Abstract:
:Patients who have an accessory pathway (AP) of atrioventricular (AV) conduction may develop circus movement tachycardia otherwise known as atrioventricular re-entrant tachycardia (AVRT). Orthodromic AVRT is the most common form. It occurs as a result of antegrade conduction through the normal AV conduction system and retrograde conduction to the atria via the AP. Less commonly, conduction occurs in the opposite direction resulting in antidromic AVRT. Tachycardia may also involve multiple APs which may provide both antegrade and retrograde conduction and may alternate antegradely or retrogradely. Tachycardia may occur in which the AP simply acts as a bystander, and does not participate in the tachycardia mechanism. When atrial fibrillation is conducted to the ventricles via and AP, the resultant ventricular rate may be extremely rapid, placing the patient at risk of developing ventricular fibrillation and cardiac arrest. This paper reviews the anatomical and physiological substrates involved in the pathogenesis of AVRT. The acute and long-term management of patients who suffer from these arrhythmias will then be discussed. The normal AV annulus is composed exclusively of electrically inert fibrous tissue. The AV node and His bundle normally act as the sole route of electrical conduction. Accessory pathways occur at all points along the AV ring, and usually occur as isolated abnormalities, although a proportion of patients have associated congenital abnormalities. This is particularly true of right-sided APs. Most APs exhibit non-decremental conduction properties, and conduct faster than normal AV conduction tissue. In many patients with APs the surface ECG reveals clear evidence of pre-excitation, and a good idea of pathway localization is possible using one or more of several algorithms which have been developed. Patients with latent pre-excitation, intermittent pre-excitation, and patients with concealed APs have not evidence of pre-excitation on a proportion or all of Their surface ECGs. Patients present with a history of paroxysmal palpitations, often with associated symptoms such as chest discomfort Syncope is a rare presenting symptom. Unless bundle branch block is present, patients with orthodromic AVRT exhibit a narrow complex tachycardia on the surface ECG. Patients with pre-excited tachycardia including antidromic AVRT, and other forms of SVT in which the AP conducts to the ventricles as a bystander but does not participate in the tachycardias mechanism, present as broad complex tachycardias on the surface ECG which may be difficult to distinguish from ventricular tachycardia. Adenosine is increasingly used for this purpose since it is highly efficacious and has an extremely short half-life. Adenosine is also very useful in the diagnosis of broad-complex tachycardia, and in unmasking latent pre-excitation during sinus rhythm. Electrophysiology study in these patients is frequently performed at the same time as an attempt at catheter ablation; it aims to diagnose, localize and determine the functional characteristics of an AP, and to characterize the role of the pathway in tachycardia. AVRT can be reliably terminated by effective AV nodal blockade. Drug therapy for the prevention of AVRT is useful for temporary control whilst awaiting more definitive measures and in certain cases as long-term management. No class of drug stands out as 'therapy of choice', and physician preference, pro-arrhythmic effects and associated conditions need to be taken into account such that an individual choice can be made in each patient. The management of patients with AVRT has been revolutionized in recent years with the advent of catheter-based techniques for their cure. Whilst this method of treatment is highly effective and has low complication rates, pathways in particular locations such as the septal region remain challenging.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Obel OA,Camm AJsubject
Has Abstractpub_date
1998-05-01 00:00:00pages
E13-24, E50-1eissn
0195-668Xissn
1522-9645journal_volume
19 Suppl Epub_type
杂志文章,评审abstract:AIMS:The importance of heart rate in the pathophysiology of heart failure with reduced LVEF has recently attracted attention. In particular, the findings of the Systolic Heart failure treatment with the I(f) inhibitor ivabradine Trial (SHIFT) have put special emphasis on heart rate reduction with ivabradine for improve...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehs004
更新日期:2012-05-01 00:00:00
abstract::Scandinavian Cardiovascular Journal began as a journal for cardiothoracic surgery, but joining forces with cardiology has increased the impact factor and number of subscribers. ...
journal_title:European heart journal
pub_type: 杂志文章
doi:
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abstract:AIMS:There have been substantial declines in cerebrovascular disease mortality across much of Europe, mirroring trends in deaths from cardiovascular disease as a whole. No study has investigated trends in cerebrovascular disease, and its subtypes within all European countries. This study aimed to examine sex-specific t...
journal_title:European heart journal
pub_type: 杂志文章
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journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/16.suppl_b.75
更新日期:1995-04-01 00:00:00
abstract:AIMS:We investigated the potential influence of a moderate-to-high cardiovascular (CV) risk (CVR) (defined as a Systematic COronary Risk Evaluation model, or SCORE ≥ 4%), in the absence of an established CV disease, on the duration and cost of CV and non-CV sick leave (SL) resulting from common and occupational acciden...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/eht156
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abstract::The aim of the study was to assess the relationship between paroxysmal atrial fibrillation during acute myocardial infarction and the long-term prognosis of patients after acute myocardial infarction. The incidence of paroxysmal atrial fibrillation among 5803 consecutive hospitalized patients was 9.9% (557/5803). Inci...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060046
更新日期:1992-01-01 00:00:00
abstract::Atrial natriuretic peptide (ANP) is a member of the natriuretic peptide family that exerts various biological effects via acting on the receptor-guanylyl cyclase system, increasing the content of intracellular cyclic guanosine monophosphate (cGMP). ANP was first identified as a diuretic/natriuretic and vasodilating ho...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehn206
更新日期:2008-06-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehi556
更新日期:2005-12-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehw240
更新日期:2017-01-14 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehq013
更新日期:2010-03-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1997.0741
更新日期:1998-02-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehw683
更新日期:2017-04-07 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062036
更新日期:1986-02-01 00:00:00
abstract:AIMS:Atrial fibrillation (AF) occurs often in patients after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality. Previous studies using P-wave signal-averaged electrocardiogram (P-SAECG) have shown that patients with a longer filtered P-wave duration (FPD) have a high risk of AF ...
journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1093/eurheartj/ehl082
更新日期:2006-07-01 00:00:00
abstract::Simultaneous two-channel Holter monitoring, with a direct recording system, and maximal exercise testing with a 12-lead precordial electrocardiographic mapping system were performed in 50 patients with chest pain (41 with documented coronary artery disease, 9 without). The exploring Holter leads were placed to corresp...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062518
更新日期:1988-04-01 00:00:00
abstract:AIMS:The aim of the study was to investigate the atrial myocardial deformation properties using ultrasound strain rate (SR) imaging in patients after catheter ablation of atrial fibrillation (AF) and to compare its prognostic value in maintaining sinus rhythm. METHODS AND RESULTS:A total of 118 patients with AF (74 pa...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehn168
更新日期:2008-06-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/14.7.941
更新日期:1993-07-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/14.3.316
更新日期:1993-03-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehz068
更新日期:2019-04-14 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
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更新日期:2008-02-01 00:00:00
abstract:AIMS:Transthyretin amyloidosis (ATTR amyloidosis) is a heterogeneous disorder with cardiac, neurologic, and mixed phenotypes. We describe the phenotypic and genotypic profiles of this disease in continental Western Europe as it appears from the Transthyretin Amyloidosis Survey (THAOS). METHODS AND RESULTS:THAOS is an ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehz173
更新日期:2019-04-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehi388
更新日期:2005-11-01 00:00:00
abstract:AIMS:To evaluate the association between occupational and leisure-time physical activity (PA), ownership of goods promoting sedentary behaviour, and the risk of myocardial infarction (MI) in different socio-economic populations of the world. Studies in developed countries have found low PA as a risk factor for cardiova...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehr432
更新日期:2012-02-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.2000.2315
更新日期:2001-05-01 00:00:00
abstract:AIMS:The curiosity that leanness is associated with poor survival in patients with chronic heart failure (CHF) needs further insight by investigating the impact of weight loss on prognosis in a large sample of patients across a broad spectrum of both reduced and preserved left ventricular (LV) systolic function. METHO...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehn420
更新日期:2008-11-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/j.ehj.2004.04.009
更新日期:2004-06-01 00:00:00
abstract::The treatment of hypertensive aircrew should also include changes in dietary habits, and advice against smoking. Relaxation exercises and changes in life style may prove of benefit. Increasing age, hypertension and smoking multiply to give a risk of cardiovascular event which merits careful assessment. ...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/5.suppl_a.33
更新日期:1984-03-01 00:00:00
abstract:BACKGROUND:Atrial abnormalities in patients with progressive systemic sclerosis have not been evaluated in terms of intra-atrial conduction. We hypothesized that a delay in atrial conduction in these patients might produce diastolic abnormalities as well as atrial arrhythmias. OBJECTIVE:To evaluate the atrial function...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a015211
更新日期:1997-12-01 00:00:00
abstract::Some studies provide a link between the width of QRS complexes and late potentials occurring at the end of the QRS complex in signal-averaged recordings. The purpose of this study was to compare three methods of QRS duration measurement: the conventional 12 lead ECG, the Frank vectorcardiogram (VCG) and the signal-ave...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060375
更新日期:1994-01-01 00:00:00
abstract::From a clinicopharmacological standpoint, the urinary excretory potency of diuretics should be assessed comparatively, on the basis of placebo-controlled changes in 24 h natriuresis, following single oral doses administered to healthy adult subjects who are in steady-state habitual external sodium balance. The potency...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/eurheartj/13.suppl_g.15
更新日期:1992-12-01 00:00:00