ArticleHeart rhythm O22025
A "drop" in the atrioventricular conduction curve and dual-pathway electrophysiology.
Article in Heart rhythm O2, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Atrioventricular (AV) conduction time is rate-dependent. As the atrial coupling interval (A1A2) shortens, AV conduction time (A2H2) prolongs. Thus, the AV conduction curve, plotted using A1A2 vs A2H2, is usually "smooth" and "monotonic". A "jump" in the curve is the current clinical criterion of dual-pathway electrophysiology, whereas a "gap" in the curve has also been described. Objective: This study described a new phenomenon, a "drop" in the AV conduction curve. The potential relationship between a drop in the AV conduction curve and the dual-pathway electrophysiology was also examined. Methods: Overall, 81 experimental records from rabbit AV nodal preparations containing the following data were analyzed: (1) had at least 1 AV conduction curve and (2) had a recording of His electrogram alternans (a validated new index of dual-pathway conduction). Most cases had intracellular action potential recordings from the AV nodal fibers. Results: Of the 81 preparations, 3 (3.7%) showed a drop in the AV conduction curve. The drops (at A1A2 = 115 ± 35 ms) always occurred after fast pathway to slow pathway (SP) transition (at 148 ± 7 ms). The drops showed an SP-fast pathway pattern in 2 of the 3 preparations and an SP-SP pattern in the remaining 1 preparation. The drops were associated with and most likely caused by the formation of intranodal/nodal-atrial reentry and its subsequent conduction. Conclusion: A new phenomenon, a drop in the AV conduction curve, has been demonstrated in this study. A drop is likely caused by the formation of intranodal/nodal-atrial reentry and its subsequent conduction.
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