Background: During right atrial stimulation, the anterior and posterior approaches provide inputs to the atrioventricular (AV) node. The purpose of the present study was to determine how activation proceeding from the left atrium reaches the AV node.
Methods And Results: We studied AV nodal conduction during right and left atrial (coronary sinus) stimulation in 46 patients (27 women and 19 men; mean age, 46+/-4 years) who had structurally normal hearts. At an identical cycle length (600 ms), left atrial stimulation resulted in shorter A-H intervals than right atrial stimulation (73+/-3 ms versus 99+/-3 ms; P<0.05). In addition, atrial electrograms recorded close to the His bundle changed from near to far field potentials when stimulation was shifted to the left atrium. The A-H interval prolonged as the site of pacing was progressively moved from the distal to the proximal coronary sinus. During constant pacing from the distal coronary sinus, atrial activation close to the His bundle could be advanced by late extrastimuli delivered at the anterior and posterior approaches (up to 11+/-2 ms and 9+/-1 ms, respectively), without altering His bundle activation time. In contrast, late extrastimuli delivered at the inferoparaseptal mitral annulus advanced both the A and H electrograms in 19 of 20 patients, which is consistent with a left-sided input to the AV node. Right and left atrial stimulation resulted in similar AV nodal function.
Conclusion: The mitral annulus provides a left atrial input to the human AV node.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1161/01.cir.0000041000.94343.28 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Left Atrial Appendage Clip Reentry: The Case for Ablation From the Appendage to Left Pulmonary Veins.
Ann Thorac Surg Short Rep
September 2023
Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida.
Convergent hybrid atrial fibrillation ablation combines epicardial posterior left atrial ablation with catheter pulmonary vein isolation. Concomitant left atrial appendage AtriClip placement has recently been included to mitigate stroke risk. We describe a 72-year-old woman with long-standing persistent atrial fibrillation in whom atrial flutter with reentry encircling the AtriClip developed 18 months after a successful convergent procedure.
View Article and Find Full Text PDFAtypical Presentation of Andersen-Tawil Syndrome: Heart Failure with Reduced Ejection without Periodic Paralysis or Dysmorphic Features.
Eur J Case Rep Intern Med
December 2024
Internal Medicine, Holy Family Hospital, Rawalpindi, Pakistan.
Background: Andersen-Tawil syndrome (ATS) is a rare autosomal dominant disorder caused by variants in the gene. It is associated with periodic paralysis, dysmorphic features and cardiac arrhythmias. The syndrome exhibits incomplete penetrance, leading to a broad spectrum of clinical manifestations, making diagnosis challenging.
View Article and Find Full Text PDFLeft Atrial to Left Ventricular Bypass Using a Valved Conduit for Mitral Prosthesis-Patient Mismatch.
Ann Thorac Surg Short Rep
December 2023
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
A 72-year-old woman presented with dyspnea 2 years after mitral valve replacement with a 25-mm Epic bioprosthesis. Exercise echocardiography revealed a mean transvalvular gradient of 16 mm Hg, consistent with functional mitral stenosis due to prosthesis-patient mismatch. Because of the anticipated difficulties with insertion of a larger prosthesis, we proceeded with bypass of the mitral valve using a left atrial to left ventricular valved conduit.
View Article and Find Full Text PDFRacial Disparities in Atrial Fibrillation After Coronary Artery Bypass: Impact of Left Atrial Volume.
Ann Thorac Surg Short Rep
December 2023
Department of Cardiac Surgery, Hartford HealthCare Heart and Vascular Institute, Hartford, Connecticut.
Background: Prior studies have demonstrated a lower prevalence of postoperative atrial fibrillation (POAF) in Black, Hispanic, Asian, and Native American patients compared with White cohorts after coronary artery bypass grafting. We hypothesized that preoperative differences in left atrial size may explain this disparity.
Methods: We assessed the incidence of new POAF in 1218 patients (215 minority patients and 1003 White patients) undergoing isolated, first-time coronary artery bypass grafting from January 2017 through September 2022.
Biventricular Dysfunction Due to Chronic Mitral Valve Regurgitation Caused by Aberrant Mitral Arcade.
Ann Thorac Surg Short Rep
December 2024
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!