His electrogram alternans reveal dual atrioventricular nodal pathway conduction during atrial fibrillation: The role of slow-pathway modification

Traditional tools to study dual-pathway atrioventricular nodal (AVN) electrophysiology are not applicable in subjects with permanent atrial fibrillation (AF). The presence of fast-pathway (FP) and slow-pathway (SP) wavefronts and their possible modification remain uncertain in this condition. We dem...

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Published in:Circulation (New York, N.Y.) N.Y.), 2003-02, Vol.107 (7), p.1059-1065
Main Authors: YOUHUA ZHANG, BHARATI, Saroja, MOWREY, Kent A, MAZGALEV, Todor N
Format: Article
Language:English
Subjects:
Animals
Atrial Fibrillation - etiology
Atrial Fibrillation - pathology
Atrial Fibrillation - physiopathology
Atrioventricular Node - pathology
Atrioventricular Node - physiopathology
Biological and medical sciences
Bundle of His - physiopathology
Cold Temperature
Electrocardiography. Vectocardiography
Electrodiagnosis. Electric activity recording
Electrophysiology
Investigative techniques, diagnostic techniques (general aspects)
Kinetics
Medical sciences
Models, Cardiovascular
Rabbits
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Summary:Traditional tools to study dual-pathway atrioventricular nodal (AVN) electrophysiology are not applicable in subjects with permanent atrial fibrillation (AF). The presence of fast-pathway (FP) and slow-pathway (SP) wavefronts and their possible modification remain uncertain in this condition. We demonstrated previously that His electrogram (HE) alternans can determine whether the FP or the SP reaches the His bundle on a beat-by-beat basis. We have now applied this novel index to monitor dual-pathway conduction and the effects of SP modification during AF. In 12 rabbit AVN preparations, HE alternans were confirmed during a standard A(1)A(2) pacing protocol. During AF, in 9 of the 12 hearts, HE alternans indicated the presence of dual pathways. Successful SP modification guided by the HE alternans eliminated the SP, resulting in a predominantly FP conduction during AF in all hearts. This increased the average His-His interval (204+/-14 versus 276+/-51 ms, P
ISSN:0009-7322
1524-4539
DOI:10.1161/01.CIR.0000051464.52601.F4