Para-Hisian pacing: A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node

Kenzo Hirao, Kenichiro Otomo, Xunzhang Wang, Karen J. Beckman, James H. McClelland, Lawrence Widman, Mario Gonzalez, Mauricio Arruda, Hiroshi Nakagawa, Ralph Lazzara, Warren M. Jackman

Research output: Contribution to journalArticle

173 Citations (Scopus)

Abstract

Background: Differentiation between ventriculoatrial (VA) conduction over an accessory AV pathway (AP) and the AV node (AVN) may be difficult, especially in patients with a septal AP. Methods and Results: A new pacing method, para-Hisian pacing, was tested in 149 patients with AP and 53 patients without AP who had AV nodal reentrant tachycardia (AVNRT). Ventricular pacing was performed adjacent to the His bundle and proximal right bundle branch (HB-RB), initially at high output to capture both RV and HB-RB. The output was then decreased to lose HB-RB capture. The change in timing and sequence of retrograde atrial activation between HB-RB capture and noncapture was examined. Loss of HB-RB capture without change in stimulus- atrial (S-A) interval or atrial activation sequence indicated exclusive retrograde AP conduction. An increase in S-A interval without change in His bundle-atrial interval or atrial activation sequence indicated exclusive retrograde AVN conduction. A change in atrial activation sequence indicated the presence of both retrograde AP and AVN conduction. Para-Hisian pacing correctly identified retrograde AP conduction in 132 of 147 AP patients, including all septal and right free wall APs. Retrograde AVN conduction masked AP conduction in 9 of 34 patients with a left free wall AP and 6 of 9 patients with the permanent form of junctional reciprocating tachycardia. Para-Hisian pacing correctly excluded AP conduction in all 53 patients with AVNRT. Conclusions: Para-Hisian pacing reliably identifies retrograde conduction over septal and right free wall APs, but AVN conduction may mask APs located far from the pacing site or with a long retrograde conduction time.

Original languageEnglish (US)
Pages (from-to)1027-1035
Number of pages9
JournalCirculation
Volume94
Issue number5
DOIs
StatePublished - Jan 1 1996

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Atrioventricular Node
Atrioventricular Nodal Reentry Tachycardia
Bundle of His
Reciprocating Tachycardia
Masks

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hirao, K., Otomo, K., Wang, X., Beckman, K. J., McClelland, J. H., Widman, L., ... Jackman, W. M. (1996). Para-Hisian pacing: A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation, 94(5), 1027-1035. https://doi.org/10.1161/01.CIR.94.5.1027
Hirao, Kenzo ; Otomo, Kenichiro ; Wang, Xunzhang ; Beckman, Karen J. ; McClelland, James H. ; Widman, Lawrence ; Gonzalez, Mario ; Arruda, Mauricio ; Nakagawa, Hiroshi ; Lazzara, Ralph ; Jackman, Warren M. / Para-Hisian pacing : A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. In: Circulation. 1996 ; Vol. 94, No. 5. pp. 1027-1035.
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abstract = "Background: Differentiation between ventriculoatrial (VA) conduction over an accessory AV pathway (AP) and the AV node (AVN) may be difficult, especially in patients with a septal AP. Methods and Results: A new pacing method, para-Hisian pacing, was tested in 149 patients with AP and 53 patients without AP who had AV nodal reentrant tachycardia (AVNRT). Ventricular pacing was performed adjacent to the His bundle and proximal right bundle branch (HB-RB), initially at high output to capture both RV and HB-RB. The output was then decreased to lose HB-RB capture. The change in timing and sequence of retrograde atrial activation between HB-RB capture and noncapture was examined. Loss of HB-RB capture without change in stimulus- atrial (S-A) interval or atrial activation sequence indicated exclusive retrograde AP conduction. An increase in S-A interval without change in His bundle-atrial interval or atrial activation sequence indicated exclusive retrograde AVN conduction. A change in atrial activation sequence indicated the presence of both retrograde AP and AVN conduction. Para-Hisian pacing correctly identified retrograde AP conduction in 132 of 147 AP patients, including all septal and right free wall APs. Retrograde AVN conduction masked AP conduction in 9 of 34 patients with a left free wall AP and 6 of 9 patients with the permanent form of junctional reciprocating tachycardia. Para-Hisian pacing correctly excluded AP conduction in all 53 patients with AVNRT. Conclusions: Para-Hisian pacing reliably identifies retrograde conduction over septal and right free wall APs, but AVN conduction may mask APs located far from the pacing site or with a long retrograde conduction time.",
author = "Kenzo Hirao and Kenichiro Otomo and Xunzhang Wang and Beckman, {Karen J.} and McClelland, {James H.} and Lawrence Widman and Mario Gonzalez and Mauricio Arruda and Hiroshi Nakagawa and Ralph Lazzara and Jackman, {Warren M.}",
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Hirao, K, Otomo, K, Wang, X, Beckman, KJ, McClelland, JH, Widman, L, Gonzalez, M, Arruda, M, Nakagawa, H, Lazzara, R & Jackman, WM 1996, 'Para-Hisian pacing: A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node', Circulation, vol. 94, no. 5, pp. 1027-1035. https://doi.org/10.1161/01.CIR.94.5.1027

Para-Hisian pacing : A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. / Hirao, Kenzo; Otomo, Kenichiro; Wang, Xunzhang; Beckman, Karen J.; McClelland, James H.; Widman, Lawrence; Gonzalez, Mario; Arruda, Mauricio; Nakagawa, Hiroshi; Lazzara, Ralph; Jackman, Warren M.

In: Circulation, Vol. 94, No. 5, 01.01.1996, p. 1027-1035.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Para-Hisian pacing

T2 - A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node

AU - Hirao, Kenzo

AU - Otomo, Kenichiro

AU - Wang, Xunzhang

AU - Beckman, Karen J.

AU - McClelland, James H.

AU - Widman, Lawrence

AU - Gonzalez, Mario

AU - Arruda, Mauricio

AU - Nakagawa, Hiroshi

AU - Lazzara, Ralph

AU - Jackman, Warren M.

PY - 1996/1/1

Y1 - 1996/1/1

N2 - Background: Differentiation between ventriculoatrial (VA) conduction over an accessory AV pathway (AP) and the AV node (AVN) may be difficult, especially in patients with a septal AP. Methods and Results: A new pacing method, para-Hisian pacing, was tested in 149 patients with AP and 53 patients without AP who had AV nodal reentrant tachycardia (AVNRT). Ventricular pacing was performed adjacent to the His bundle and proximal right bundle branch (HB-RB), initially at high output to capture both RV and HB-RB. The output was then decreased to lose HB-RB capture. The change in timing and sequence of retrograde atrial activation between HB-RB capture and noncapture was examined. Loss of HB-RB capture without change in stimulus- atrial (S-A) interval or atrial activation sequence indicated exclusive retrograde AP conduction. An increase in S-A interval without change in His bundle-atrial interval or atrial activation sequence indicated exclusive retrograde AVN conduction. A change in atrial activation sequence indicated the presence of both retrograde AP and AVN conduction. Para-Hisian pacing correctly identified retrograde AP conduction in 132 of 147 AP patients, including all septal and right free wall APs. Retrograde AVN conduction masked AP conduction in 9 of 34 patients with a left free wall AP and 6 of 9 patients with the permanent form of junctional reciprocating tachycardia. Para-Hisian pacing correctly excluded AP conduction in all 53 patients with AVNRT. Conclusions: Para-Hisian pacing reliably identifies retrograde conduction over septal and right free wall APs, but AVN conduction may mask APs located far from the pacing site or with a long retrograde conduction time.

AB - Background: Differentiation between ventriculoatrial (VA) conduction over an accessory AV pathway (AP) and the AV node (AVN) may be difficult, especially in patients with a septal AP. Methods and Results: A new pacing method, para-Hisian pacing, was tested in 149 patients with AP and 53 patients without AP who had AV nodal reentrant tachycardia (AVNRT). Ventricular pacing was performed adjacent to the His bundle and proximal right bundle branch (HB-RB), initially at high output to capture both RV and HB-RB. The output was then decreased to lose HB-RB capture. The change in timing and sequence of retrograde atrial activation between HB-RB capture and noncapture was examined. Loss of HB-RB capture without change in stimulus- atrial (S-A) interval or atrial activation sequence indicated exclusive retrograde AP conduction. An increase in S-A interval without change in His bundle-atrial interval or atrial activation sequence indicated exclusive retrograde AVN conduction. A change in atrial activation sequence indicated the presence of both retrograde AP and AVN conduction. Para-Hisian pacing correctly identified retrograde AP conduction in 132 of 147 AP patients, including all septal and right free wall APs. Retrograde AVN conduction masked AP conduction in 9 of 34 patients with a left free wall AP and 6 of 9 patients with the permanent form of junctional reciprocating tachycardia. Para-Hisian pacing correctly excluded AP conduction in all 53 patients with AVNRT. Conclusions: Para-Hisian pacing reliably identifies retrograde conduction over septal and right free wall APs, but AVN conduction may mask APs located far from the pacing site or with a long retrograde conduction time.

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