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Prevalence of Retrograde Accessory Pathway Conduction During Atrial Fibrillation

Identifieur interne : 000463 ( Main/Corpus ); précédent : 000462; suivant : 000464

Prevalence of Retrograde Accessory Pathway Conduction During Atrial Fibrillation

Auteurs : James J. C. Ong ; Jolene M. Kriett ; Gregory K. Feld ; Peng-Sheng Chen

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RBID : ISTEX:A2CBEB0BED5B611A2E6E316A4FE252E874D7841C

English descriptors

Abstract

Retrograde Conduction in Atrial Fibrillation. Introduction: Although atrial fibrillation occurs frequently in patients with the preexcitation syndrome, its pathogenesis remains controversial. The purpose of this study was to test the hypothesis that retrograde conduction over the accessory pathway occurs during atrial fibrillation and can serve as an important source of new wavefronts in atrial fibrillation. Methods and Results: Eight patients undergoing surgical division of their accessory path‐way(s) were studied. A plaque electrode array containing 56 (7 × 8) bipolar electrodes (5‐mm resolution) was placed epicardially at the AV junction over the accessory pathway and atrial fibrillation was electrically induced. Excluding one patient who had only preexcited QRS complexes during atrial fibrillation and another whose accessory pathway was outside the mapped region, 4 of the 6 patients studied showed retrograde conduction over the accessory pathway during atrial fibrillation (mean atrial cycle length 157 ± 59 msec). In these patients, 186 atrial wavefronts near the accessory pathway were analyzed. Among 67 wavefronts immediately following nonpreexcited QRS complexes, 17 originated from retrograde conduction. This constituted 9% (17/186) of total atrial wavefronts near the accessory pathway. Estimated atrial refractory period during atrial fibrillation ranged from 81 to 165 msec. Conclusions: (1) In patients with the preexcitation syndrome and atrial fibrillation, retrograde conduction over the accessory pathway contributed up to 9% of total atrial wavefronts near the accessory pathway. (2) The presence of an excitable gap in human atrial fibrillation was suggested by atrial preexcitation during retrograde conduction.

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DOI: 10.1111/j.1540-8167.1997.tb00803.x

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ISTEX:A2CBEB0BED5B611A2E6E316A4FE252E874D7841C

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<p>
<i>Methods and Results</i>
: Eight patients undergoing surgical division of their accessory path‐way(s) were studied. A plaque electrode array containing 56 (7 × 8) bipolar electrodes (5‐mm resolution) was placed epicardially at the AV junction over the accessory pathway and atrial fibrillation was electrically induced. Excluding one patient who had only preexcited QRS complexes during atrial fibrillation and another whose accessory pathway was outside the mapped region, 4 of the 6 patients studied showed retrograde conduction over the accessory pathway during atrial fibrillation (mean atrial cycle length 157 ± 59 msec). In these patients, 186 atrial wavefronts near the accessory pathway were analyzed. Among 67 wavefronts immediately following nonpreexcited QRS complexes, 17 originated from retrograde conduction. This constituted 9% (17/186) of total atrial wavefronts near the accessory pathway. Estimated atrial refractory period during atrial fibrillation ranged from 81 to 165 msec.</p>
<p>
<i>Conclusions</i>
: (1) In patients with the preexcitation syndrome and atrial fibrillation, retrograde conduction over the accessory pathway contributed up to 9% of total atrial wavefronts near the accessory pathway. (2) The presence of an excitable gap in human atrial fibrillation was suggested by atrial preexcitation during retrograde conduction.</p>
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<note xml:id="n-fnt-1" numbered="no">
<p>This work was done during the tenure of an ACC/Merck Fellowship and a National Institutes of Health NRSA (HL0930201) to Dr. Ong, and an AHA/Wyeth‐Ayerst Established Investigatorship Award (93002670) to Dr. Chen, and was supported in part by a National Institutes of Health FIRST Award (HL50259), a National Institutes of Health SCOR for sudden death (HL52319), and an American Heart Association National Center Grant‐in‐Aid (92009820).</p>
</note>
<note xml:id="n-fnt-2" numbered="no">
<p>Part of this paper was presented as an abstract at the 45th Annual Scientific Session of the American College of Cardiology, Orlando, Florida, March 25‐27, 1996.</p>
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<title>Prevalence of Retrograde Accessory Pathway Conduction During Atrial Fibrillation</title>
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<title>Prevalence of Retrograde Accessory Pathway Conduction During Atrial Fibrillation</title>
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<name type="personal">
<namePart type="given">JAMES J.C.</namePart>
<namePart type="family">ONG</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Division of Cardiology, Department of Medicine, Cedars‐Sinai Medical Center and the School of Medicine, UCLA, Los Angeles, California</affiliation>
<description>Correspondence: Address for correspondence: James J.C. Ong, M.D., Section of Electrophysiology, Division of Cardiology, Cedars‐Sinai Medical Center, Room 5342, 8700 Beverly Boulevard, Los Angeles, CA 90048, Fax:310‐289‐0780.</description>
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<name type="personal">
<namePart type="given">JOLENE M.</namePart>
<namePart type="family">KRIETT</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Division of Cardiohoracic Surgery, Department of Surgery</affiliation>
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<name type="personal">
<namePart type="given">GREGORY K.</namePart>
<namePart type="family">FELD</namePart>
<namePart type="termsOfAddress">M.D.</namePart>
<affiliation>Division of Cardiology, Department of Medicine, UCSD Medical Center, San Diego, California</affiliation>
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<namePart type="given">PENG‐SHENG</namePart>
<namePart type="family">CHEN</namePart>
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<affiliation>Division of Cardiology, Department of Medicine, Cedars‐Sinai Medical Center and the School of Medicine, UCLA, Los Angeles, California</affiliation>
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<dateIssued encoding="w3cdtf">1997-04</dateIssued>
<edition>Manuscript received 17 May 1996; Accepted for publication 11 January 1997.</edition>
<copyrightDate encoding="w3cdtf">1997</copyrightDate>
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<abstract lang="en">Retrograde Conduction in Atrial Fibrillation. Introduction: Although atrial fibrillation occurs frequently in patients with the preexcitation syndrome, its pathogenesis remains controversial. The purpose of this study was to test the hypothesis that retrograde conduction over the accessory pathway occurs during atrial fibrillation and can serve as an important source of new wavefronts in atrial fibrillation. Methods and Results: Eight patients undergoing surgical division of their accessory path‐way(s) were studied. A plaque electrode array containing 56 (7 × 8) bipolar electrodes (5‐mm resolution) was placed epicardially at the AV junction over the accessory pathway and atrial fibrillation was electrically induced. Excluding one patient who had only preexcited QRS complexes during atrial fibrillation and another whose accessory pathway was outside the mapped region, 4 of the 6 patients studied showed retrograde conduction over the accessory pathway during atrial fibrillation (mean atrial cycle length 157 ± 59 msec). In these patients, 186 atrial wavefronts near the accessory pathway were analyzed. Among 67 wavefronts immediately following nonpreexcited QRS complexes, 17 originated from retrograde conduction. This constituted 9% (17/186) of total atrial wavefronts near the accessory pathway. Estimated atrial refractory period during atrial fibrillation ranged from 81 to 165 msec. Conclusions: (1) In patients with the preexcitation syndrome and atrial fibrillation, retrograde conduction over the accessory pathway contributed up to 9% of total atrial wavefronts near the accessory pathway. (2) The presence of an excitable gap in human atrial fibrillation was suggested by atrial preexcitation during retrograde conduction.</abstract>
<subject lang="en">
<genre>Keywords</genre>
<topic>Wolff‐Parkinson‐White syndrome</topic>
<topic>excitable gap</topic>
<topic>wavefronts</topic>
<topic>retrograde conduction</topic>
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<title>Journal of Cardiovascular Electrophysiology</title>
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<identifier type="ISSN">1045-3873</identifier>
<identifier type="eISSN">1540-8167</identifier>
<identifier type="DOI">10.1111/(ISSN)1540-8167</identifier>
<identifier type="PublisherID">JCE</identifier>
<part>
<date>1997</date>
<detail type="volume">
<caption>vol.</caption>
<number>8</number>
</detail>
<detail type="issue">
<caption>no.</caption>
<number>4</number>
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<start>377</start>
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<total>11</total>
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<identifier type="ArticleID">JCE377</identifier>
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