title: Influence of isoproterenol on the accelerated junctional rhythm observed during radiofrequency catheter ablation of atrioventricular nodal slow pathway conduction.
abstract: BACKGROUND
  Accelerated junctional rhythm (AJR) has been considered as a sensitive but rather nonspecific marker of successful radiofrequency (RF) ablation of slow pathway in patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, AJR also occurs commonly during isoproterenol infusion. We therefore investigated the effect of isoproterenol on the significance of AJR while attempting slow pathway ablation.
  
  
  METHODS
  Forty patients with AVNRT underwent slow pathway ablation. Sixty-nine RF applications accompanied by AJR were observed and were separated into 2 groups: applications performed without (group I, n = 26) and with (group II, n = 43) isoproterenol infusion. The specificity of AJR for successful ablation for each group was calculated.
  
  
  RESULTS
  The specificity of AJR in groups I and II was 73% (19/26) and 49% (21/43), respectively (P <.05). There was no significant difference between the groups in the atrial electrogram width, atrial/ventricular electrogram amplitude ratio, the time from application onset to AJR emergence, or AJR cycle length. The catheter-tip temperature at AJR emergence was significantly lower (47 degrees C +/- 3 degrees C vs 52 degrees C +/- 3 degrees C, P <.001) and the ratio of junctional beats to total heart beats during RF application was significantly greater (46% +/- 24% vs 33% +/- 18%, P <.05) in group II compared with group I.
  
  
  CONCLUSIONS
  Isoproterenol lowers the threshold of AJR emergence during RF application and thereby lowers the specificity of AJR for successful ablation. Complete washout of isoproterenol may therefore improve the specificity of AJR during RF ablation in patients with AVNRT.
authors.affiliation: Cardiac Electrophysiology and Arrhythmia Service, Stanford University Medical Center, Stanford, CA 94305-5233., USA. tmatsushita@cvmed.stanford.edu
authors.forename: T
authors.initials: T
authors.lastname: Matsushita
authors.forename: S
authors.initials: S
authors.lastname: Chun
authors.forename: R J
authors.initials: RJ
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001283:Atrioventricular Node / Q000502:physiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006321:Heart / Q000187:drug effects / Q000502:physiology; D006329:Heart Conduction System / Q000187:drug effects / Q000502:physiology; D006339:Heart Rate / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D007545:Isoproterenol