Published online before print January 30, 2003, doi: 10.1161/01.RES.0000059304.97120.2F
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© 2003 American Heart Association, Inc.
Integrative Physiology |
Cx43 and Dual-Pathway Electrophysiology of the Atrioventricular Node and Atrioventricular Nodal Reentry
From the Department of Biomedical Engineering (V.P.N., I.R.E.), Case Western Reserve University, Cleveland, Ohio; and the School of Biomedical Sciences (S.A.J., M.K.L., M.R.B.), University of Leeds, Leeds, UK.
Correspondence to Igor R. Efimov, PhD, Cardiac Bioelectricity Research and Training Center, Dept of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-7207. E-mail ire{at}po.cwru.edu
Fluorescent imaging has revealed that posterior nodal extensions provide the anatomical substrate for the dual-pathway electrophysiology of the atrioventricular (AV) node during normal conduction and reentry. The reentry can be intranodal, or as well as the posterior nodal extensions, it can involve an endocardial layer of atrial/atrial-nodal (A/AN) cells as part of the AV nodal reentry (AVNR) circuit. Using fluorescent imaging with a voltage-sensitive dye and immunolabeling of Cx43, we mapped the electrical activity and structural substrate in 3 types of AVNR induced by premature atrial stimulation in 8 rabbit hearts. In 6 cases, the AVNR pathway involved (1) a fast pathway (FP), (2) the A/AN layer, and (3) a slow pathway (SP). In 4 cases, reentry took the path (1) SP, (2) A/AN layer, and (3) FP. In 2 cases, reentry was intranodal, propagating between the 2 posterior nodal extensions. Immunolabeling revealed that the FP and SP are formed by Cx43-expressing bundles surrounded by tissue without Cx43. Cx43-expressing posterior nodal extensions are the substrate of AVNR during both intranodal and extranodal reentry.
Key Words: ablation • electrophysiology • arrhythmia • imaging
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