title: Multiple AV nodal pathways with multiple peaks in the RR interval histogram of the Holter monitoring ECG during atrial fibrillation.
abstract: Two or more peaks on the 24-hour electrocardiogram (ECG) RR interval histogram of patients with atrial fibrillation suggests the presence multiple AV nodal pathways. The prevalence of multiple AV nodal pathways in this population is unknown. The study included 250 patients with permanent atrial fibrillation during 24-hour ECG. The number of peaks on the RR interval histogram was measured in each patient. A single peak was present in 153 patients (61%), 80 patients (32%) had two peaks, 13 patients (5%) had three, and 4 patients (2%) had four peaks. Among the 97 patients (39%) with > 1 AV nodal pathway, the estimated mean heart rate reduction by hypothetical ablation of all supernumerary AV nodal pathways with short refractory periods was 16 beats/min, from 82 to 65 beats/min. Among the overall population, 16 patients (6%) with > 1 AV nodal pathway had a mean heart rate > 100 beats/min. In this subgroup, modulation of AV node conduction by hypothetical ablation of all supernumerary AV nodal pathways with short refractory periods yielded an estimated reduction in mean heart rate of 26 +/- 15 beats/min, from 110 +/- 9 beats/min to 84 +/- 14 beats/min (P < 0.01), a 23% decrease. The presence of > 1 AV nodal pathway was suspected in 39% of all patients with permanent atrial fibrillation. The hypothetical ablation of all supernumerary AV nodal pathways with short refractory periods resulted in a clinically significant reduction in heart rate in 6% of patients in this population.
authors.affiliation: Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625 Herne, Germany. Peter.Weismueller@ruhr-uni-bochum.de
authors.forename: P
authors.initials: P
authors.lastname: Weismüller
authors.forename: C
authors.initials: C
authors.lastname: Braunss
authors.forename: C
authors.initials: C
authors.lastname: Ranke
authors.forename: H J
authors.initials: HJ
authors.lastname: Trappe
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D001283:Atrioventricular Node / Q000503:physiopathology*; D017115:Catheter Ablation; D015716:Electrocardiography, Ambulatory; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011930:Reaction Time