This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Jackman, W. M. Articles by Lazzara, R. Search for Related Content PubMed PubMed Citation Articles by Jackman, W. M. Articles by Lazzara, R.

Circulation, Vol 68, 906-916, Copyright © 1983 by American Heart Association

ARTICLES

Direct endocardial recording from an accessory atrioventricular pathway: localization of the site of block, effect of antiarrhythmic drugs, and attempt at nonsurgical ablation

WM Jackman, KJ Friday, BJ Scherlag, MM Dehning, E Schechter, DW Reynolds, EG Olson, EJ Berbari, LA Harrison and R Lazzara

We recorded a discrete 0.95 mV potential consistent with accessory atrioventricular pathway (AP) activation during serial electrophysiologic studies in a patient with Ebstein's anomaly and Wolff-Parkinson-White syndrome. Bipolar pacing from the catheter electrode in which the AP potential was recorded resulted in a stimulus- ventricle interval identical to the AP-ventricle interval during antegrade conduction, and a stimulus-atrium interval identical to the AP-atrium interval during retrograde conduction. With the patient in the drug-free state, antegrade AP block during atrial pacing and retrograde AP block during ventricular pacing occurred distal to the AP potential (AP-ventricle junction and AP-atrium junction, respectively), supporting the "impedance mismatch" hypothesis. Procainamide and disopyramide each lengthened the antegrade AP effective refractory period by affecting the AP-ventricle junction (possibly by decreasing the current generated by the AP). Both drugs also lengthened the retrograde AP effective refractory period but produced a greater effect on the ventricle-AP junction than on the AP-atrium junction, suggesting marginal geometry of the former. R wave synchronous shocks of 160 and 320 W-sec delivered between the catheter electrode recording the largest unipolar AP potential and a skin electrode produced transient, complete, antegrade block over the AP, suggesting the feasibility of this new nonsurgical technique for AP ablation.

This article has been cited by other articles:

				C. Wolpert, H. Pitschner, and M. Borggrefe Evolution of ablation techniques: from WPW to complex arrhythmias Eur. Heart J. Suppl., December 1, 2007; 9(suppl_I): I116 - I121. [Abstract] [Full Text] [PDF]

				H. Nakagawa and W. M. Jackman Catheter Ablation of Paroxysmal Supraventricular Tachycardia Circulation, November 20, 2007; 116(21): 2465 - 2478. [Full Text] [PDF]

				A. B. Wagshal, L. A. Pires, and S. K. Stephen Management of Cardiac Arrhythmias With Radiofrequency Catheter Ablation Arch Intern Med, January 23, 1995; 155(2): 137 - 147. [Abstract] [PDF]

				M. E. JOSEPHSON Catheter Ablation of Arrhythmias Ann Intern Med, August 1, 1984; 101(2): 234 - 237. [Abstract] [PDF]