{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T22:21:17Z","timestamp":1761949277770,"version":"build-2065373602"},"reference-count":19,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"published-print":{"date-parts":[[1996,5]]},"abstract":"<jats:p>OBJECTIVE: To examine the hypothesis that the anatomic equivalents of the fast and slow pathways identified in patients with atrioventricular (AV) nodal tachycardia may be universal and represent the principal sites of atrial input into the normal compact AV node. METHODS: 15 patients undergoing complete AV junction ablation for paroxysmal atrial fibrillation were studied. Radiofrequency energy was delivered first in the anterior \"fast pathway\" position so as to prolong the atrium to bundle of His (AH) interval by over 50% of baseline (protocol 1) and then to the \"slow pathway\" position using the anatomical technique (protocol 2). RESULTS: Ablation protocol 1 resulted in prolongation of AH interval in all patients. Subsequent lesions at the level of the coronary sinus produced complete heart block in four patients, and in five caused a further increase in AH interval above that produced by protocol 1. Four of these latter patients developed complete block after delivery of RF energy slightly anterior to the level of the coronary sinus os, as did three further patients in whom ablation at the level of the coronary sinus had no effect. In four patients complete heart block could not be achieved by protocol 2. CONCLUSIONS: A discrete anterior \"fast\" pathway and a posterior \"slow\" pathway or network of posterior pathways form the principal inputs to the compact AV node in most patients with atrial fibrillation. The absence of dual AV nodal physiology in the majority of these patients may be related to the functional properties of the individual components of this posterior network.<\/jats:p>","DOI":"10.1136\/hrt.75.5.502","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:46:00Z","timestamp":1190137560000},"page":"502-508","source":"Crossref","is-referenced-by-count":8,"title":["Effect of sequential radiofrequency ablation lesions at fast and slow atrioventricular nodal pathway positions in patients with paroxysmal atrial fibrillation."],"prefix":"10.1136","volume":"75","author":[{"given":"C. J.","family":"Garratt","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. D.","family":"Skehan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G. E.","family":"Payne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. J.","family":"Stafford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1996,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1161\/01.CIR.88.1.282","article-title":"Atrioventricular nodal reentry: clinical, electrophysiological and therapeutic considerations","volume":"88","author":"Akhtar, M.; Jazayeri, M.R.; Sra, J.; Blanck, Z.; Deshpande, S.; Dhala, A.","year":"1993","unstructured":"Akhtar M, Jazayeri MR, Sra J, Blanck Z, Deshpande S, Dhala A. Atrioventricular nodal reentry: clinical, electrophysiological and therapeutic considerations. 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Closed-chest ablation of retrograde conduction in patients with atrioventricular nodal reentrant tachycardia. N EngJ Med 1989;320:426-33.","journal-title":"N EngJ Med"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1161\/01.CIR.83.3.827","article-title":"Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia","volume":"83","author":"Lee, M.A.; Morady, F.; Kadish, A.; Schamp, D.J.; Chin, M.C.; Scheinman, M.M.","year":"1991","unstructured":"Lee MA, Morady F, Kadish A, Schamp DJ, Chin MC, Scheinman MM, et al. Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. 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NEngJMed 1992;327:313-8.","journal-title":"NEngJMed"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1161\/01.CIR.85.4.1318","article-title":"Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia","volume":"85","author":"Jazayeri, M.R.; Hempe, S.L.; Sra, J.S.; Dhala, A.A.; Blank, A.; Deshpande, S.S.","year":"1992","unstructured":"Jazayeri MR, Hempe SL, Sra JS, Dhala AA, Blank A, Deshpande SS, et al. Selective transcatheter ablation of the fast and slow pathways using radiofrequency energy in patients with atrioventricular nodal reentrant tachycardia. 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A randomised, prospective comparison of anterior and posterior approaches to radiofrequency catheter ablation of atrioventricular nodal reentry tachycardia. Circulation 1993;87: 1551-6.","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1093\/eurheartj\/14.12.1644","article-title":"The Multicentre European Radiofrequency Survey [MERFS]: complications of radiofrequency catheter ablation of arrhythmias","volume":"7","author":"Hindricks, G.","year":"1993","unstructured":"Hindricks G. The Multicentre European Radiofrequency Survey [MERFS]: complications of radiofrequency catheter ablation of arrhythmias. Eur Heart J7 1993;14: 1644-53.","journal-title":"Eur Heart"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1111\/j.1540-8159.1993.tb01635.x","article-title":"Radiofrequency current therapy in atrial tachyarrhythmias: modulation versus ablation of atrioventricular nodal conduction","volume":"16","author":"Duckeck, W.; Engelstein, E.D.; Kuck, K.-H.","year":"1993","unstructured":"Duckeck W, Engelstein ED, Kuck K-H. Radiofrequency current therapy in atrial tachyarrhythmias: modulation versus ablation of atrioventricular nodal conduction. PACE 1993;16:629-36.","journal-title":"PACE"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/j.1540-8159.1993.tb01597.x","article-title":"Radiofrequency modification of atrioventricular conduction by selective ablation of the low posterior septal right atrium in a patient with atrial fibrillation and a rapid ventricular response","volume":"16","author":"Fleck, R.P.; Chen, P.-S.; Boyce, K.; Ross, R.; Dittrich, H.C.; Feld, G.K.","year":"1993","unstructured":"Fleck RP, Chen P-S, Boyce K, Ross R, Dittrich HC, Feld GK. Radiofrequency modification of atrioventricular conduction by selective ablation of the low posterior septal right atrium in a patient with atrial fibrillation and a rapid ventricular response. PACE 1993;16:377-81.","journal-title":"PACE"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2299","DOI":"10.1161\/01.CIR.90.5.2299","article-title":"Control of rapid ventricular response by radiofrequency catheter modification of the atrioventricular node in patients with medically refractory atrial fibrillation","volume":"90","year":"1994","unstructured":"Feld GK, Fleck RP, Fujimara 0, Prothro DL, Bahnson TD, Ibarra M. Control of rapid ventricular response by radiofrequency catheter modification of the atrioventricular node in patients with medically refractory atrial fibrillation. 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Electrophysiol 1988;2: 175-89.","journal-title":"Electrophysiol"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/hrt.75.5.502","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T21:55:00Z","timestamp":1758405300000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/hrt.75.5.502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1996,5]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[1996,5,1]]},"published-print":{"date-parts":[[1996,5]]}},"alternative-id":["10.1136\/hrt.75.5.502"],"URL":"https:\/\/doi.org\/10.1136\/hrt.75.5.502","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"type":"print","value":"1355-6037"},{"type":"electronic","value":"1468-201X"}],"subject":[],"published":{"date-parts":[[1996,5]]}}}