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Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node

INTRODUCTION: During ventricular pacing, a fusion of atrial activation may occur owing to the simultaneous retrograde conduction of the atrioventricular (AV) node and accessory pathway (AP), potentially leading to an inaccurate mapping of the atrial AP insertion site. OBJECTIVE: We tested the hypoth...

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Autores principales: Kinjo, Takahiko, Kimura, Masaomi, Kaname, Noriyoshi, Horiuchi, Daisuke, Itoh, Taihei, Ishida, Yuji, Nishizaki, Kimitaka, Toyama, Yuichi, Sasaki, Shingo, Tomita, Hirofumi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692861/
https://www.ncbi.nlm.nih.gov/pubmed/38045455
http://dx.doi.org/10.1002/joa3.12934
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author Kinjo, Takahiko
Kimura, Masaomi
Kaname, Noriyoshi
Horiuchi, Daisuke
Itoh, Taihei
Ishida, Yuji
Nishizaki, Kimitaka
Toyama, Yuichi
Sasaki, Shingo
Tomita, Hirofumi
author_facet Kinjo, Takahiko
Kimura, Masaomi
Kaname, Noriyoshi
Horiuchi, Daisuke
Itoh, Taihei
Ishida, Yuji
Nishizaki, Kimitaka
Toyama, Yuichi
Sasaki, Shingo
Tomita, Hirofumi
author_sort Kinjo, Takahiko
collection PubMed
description INTRODUCTION: During ventricular pacing, a fusion of atrial activation may occur owing to the simultaneous retrograde conduction of the atrioventricular (AV) node and accessory pathway (AP), potentially leading to an inaccurate mapping of the atrial AP insertion site. OBJECTIVE: We tested the hypothesis that landiolol, an ultra‐short‐acting intravenous β1‐blocker, could dissociate a fusion of atrial activation. METHODS: We conducted a prospective before‐and‐after study to investigate the effect of landiolol on retrograde conduction via the AV node and AP. We enrolled 21 consecutive patients with orthodromic AV reciprocating tachycardia who underwent electrophysiological studies at our hospital between January 1, 2018, and August 31, 2020. RESULTS: Six patients exhibited a fusion of atrial activation. After landiolol administration (10 μg/kg/min), the effective refractory period was unchanged in AP (280 [240–290] ms vs. 280 [245–295] ms, p = .91), whereas that of the AV node was prolonged (275 [215–380] ms vs. 332 [278–445] ms, p = .03). The Wenckebach pacing rate via retrograde AV node decreased after landiolol administration (180 [140–200] beats per minute [bpm] vs. 140 [120–180] bpm, p = .02). Thus, landiolol decreased the minimum ventricular pacing rate required to dissociate a fusion of atrial activation (180 [160–200] bpm vs. 140 [128–155] bpm, p = .007). Radiofrequency catheter ablation under landiolol administration successfully eliminated AP in all patients during ventricular pacing without complications or recurrence. CONCLUSION: Landiolol inhibited the AV node without affecting the AP and helped dissociate a fusion of atrial activation at a lower ventricular pacing rate.
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spelling pubmed-106928612023-12-03 Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node Kinjo, Takahiko Kimura, Masaomi Kaname, Noriyoshi Horiuchi, Daisuke Itoh, Taihei Ishida, Yuji Nishizaki, Kimitaka Toyama, Yuichi Sasaki, Shingo Tomita, Hirofumi J Arrhythm Original Articles INTRODUCTION: During ventricular pacing, a fusion of atrial activation may occur owing to the simultaneous retrograde conduction of the atrioventricular (AV) node and accessory pathway (AP), potentially leading to an inaccurate mapping of the atrial AP insertion site. OBJECTIVE: We tested the hypothesis that landiolol, an ultra‐short‐acting intravenous β1‐blocker, could dissociate a fusion of atrial activation. METHODS: We conducted a prospective before‐and‐after study to investigate the effect of landiolol on retrograde conduction via the AV node and AP. We enrolled 21 consecutive patients with orthodromic AV reciprocating tachycardia who underwent electrophysiological studies at our hospital between January 1, 2018, and August 31, 2020. RESULTS: Six patients exhibited a fusion of atrial activation. After landiolol administration (10 μg/kg/min), the effective refractory period was unchanged in AP (280 [240–290] ms vs. 280 [245–295] ms, p = .91), whereas that of the AV node was prolonged (275 [215–380] ms vs. 332 [278–445] ms, p = .03). The Wenckebach pacing rate via retrograde AV node decreased after landiolol administration (180 [140–200] beats per minute [bpm] vs. 140 [120–180] bpm, p = .02). Thus, landiolol decreased the minimum ventricular pacing rate required to dissociate a fusion of atrial activation (180 [160–200] bpm vs. 140 [128–155] bpm, p = .007). Radiofrequency catheter ablation under landiolol administration successfully eliminated AP in all patients during ventricular pacing without complications or recurrence. CONCLUSION: Landiolol inhibited the AV node without affecting the AP and helped dissociate a fusion of atrial activation at a lower ventricular pacing rate. John Wiley and Sons Inc. 2023-10-03 /pmc/articles/PMC10692861/ /pubmed/38045455 http://dx.doi.org/10.1002/joa3.12934 Text en © 2023 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Kinjo, Takahiko
Kimura, Masaomi
Kaname, Noriyoshi
Horiuchi, Daisuke
Itoh, Taihei
Ishida, Yuji
Nishizaki, Kimitaka
Toyama, Yuichi
Sasaki, Shingo
Tomita, Hirofumi
Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node
title Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node
title_full Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node
title_fullStr Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node
title_full_unstemmed Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node
title_short Landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node
title_sort landiolol, an intravenous β1‐selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10692861/
https://www.ncbi.nlm.nih.gov/pubmed/38045455
http://dx.doi.org/10.1002/joa3.12934
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