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At least 721 records · Page 40Linked to original sources
PubMed1975

Concealed retrograde conduction of an atrial echo in second degree A-V block of the Wenckebach type with modified ventricular acceleration.

Whereas second degree A-V block showing the classical pattern of the Wenckebach phenomenon is easily diagnosed, variant forms of the Wenckebach phenomenon in second degree A-V block may pose difficulties to the interpretor. A case is presented, where modified acceleration of the ventricles--a crucial "pointer" to the Wenckebach A-V block -- is disturbed by concealed conduction of an atrial echo. Differences in the electrocardiographic manifestation between this and the classical type of second degree A-V block of the Wenckebach type are discussed.

Atrial Fibrillation↗
PubMed1994

Tissue-specific determinants of anisotropic conduction velocity in canine atrial and ventricular myocardium.

Electrical conduction is very rapid and highly anisotropic in atrial fiber bundles, such as the crista terminalis. In contrast to left ventricular myocardium in which the ratio of longitudinal to transverse conduction velocities is approximately 3, propagation velocity in the crista terminalis is approximately 10 times greater in the longitudinal than in the transverse direction. To elucidate potential determinants of these distinct conduction properties, we characterized structural and molecular features of intercellular coupling in the crista terminalis and left ventricular myocardium of the canine heart. Analysis of the number and spatial orientation of myocyte interconnections at gap junctions revealed that a typical left ventricular myocyte was connected to 11.3 +/- 2.2 other myocytes. Approximately equal numbers of connections occurred between ventricular myocytes juxtaposed in side-to-side and end-to-end orientation. In contrast, a typical myocyte of the crista terminalis was connected to only 6.4 +/- 1.7 other cells (P < .05), but nearly 80% of these connections occurred between cells oriented in an end-to-end configuration. In comparison with the ventricular pattern, this spatial distribution of connections would limit intercellular current transfer between laterally apposed cells and thereby enhance anisotropy of conduction velocity in the longitudinal and transverse directions. Ultrastructural analysis showed that crista terminalis myocytes were connected by numerous small gap junctions that occurred in relatively simple, straight intercalated disks. Northern blot analysis showed approximately equivalent amounts of mRNAs encoding the gap junction channel proteins connexin43 and connexin45 but approximately four times more connexin40 mRNA in crista terminalis than in the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Ventricular conduction defects and atrial fibrillation after coronary artery bypass grafting. Multivariate analysis of preoperative, intraoperative and postoperative variables.

Preoperative, intraoperative and postoperative variables, which might play a role in the development of ventricular conduction defects (VCD) and atrial fibrillation (AF) following coronary artery bypass grafting (CABG), were evaluated in 236 consecutive patients. VCD and AF developed postoperatively in 15.5% of patients: 4.5% had VCD (subgroup A), 11.0% had AF (subgroup B). In 84.5% of patients VCD and AF did not occur (subgroup C). Univariate analysis showed statistically significant differences between subgroups A and C with respect to: left main significant stenoses and number of diseased vessels. Bypass pump time and aortic cross-clamp time were significantly longer in subgroup B. Multivariate analysis showed a significantly greater incidence of left main disease and of right coronary artery occlusion associated with significant stenosis of the proximal left anterior descending artery in subgroup A. In subgroup B, the duration of aortic cross-clamp time was significantly higher. Ischaemic injury, with increasing duration of cardioplegic arrest, seems to play a key role in the development of AF. Nonhomogeneous cardioplegic delivery to critical areas of myocardium, and particularly to the specialized conducting system, may cause VCD after CABG.

Adult↗
PubMedDate not supplied

Cardiac conduction abnormalities and atrial arrhythmias associated with salicylate toxicity.

Cardiac side effects from aspirin are uncommon; however, severe acid-base imbalance, pulmonary edema, ventricular ectopic activity and cardiopulmonary arrest have been reported in patients with toxic serum salicylate concentrations. We saw a patient with salicylate toxicity who developed a variety of sinus and atrioventricular nodal conduction disturbances and atrial arrhythmias with a relatively low toxic serum salicylate concentration. The cardiac rhythm returned to normal as the serum salicylate concentration decreased, and results of subsequent electrophysiologic testing and Holter monitoring were normal. A low serum albumin level may have resulted in altered salicylate binding in this patient, thereby increasing the availability of unbound (active) drug for toxic effects.

Aged↗
PubMed1994

Independent ablation of retrograde and anterograde accessory connection conduction at the atrial and ventricular insertion sites: evidence supporting the impedance mismatch hypothesis for unidirectional block.

INTRODUCTION: The impedance mismatch hypothesis has been proposed as one of the mechanisms responsible for accessory connection conduction block. METHODS AND RESULTS: We describe a case in which retrograde conduction across a posteroseptal accessory connection was ablated at the atrial insertion site in the coronary sinus os, whereas anterograde conduction was ablated at the ventricular insertion site in the left ventricle. CONCLUSION: The evidence supports the impedance mismatch concept as the cause of unidirectional conduction block and shows that the distal junction between the accessory connection and the myocardium is more vulnerable to ablation.

Adult↗
PubMed2004

Atrial standstill with subnodal conduction defect and diffuse ventricular fibrosis managed with low right atrial pacing.

In patients with congenital heart disease presenting with bradyarrhythmia, many electrophysiological abnormalities are found. This report presents a case of a man with surgically corrected single atrium and pulmonary valve stenosis, atrial standstill, delayed AV node conduction, first-degree intra- and second-degree infra-His block, who was permanently paced from a restricted excitable area of the low right atrium, as the pacing threshold was unacceptable at any ventricular site.

Arrhythmias, Cardiac↗
PubMed1988

Two ATP-activated conductances in bullfrog atrial cells.

Currents activated by extracellular ATP were studied in single voltage-clamped bullfrog atrial cells. Rapid application of ATP elicited currents carried through two different conductance pathways: a rapidly desensitizing conductance reversing near -10 mV, and a maintained, inwardly rectifying conductance reversing near -85 mV. ATP activated the desensitizing component of current with a K 1/2 of approximately 50 microM and the maintained component with a K 1/2 of approximately 10 microM. Both types of current were activated by ATP but not by adenosine, AMP, or ADP. The desensitizing current was selectively inhibited by alpha, beta-methylene ATP, and the maintained, inwardly rectifying current was selectively suppressed by extracellular Cs. The desensitizing component of current was greatly reduced when extracellular Na was replaced by N-methylglucamine, but was slightly augmented when Na was replaced by Cs. GTP, ITP, and UTP were all ineffective in activating the desensitizing current, and of a variety of ATP analogues, only ATP-gamma-S was effective. Addition of EGTA or BAPTA to the intracellular solution did not obviously affect the desensitizing current. Fluctuation analysis of currents through the desensitizing conductance suggested that current is carried through ionic channels with a small (less than pS) unitary conductance.

Adenosine Triphosphate↗
PubMed2001

Decremental atriofascicular accessory pathway with bidirectional conduction: delineation of atrial and ventricular insertion by radiofrequency current application.

A 17-year-old girl with a corrected complex congenital heart disease and recurrent episodes of supraventricular tachycardia was referred for catheter ablation. Electrophysiologic studies revealed the presence of an accessory pathway (AP) with bidirectional conduction and decremental properties. We demonstrated a course parallel to the node-His AV conduction system. Transient abolition of the bidirectional conduction through the AP was obtained by radiofrequency application to the ventricular insertion located in the distal right bundle branch and to the atrial insertion, located in the mid-anterior atrial septum. Radiofrequency application at the low anterior atrial septum, above the His bundle, successfully abolished AP conduction without affecting AV nodal conduction. Demonstration of the course and insertions of the AP, its bidirectional decremental conduction properties, and the association with a complex congenital heart disease are exceptional and interesting findings and raise the possibility of an accessory AV node with a parallel conduction pathway to the right bundle branch.

Adolescent↗
PubMed1995

Chloride conductance in human atrial cells.

Many types of chloride current have been reported in the hearts of various species; however, the nature of chloride conductance in the human heart is still unclear. We investigated cyclic AMP-dependent chloride current and swelling-induced chloride current in isolated human atrial cells using the whole-cell voltage-clamp method. External application of 1 microM isoprenaline increased calcium current by 391.9 +/- 48.6% (mean +/- S.D., n = 8); however, there was no activation of cyclic AMP-dependent chloride current at steady-state membrane potentials between -80 and +50 mV. Neither external application of 10 microM forskolin nor internal application of 50 microM cyclic AMP activated a cyclic AMP-dependent chloride current. On the other hand, when the same cell was superfused with a 50% hypotonic solution, it exhibited osmotic swelling and an outward rectifying current (6.59 +/- 0.96 pA/pF at +30 mV, n = 10). This swelling-induced current reversed at -26.5 +/- 3.1 mV (n = 10), close to the calculated equilibrium potential for chloride, and it was sensitive to the stilbene-derivative chloride channel blocker. In conclusion, no activation of cyclic AMP-dependent chloride current was observed in human atrial cells. On the other hand, a swelling-induced chloride current was consistently demonstrated and its kinetic properties were similar to those reported in other cardiac myocytes.

4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfo↗
PubMed1993

[Retrograde conduction (ventriculo-atrial) in patients with AV or intraventricular block. Electrophysiologic evaluation].

The purpose of the study was to evaluate ventriculoatrial conduction in patients with chronic complete AV block (AVB) (35 pts--gr. A), who were qualified for pacemaker implantation and in patients with bifascicular block (BFB) (20 pts--gr. B), who had electrophysiological study performed to determine indications for permanent pacing. Anterograde and retrograde conduction by accessory pathways were excluded in all patients. Incremental ventricular pacing (60-80 bpm to 200-220 bpm) and programmed ventricular stimulation were performed. Ventriculoatrial (VA) conduction was present in 12 of 35 patients in gr. A (34%) and in 15/20 patients in gr. B (75%). Mean VA conduction time was 192 +/- 50 ms in gr. A and 200 +/- 54 ms in gr. B, effective refractory period of right ventricle (ERP-RV) was 270 +/- 30 ms and 250 +/- 29 ms respectively. Mean retrograde Wenckebach point was 128 +/- 41 bpm in gr. A and 132 +/- 30 bpm in gr. B. The level of VA Wenckebach block in gr. A was found at AVN in 4 of 12 patients and in remaining was not directly recognised. Levels in gr. B were: AVN--6, not recognised--9 patients. Ventriculoatrial conduction shows complex properties and dependence on the type of ventricular stimulation. Electrophysiological study enables to find a level of retrograde block in some patients.

Adult↗
PubMed1975

Electrophysiological significance of rapid atrial pacing as a test of atrioventricular conduction.

Although rapid atrial pacing is frequently used as a test of atrioventricular conduction, no studies have compared this method with other conduction parameters. The purpose of this study was to compare the results of rapid atrial pacing with refractory period measurements utilizing the extrastimulus technique. Determination of the refractory periods of the atrium, A-V node, and His-Purkinje system were accomplished in 41 patients undergoing diagnostic cardiac catheterization, and the results compared with rapid atrial pacing to the point at which A-V Wenckebach occurred (WP). The results showed significant correlation (P less than 0.01) between the WP and functional refractory period (FRP) of the A-V node (r=0.89, FRP=865-2.6 WP), and significant correlation between the WP and the effective refractory period (ERP) of the total A-V conducting system(r=0.81, ERP=729-2.6 WP). The relationship between WP and the refractory periods also allowed prediction of the occurrence of physiological His-Purkinje block during introduction of premature atrial contractions and the site of the effective refractory period of the total A-V conducting system. This study establishes a close relationship between these methods and confirms the usefulness of rapid atrial pacing as a reliable test of A-V conduction in man.

Atrial Function↗
PubMed2005

Site specificity of transverse crista terminalis conduction in patients with atrial flutter.

INTRODUCTION: The causes of transcristal conduction (TC) in patients with atrial flutter (AFL) are unknown. METHODS AND RESULTS: In two groups of patients referred for AFL ablation, 36 had cavotricuspid isthmus (CTI) dependent flutter (Group I) and 24 had lower (n = 21) or upper loop reentry (n = 5) (Group II). After ablation, isthmus block was evaluated by pacing from the coronary sinus (CS) and low lateral right atrium and by alternative techniques, including mapping with electrodes spanning the CTI or electroanatomic mapping. After bidirectional CTI block was verified, 21/36 (58%) in Group I showed TC with CS pacing, including low TC in 16 (including 11 showing "pseudo" CTI conduction), higher TC in 6 and multiple breaks in 3. However, 8 with low TC during CS pacing showed unidirectional block by pacing outside of the CS os. Twelve (50%) in Group II had TC during CS pacing after bidirectional CTI block, with low TC in 5 (2 mimicking residual CTI conduction) and higher breaks in 9. There was no significant difference in the incidence of TC during CS pacing after CTI block between groups. In seven autopsied hearts, the muscle orientation between the proximal CS musculature and Eustachian ridge were examined. Muscular connections between the CS and Eustachian ridge coursing toward the orifice of inferior vena cava were found in one of the hearts. CONCLUSIONS: It is concluded that in patients with bidirectional CTI block, pacing from the CS may be associated with TC mimicking a conduction leak through the isthmus. Pacing just outside the CS os helps distinguish pseudo from true isthmus block.

Aged↗
PubMed1988

Influence of the passive anisotropic properties on directional differences in propagation following modification of the sodium conductance in human atrial muscle. A model of reentry based on anisotropic discontinuous propagation.

Available models of circus movement reentry in cardiac muscle and of drug action on reentrant arrhythmias are based on continuous medium theory, which depends solely on the membrane ionic conductances to alter propagation. The purpose of this study is to show that the anisotropic passive properties at a microscopic level highly determine the propagation response to modification of the sodium conductance by premature action potentials and by sodium channel-blocking drugs. In young, uniform anisotropic atrial bundles, propagation of progressively earlier premature action potentials continued as a smooth process until propagation ceased simultaneously in all directions. In older, nonuniform anisotropic bundles, however, premature action potentials produced either unidirectional longitudinal conduction block or a dissociated zigzag type of longitudinal conduction (a safer type of propagation, similar to transverse propagation). Directional differences in the velocity of premature action potentials demonstrated that anisotropic propagation was necessary for a reentrant circuit to be contained within an area of 50 mm2, even with very short refractory periods. Quinidine produced Wenckebach periodicity, which disappeared after acetylcholine shortened the action potential. Quinidine also produced use-dependent dissociated zigzag longitudinal conduction in the older, nonuniform anisotropic bundles but not in the young, uniform anisotropic bundles. The electrophysiological consequence was that propagation events differed in an age-related manner in response to the same modification of the sodium conductance. The electrical events at microscopic level showed that conditions leading to obliteration of side-to-side electrical coupling between fibers (e.g., aging and chronic hypertrophy) provide a primary mechanism for reentry to occur within very small areas (1-2 mm) due to a variety of propagation phenomena that do not occur in tissues with tight electrical coupling in all directions.

Action Potentials↗