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Conduction Time Oscillations Precede the Spontaneous Termination of Human Atrioventricular Reciprocating Tachycardia

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Abstract

Prior clinical research indicates that conduction slowing is the primary mechanism leading to the spontaneous termination of reentrant tachycardia in humans. Yet, some experimental models indicate that cycle length oscillations and enhanced conduction are important prerequisites. The role of oscillations in conduction times and enhanced conduction in the spontaneous termination of human reentrant tachycardia has not been adequately investigated.

The electrophysiologic features preceding the spontaneous termination of orthodromic atrioventricular (AV) reciprocating tachycardia (RT) were evaluated in 21 patients, each of whom had a sustained (>60 seconds) and a spontaneously terminating (≥10 beats and ≤60 seconds) episode of AVRT during the same electrophysiologic study. Atrio-His, His-ventricular, interventricular, ventriculoatrial and atrial conduction times were measured for each beat of spontaneously terminating AVRT and for paired beats of sustained AVRT. Beats of spontaneously terminating and sustained tachycardia were pooled and Hadi multivariate outlier analysis was used to identify whether significant beat-to-beat alterations in conduction times preceded the spontaneous termination of reentry.

Cycle lengths of sustained (348±62 msec) and spontaneously terminating AVRT (351±70 msec) were similar. Significant beat-to-beat oscillations in conduction times preceded the spontaneous termination of AVRT in 10 of the 21 (48%) patients. An apparent enhancement in atrio-His or ventriculoatrial conduction times immediately preceded the spontaneous termination of AVRT in 11 patients (52%), while an apparent conduction delay occurred in only 2 patients (10%). Moreover, significant oscillations in conduction times were present in 9 of the 11 patients (82%) with enhanced conduction, but only in 1 of the 10 (10%) remaining patients (p=0.002.

Conduction time oscillations, which are related to apparent enhancement in atrio-His or ventriculoatrial conduction, frequently precede the spontaneous termination of reentry in humans.

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References

  1. Mines GR. On circulating excitations in heart muscle and their possible relation to tachycardia and fibrillation. Trans R Soc Can 1914;8:43–52.

    Google Scholar 

  2. Hoffman BF, Rosen MR. Cellular mechanisms for cardiac arrhythmias. Circ Res 1981;49:1–15.

    PubMed  Google Scholar 

  3. Brugada P, Bar FWHM, Vanagt EJ, Wellens HJJ. Observations on mechanisms of circus movement tachycardia in the Wolff-Parkinson-White syndrome. Role of different tachycardia circuits and sites of block in maintenance of tachycardia. PACE 1981;4:507–512.

    PubMed  Google Scholar 

  4. Durrer D, Schoo L, Schuilenburg RM, Wellens HJ. The role of premature beats in the initiation and the termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation 1967; 36:644–662.

    PubMed  Google Scholar 

  5. Westveer D, Swiryn S, Bauernfeind R, Rosen KM. An unusual termination of a wide QRS tachycardia in a patient with the Wolff-Parkinson-White syndrome. Chest 1981;80:217–219.

    PubMed  Google Scholar 

  6. Adams JR, Hess D, Scheinman M. Mechanisms of spontaneous tachycardia termination in a patient with Wolff-Parkinson-White syndrome and dual atrio-ventricular nodal pathways. PACE 1981;4:367–375.

    PubMed  Google Scholar 

  7. Kuck HH, Kunze KP, Schluter M, Bleifeld W. Spontaneous termination of reciprocating tachycardia owing to interaction of dual atrioventricular nodal pathways in patients with an accessory pathway. Am J Cardiol 1985;56:872–876.

    PubMed  Google Scholar 

  8. Ross DL, Wiener I, Farre J, et al. Termination of circus movement tachycardia utilizing an accessory atrio-ventricular pathway by retrograde concealed penetration of the atrioventricular node through the bundle branch system: a mechanism of tachycardia termination in the Wolff-Parkinson-White syndrome. Am J Cardiol 1981;47:1173–1177.

    PubMed  Google Scholar 

  9. Waxman MB, Cupps CL. Spontaneous termination of paroxysmal supraventricular tachycardia following disappearance of bundle branch block ipsilateral to a concealed atrioventricular accessory pathway: The role of autonomic tone in tachycardia diagnosis. PACE 1986;9:26–35.

    PubMed  Google Scholar 

  10. Ross DL, Farre J, Bar FWHM, et al. Spontaneous termination of circus movement tachycardia using an atrioventricular accessory pathway: Incidence, site of block and mechanisms. Circulation 1981;63:1129–1139.

    PubMed  Google Scholar 

  11. Simson MB, Spear JF, Moore EN. Stability of an experimental atrioventricular reentrant tachycardia in dogs. Am J Physiol 1981; 240:H947–H953.

    PubMed  Google Scholar 

  12. Frame LH, Simson MB. Oscillations of conduction, action potential duration, and refractoriness: A mechanism for spontaneous termination of reentrant tachycardias. Circulation 1988;78:1277–1287.

    PubMed  Google Scholar 

  13. Talajic M, Villemaire C, Papadatos D, et al. Cycle length alteration during supraventricular tachycardia: Occurrence and mechanism in a canine model of AV reentrant tachycardia. PACE 1990;13:314–325.

    PubMed  Google Scholar 

  14. Ortiz J, Igarashi M, Gonzalez HX, Laurita K, Rudy Y, Waldo AL. Mechanism of spontaneous termination of stable atrial flutter in the canine sterile pericarditis model. Circulation 1993;88:1866–77.

    PubMed  Google Scholar 

  15. Hadi AS. Identifying multiple outliers in multivariate data. J Royal Stat Soc 1992; 54:761–771.

    Google Scholar 

  16. Hadi AS, Smirnoff JS. Procedures for identification of multiple outliers in linear models. J Am Stat Assoc 1993;88:1264–1272.

    Google Scholar 

  17. Pocock SJ, Geller NL, Tsiatis AA. The analysis of multiple endpoints in clinical trials. Biometrics 1987;43:487–498.

    PubMed  Google Scholar 

  18. Denes P, Wu D, Dhingra RC, et al. Demonstration of dual A-V nodal pathways in patients with paroxysmal supraventricular tachycardia. Circulation 1973;48: 549–55.

    PubMed  Google Scholar 

  19. Duff HJ, Mitchell LB, Gillis AM et al. Electrocardio-graphic correlates of spontaneous termination of ventricular tachycardia in patients with coronary artery disease. Circulation 1993;88:1054–1062.

    PubMed  Google Scholar 

  20. Jackman WJ, Nakagawa H, Heidbüchel H, et al. Three forms of atrioventricular nodal (junctional) reentrant tachycardia: Differential Diagnosis, Electrophysiological Characteristics, and Implications for Anatomy of the Reentrant Circuit. In Zipes DP and Jalife J. (Eds). Cardiac Electrophysiology: From Cell to Bedside, 2nd Edition, Saunders. 1995:620-637.

  21. Yamamoto T, Yeh SJ, Lin FC, Wu D. Effects of isoproterenol on accessory pathway conduction in intermittent or concealed Wolff-Parkinson-White syndrome. Am J Cardiol 1990;65:1438–1442.

    PubMed  Google Scholar 

  22. Prystowsky EN, Pritchett ELC, Smith WM, et al. Electrophysiologic assessment of the atrioventricular conduction system after surgical correction of ventricular pre-excitation. Circulation 1979;59:789–96.

    PubMed  Google Scholar 

  23. Sheehan RG, Klein GJ, Yee R, et al. Atrioventricular node reentry with “smooth” AV node function curves: A different arrhythmia substrate? Circulation 1996;93:969–72.

    PubMed  Google Scholar 

  24. Spinelli W, Hoffman BF. Mechanisms of termination of reentrant atrial arrhythmias by class I and class III antiarrhythmic agents. Circ Res 1989;65:1565–1579.

    PubMed  Google Scholar 

  25. Boyden PA, Graziano JN. Activation mapping of reentry around an anatomical barrier in the canine atrium: observations during the action of the class III agent, d-sotalol. J Cardiovasc Electrophysiol 1993;4:266–279.

    PubMed  Google Scholar 

  26. Brugada J, Boersma L, Abdollah H, et al. Echo-wave termination of ventricular tachycardia. A common mechanism of termination of reentrant arrhythmias by various pharmacological interventions. Circulation 1992;85:1879–1887.

    PubMed  Google Scholar 

  27. Schubert B, Vandongen AM, Kirsch GE, Brown AM. Inhibition of cardiac Na+ currents by isoproterenol. Am J Physiol 1990;258:H977–H982.

    PubMed  Google Scholar 

  28. Osterrieder W, Brum G, Hescheler J, et al. Injection of subunits of cyclic AMP-dependent protein kinase into cardiac myocytes modulates Ca++ current. Nature 1982;298:576–578.

    PubMed  Google Scholar 

  29. Welch WJ, Smith ML, Rea RF, et al. Enhancement of sympathetic nerve activity by single premature ventricular beats in humans. J Am Coll Cardiol 1989, 13:69–75.

    PubMed  Google Scholar 

  30. Waxman MB, Sharma AD, Cameron DA, et al. Reflex mechanisms responsible for early spontaneous termination of paroxysmal supraventricular tachycardia. Am J Cardiol 1982; 49:259–272.

    PubMed  Google Scholar 

  31. El-Sherif N, Yin H, Caref EB, Retsivo M. Electrophysiologic mechanisms of spontaneous termination of sustained monomorphic reentrant ventricular tachycardia in the canine postinfarction heart. Circulation 1996;93:1567–1578.

    PubMed  Google Scholar 

  32. Pogwizd SM, Chung MK, Cain ME. Termination of ventricular tachycardia in the human heart: Insights from three-dimensional mapping of nonsustained and sustained ventricular tachycardias. Circulation 1997;95:2528–2540.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, University of Calgary, Canada

    Derek V. Exner MD, MPH, L. Brent Mitchell MD, D. George Wyse MD, Ph.D., Robert S. Sheldon MD, Ph.D., Anne M. Gillis MD, Peggy Cassidy BN & Henry J. Duff MD

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  1. Derek V. Exner MD, MPH
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  2. L. Brent Mitchell MD
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  3. D. George Wyse MD, Ph.D.
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  4. Robert S. Sheldon MD, Ph.D.
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  5. Anne M. Gillis MD
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  6. Peggy Cassidy BN
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  7. Henry J. Duff MD
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Exner, D.V., Mitchell, L.B., Wyse, D.G. et al. Conduction Time Oscillations Precede the Spontaneous Termination of Human Atrioventricular Reciprocating Tachycardia. J Interv Card Electrophysiol 4, 231–239 (2000). https://doi.org/10.1023/A:1009821830582

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