[Electrophysiological heterogeneity of rabbit atrioventricular node cells: possible relationship to fast and slow...

Catheter ablation has been applied for the therapy of atrioventricular nodal re-entrant tachycardia for several years. Although this procedure is quite successful, the cellular electrophysiological mechanisms underlying fast and slow conductions remain unknown. Therefore, the characteristics of the action potential waveform of rabbit atrioventricular node (AVN) cells obtained from different regions within Koch's triangle were studied using nystatin-permeabilized patch methods, and 64 AVN cells were used for this study. Based on gross morphology, AVN cells were classified into three groups: ovoid cells, rod shaped cells, and cells with an intermediate shape. Results obtained by measuring the maximum velocity dV/dt of action potentials fell into four subgroups: Group I (dV/dt < 5 V/sec, n = 23), Group II (dV/dt > 5 but < 10 V/sec, n = 20), Group III (dV/dt > 10 but < 20 V/sec, n = 13), and Group IV (dV/dt > 20 V/sec, n = 8). Ovoid cells had the smallest dV/dt, whereas the rod shaped cells had the highest dV/dt. The maximum diastolic potential was more negative in Groups III and IV than in Groups I and II. A notch in the phase II of the action potential was observed in 23% of Group III cells and 56% of those in Group IV, but was not present in Groups I and II. These findings provide further evidence that AVN cells are heterogeneous both in morphology and electrophysiological characteristics. Provided that values of dV/dt can be related to conduction velocity, our findings suggest that cells in Groups III and IV may contribute to fast conduction pathways whereas those in Groups I and II are responsible for slow conduction pathways.