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Noninvasive Assessment of Atrioventricular Nodal Function: Effect of Rate-Control Drugs during Atrial Fibrillation

Corino, Valentina D. A.; Sandberg, Frida LU ; Mainardi, Luca T.; Platonov, Pyotr LU and Sörnmo, Leif LU (2015) In Annals of Noninvasive Electrocardiology 20(6). p.534-541
Abstract
Background: During atrial fibrillation (AF), conventional electrophysiological techniques for assessment of refractory period or conduction velocity of the atrioventricular (AV) node cannot be used. We aimed at evaluating changes in AV nodal properties during administration of tecadenoson and esmolol using a novel ECG-based method. Methods: Fourteen patients (age 58 +/- 8 years, 10 men) with AF were randomly assigned to either 75 or 300 mu g intravenous tecadenoson. After tecadenoson wash-out, patients received esmolol continuously (100 mu g/kg per min for 10 mins, then 50 mu g/kg per min for 50 mins). Atrial fibrillatory rate (AFR) and heart rate (HR) were assessed in 15-min segments. Using the novel method, we assessed the absolute... (More)
Background: During atrial fibrillation (AF), conventional electrophysiological techniques for assessment of refractory period or conduction velocity of the atrioventricular (AV) node cannot be used. We aimed at evaluating changes in AV nodal properties during administration of tecadenoson and esmolol using a novel ECG-based method. Methods: Fourteen patients (age 58 +/- 8 years, 10 men) with AF were randomly assigned to either 75 or 300 mu g intravenous tecadenoson. After tecadenoson wash-out, patients received esmolol continuously (100 mu g/kg per min for 10 mins, then 50 mu g/kg per min for 50 mins). Atrial fibrillatory rate (AFR) and heart rate (HR) were assessed in 15-min segments. Using the novel method, we assessed the absolute refractory periods of the slow and fast pathways (aRPs and aRPf) of the AV node to produce an estimate of the functional refractory period. Results: During esmolol infusion, AFR and HR were significantly decreased and the absolute refractory period was significantly prolonged in both pathways (aRPs: 387 +/- 73 vs 409 +/- 62 ms, P < 0.05; aRPf: 490 +/- 80 vs 529 +/- 58 ms, P < 0.05). During both tecadenoson doses, HR decreased significantly and AFR was unchanged. Both aRPs and aRPf were prolonged for a 75 mu g dose (aRPs: 322 +/- 97 vs 476 +/- 75 ms, P < 0.05; aRPf: 456 +/- 102 vs 512 +/- 55 ms, P < 0.05) whereas a trend toward prolongation was observed for a 300 mu g dose. Conclusions: The estimated parameters reflect expected changes in AV nodal properties, i.e., slower conduction through the AV node for tecadenoson and prolongation of the AV node refractory period for esmolol. Thus, the proposed approach may be used to assess drug effects on the AV node in AF patients. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
atrioventricular node, atrial fibrillation, functional refractory, period, tecadenoson, esmolol
in
Annals of Noninvasive Electrocardiology
volume
20
issue
6
pages
534 - 541
publisher
Wiley-Blackwell
external identifiers
  • wos:000367678900004
  • scopus:84957846927
ISSN
1082-720X
DOI
10.1111/anec.12253
language
English
LU publication?
yes
id
1221ae90-3a92-4bd9-9cc9-1ed9645ca0dd (old id 8761528)
date added to LUP
2016-02-24 11:00:06
date last changed
2017-08-09 14:28:21
@article{1221ae90-3a92-4bd9-9cc9-1ed9645ca0dd,
  abstract     = {Background: During atrial fibrillation (AF), conventional electrophysiological techniques for assessment of refractory period or conduction velocity of the atrioventricular (AV) node cannot be used. We aimed at evaluating changes in AV nodal properties during administration of tecadenoson and esmolol using a novel ECG-based method. Methods: Fourteen patients (age 58 +/- 8 years, 10 men) with AF were randomly assigned to either 75 or 300 mu g intravenous tecadenoson. After tecadenoson wash-out, patients received esmolol continuously (100 mu g/kg per min for 10 mins, then 50 mu g/kg per min for 50 mins). Atrial fibrillatory rate (AFR) and heart rate (HR) were assessed in 15-min segments. Using the novel method, we assessed the absolute refractory periods of the slow and fast pathways (aRPs and aRPf) of the AV node to produce an estimate of the functional refractory period. Results: During esmolol infusion, AFR and HR were significantly decreased and the absolute refractory period was significantly prolonged in both pathways (aRPs: 387 +/- 73 vs 409 +/- 62 ms, P &lt; 0.05; aRPf: 490 +/- 80 vs 529 +/- 58 ms, P &lt; 0.05). During both tecadenoson doses, HR decreased significantly and AFR was unchanged. Both aRPs and aRPf were prolonged for a 75 mu g dose (aRPs: 322 +/- 97 vs 476 +/- 75 ms, P &lt; 0.05; aRPf: 456 +/- 102 vs 512 +/- 55 ms, P &lt; 0.05) whereas a trend toward prolongation was observed for a 300 mu g dose. Conclusions: The estimated parameters reflect expected changes in AV nodal properties, i.e., slower conduction through the AV node for tecadenoson and prolongation of the AV node refractory period for esmolol. Thus, the proposed approach may be used to assess drug effects on the AV node in AF patients.},
  author       = {Corino, Valentina D. A. and Sandberg, Frida and Mainardi, Luca T. and Platonov, Pyotr and Sörnmo, Leif},
  issn         = {1082-720X},
  keyword      = {atrioventricular node,atrial fibrillation,functional refractory,period,tecadenoson,esmolol},
  language     = {eng},
  number       = {6},
  pages        = {534--541},
  publisher    = {Wiley-Blackwell},
  series       = {Annals of Noninvasive Electrocardiology},
  title        = {Noninvasive Assessment of Atrioventricular Nodal Function: Effect of Rate-Control Drugs during Atrial Fibrillation},
  url          = {http://dx.doi.org/10.1111/anec.12253},
  volume       = {20},
  year         = {2015},
}