Computer algorithm for modeling transmission over one or two conduction pathways through AV node.

The goal of this study was to develop and test models of conduction through the atrioventricular node, particularly to encompass possible transmission over multiple pathways. Output from the atrioventricular node was related to its input, the variable coupling interval of a single extrastimulus introduced to scan diastole during programmed atrial stimulation. Trials were performed three times in 15 patients after pacing for eight beats at 100 beats/min. Hyperbolic and exponential functions were used to model trial data. For conduction over a single pathway, the standard error of the estimate was less with the exponential than with the hyperbolic model. The preferred exponential model had the general form A2H2 = K1 + K2 exp(-A1A2/K3), with K1, K2, K3 being the parameters fitted. The algorithm describing transmission over two pathways minimized sums of squares of deviations from two such exponential functions, with potential "bifurcation" points between the functions being those farthest from the computed single curve of best fit. The model predicted (R2 greater than 0.90) that 43% of the trials showed single conduction pathways and the remaining 57% showed dual pathways. A cardiologist who independently examined the data discarded eight trials because of insufficient data or scatter and agreed with presence of two pathways and the point of discontinuity in plots in 81% of trials. The reasons for discordance were minor and thus the model was reasonably verified.