Summary
In the words of Dr. Douglas Zipes, "the AV [atrioventricular] node is the 'soul'' of the heart, and whoever understands its anatomy and electrophysiology will unlock the key to understanding the anatomical and electrical workings of the heart itself. This book reviews what we know and do not know about the AV node, and as such, serves as a good road map in our search for that elusive key."The book is divided into two parts, basic and clinical. The basic chapters discuss the fundamentals of AV nodal anatomy and morphology in the normal and diseased heart, the principles of slow conduction, the functional property of the transmission through the AV node, its cellular electrophysiology, its control by the autonomic nervous system as well as its behavior and participation in arrhythmias such as atrial fibrillation. The clinical chapters are devoted to a wide array of problems, including the clinical pharmacology of the AV nodal conduction, slow and fast pathway ablation in AV nodal reentrant tachycardia, unusual electrophysiology of the human AV node in relation to AV nodal reentrant tachycardia, AV nodal modification and/or ablation for control of ventricular rate during atrial fibrillation, and the effects of radiofrequency ablation on autonomic regulation of the AV node. Renowned specialists from around the globe share their different, sometimes controversial, opinions on these subjects, thus giving the reader the opportunity to evaluate the current knowledge through the experience of different schools.This book was written to serve as an important source of information for cardiologists, electrophysiologists, anatomopathologists, biophysicists, and biomedical engineers. The authors believe it will be useful "both for those that remember the growth of our knowledge in the past (20th) century, and for those that will finally be able to resolve the remaining mysteries in the next."
Author Biography
Farid Amellal, PhD Lecturer, Faculte des Etudes Permanentes, Universite de Montreal; Cardiac Pacing and Electrophysiology Specialist, Medtronic Canada Ltd., Canada Robert H. Anderson, BSc, MD, FRCPath Professor, Cardiac Unit, Institute of Child Health, University College London, UK Jacques M.T. de Bakker, PhD Professor of Experimental Cardiac Electrophysiology, Department of Cardiology of the University Medical Center, Utrecht, The Netherlands Karen J. Beckman, MD Associate Professor of Medicine, Scientist, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Saroja Bharati, MD Director, The Maurice Lev Congenital Heart and Conduction System Center, Oak Lawn, IL; Professor of Pathology, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, Chicago, IL Jacques Billette, MD, PhD Professor, Departement de Physiologie, Faculte de Medecine, Universite de Montreal, Canada A. John Camm, BSc, MD, FRCP, FACC, FESC, CStJ Professor of Clinical Cardiology, Chief, Department of Cardiological Sciences, St. George's Hospital Medical School, London, UK Mau-Song Chang, MD Professor of Medicine, Director of Taipei Veterans General Hospital, Taiwan Shih-Ann Chen, MD Professor of Medicine, National Yang-Ming University; Director of Cardiac Electrophysiology Laboratory, Taipei Veterans General Hospital, Taiwan Chern-En Chiang, MD Associate Professor of Medicine, National Yang-Ming University; Cardiac Electrophysiology Laboratory, Taipei Veterans General Hospital, Taiwan Mina K. Chung, MD Director, Atrial Fibrillation Clinic, Section of Electrophysiology and Pacing, Department of Cardiology, The Cleveland Clinic Foundation, OH Jacques Clementy, MD Professor of Cardiology, Chief, Department of Clinical Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Leveque, University of Bordeaux, France Christopher R. Cole, MD Department of Cardiology, The Cleveland Clinic Foundation, OH John P. DiMarco, MD, PhD Professor of Medicine, Director, Clinical Electrophysiology Laboratory, The University of Virginia Health System, Cardiovascular Division, Charlottesville Leonard S. Dreifus, MD, MACC Clinical Professor of Medicine, University of South Florida, Tampa Michael Drucker, MD Consultant Electrophysiologist, Winston-Salem Cardiology Associates, NC Igor R. Efimov, PhD Assistant Staff, Basic Cardiac Electrophysiology Laboratories, Department of Cardiology, The Cleveland Clinic Foundation, OH Kenneth A. Ellenbogen, MD Professor of Medicine, Director, Clinical Electrophysiology Laboratory, Medical College of Virginia/Virginia Commonwealth University, Richmond Charles Fisch, MD Distinguished Professor Emeritus of Medicine, Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis Stephane X. Garrigue, MD, MS Clinical Fellow, Department of Clinical Cardiac Pacing and Electrophysiology, Hopital Cardiologique du Haut-Leveque, University of Bordeaux, France Michel Haissaguerre, MD Professor of Cardiology, Director, Department of Clinical Cardiac Pacing and Electrophysiology, Hopital Cardiologique du Haut-Leveque, University of Bordeaux, France Tadayoshi Hata, MD Assistant Professor of Clinical Pathology, Fujita Health University School of Hygiene, Toyoake, Japan Siew Yen Ho, PhD, FRCPath Reader in Cardiac Morphology, Pediatrics, National Heart and Lung Institute, Imperial College, London, UK Meleze Hocini, MD, MS Clinical Fellow Department of Clinical Cardiac Pacing and Electrophysiology, Hopital Cardiologique du Haut-Leveque, University of Bordeaux, France Pierre Jais, MD, MS Assistant Professor, Department of Clinical Cardiac Pacing and Electrophysiology, Hopital Cardiologique du Haut-Leveque, University of Bordeaux, France Jose Jalife, MD Professor and Chairman of Pharmacology, Professor of Medicine and Pediatrics, SUNY Upstate Medical University, Syracuse, NY Warren M. Jackman, MD Professor of Medicine, George Lynn Cross Research Professor, Director, Clinical Cardiac Electrophysiology, Co-director, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Michiel J. Janse, MD Professor Emeritus of Experimental Cardiology, University of Amsterdam, The Netherlands Josef Kautzner, MD, PhD Consultant Cardiologist, Institute of Clinical and Experimental Medicine, Prague, Czech Republic Andre G. Kleber, MD Professor of Physiology, Department of Physiology, University of Bern, Switzerland George J. Klein, MD, FRCPC, FACC Professor of Medicine and Chief of Cardiology, University of Western Ontario, Canada Andrew D. Krahn, MD, FRCPC, FACC Associate Professor of Medicine, Division of Cardiology, University of Western Ontario, Canada Jan P. Kucera, MD Assistant Professor, Department of Physiology, University of Bern, Switzerland Ralph Lazzara, MD Natalie O. Warren Professor of Medicine, George Lynn Cross Research Professor, Director, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Bruce B. Lerman, MD H. Altschul Master Professor of Medicine, Chief, Division of Cardiology, Director, Electrophysiology Laboratory, New York Hospital-Cornell University Medical Center Matthew N. Levy, MD Senior Scientist, Rammelkamp Center, Professor Emeritus of Physiology and Biomedical Engineering, Case Western Reserve University, Cleveland, OH Peter Loh, MD Research Associate, Laboratory of Experimental Cardiology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; Staff Physician, Department of Cardiology and Angiology, University of Munster, Germany Marek Malik, PhD, MD, DSc, DSc (Med), FACC, FESC Professor of Cardiac Electrophysiology, St. George's Hospital Medical School, London, UK Steven M. Markowitz, MD Assistant Professor of Medicine, Assistant Director, Electrophysiology Laboratory, New York Hospital-Cornell University Medical Center Kagari Matsudaira, MD Research Fellow in Electrophysiology, Associates, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Todor N. Mazgalev, PhD, FACC Director, Basic Cardiac Electrophysiology Laboratories, Department of Cardiology, The Cleveland Clinic Foundation, OH Mark A. McGuire, MB BS, PhD, FRACP Director, Cardiac Arrhythmia Service, Cardiology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia Frits L. Meijler, MD, PhD Professor Emeritus of Cardiology, Amsterdam, The Netherlands Suneet Mittal, MD Assistant Professor of Medicine, New York Hospital-Cornell University Medical Center Hiroshi Nakagawa, MD, PhD Associate Professor of Medicine Research, Scientist, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Jeanne M. Nerbonne, PhD Professor of Molecular Biology and Pharmacology, Washington University School of Medicine, St. Louis, MO Mary R. Olsovsky, MD Electrophysiology Associates, Colorado Springs, CO Kenichiro Otomo, MD, PhD Assistant Professor of Medicine Research, Scientist, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Eugene Patterson, PhD Associate Professor, University of Oklahoma Health Sciences Center, Oklahoma City Kevin Petrecca, MD, PhD candidate Department of Physiology, Faculty of Medicine, McGill University, Montreal, Canada Eric N. Prystowksy, MD Director, Clinical Electrophysiology Laboratory, St. Vincent Hospital, Indianapolis, IN Stephan Rohr, MD Associate Professor, Department of Physiology, University of Bern, Switzerland Yoram Rudy, PhD Professor of Biomedical Engineering, Physiology and Biophysics, and Medicine, Director, Cardiac Bioelectricity Research and Training Center (CBRTC), Case Western Reserve University, Cleveland, OH Jeffrey E. Saffitz, MD, PhD Paul E. Lacy and Ellen Lacy Professor of Pathology, Department of Pathology, Washington University School of Medicine, St. Louis, MO Benjamin J. Scherlag, PhD Professor of Medicine, University of Oklahoma Health Sciences Center; Research Career Scientist, Department of Veterans Affairs Medical Center, Oklahoma City Richard B. Schuessler, PhD Associate Research Professor of Surgery, Department of Surgery, Cardiothoracic Division, Washington University School of Medicine, St. Louis, MO Dipen C. Shah, MD Research Fellow, Department of Clinical Cardiac Pacing and Electrophysiology, Hopital Cardiologique du Haut-Leveque, University of Bordeaux France Alvin Shrier, PhD Professor and Chair, Department of Physiology, Faculty of Medicine, McGill University, Montreal, Canada Allan C. Skanes, MD, FRCPC Assistant Professor of Medicine, Division of Cardiology, University of Western Ontario, Canada Peter Spector, MD Assistant Professor of Medicine, Scientist, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Kenneth M. Stein, MD Assistant Professor of Medicine and Associate Director, Electrophysiology Laboratory, New York Hospital-Cornell University Medical Center Sherry L. Stuesse, PhD Professor of Neurobiology and Pharmacology, Northeastern Ohio University College of Medicine, Rootstown, OH Ching-Tai Tai, MD Associate Professor of Medicine, National Yang-Ming University; Cardiac Electrophysiology Laboratory, Taipei Veterans General Hospital, Taiwan Atsushi Takahashi, MD Research Fellow, Department of Clinical Cardiac Pacing and Electrophysiology, Hopital Cardiologique du Haut-Leveque, University of Bordeaux, France Patrick J. Tchou, MD, FACC Head, Section of Clinical Pacing and Electrophysiology, Department of Cardiology, The Cleveland Clinic Foundation, OH David R. Van Wagoner, PhD Assistant Staff, Basic Cardiac Electrophysiology Laboratories, Department of Cardiology, The Cleveland Clinic Foundation, OH Albert L. Waldo The Walter H. Pritchard Professor of Cardiology, Professor of Medicine and Biomedical Engineering, Case Western Reserve University and University Hospitals, Cleveland, OH Don W. Wallick, PhD Research Associate, Basic Cardiac Electrophysiology Laboratories, Department of Cardiology, The Cleveland Clinic Foundation, OH Zulu Wang, MD Research Fellow in Electrophysiology, Associates, Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City Yoshio Watanabe, MD, FACC Consultant Cardiologist, Chiba Tokushu-kai Hospital, Funabashi; Professor Emeritus of Medicine, Fujita Health University School of Medicine, Toyoake, Japan Kathryn A. Yamada, PhD Assistant Professor of Medicine, Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO William Yamanashi, PhD Professor of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City Raymond Yee, MD, FRCPC, FACC Professor of Medicine, Director of Arrhythmia Service, Division of Cardiology, University of Western Ontario Canada Douglas P. Zipes, MD, FACC Distinguished Professor of Medicine, Pharmacology, and Toxicology, Director of the Krannert Institute of Cardiology and of the Division of Cardiology, Indiana University School of Medicine, Indianapolis
Table of Contents
From the Editors |
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v | |
Foreword |
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vii | |
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Introduction |
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ix | |
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Contributors |
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xiii | |
Part I Anatomy and Basic Electrophysiology of the AV Nodal Conduction |
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The Atrial Connections of the Specialized Axis Responsible for AV Conduction |
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3 | (22) |
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Anatomic-Morphologic Relations Between AV Nodal Structure and Function in the Normal and Diseased Heart |
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25 | (24) |
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Historical Perspective of Studies on Impulse Formation and Conduction in the AV Node |
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49 | (12) |
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Principles of Slow Conduction in Cardiac Tissue: Mathematical Modeling |
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61 | (12) |
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Principles of Slow and Discontinuous Conduction: Experimental Observations |
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73 | (16) |
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Spatial Distribution of Ion Channels, Receptors, and Innervation in the AV Node |
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89 | (18) |
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Distribution and Function of Gap Junction Proteins in Atrial-AV Nodal Conduction |
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107 | (14) |
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Cellular Pharmacology of AV Nodal Conduction and Automaticity |
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121 | (12) |
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Mechanisms of Vagosympathetic Control of the Atrial-AV Nodal Conduction |
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133 | (22) |
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Functional Properties of the AV Node: Characterization and Role in Cardiac Rhythms |
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155 | (20) |
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Is the Atrium Involved in AV Nodal Reentry? |
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175 | (8) |
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What is the Slow AV Nodal Pathway? |
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183 | (16) |
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The AV Conjunction: A Concept Based on Ablation Techniques in the Normal Heart |
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199 | (18) |
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The AV Nodal Dual Pathway Electrophysiology: Still a Controversial Concept |
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217 | (20) |
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Autonomic Modulation of AV Nodal Conduction |
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237 | (14) |
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AV Node Function During Atrial Fibrillation |
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251 | (18) |
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Role of the AV Nodal Inputs for Modulation of the Ventricular Rate During Atrial Fibrillation |
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269 | (26) |
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Fluorescent Imaging of Electrical Activity in the AV Node of Rabbit Heart |
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295 | (28) |
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Part II Clinical Electrophysiology of the AV Nodal Conduction |
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Clinical Pharmacology of AV Nodal Conduction |
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323 | (12) |
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Remodeling of the Atria During Atrial Fibrillation |
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335 | (18) |
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Dual Atrionodal Physiology in the Human Heart |
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353 | (18) |
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Electrocardiographic Manifestations of Dual AV Nodal Conduction During Sinus Rhythm |
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371 | (14) |
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Slow And Fast Pathway Ablation in AV Nodal Reentrant Tachycardia: Anatomic Approaches and Pathway Potentials |
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385 | (18) |
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Unusual Electrophysiology of the Human AV Node in Relation to AV Nodal Reentrant Tachycardia. Part I: Multiple AV Nodal Pathways. Part II: Continuous AV Nodal Function Curves |
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403 | (18) |
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The Reentry Circuit for Slow/Fast AV Nodal Reentrant Tachycardia |
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421 | (16) |
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Autonomic Effects on the Human AV Node |
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437 | (10) |
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AV Nodal Modification for Ventricular Rate Control of Atrial Fibrillation |
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447 | (20) |
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AV Node Ablation for Ventricular Rate Control of Atrial Fibrillation |
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467 | (12) |
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Autonomic Effects of Radiofrequency Catheter Ablation |
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479 | (14) |
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Index |
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493 | |