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Nodal Pathways (nodal + pathway)

Distribution by Scientific Domains
Medical Sciences90%

Kinds of Nodal Pathways

  • av nodal pathway
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    Selected Abstracts

    The Most Common Site of Success and Its Predictors in Radiofrequency Catheter Ablation of the Slow Atrioventricular Nodal Pathway in Children

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2008
    HAW-KWEI HWANG M.D.
    Background:Locating ablation targets on the slow pathway in children as one would in adults may not accommodate the dimensional changes of Koch's triangle that occur with heart growth. We investigated the most common site of success and the effect of a variety of variables on the outcome of slow pathway ablation in children. Methods:A total of 116 patients (ages 4,16 years) with structurally normal hearts underwent radiofrequency ablation of either the antegrade or the retrograde slow pathway. Ablation sites were divided into eight regions (A1, A2, M1, M2, P1, P2, CS1, and CS2) at the septal tricuspid annulus. Results:Ablation was successful in 112 (97%) children. The most common successful ablation sites were at the P1 region. The less the patient weighed, the more posteriorly the successful site was located (P = 0.023, OR 0.970, 95% CI 0.946,0.996), and the more likely the slow pathway was eliminated rather than modified: median weight was 46.7 kg (range, 14.5,94.3 kg) in the eliminated group and 56.5 kg (range, 20,82.6 kg) in the modified group (P = 0.021, OR 1.039, 95% CI 1.006,1.073). Conclusions:The most common site of success for slow pathway ablation in children is at the P1 region of the tricuspid annulus. The successful sites in lighter children are more posteriorly located. Weight is also a predictor of whether the slow pathway is eliminated or only modified. [source]

    Need for Fast Pathway Ablation in Typical Irregular AV Nodal Reentrant Tachycardia in a Patient with Multiple AV Nodal Pathways

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2000
    PETER WEISMÜLLER M.D.
    A case of a 60-year-old male with irregular AV nodal reentrant tachycardia of the common type is reported. Electrophysiological study revealed multiple antegrade slowly conducting AV nodal pathways and one exclusively retrogradely conducting fast AV nodal pathway. Despite the recommendation for slow pathway ablation as the treatment of choice in patients with AVNRT, first pathway ablation was successfully performed in this case due to the risk of total A V block of ablating the slow pathways. The present report shows that there is the rare patient in whom fast pathway ablation is required for curative treatment of AV nodal reentrant tachycardia. [source]

    AV Nodal Pathways in the R-R Interval Histogram of the 24-Hour Monitoring ECG in Patients with Atrial Fibrillation

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2001
    Peter Weismüller M.D.
    Background: Patients with more than one AV nodal pathway show two and more peaks in the histogram of the R-R intervals of the Holter monitoring ECG during atrial fibrillation. It was the purpose of the present study to determine the number of patients showing more than one AV nodal pathway in a larger patient group with permanent atrial fibrillation by analyzing the Holter monitoring ECG. Methods: 250 patients with permanent atrial fibrillation during Holter monitoring ECG were studied; 203 patients had structural heart disease. The number of peaks in the R-R interval histogram of each patient was determined. The distribution of the number of peaks in the R-R interval histogram in different patient groups was analyzed. Results: 153 patients (61 %) had one peak, 80 patients (32%) two peaks, 13 patients (5%) three peaks, and four patients (2%) four peaks, reflecting the number of different AV nodal pathways. In the different patient groups, in the patients with or without structural heart disease, with coronary heart disease, with a history of syncope, and in patients with a mean heart rate of more than 100/min, there was no significant difference in the distribution of the number of peaks in the R-R interval histogram. Conclusions: In more than one third of all patients with permanent atrial fibrillation there are two, three, or four AV nodal pathways. It is suggested that this number of different AV nodal pathways found in the studied group can be applied to all humans. 38.8% of all patients with permanent atrial fibrillation have more than one AV nodal pathway; 6.4% of all patients with atrial fibrillation would benefit from an ablation of AV nodal pathways with shorter refractory periods for reduction of the heart rate. A.N.E. 2001;6(4):285,289 [source]

    Roles of bone morphogenetic protein signaling and its antagonism in holoprosencephaly,

    AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2010
    John Klingensmith
    Abstract Holoprosencephaly (HPE) is the most common malformation of the forebrain, resulting from a failure to completely septate the left and right hemispheres at the rostral end of the neural tube. Because of the tissue interactions that drive head development, these forebrain defects are typically accompanied by midline deficiencies of craniofacial structures. Early events in setting up tissue precursors of the head, as well as later interactions between these tissues, are critical for normal head formation. Defects in either process can result in HPE. Signaling by bone morphogenetic proteins (BMPs), a family of secreted cytokines, generally plays negative roles in early stages of head formation, and thus must be attenuated in multiple contexts to ensure proper forebrain and craniofacial development. Chordin and Noggin are endogenous, extracellular antagonists of BMP signaling that promote the normal organization of the forebrain and face. Mouse mutants with reduced levels of both factors display mutant phenotypes remarkably analogous to the range of malformations seen in human HPE sequence. Chordin and Noggin function in part by antagonizing the inhibitory effects of BMP signaling on the Sonic hedgehog and Nodal pathways, genetic lesions in each being associated with human HPE. Study of Chordin;Noggin mutant mice is helping us to understand the molecular, cellular, and genetic pathogenesis of HPE and associated malformations. © 2010 Wiley-Liss, Inc. [source]

    Need for Fast Pathway Ablation in Typical Irregular AV Nodal Reentrant Tachycardia in a Patient with Multiple AV Nodal Pathways

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2000
    PETER WEISMÜLLER M.D.
    A case of a 60-year-old male with irregular AV nodal reentrant tachycardia of the common type is reported. Electrophysiological study revealed multiple antegrade slowly conducting AV nodal pathways and one exclusively retrogradely conducting fast AV nodal pathway. Despite the recommendation for slow pathway ablation as the treatment of choice in patients with AVNRT, first pathway ablation was successfully performed in this case due to the risk of total A V block of ablating the slow pathways. The present report shows that there is the rare patient in whom fast pathway ablation is required for curative treatment of AV nodal reentrant tachycardia. [source]

    Latent Atriofascicular Pathway Participating in a Wide Complex Tachycardia: Differentiation from Ventricular Tachycardia

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2006
    MOHAMMAD V. JORAT M.D.
    Accessory pathways with anterograde decremental conduction properties usually are characterized by presence of antegrade preexcitation during atrial pacing. We report a 38-year-old man with frequent episodes of palpitation. No evidence of ventricular preexcitation was seen during sinus rhythm or atrial pacing. All electrophysiologic maneuvers were compatible with an antidromic tachycardia using atriofascicular pathway as the antegrade limb and the atrioventricular nodal pathway as retrograde limb. Radiofrequency ablation at recording site of accessory pathway potential resulted in cure of tachycardia with no recurrence during 3-month follow-up. This report indicated that atriofascicular pathway-mediated tachycardia should be considered in differential diagnosis of all cases of wide complex tachycardia with left bundle branch morphology and left axis. [source]

    AV Nodal Pathways in the R-R Interval Histogram of the 24-Hour Monitoring ECG in Patients with Atrial Fibrillation

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2001
    Peter Weismüller M.D.
    Background: Patients with more than one AV nodal pathway show two and more peaks in the histogram of the R-R intervals of the Holter monitoring ECG during atrial fibrillation. It was the purpose of the present study to determine the number of patients showing more than one AV nodal pathway in a larger patient group with permanent atrial fibrillation by analyzing the Holter monitoring ECG. Methods: 250 patients with permanent atrial fibrillation during Holter monitoring ECG were studied; 203 patients had structural heart disease. The number of peaks in the R-R interval histogram of each patient was determined. The distribution of the number of peaks in the R-R interval histogram in different patient groups was analyzed. Results: 153 patients (61 %) had one peak, 80 patients (32%) two peaks, 13 patients (5%) three peaks, and four patients (2%) four peaks, reflecting the number of different AV nodal pathways. In the different patient groups, in the patients with or without structural heart disease, with coronary heart disease, with a history of syncope, and in patients with a mean heart rate of more than 100/min, there was no significant difference in the distribution of the number of peaks in the R-R interval histogram. Conclusions: In more than one third of all patients with permanent atrial fibrillation there are two, three, or four AV nodal pathways. It is suggested that this number of different AV nodal pathways found in the studied group can be applied to all humans. 38.8% of all patients with permanent atrial fibrillation have more than one AV nodal pathway; 6.4% of all patients with atrial fibrillation would benefit from an ablation of AV nodal pathways with shorter refractory periods for reduction of the heart rate. A.N.E. 2001;6(4):285,289 [source]

    Atrioventricular Nodal Reentrant Tachycardia in Children: Effect of Slow Pathway Ablation on Fast Pathway Function

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2002
    GEORGE F. VAN HARE M.D.
    AV Nodal Reentry in Children.Introduction: Prior studies in adults have shown significant shortening of the fast pathway effective refractory period after successful slow pathway ablation. As differences between adults and children exist in other characteristics of AV nodal reentrant tachycardia (AVNRT), we sought to characterize the effect of slow pathway ablation or modification in a multicenter study of pediatric patients. Methods and Results: Data from procedures in pediatric patients were gathered retrospectively from five institutions. Entry criteria were age < 21 years, typical AVNRT inducible with/without isoproterenol infusion, and attempted slow pathway ablation or modification. Dual AV nodal pathways were defined as those with > 50 msec jump in A2-H2 with a 10-msec decrease in A1-A2. Successful ablation was defined as elimination of AVNRT inducibility. A total of 159 patients (age 4.4 to 21 years, mean 13.1) were studied and had attempted slow pathway ablation. AVNRT was inducible in the baseline state in 74 (47%) of 159 patients and with isoproterenol in the remainder. Dual AV nodal pathways were noted in 98 (62%) of 159 patients in the baseline state. Ablation was successful in 154 (97%) of 159 patients. In patients with dual AV nodal pathways and successful slow pathway ablation, the mean fast pathway effective refractory period was 343 ± 68 msec before ablation and 263 ± 64 msec after ablation. Mean decrease in the fast pathway effective refractory period was 81 ± 82 msec (P < 0.0001) and was not explained by changes in autonomic tone, as measured by changes in sinus cycle length during the ablation procedure. Electrophysiologic measurements were correlated with age. Fast pathway effective refractory period was related to age both before (P = 0.0044) and after ablation (P < 0.0001). AV block cycle length was related to age both before (P = 0.0005) and after ablation (P < 0.0001). However, in dual AV nodal pathway patients, the magnitude of change in the fast pathway effective refractory period after ablation was not related to age. Conclusion: Lack of clear dual AV node physiology is common in pediatric patients with inducible AVNRT (38%). Fast pathway effective refractory period shortens substantially in response to slow pathway ablation. The magnitude of change is large compared with adult reports and is not completely explained by changes in autonomic tone. Prospective studies in children using autonomic blockade are needed. [source]

    Need for Fast Pathway Ablation in Typical Irregular AV Nodal Reentrant Tachycardia in a Patient with Multiple AV Nodal Pathways

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2000
    PETER WEISMÜLLER M.D.
    A case of a 60-year-old male with irregular AV nodal reentrant tachycardia of the common type is reported. Electrophysiological study revealed multiple antegrade slowly conducting AV nodal pathways and one exclusively retrogradely conducting fast AV nodal pathway. Despite the recommendation for slow pathway ablation as the treatment of choice in patients with AVNRT, first pathway ablation was successfully performed in this case due to the risk of total A V block of ablating the slow pathways. The present report shows that there is the rare patient in whom fast pathway ablation is required for curative treatment of AV nodal reentrant tachycardia. [source]

    Inducible Atrioventricular Nodal Reentrant Echo Behind Organic 2:1 Infra-Hisian Block During Sinus Rhythm

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2006
    CHIH-SHENG CHU
    A 77-year-old male patient with an intermittent 2:1 infra-Hisian block during sinus rhythm was presented with dizziness and near-syncope. During electrophysiological (EP) study, dual atrioventricular (AV) nodal pathways and retrograde fast pathway were easily induced by atrial and ventricular programmed stimulation, respectively. A typical slow-fast AV nodal reentrant echo beat also could be demonstrated by single atrial extrastimulation. Atrioventricular nodal reentrant tachycardia (AVNRT) can occasionally exhibit 2:1 AV block. Conversely, AV nodal reentry property had been rarely reported behind 2:1 infra-Hisian block. The EP presentation from this case may support the notion that tissues below the His are not part of the reentrant circuit of AVNRT. [source]

    AV Nodal Pathways in the R-R Interval Histogram of the 24-Hour Monitoring ECG in Patients with Atrial Fibrillation

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2001
    Peter Weismüller M.D.
    Background: Patients with more than one AV nodal pathway show two and more peaks in the histogram of the R-R intervals of the Holter monitoring ECG during atrial fibrillation. It was the purpose of the present study to determine the number of patients showing more than one AV nodal pathway in a larger patient group with permanent atrial fibrillation by analyzing the Holter monitoring ECG. Methods: 250 patients with permanent atrial fibrillation during Holter monitoring ECG were studied; 203 patients had structural heart disease. The number of peaks in the R-R interval histogram of each patient was determined. The distribution of the number of peaks in the R-R interval histogram in different patient groups was analyzed. Results: 153 patients (61 %) had one peak, 80 patients (32%) two peaks, 13 patients (5%) three peaks, and four patients (2%) four peaks, reflecting the number of different AV nodal pathways. In the different patient groups, in the patients with or without structural heart disease, with coronary heart disease, with a history of syncope, and in patients with a mean heart rate of more than 100/min, there was no significant difference in the distribution of the number of peaks in the R-R interval histogram. Conclusions: In more than one third of all patients with permanent atrial fibrillation there are two, three, or four AV nodal pathways. It is suggested that this number of different AV nodal pathways found in the studied group can be applied to all humans. 38.8% of all patients with permanent atrial fibrillation have more than one AV nodal pathway; 6.4% of all patients with atrial fibrillation would benefit from an ablation of AV nodal pathways with shorter refractory periods for reduction of the heart rate. A.N.E. 2001;6(4):285,289 [source]