Skip to main content
SpringerLink
Log in

The underrecognized and neglected compact atrioventricular nodal potential: clinical significance for preventing atrioventricular block during so-called slow pathway radiofrequency ablation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The radiofrequency (RF) ablation target may be located at the compact atrioventricular node (AVN) region during so-called slow pathway (SP) RF ablation, potentially leading to transient or permanent atrioventricular block (AVB). However, related data are rare.

Methods

Among 715 index consecutive patients who underwent RF ablation for atrioventricular nodal re-entry tachycardia, 17 patients subsequently experienced transient or permanent AVB and were included in this retrospective observational study.

Results

Among the 17 patients, two patients (11.8%) developed transient first-degree AVB, four patients (23.5%) developed transient second-degree AVB, seven patients (41.2%) developed transient third-degree AVB, and four patients (23.5%) developed permanent third-degree AVB. During baseline sinus rhythm before the start of RF ablation, no His-bundle potential was recorded from the RF ablation catheter. During the so-called SP RF ablation that led to transient or permanent AVB, junctional rhythm with ventriculoatrial (VA) conduction block followed by subsequent AVB was observed in 14 of 17 patients (82.4%), and a low-amplitude, low-frequency hump-shaped atrial potential was recorded before the start of RF ablation in 7 of the 17 patients (41.2%). Direct AVB occurred in 3 of the 17 patients (17.6%), and a low-amplitude, low-frequency hump-shaped atrial potential was recorded before the start of RF ablation in all 3 patients.

Conclusions

The low-amplitude, low-frequency hump-shaped atrial potential recorded at the so-called SP region may reflect the electrogram of compact AVN activation, and RF ablation to this site heralds impending AVB even when a His-bundle potential is not recorded.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Lee MA, Morady F, Kadish A, Schamp DJ, Chin MC, Scheinman MM, et al. Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation. 1991;83:827–35.

    Article  CAS  PubMed  Google Scholar 

  2. Jackman WM, Beckman KJ, McClelland JH, Wang X, Friday KJ, Roman CA, et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. N Engl J Med. 1992;327:313–8.

    Article  CAS  PubMed  Google Scholar 

  3. Mitrani RD, Klein LS, Hackett FK, Zipes DP, Miles WM. Radiofrequency ablation for atrioventricular node reentrant tachycardia: comparison between fast (anterior) and slow (posterior) pathway ablation. J Am Coll Cardiol. 1993;21:432–41.

    Article  CAS  PubMed  Google Scholar 

  4. Jazayeri MR, Hempe SL, Sra JS, Dhala AA, Blanck Z, Deshpande SS, et al. Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. Circulation. 1992;85:1318–28.

    Article  CAS  PubMed  Google Scholar 

  5. Li HG, Klein GJ, Stites HW, Zardini M, Morillo CA, Thakur RK, et al. Elimination of slow pathway conduction: an accurate indicator of clinical success after radiofrequency atrioventricular node modification. J Am Coll Cardiol. 1993;22:1849–53.

    Article  CAS  PubMed  Google Scholar 

  6. Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016;67:e27–e115.

    Article  PubMed  Google Scholar 

  7. Fragakis N, Krexi L, Kyriakou P, Sotiriadou M, Lazaridis C, Karamanolis A, et al. Electrophysiological markers predicting impeding AV-block during ablation of atrioventricular nodal reentry tachycardia. Pacing Clin Electrophysiol. 2018;41:7–13.

    Article  PubMed  Google Scholar 

  8. His W Jr. Die Tätigkeit des embryonalen herzens und deren bedeutung für die Lehre von der Hezebewegung beim menschen. Arbeiten aus der medidizinischen Klinik zu Leipzig. 1893:14–49.

  9. Tawara S. Das Reizleitungssystem Des Saugetierherzens: Eine Anatomisch-Histologische Studie Uber Das Atrioventrikularbundel Und Die Purkinjeschen Faden. Jena, Germany: Fisher. 1906;9–70:114–56.

    Google Scholar 

  10. Katritsis DG, Becker A. The atrioventricular nodal reentrant tachycardia circuit: a proposal. Heart Rhythm. 2007;4:1354–60.

    Article  PubMed  Google Scholar 

  11. Markowitz SM, Lerman BB. A contemporary view of atrioventricular nodal physiology. J Interv Card Electrophysiol. 2018;52:271–9.

    Article  PubMed  Google Scholar 

  12. Padala SK, Cabrera JA, Ellenbogen KA. Anatomy of the cardiac conduction system. Pacing Clin Electrophysiol. 2021;44:15–25.

    Article  PubMed  Google Scholar 

  13. Cabrera JÁ, Anderson RH, Macías Y, Nevado-Medina J, Porta-Sánchez A, Rubio JM, et al. Variable arrangement of the atrioventricular conduction axis within the triangle of Koch: implications for permanent His bundle pacing. JACC Clin Electrophysiol. 2020;6:362–77.

    Article  PubMed  Google Scholar 

  14. Ueng KC, Chen SA, Chiang CE, Tai CT, Lee SH, Chiou CW, et al. Dimension and related anatomical distance of Koch’s triangle in patients with atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol. 1996;7:1017–23.

    Article  CAS  PubMed  Google Scholar 

  15. Scher AM, Rodriguez MI, Liikane J, Young AC. The mechanism of atrioventricular conduction. Circ Res. 1959;7:54–61.

    Article  CAS  PubMed  Google Scholar 

  16. Kupersmith J, Krongrad E, Waldo AL. Conduction intervals and conduction velocity in the human cardiac conduction system Studies during open-heart surgery. Circulation. 1973;47:776–85.

    Article  CAS  PubMed  Google Scholar 

  17. Jalife J. The sucrose gap preparation as a model of AV nodal transmission: are dual pathways necessary for reciprocation and AV nodal “echoes”? Pacing Clin Electrophysiol. 1983;6:1106–22.

    Article  CAS  PubMed  Google Scholar 

  18. Antzelevitch C, Moe GK. Electrotonically mediated delayed conduction and reentry in relation to “slow responses” in mammalian ventricular conducting tissue. Circ Res. 1981;49:1129–39.

    Article  CAS  PubMed  Google Scholar 

  19. Ho SY, McComb JM, Scott CD, Anderson RH. Morphology of the cardiac conduction system in patients with electrophysiologically proven dual atrioventricular nodal pathways. J Cardiovasc Electrophysiol. 1993;4:504–12.

    Article  CAS  PubMed  Google Scholar 

  20. Janse MJ, Anderson RH, McGuire MA, Ho SY. “AV nodal” reentry: part I: “AV nodal” reentry revisited. J Cardiovasc Electrophysiol. 1993;4:561–72.

    Article  CAS  PubMed  Google Scholar 

  21. McGuire MA, Janse MJ, Ross DL. “AV nodal” reentry: part II: AV nodal, AV junctional, or atrionodal reentry? J Cardiovasc Electrophysiol. 1993;4:573–86.

    Article  CAS  PubMed  Google Scholar 

  22. Haissaguerre M, Gaita F, Fischer B, Commenges D, Montserrat P, d'Ivernois C, et al. Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation. 1992;85:2162–75.

    Article  CAS  PubMed  Google Scholar 

  23. McGuire MA, de Bakker JM, Vermeulen JT, Opthof T, Becker AE, Janse MJ. Origin and significance of double potentials near the atrioventricular node. Correlation of extracellular potentials, intracellular potentials, and histology. Circulation. 1994;89:2351–60.

    Article  CAS  PubMed  Google Scholar 

  24. Makker P, Saleh M, Vaishnav AS, Coleman KM, Beldner S, Ismail H, et al. Clinical predictors of heart block during atrioventricular nodal reentrant tachycardia ablation: a multicenter 18-year experience. J Cardiovasc Electrophysiol. 2021;32:1658–64.

    Article  PubMed  Google Scholar 

  25. Anderson RH, Sanchez-Quintana D, Mori S, Cabrera JA, Back SE. Re-evaluation of the structure of the atrioventricular node and its connections with the atrium. Europace. 2020;22:821–30.

    Article  PubMed  Google Scholar 

  26. Tuohy S, Trulock KM, Wiggins NB, Bassiouny M, Ono M, Kiehl EL, et al. Should fast pathway ablation be reconsidered in typical atrioventricular nodal re-entrant tachycardia? J Cardiovasc Electrophysiol. 2019;30:1569–77.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, 3rd Street, Tianjin Economic-Technological Development Area, Tianjin, 300457, China

    Chengye Di, Qun Wang, Yanxi Wu, Longlu Li & Wenhua Lin

  2. College of Clinical Cardiology, Tianjin Medical University, Tianjin, China

    Chengye Di, Qun Wang, Yanxi Wu, Longlu Li & Wenhua Lin

  3. Cardiovascular Institute, Tianjin University, Tianjin, China

    Chengye Di, Qun Wang, Yanxi Wu, Longlu Li & Wenhua Lin

Authors
  1. Chengye Di
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yanxi Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Longlu Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenhua Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wenhua Lin.

Ethics declarations

Ethics approval

The study was approved by the TEDA International Cardiovascular Hospital ethics committee for clinical research. All patients provided written informed consent.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di, C., Wang, Q., Wu, Y. et al. The underrecognized and neglected compact atrioventricular nodal potential: clinical significance for preventing atrioventricular block during so-called slow pathway radiofrequency ablation. J Interv Card Electrophysiol 67, 165–174 (2024). https://doi.org/10.1007/s10840-023-01597-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-023-01597-7

Keywords

Search

Navigation