Modification of atrioventricular node transmission properties by intraoperative neodymium-YAG laser photocoagulation in dogs
| Autor: | Robert Splinter, Laszlo Littmann, Maurice Lev, Jan R. Tuntelder, John J. Gallagher, Robert H. Svenson, George P. Tatsis, Istvan Tomcsanyi, Christoph Hehrlein, Saroja Bharati |
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| Rok vydání: | 1991 |
| Předmět: |
Male
Tachycardia Light Coagulation law.invention Dogs Heart Conduction System law Heart rate Heart Septum medicine Carnivora Cardiopulmonary bypass Animals Tachycardia Atrioventricular Nodal Reentry Sinus rhythm Retrospective Studies biology business.industry Fissipedia Isoproterenol Atrial fibrillation medicine.disease biology.organism_classification Fibrosis Propranolol Atrioventricular node medicine.anatomical_structure Anesthesia Atrioventricular Node Feasibility Studies Female medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 17:797-804 |
| ISSN: | 0735-1097 |
| Popis: | The purpose of this study was to test the feasibility of neodymiumyttrium-aluminum-garnet (Nd-YAG) laser photocoagulation of the atrioventricular (AV) node to control the ventricular rate during rapid atrial rhythms without creating AV block. In 12 dogs on normothermic cardiopulmonary bypass, short laser pulses were delivered to an area between the coronary sinus orifice and the site of the most proximally recorded His deflection until second degree AV block occurred at a paced atrial rate of 200 beats/min. Long-term effects on AV node function were followed up for 3 months. Three animals developed chronic high grade AV block. In nine animals with preserved 1:1 conduction, the mean (±SEM) critical atrial cycle length resulting in AV node Wenckebach periodicity increased from 183 ± 6 to 261 ± 24 ms (+43%), the mean RR interval during induced atrial fibrillation increased from 248 ± 14 to 330 ± 27 ms (+32%) and the shortest RR interval during atrial fibrillation increased from 215 ± 11 to 275 ± 20 ms (+28%). Laser effects were not reversed by isoproterenol infusion. Histologic examination of the irradiated area showed fibrotic changes in the AV node and fatty metamorphosis. This study suggests that 1) graded Nd-YAG laser photocoagulation of the AV node region in dogs results in long-term modification of anterograde AV node transmission properties; 2) 1:1 conduction during sinus rhythm usually remains preserved, but ventricular rate during rapid atrial rhythms is chronically reduced; and 3) progression to high grade AV block occurs in a minority of animals. Laser modification of the AV node could become a form of nonpharmacologic heart rate control in patients with disabling atrial tachyarrhythmias. |
| Databáze: | OpenAIRE |
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