1 From the Cardiovascular Institute, Michael Reese Hospital and Medical Center, Chicago, Illinois.
The ventricular response in atrial fibrillation is determined by the long refractory period of the AV junction. Since an atrial impulse is always available for transmission to the ventricles, a regular ventricular rhythm would be expected, the rate of which would reflect the duration of a stable junctional refractory phase. The irregularity of the ventricular action associated with atrial fibrillation, therefore, indicates changes of refractoriness of the AV junctional tissues from cycle to cycle. This can best be attributed to varying degrees of penetration of "blocked" atrial impulses into parts of the AV junction, and to the effect of such concealed conduction on the propagation of subsequent impulses. The following facts are pointed out and illustrated as evidence of concealed AV and VA conduction during atrial fibrillation: (a) Occurrence of a "compensatory pause" following a ventricular premature systole. (b) Failure of an AV nodal escape to appear at the expected time due to concealed discharge of a subsidiary AV nodal pacemaker by a penetrating atrial impulse. (c) Acceleration of the ventricular rate when atrial fibrillation changes to flutter (elimination of concealed conduction with slowing of the atria). (d) A tendency for two or more long cycles to occur in succession (each containing one or more concealed responses). The reasons for the variations of the refractory period at different levels of the AV junction as a result of concealed conduction are analyzed. Their complex interplay may readily account for the over-all irregularity of the ventricular response associated with atrial fibrillation.
© 1965 American Heart Association, Inc.
Ventricular Response in Atrial Fibrillation
Role of Concealed Conduction in the AV Junction
This article has been cited by other articles:
 |
|
 |
|
  Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]
|
|
|
|
 |
|
 V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]
|
|
|
|
 |
|
 Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266. [Full Text] [PDF]
|
|
|
|
|
|
A. Yamada, J. Hayano, S. Sakata, A. Okada, S. Mukai, N. Ohte, and G. Kimura Reduced Ventricular Response Irregularity Is Associated With Increased Mortality in Patients With Chronic Atrial Fibrillation Circulation, July 18, 2000; 102(3): 300 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Garrigue, K. A. Mowrey, G. Fahy, P. J. Tchou, and T. N. Mazgalev Atrioventricular Nodal Conduction During Atrial Fibrillation : Role of Atrial Input Modification Circulation, May 4, 1999; 99(17): 2323 - 2333. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hayano, F. Yamasaki, S. Sakata, A. Okada, S. Mukai, and T. Fujinami Spectral characteristics of ventricular response to atrial fibrillation Am J Physiol Heart Circ Physiol, December 1, 1997; 273(6): H2811 - H2816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. P. van den Berg, J. Haaksma, J. Brouwer, R. G. Tieleman, G. Mulder, and H. J. G. M. Crijns Heart Rate Variability in Patients With Atrial Fibrillation Is Related to Vagal Tone Circulation, August 19, 1997; 96(4): 1209 - 1216. [Abstract] [Full Text]
|
|
|
|
|
|
S.-A. Chen, S.-H. Lee, C.-E. Chiang, C.-T. Tai, T.-J. Wu, C.-C. Cheng, Z.-C. Wen, C.-W. Chiou, K.-C. Ueng, and M.-S. Chang Electrophysiological Mechanisms in Successful Radiofrequency Catheter Modification of Atrioventricular Junction for Patients With Medically Refractory Paroxysmal Atrial Fibrillation Circulation, May 1, 1996; 93(9): 1690 - 1701. [Abstract] [Full Text]
|
|
|
|
|
|
Z. Blanck, A. A. Dhala, J. Sra, S. S. Deshpande, A. J. Anderson, M. Akhtar, and M. R. Jazayeri Characterization of Atrioventricular Nodal Behavior and Ventricular Response During Atrial Fibrillation Before and After a Selective Slow-Pathway Ablation Circulation, February 15, 1995; 91(4): 1086 - 1094. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. Mulcahy The Physiology and Diagnosis of the Atrial Tachyarrhythmias: Some Recent Concepts Angiology, September 1, 1971; 22(9): 538 - 545. [PDF]
|
|
|
|
 |
|
 W. L. Sugg and L. M. Fox Congenital Mitral Insufficiency and Secundum Atrial Septal Defect Vascular and Endovascular Surgery, December 1, 1967; 1(4): 205 - 213. [PDF]
|
|