Eugene Patterson1, Benjamin J Scherlag. 1. University of Oklahoma Health Sciences Center, and Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, USA. eugene-patterson@ouhsc.edu
Abstract
OBJECTIVES: The incidence and the physiologic roles for direct fast pathway-His bundle connections were examined in 102 rabbit hearts. METHODS: Extracellular bipolar and intracellular microelectrode recordings were made from the superfused rabbit AV junction. RESULTS: In 13 of 27 preparations demonstrating anterior extensions of the fast pathway, the retrograde HA ERP and 2:1 block cycle length were shortened (128 +/- 12 and 145 +/- 5 msec, respectively) versus the remaining 89 preparations (178 +/- 15 and 185 +/- 10 msec, respectively, p < 0.01). The former values were similar to the ERP and 2:1 block cycle length of fast pathway transitional cells (128 +/- 23 and 141 +/- 4 msec, respectively), suggestive of a direct fast pathway-His bundle connection. A deflection recorded between the A and H potentials of the His bundle electrogram could be dissociated from both atrial and His bundle activation. Intracellular microelectrode recordings and light microscopy confirmed the deflection to be an accessory pathway consisting of an anterior extension of fast pathway transitional cells connecting the atrium and His bundle. Transection along the AV groove anterior to the compact AV node ( N = 5) increased the retrograde ERP and Wenckebach block cycle length by severing the AH connection, or transection of the penetrating bundle ( N = 4) produced antegrade AH block without altering rapid retrograde conduction. CONCLUSIONS: Fast pathway-His bundle connections were present in 13 of 102 rabbit hearts, providing an anatomic and physiologic basis for rapid retrograde VA conduction and a possible retrograde pathway for sustained AV nodal reentrant tachycardia.
OBJECTIVES: The incidence and the physiologic roles for direct fast pathway-His bundle connections were examined in 102 rabbit hearts. METHODS: Extracellular bipolar and intracellular microelectrode recordings were made from the superfused rabbit AV junction. RESULTS: In 13 of 27 preparations demonstrating anterior extensions of the fast pathway, the retrograde HA ERP and 2:1 block cycle length were shortened (128 +/- 12 and 145 +/- 5 msec, respectively) versus the remaining 89 preparations (178 +/- 15 and 185 +/- 10 msec, respectively, p < 0.01). The former values were similar to the ERP and 2:1 block cycle length of fast pathway transitional cells (128 +/- 23 and 141 +/- 4 msec, respectively), suggestive of a direct fast pathway-His bundle connection. A deflection recorded between the A and H potentials of the His bundle electrogram could be dissociated from both atrial and His bundle activation. Intracellular microelectrode recordings and light microscopy confirmed the deflection to be an accessory pathway consisting of an anterior extension of fast pathway transitional cells connecting the atrium and His bundle. Transection along the AV groove anterior to the compact AV node ( N = 5) increased the retrograde ERP and Wenckebach block cycle length by severing the AH connection, or transection of the penetrating bundle ( N = 4) produced antegrade AH block without altering rapid retrograde conduction. CONCLUSIONS: Fast pathway-His bundle connections were present in 13 of 102 rabbit hearts, providing an anatomic and physiologic basis for rapid retrograde VA conduction and a possible retrograde pathway for sustained AV nodal reentrant tachycardia.
Authors: M Antz; B J Scherlag; E Patterson; K Otomo; C Tondo; J Pitha; M D Gonzalez; W M Jackman; R Lazzara Journal: J Cardiovasc Electrophysiol Date: 1997-01