Long-term results of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia: simple approach

AimsThe aim of this study was to report the short- and long-term results of slow pathway radiofrequency (RF) ablation in patients with atrioventricular (AV) nodal reentrant tachycardia (AVNRT) using a simplified approach (2 catheters and short applications of RF).Materials and MethodsThis was a retrospective study that included consecutive patients with AVNRT. We used an anatomical approach with only 2 catheters. Decremental AV nodal conduction and atrial-His conduction interval jump were measured. To detect the onset of the QRS, we used surface lead II. During the stimulation protocol, we performed S2-QRS and S3-QRS measurements. An increase in the S3-QRS3 interval of 50 milliseconds or greater in response to a decrease in the S2-QRS2 coupling interval of 10 milliseconds was defined as a discontinuous AV nodal function curve and taken as evidence of dual antegrade AV pathways. Atrioventricular nodal reentrant tachycardia was demonstrated by the presence of dual AV nodal physiology, atrial echoes, and tachycardia induction with a 1:1 AV relationship and a VA interval of less than 70 milliseconds. Short RF applications (10-15 seconds) were delivered at an intermediate point between the posteroseptal and medioseptal regions of the Koch triangle. The applications were considered effective when junctional rhythm appeared. The end point was the demonstration of slow pathway modification without AVNRT induction.ResultsThree hundred forty-four patients (age, 49.22 ± 17.47 years; 254 were female) were included. Discontinuous AV nodal function curves were found in 271 patients (78.77%), and short-term success was achieved in all patients. The anterograde jump in AV nodal conduction was abolished after RF in 222 patients (81.91%), and discontinuous AV nodal conduction and single AV nodal echo beats persisted in 49 cases (18%). The mean number of RF application was 7.79 ± 2.23, the mean number of effective applications was 4.63 ± 0.62, and the mean RF application time was 54.92 ± 8.03 seconds. The total procedure and fluoroscopy time was 29.45 ± 9.6 and 10.87 ± 2.36 minutes, respectively. After the procedure, all patients were followed up for a mean of 46.44 ± 18.89 months, and 7 patients (2%) presented AVNRT recurrences. Complications were observed in 4 patients (1.16%); no permanent AV block was observed.ConclusionIn this study, slow pathway RF ablation using a simplified approach technique is an effective and safe approach for the treatment of AVNRT.     

Ultrastructural organization of the noradrenergic innervation of the superficial gray layer of the hamster's superior colliculus

Immunocytochemistry with an antibody-directed tyrosine hydroxylase (TH) was combined with electron microscopy and serial-section analysis to examine the synaptic organization of the catecholaminergic projection to the stratum griseum superfciale (SGS) of the hamster's superior colliculus (SC). A total of 250 TH-immunoreactive profiles within SGS were examined. Of these, 114 (45.6%) made synaptic contacts; 81 (71.1%) were axodendritic, and the remainder (33, 28.9%) were axo-axonic. Serial-section analysis was employed to evaluate the presence or absence of synaptic contacts for 26 profiles. Overall, 19 (73.1%) of the profiles followed through serial sections exhibited synaptic contacts. Double staining of single sections with antibodies directed against TH and dopamine-ß-hydroxylase (DßH) and examination in the light microscope indicated that virtually all TH-positive fibers also contained DßH. This indicated that the fibers examined at the electron microscopic level were noradrenergic rather than dopaminergic. These results suggest that norepinephrine may have both pre- and postsynaptic actions in the hamster's SC and that at least some of these effects are mediated by conventional synapses.     

Novel cross-reactive anti-idiotype antibodies with properties close to the human intravenous immunoglobulin (IVIg).

The most important link between the immune network theory and clinically useful therapies so far is the use of human intravenous immunoglobulin (IVIg) in the treatment of autoimmune diseases. Although still controversial, one of the main mechanisms that has been postulated for the in vivo effects of IVIg, is the selection of immune repertoires through idiotypic interactions. We describe here anti-idiotype IgG monoclonal antibodies (MAbs), which were obtained by immunization of syngeneic mice (Balb/c) with an anti-ganglioside antibody. These anti-idiotype MAbs show multiple idiotypic connections and share some of the properties of the IVIg pool. The antiidiotype (Ab2) MAbs B7 and 34B7 showed heterogeneous binding with the idiotypes of several anti-ganglioside antibodies, MAbs obtained from splenocytes of nonimmunized newborn mice, F(ab')2 fragments of IgG human myeloma proteins, and nonimmunoglobulin antigens. The recognition pattern of the B7 MAb to the idiotypes of human immunoglobulins was also studied using a phage display library obtained from the variable region genes of an asymptomatic AIDS patient and also F(ab')2 fragments obtained from an IVIg pool of healthy human donors. We also demonstrated that these MAbs produced some of the in vitro effects reported for the human IVIg pool, such as the inhibition of cell proliferation of human B and T cell lines and of normal human lymphocytes activated with different mitogens. Another striking property of the MAb B7 was its ability to induce a dose-dependent specific antibody T-cell response in vivo in syngeneic mice. Both anti-idiotype MAbs showed anti-metastatic effect in vivo when injected intravenously to mice inoculated with MB16-F10 melanoma cells. The antimetastatic effect of the antiidiotype MAbs was not observed in athymic mice inoculated with the same tumor. This kind of antibody can become an interesting tool for further exploration of the role of idiotypic network connections in the regulation of the immune system and to study the effects of interventions on network connectivity in experimental autoimmune disease, using a reagent better chemically defined than the IVIg pool.     

Growth hormone (GH) responsiveness to GHRH in normal adults is not affected by short-term gonadal blockade

The effects of changes in circulating gonadal steroids on GH secretion elicited by GHRH challenge (1 microgram/kg) in normal adults volunteers (aged 18-24 years), were evaluated in 10 women and 10 men before and after gonadal blockade was achieved by a GnRH agonist (1500 micrograms/day by nasal spray for 40 days). To see if the effect of testosterone on GH secretion was dependent on its aromatization to estradiol (E2), GHRH tests were performed in 7 normal men prior to administration of testosterone enanthate (250 mg im), 8 days after this treatment had began, and again after E2 receptor blockade with tamoxifen (30 mg for 2 days plus 10 mg on the third day 2 h before the GHRH test, po) administered 8 days after testosterone enanthate. The study of the functional status of the somatotropes at the time of GHRH testing was made according to our previous postulate. Short-term gonadal blockade did not affect the parameters of GH response to GHRH in neither women nor men. Thus, the functional blockade of the gonads may be advisable as an adjunct therapy in the treatment of hypothalamic GH-deficiency during the peripubertal stage. In the other group of men, administration of testosterone enanthate significantly increased GHRH-elicited GH release, but this was reverted after E2 receptor blockade. Since the hypothalamic-somatotrope rhythm was altered by both these pharmacological manipulations, it appears that testosterone acts on GH release mainly at the suprapituitary level, and that this action is secondary to its aromatization to E2.     

Learning and novelty induced increase of central benzodiazepine receptors from chick forebrain, in a food discrimination task

Young chicks were trained to discriminate food grains from inedible pebbles. On Day 1 and Day 2 of the task, latency to peck, and number of pecks were scored and the forebrain [³H]flunitrazepam receptor binding was also determined at 0 and 30 min after an 8-min training session. Compared with quiet controls, the receptor density increased 46%, 30 min after the training session on Day 1. Compared with chicks that had learned the discrimination and were merely repeating already learned behavior on Day 2, the receptor increased more than 46%. Since chicks that had learned the discrimination had a higher behavioral activity, we interpret that the learning of a new task is itself responsible in addition to stress for the receptor density increase. Stressful factors accompanying the learning task as handling and novelty increased 17% the receptor density, 30 min after a training session without food, compared with quiet controls. However, receptor density did not increase in chicks repeating the same housing conditions, suggesting that chicks were habituated to handling and novelty on Day 2. Differences in receptor density were not observed between quiet controls and experimental groups, at 0 min after the training session, indicating that changes were time dependent. In all cases the affinity remained unchanged. Our results suggest that, the GABA_A receptor (i) is involved in early stages of memory formation and in stress adaptive responses, and (ii) is modulated by new non-repetitive environmental conditions.