Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway

Shih Ann Chen, Ching Tai Tai, Chern En Chiang, Shih Huang Lee, Zu Chi Wen, Chuen Wang Chiou, Kwo Chang Ueng, Yi Jen Chen, Wen Chung Yu, Jin Long Huang, Mau Song Chang

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objectives. This study sought to characterize the functional properties of decremental accessory atrioventricular (AV) pathways and to investigate their pharmacologic responses. Background. Although decremental AV pathways associated with incessant reciprocating tachycardia have been studied extensively, information about the electrophysiologic characteristics and pharmacologic responses of anterograde and retrograde decremental AV pathways is limited. Methods. Of 759 consecutive patients with accessory pathway-mediated tachyarrhythmia, 74 with decremental AV pathways were investigated (mean age 43 ± 18 years). After baseline electrophysiologic study, the serial drugs adenosine, verapamil and procainamide were tested during atrial and ventricular pacing. Finally, radiofrequency catheter ablation was performed. Results. Five patients had anterograde decremental conduction over the acessory pathway but no retrograde conduction. Of the 64 patients with retrograde decremental conduction over the accessory pathway, anterograde conduction over the pathway was absent in 41 (64%), intermittent in 5 (8) and nondecremental in 18 (28%). In the remaining five patients, anterograde and retrograde decremental conduction over the same pathway was found. The anterograde and retrograde conduction properties and extent of decrement did not differ between anterograde and retrograde decremental pathways. Posteroseptal pathways had the highest incidences of anterograde and retrograde decremental conduction. Intravenous adenosine, procainamide and verapamil caused conduction delay or block, or both, in 10 of 10, 10 of 10 and 4 of 10 of the anterograde and 20 of 20, 20 of 20 and 8 of 20 of the retrograde decremental pathways, respectively. All patients had successful ablation of the decremental pathways without complications. During the follow-up period of 31 ± 19 months, only one patient experienced recurrence. Conclusions. Decremental accessory pathways usually had functionally distinct conduction characteristics in the anterograde and retrograde directions. Their pharmacologic responses suggested the heterogeneous mechanisms of decremental conduction.

Original languageEnglish
Pages (from-to)732-737
Number of pages6
JournalJournal of the American College of Cardiology
Volume28
Issue number3
DOIs
Publication statusPublished - Sep 1996
Externally publishedYes

Fingerprint

Procainamide
Verapamil
Adenosine
Reciprocating Tachycardia
Accessory Atrioventricular Bundle
Catheter Ablation
Tachycardia
Recurrence
Incidence
Pharmaceutical Preparations
Direction compound

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway. / Chen, Shih Ann; Tai, Ching Tai; Chiang, Chern En; Lee, Shih Huang; Wen, Zu Chi; Chiou, Chuen Wang; Ueng, Kwo Chang; Chen, Yi Jen; Yu, Wen Chung; Huang, Jin Long; Chang, Mau Song.

In: Journal of the American College of Cardiology, Vol. 28, No. 3, 09.1996, p. 732-737.

Research output: Contribution to journalArticle

Chen, Shih Ann ; Tai, Ching Tai ; Chiang, Chern En ; Lee, Shih Huang ; Wen, Zu Chi ; Chiou, Chuen Wang ; Ueng, Kwo Chang ; Chen, Yi Jen ; Yu, Wen Chung ; Huang, Jin Long ; Chang, Mau Song. / Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway. In: Journal of the American College of Cardiology. 1996 ; Vol. 28, No. 3. pp. 732-737.
@article{6efd0b0409ed456eb93b83bb1ba51d50,
title = "Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway",
abstract = "Objectives. This study sought to characterize the functional properties of decremental accessory atrioventricular (AV) pathways and to investigate their pharmacologic responses. Background. Although decremental AV pathways associated with incessant reciprocating tachycardia have been studied extensively, information about the electrophysiologic characteristics and pharmacologic responses of anterograde and retrograde decremental AV pathways is limited. Methods. Of 759 consecutive patients with accessory pathway-mediated tachyarrhythmia, 74 with decremental AV pathways were investigated (mean age 43 ± 18 years). After baseline electrophysiologic study, the serial drugs adenosine, verapamil and procainamide were tested during atrial and ventricular pacing. Finally, radiofrequency catheter ablation was performed. Results. Five patients had anterograde decremental conduction over the acessory pathway but no retrograde conduction. Of the 64 patients with retrograde decremental conduction over the accessory pathway, anterograde conduction over the pathway was absent in 41 (64{\%}), intermittent in 5 (8) and nondecremental in 18 (28{\%}). In the remaining five patients, anterograde and retrograde decremental conduction over the same pathway was found. The anterograde and retrograde conduction properties and extent of decrement did not differ between anterograde and retrograde decremental pathways. Posteroseptal pathways had the highest incidences of anterograde and retrograde decremental conduction. Intravenous adenosine, procainamide and verapamil caused conduction delay or block, or both, in 10 of 10, 10 of 10 and 4 of 10 of the anterograde and 20 of 20, 20 of 20 and 8 of 20 of the retrograde decremental pathways, respectively. All patients had successful ablation of the decremental pathways without complications. During the follow-up period of 31 ± 19 months, only one patient experienced recurrence. Conclusions. Decremental accessory pathways usually had functionally distinct conduction characteristics in the anterograde and retrograde directions. Their pharmacologic responses suggested the heterogeneous mechanisms of decremental conduction.",
author = "Chen, {Shih Ann} and Tai, {Ching Tai} and Chiang, {Chern En} and Lee, {Shih Huang} and Wen, {Zu Chi} and Chiou, {Chuen Wang} and Ueng, {Kwo Chang} and Chen, {Yi Jen} and Yu, {Wen Chung} and Huang, {Jin Long} and Chang, {Mau Song}",
year = "1996",
month = "9",
doi = "10.1016/S0735-1097(96)00219-7",
language = "English",
volume = "28",
pages = "732--737",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway

AU - Chen, Shih Ann

AU - Tai, Ching Tai

AU - Chiang, Chern En

AU - Lee, Shih Huang

AU - Wen, Zu Chi

AU - Chiou, Chuen Wang

AU - Ueng, Kwo Chang

AU - Chen, Yi Jen

AU - Yu, Wen Chung

AU - Huang, Jin Long

AU - Chang, Mau Song

PY - 1996/9

Y1 - 1996/9

N2 - Objectives. This study sought to characterize the functional properties of decremental accessory atrioventricular (AV) pathways and to investigate their pharmacologic responses. Background. Although decremental AV pathways associated with incessant reciprocating tachycardia have been studied extensively, information about the electrophysiologic characteristics and pharmacologic responses of anterograde and retrograde decremental AV pathways is limited. Methods. Of 759 consecutive patients with accessory pathway-mediated tachyarrhythmia, 74 with decremental AV pathways were investigated (mean age 43 ± 18 years). After baseline electrophysiologic study, the serial drugs adenosine, verapamil and procainamide were tested during atrial and ventricular pacing. Finally, radiofrequency catheter ablation was performed. Results. Five patients had anterograde decremental conduction over the acessory pathway but no retrograde conduction. Of the 64 patients with retrograde decremental conduction over the accessory pathway, anterograde conduction over the pathway was absent in 41 (64%), intermittent in 5 (8) and nondecremental in 18 (28%). In the remaining five patients, anterograde and retrograde decremental conduction over the same pathway was found. The anterograde and retrograde conduction properties and extent of decrement did not differ between anterograde and retrograde decremental pathways. Posteroseptal pathways had the highest incidences of anterograde and retrograde decremental conduction. Intravenous adenosine, procainamide and verapamil caused conduction delay or block, or both, in 10 of 10, 10 of 10 and 4 of 10 of the anterograde and 20 of 20, 20 of 20 and 8 of 20 of the retrograde decremental pathways, respectively. All patients had successful ablation of the decremental pathways without complications. During the follow-up period of 31 ± 19 months, only one patient experienced recurrence. Conclusions. Decremental accessory pathways usually had functionally distinct conduction characteristics in the anterograde and retrograde directions. Their pharmacologic responses suggested the heterogeneous mechanisms of decremental conduction.

AB - Objectives. This study sought to characterize the functional properties of decremental accessory atrioventricular (AV) pathways and to investigate their pharmacologic responses. Background. Although decremental AV pathways associated with incessant reciprocating tachycardia have been studied extensively, information about the electrophysiologic characteristics and pharmacologic responses of anterograde and retrograde decremental AV pathways is limited. Methods. Of 759 consecutive patients with accessory pathway-mediated tachyarrhythmia, 74 with decremental AV pathways were investigated (mean age 43 ± 18 years). After baseline electrophysiologic study, the serial drugs adenosine, verapamil and procainamide were tested during atrial and ventricular pacing. Finally, radiofrequency catheter ablation was performed. Results. Five patients had anterograde decremental conduction over the acessory pathway but no retrograde conduction. Of the 64 patients with retrograde decremental conduction over the accessory pathway, anterograde conduction over the pathway was absent in 41 (64%), intermittent in 5 (8) and nondecremental in 18 (28%). In the remaining five patients, anterograde and retrograde decremental conduction over the same pathway was found. The anterograde and retrograde conduction properties and extent of decrement did not differ between anterograde and retrograde decremental pathways. Posteroseptal pathways had the highest incidences of anterograde and retrograde decremental conduction. Intravenous adenosine, procainamide and verapamil caused conduction delay or block, or both, in 10 of 10, 10 of 10 and 4 of 10 of the anterograde and 20 of 20, 20 of 20 and 8 of 20 of the retrograde decremental pathways, respectively. All patients had successful ablation of the decremental pathways without complications. During the follow-up period of 31 ± 19 months, only one patient experienced recurrence. Conclusions. Decremental accessory pathways usually had functionally distinct conduction characteristics in the anterograde and retrograde directions. Their pharmacologic responses suggested the heterogeneous mechanisms of decremental conduction.

UR - http://www.scopus.com/inward/record.url?scp=0030407635&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030407635&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(96)00219-7

DO - 10.1016/S0735-1097(96)00219-7

M3 - Article

C2 - 8772764

AN - SCOPUS:0030407635

VL - 28

SP - 732

EP - 737

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 3

ER -