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Titolo:
PHYSIOLOGY OF THE ESCAPE RHYTHM AFTER RADIOFREQUENCY ATRIOVENTRICULARJUNCTIONAL ABLATION
Autore:
SHEPARD RK; NATALE A; STAMBLER BS; WOOD MA; GILLIGAN DM; ELLENBOGEN KA;
Indirizzi:
VIRGINIA COMMONWEALTH UNIV,MED COLL VIRGINIA,DIV CARDIOL,POB 980053 RICHMOND VA 23298 VIRGINIA COMMONWEALTH UNIV,MED COLL VIRGINIA,DIV CARDIOL RICHMOND VA 23298 HUNTER HOLMES MCGUIRE VET ADM MED CTR RICHMOND VA 00000 DUKE UNIV,MED CTR,DIV CARDIOL DURHAM NC 00000 VET ADM MED CTR DURHAM NC 00000 BRIGHAM & WOMENS HOSP,DIV CARDIOL BOSTON MA 02115 VET ADM MED CTR W ROXBURY,DIV CARDIOL BOSTON MA 02115
Titolo Testata:
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY
fascicolo: 5, volume: 21, anno: 1998,
pagine: 1085 - 1092
SICI:
0147-8389(1998)21:5<1085:POTERA>2.0.ZU;2-0
Fonte:
ISI
Lingua:
ENG
Soggetto:
CATHETER ABLATION; NODE ABLATION; HIS-BUNDLE; AUTOMATICITY; PACEMAKER; CONDUCTION; ENERGY;
Keywords:
AV JUNCTION ABLATION; RADIOFREQUENCY ABLATION; ATRIAL FIBRILLATION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
20
Recensione:
Indirizzi per estratti:
Citazione:
R.K. Shepard et al., "PHYSIOLOGY OF THE ESCAPE RHYTHM AFTER RADIOFREQUENCY ATRIOVENTRICULARJUNCTIONAL ABLATION", PACE, 21(5), 1998, pp. 1085-1092

Abstract

The physiology of the escape rhythm (ER) and its response to pharmacological modulation under varying autonomic conditions were studied in 48 patients undergoing radiofrequency ablation of the atrioventricularjunction (AVJ) for refractory atrial fibrillation. The QRS morphologyand cycle length (CL) of the baseline ER were measured 15 minutes postablation. The CL of the ER was measured in response to doses of isoproterenol, atropine, adenosine, lidocaine, and verapamil. The ER QRS was narrow (QRS < 120 ms) in 20 patients and wide (QRS > 120 ms) in 28 patients. Of the 28 patients with wide QRS ER, 11 patients had a new bundle branch block (8 patients new right bundle branch block [RBBB] and2 patients new left bundle branch block [LBBB]). The ERCL rt as similar in both narrow and wide ERs (1,593 +/- 376 ms and 1,516 +/- 296 ms,P = 0.44). In 23 patients receiving isoproterenol infusion, the ER CLdecreased with increasing doses from 1 mcg/min to 2 mcg/min (1,378 +/- 200 to 1,240 +/- 229 ms, P < 0.001), but did not decrease further at3 mcg/min (1,201 +/- 192 ms, P = 0.48 vs 2 mg/min). Seven patients received 0.02 mg/kg of atropine, and ER decreased significantly (1,572 +/- 408 ms to 1,319 +/- 333 ms, P = 0.028). in 30 patients who receivedintravenous boluses of adenosine (6-18 mg), the ER did not change significantly. in 28 patients who received 150 mg of lidocaine, the ER increased from 1,462 +/- 286 ms to 1,715 +/- 467 ms (P < 0.001), and onepatient developed transient asystole. Nineteen patients received 7.5 mg of verapamil, and the ER did not change (1,488 +/- 313 ms to 1,513 /- 666 ms, P = 0.80). There was no significant difference in responseto isoproterenol, adenosine, lidocaine, or verapamil between the patients with wide and narrow QRS ERs. We conclude that patients may have stable ERs immediately following AVJ ablation even when a wide complexER results. The ER is responsive to sympathetic stimulation and vagalblockade. The ER is prolonged after lidocaine but not after verapamil, suggesting response to sodium but not to calcium channel blockade. These data ore consistent with an ER originating in the distal compact AV node or proximal His bundle.

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Documento generato il 30/11/20 alle ore 03:19:56