Anterior region of the atrioventricular perinodal area in relation to radiofrequency ablation procedures

• Autorzy: Kozlowski D , Maruszak H. , Wozniak P. , Krupa W. , Owerczuk A. , Derejko P. , Gawrysiak M. , Piwko G. , Grzybiak M.
• Języki publikacji: EN

Abstrakty

EN

Atrioventricular nodal reentry tachycardia base on reentry circulation in nodal- -perinodal area. The radical treatment of choice is radiofrequency ablation. Procedure approached from the anterior-superior (fast) region sufficient a few seconds of energy delivery for success, however this can result in A-V block. The possibility that arrhythmias substrate may lie very superficially (success of ablation) and damage the normal structures (complication) in the perinodal region must be considered. In order to confirm this hypothesis we examined the autopsy material of 100 normal hearts, both sexes from 18 to 105 years of age (control) and 50 hearts with A-V total block 45–95 years of age (block). We paid attention to the morphology of the nodal artery (NA), atrial inputs (AI) and transitional inputs (TI). It was observed that NA at the level of the central fibrous body was positioned in 94% in the central and in 6% in the inferior part of Koch’s triangle. It was removed from the endocardium 3–6 mm in control and 2–5 mm in block group respectively (NS). In the perinodal area we distinguished AI that directly joined the A-V compact node: superficial (right part of the interatrial septum) or deep (left part). The former occurred in 100% of controls and in 80% of block groups (NS), and the latter in 80% of control group and in 34% in block respectively (p < 0.05). The real substrate of arrhythmia in anterior-superior region lies very superficially and far from the conduction tissue; NA in examined hearts was lying deep beneath the endocardium; ablation close to the node could result in A-V block.

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2001
• Tom: 60
• Numer: 4
• Opis fizyczny: p.303-307,fig.,ref.

Twórcy

autor

Kozlowski D

• Medical University of Gdansk, Kieturakisa 1, 80-742 Gdansk, Poland

autor

Maruszak H.

autor

Wozniak P.

autor

Krupa W.

autor

Owerczuk A.

autor

Derejko P.

autor

Gawrysiak M.

autor

Piwko G.

autor

Grzybiak M.

Bibliografia

• 1. Gamache MC, Bharati S, Lev M, Lindsay BD (1994) Histopathological study following catheter guided radiofrequency current ablation of the slow pathway in a patient with atrioventricular nodal reentrant tachycardia. Pacing Clin Electrophysiol, 17: 247–251.
• 2. Hindricks G (1996) On Behalf Of The Multicenter European Radiofrequency Survey Investigators: Incidence of complete atrioventricular block following attempted radiofrequency catheter modification of the atrioventricular node in 880 patients. Eur Heart J, 17: 82–88.
• 3. Janse MJ, Anderson RH, Mcguire MA, Ho YS (1995) AV nodal reentry — part I: ”AV nodal” reentry revisited. J Cardiovasc Electrophysiol, 6: 26–39.
• 4. Jazayeri MR, Hempe SL, Sra JS (1992) Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. Circulation, 85: 1318–1328.
• 5. Kay NG, Plumb VJ (1996) The present role of radiofrequency catheter ablation in the management of cardiac arrhythmias. Am J Med, 100: 344–352.
• 6. Kozłowski D, Koźluk E, Adamowicz M, Grzybiak M, Walczak F, Walczak E (1998) Histological examination of the topography of the atrioventricular nodal artery within the triangle of Koch. Pacing Clin Electrophysiol, 21: 163–167.
• 7. Kozłowski D, Koźluk E, Kołodziej P, Grochowski P, Grzybiak M, Walczak F (1996) Morphology of the A-V node in relation to the mechanism of A-V nodal reentry tachycardia — a preliminary report. Folia Morphol (Warsz.), 55: 353–355.
• 8. Mcguire MA, Johnson DC, Robotin M (1992) Dimensions of the triangle of Koch in humans. Am J Cardiol, 70: 829–830.
• 9. Sung RJ, Lauer MR, Chun H (1994) Atrioventricular node reentry: current concept and new perspectives. Pacing Clin Electrophysiol, 17: 1413–1430.
• 10. Tanaka M, Satake S, Kawahara Y, Sugiura M, Hirao K, Tanaka K, Kawara T, Masuda A, Nishikawa T, Kasajima T (1991) Pathological aspects of radiofrequency catheter ablation of the canine atrioventricular node and bundle of his with special reference to chronic incomplete atrioventricular block. Acta Pathol Jpn, 41: 487–498.
• 11. Ueng KC, Chen SA, Chiang CE, Tai CT, Lee SH, Chiou CW, Wen ZC, Tseng CJ, Chen YJ, Yu WC, Chen CY, Chang MS (1996) Dimension and related anatomical distance of Koch’s triangle in patients with atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol, 7: 1017–1023.