25 Years of Insights into the Mechanisms of Supraventricular Arrhythmias
NASPE HISTORY SERIES
HEIN J.J. WELLENS,
HEIN J.J. WELLENS
From the Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
Search for more papers by this authorHEIN J.J. WELLENS,
HEIN J.J. WELLENS
From the Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
Search for more papers by this authorAddress for reprints: Hein J.J. Wellens, M.D., 21, Henric van Veldekeplein, 6211 TG Maastricht, the Netherlands. Fax: 31-43-3261903; e-mail: [email protected]
Abstract
The introduction of programmed electrical stimulation of the heart and intracardiac activation mapping 35 years ago made it possible to study the site of origin or pathway of a supraventricular tachycardia and to gain insight into the tachycardic mechanism. Information from these studies has been the basis for the development of new therapies, like arrhythmia surgery, antitachycardia pacing, and catheter ablation. The correlation of intracardiac findings with the 12-lead ECG during the tachycardia resulted in the recognition of characteristic ECG patterns for the different types of supraventricular tachycardias. Currently, gross localization of the site of origin of the arrhythmia is based on the 12-lead ECG during the arrhythmia with fine tuning using intracardiac activation mapping and pacing. These developments during the past 3 decades make accurate arrhythmia diagnosis possible and allow us to offer curative therapies to many of patients suffering from a supraventricular tachycardia. (PACE 2003; 26:1916–1922)
References
- 1 Durrer D, Schoo L, Schuilenburg RM, et al. The role of premature beats in the initiation and the termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation 1967; 36: 644–662.
- 2 Coumel P, Cabrol C, Fabiato A, et al. Tachycardie permanente par rhythme reciproque. Arch Mal Coeur 1967; 60: 1830–1845.
- 3 Haft JI, Kosowsky BD, Lau SH, et al. Termination of atrial flutter by rapid electrical pacing of the atrium. Am J Cardiol 1967; 20: 239–246.
- 4 Lister JW, Cohen LS, Bernstein WH, et al. Treatment of supraventricular tachycardias by rapid atrial stimulation. Circulation 1968; 38: 1044–1059.
- 5 Goldreyer BN, Bigger JT. Spontaneous and induced re-entrant tachycardia. Ann Intern Med 1969; 70: 87–98.
- 6
Wellens HJJ.
Electrical Stimulation of the Heart in the Study and Treatment of Tachycardias.
Baltimore
, University Park Press, 1971.
10.1007/978-94-010-2954-4 Google Scholar
- 7 Scherlag BJ, Lau SH, Helfant RW, et al. Catheter technique for recording His bundle activity in man. Circulation 1969; 39: 13–20.
- 8 Gallagher JJ, Pritchett ELC, Sealy WC, et al. The preexcitation syndromes. Prog Cardiovasc Disease 1978; 20: 285–327.
- 9
HJJ Wellens,
HE Kulbertus, eds. What's New in Electrocardiography.
The Hague
,
The Netherlands
, Marinus Nijhoff, 1981.
10.1007/978-94-009-8239-0 Google Scholar
- 10 Josephson ME. Clinical Cardiac Electrophysiology: Techniques and Interpretations. Third Edition. Philadelphia , Lippincott, 2001.
- 11 Morillo CA, Klein GJ, Thakur RK, et al. Mechanisms of “inappropriate” sinus tachycardia. Role of sympathovagal balance. Circulation 1994; 90: 873–877.
- 12 Bauernfeind RA, Amat YL, Dhingra RC, et al. Chronic nonparoxysmal sinus tachycardia in otherwise healthy persons. Ann Intern Med 1979; 91: 702–710.
- 13 Shen WK, Low PA, Jahangir A, et al. Is sinus node modification appropriate for inappropriate sinus tachycardia with features of postural orthostatic tachycardia syndrome Pacing Clin Electrophysiol 2001; 24: 217–230.
- 14 Narula OS. Sinus node reentry: A mechanism for supraventricular tachycardia. Circulation 1974; 50: 1114–1128.
- 15 Griffith MJ, Garrett CJ, Ward DE, et al. The effects of adenosine on sinus node reentrant tachycardia. Clin Cardiol 1989; 12: 409–411.
- 16 Chen SA, Chiang CE, Yang CJ, et al. Sustained atrial tachycardia in adult patients. Electrophysiological characteristics, pharmacological response, possible mechanisms and effects of radiofrequency ablation. Circulation 1994; 90: 1262–1278.
- 17 Chen SA, Chiang CE, Yang CJ, et al. Radiofrequency catheter ablation of sustained intra-atrial reentrant tachycardia in adult patients. Identification of electrophysiological characteristics and endocardial mapping techniques. Circulation 1993; 88: 578–587.
- 18 Kalman JM, Olgin JE, Karch MR, et al. Cristal tachycardias”: Origin of right atrial tachycardias from the crista terminalis identified by intracardiac echocardiography. J Am Coll Cardiol 1998; 31: 451–459.
- 19 Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659–666.
- 20 Tsai CF, Tai CT, Hsieh MH, et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: Electrophysiological characteristics and results of radiofrequency ablation. Circulation 2000; 102: 67–74.
- 21 Lewis T. A demonstration of circus movement in clinical flutter of the auricles. Heart 1921; 8: 341–359.
- 22 Latour H, Puech P. Electrocardiographie Endocavitaire. Paris, Masson , 1959.
- 23 Waldo AL, McLean WA, Karp RB, et al. Entrainment and interruption of atrial flutter with atrial pacing: Studies in man following open heart surgery. Circulation 1977; 56: 737–745.
- 24 Saoudi W, Cosio F, Waldo A, et al. for the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. A classification of atrial flutter and regular atrial tachycardia according to electrophysiological mechanisms and anatomical bases: A Statement from a Joint Expert Group from The Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 2001; 22: 1162–1182.
- 25 Bochoeyer A, Yang Y, Cheng J, et al. Surface electrocardiographic characteristics of right and left atrial flutter. Circulation 2003; 108: 60–66.
- 26 Saoudi N, Nair M, Abdelazziz A, et al. Electrocardiographic patterns and results of radiofrequency catheter ablation of clockwise type 1 atrial flutter. J Cardiovasc Electrophysiol 1996; 7: 931–942.
- 27 Rodriguez LM, Timmermans C, Nabar A, et al. Biatrial activation in Isthmus-dependent atrial flutter. Circulation 2001; 104: 2545–2550.
- 28 Allessie MA, Lammers WJEP, Bonke FIM, et al. Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. In DP Zipes, J Jalife, eds: Cardiac Electrophysiology and Arrhythmias. New York , Grune & Stratton, 1985, pp. 265–275.
- 29 Konings KTS, Kirchhof CJHJ, Smeets JLRM, et al. High density mapping of electrically induced atrial fibrillation in humans. Circulation 1994; 89: 1665–1680.
- 30 Chen SA, Hsieh MH, Tai CT, et al. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 1999; 100: 1879–1886.
- 31 Rosen KM, Mehta A, Miller RA. Demonstration of dual atrioventricular nodal pathways in men. Am J Cardiol 1974; 33: 291–294.
- 32 Akhtar M, Jazayeri MR, Sra J, et al. Atrioventricular nodal reentry. Clinical, electrophysiological and therapeutic considerations. Circulation 1993; 88: 282–295.
- 33 Wellens HJJ, Gorgels APM, Smeets JLRM, et al. Ambulatory electrocardiographic evaluation of supraventricular tachyarrhythmias and bradyarrhythmias. In HC Kennedy, ed: Cardiology Clinics: Ambulatory Electrocardiography. Philadelphia , WB Saunders, 1972, pp. 361–370.
- 34 Coumel P, Attuel P. Reciprocating tachycardia in overt and latent pre-excitation. Influence of functional bundle branch block on the rate of the tachycardia. Eur J Cardiol 1974; 1: 423–429.
- 35 Wellens HJJ, Durrer D. The role of an accessory atrioventricular pathway in reciprocal tachycardia. Observations in patients with and without the Wolff-Parkinson-White syndrome. Circulation 1975; 52: 58–72.
- 36 Hirao K, Otomo K, Wang X, et al. Para-Hissian pacing: A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation 1996; 94: 1027–1035.
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