique guided by
retrograde slow pathway activation mapping. From previous experience of
midseptal and posteroseptal mapping, we were aware of the existence of
peculiar slow potentials in most humans. Postulating their role in AVNRT,
we studied these potentials and the effects of radiofrequency energy.
METHODS AND RESULTS. Sixty-four patients (mean age, 48 +/- 19 years) with
the usual form of AVNRT were studied. Slow, low-amplitude potentials were
recorded when using the anterograde AV conducting system. Slow potentials
occupied all (giving a continuum of electrograms) or some of the time
between the atrial and ventricular electrograms. Their most specific
patterns were their progressive response to increasing atrial rates, which
resulted in a dramatic decline in amplitude and slope, a corresponding
increase in duration, and a separation from preceding atrial potentials
until the disappearance of any consistent activity. Slow potentials were
recorded along a vertical band at the mid or posterior part of the septum
near the tricuspid annulus. Radiofrequency energy applied at the slow
potential site resulted in interruption of induced tachycardia within a few
seconds and rendered tachycardia noninducible in all patients. A median of
two impulses was delivered to each patient. In 69% of patients,
postablation atrial stimulation cannot achieve a long atrial- His interval,
which previously was critical for tachycardia induction or maintenance. No
patient had AVNRT over a follow-up period of 1-16 months, and all had
preserved AV conduction. In all except two patients, the PR interval was
unchanged. In 47 patients, long-term electrophysiological studies confirmed
the efficacy of ablation and the nonreversibility of results by
isoproterenol; however, echo beats remained inducible in 40% of patients.
CONCLUSIONS. An area showing slow potentials is present at the perinodal
region in humans. In patients with AVNRT, application of radiofrequency
energy renders tachycardia noninducible through the preferential
modification of the anterograde slow pathway. With present clinical
methods, the exact origin and significance of these physiological
potentials cannot be specified.
ARTICLES
Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy
Service de Cardiologie, Hopital Saint-Andre, Bordeaux, France.
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F. Hintringer, J. Hartikainen, D. W. Davies, S. C. Heald, J. S. Gill, D. E. Ward, and E. Rowland Prediction of Atrioventricular Block During Radiofrequency Ablation of the Slow Pathway of the Atrioventricular Node Circulation, December 15, 1995; 92(12): 3490 - 3496. [Abstract] [Full Text]
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M. Haissaguerre, B. Cauchemez, F. Marcus, P. Le Metayer, P. Lauribe, F. Poquet, L. Gencel, and J. Clementy Characteristics of the Ventricular Insertion Sites of Accessory Pathways With Anterograde Decremental Conduction Properties Circulation, February 15, 1995; 91(4): 1077 - 1085. [Abstract] [Full Text]
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