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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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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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. |
format | Online Article Text |
id | pubmed-10692861 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
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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