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Wong CX, Higuchi S, Nagashima K, Kaneko Y, Gerstenfeld EP, Scheinman MM. Ventriculoatrial Block and His-His Changes During Supraventricular Tachycardia: Diagnostic and Mechanistic Implications. JACC Case Rep 2022; 6:101593. [PMID: 36704060 PMCID: PMC9871070 DOI: 10.1016/j.jaccas.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 11/06/2022]
Abstract
Supraventricular tachycardia (SVT) with ventriculoatrial (VA) block can represent a diagnostic challenge. We present a case of SVT where His-His interval shortening was repeatedly observed during episodes of VA block. This novel observation is more diagnostically suggestive of atrioventricular nodal re-entrant tachycardia, as opposed to orthodromic re-entry using a nodofascicular or nodoventricular pathway where a constant His-His is recorded during episodes of VA block. (Level of Difficulty: Intermediate.).
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Key Words
- AH, atrio-His
- AV, atrioventricular
- AVNRT
- AVNRT, atrioventricular nodal re-entrant tachycardia
- HA, His-atrial
- HH, His-His
- HV, His-ventricular
- His
- LBBB, left bundle branch block
- NF, nodofascicular
- NV, nodoventricular
- ORT, orthodromic re-entry
- RBBB, right bundle branch block
- SVT, supraventricular tachycardia
- VA, ventriculoatrial
- nodoventricular or nodofascicular
- supraventricular tachycardia
- ventriculoatrial block
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Hawson J, Van Nieuwenhuyse E, Van Den Abeele R, Al-Kaisey A, Anderson RD, Chieng D, Segan L, Watts T, Campbell T, Hendrickx S, Morton J, McLellan A, Kistler P, Lee A, Gerstenfeld EP, Hsia HH, Voskoboinik A, Pathik B, Kumar S, Kalman J, Lee G, Vandersickel N. Directed Graph Mapping for Ventricular Tachycardia: A Comparison to Established Mapping Techniques. JACC Clin Electrophysiol 2022:S2405-500X(22)00723-X. [PMID: 36752465 DOI: 10.1016/j.jacep.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Understanding underlying mechanism(s) and identifying critical circuit components are fundamental to successful ventricular tachycardia (VT) ablation. Directed graph mapping (DGM) offers a novel technique to identify the mechanism and critical components of a VT circuit. OBJECTIVES This study sought to evaluate the accuracy of DGM in VT ablation compared with traditional mapping techniques and a commercially available automated conduction velocity mapping (ACVM) tool. METHODS Patients with structural heart disease who had undergone a VT ablation with entrainment-proven critical isthmus and a high-density electroanatomical activation map were included. Traditional mapping (TM) consisted of a combination of local activation time and entrainment mapping and was considered the gold standard for determining the VT mechanism, circuit, and isthmus location. The same local activation time values were then processed using DGM and a commercially available ACVM (Coherent Mapping, Biosense Webster) tool. The aim of this study was to compare TM vs DGM and ACVM in their ability to identify the VT mechanism, characterize the VT circuit, and locate the critical isthmus. RESULTS Thirty-five cases were identified. TM classified the VT mechanism as focal in 7 patients and re-entrant in 28 patients. TM classified 11 VTs as single-loop re-entry, 15 as dual-loop re-entry, 1 as complex, and 1 case was indeterminant. The overall agreement between DGM and TM for determining VT mechanism and circuit type was strong (kappa value = 0.79; P < 0.01), as was the agreement between ACVM and TM (kappa value = 0.66; P < 0.01). Both DGM and ACVM identified the putative VT isthmus in 25 (89%) of the re-entrant cases. Focal activation was correctly identified by both techniques in all cases. CONCLUSIONS DGM is a rapid automated algorithm that has a strong level of agreement with TM for manually re-annotated VT maps.
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Griffiths JR, Nussinovitch U, Liang JJ, Sims R, Yoneda ZT, Bernstein HM, Viswanathan MN, Khairy P, Srivatsa UN, Frankel DS, Marciniak FE, Sandhu A, Shoemaker MB, Mohanty S, Burkhardt JD, Natale A, Lakkireddy D, De Groot NMS, Gerstenfeld EP, Moore JP, Avila P, Ernst S, Nguyen DT. Catheter Ablation for Atrial Fibrillation in Adult Congenital Heart Disease: An International Multicenter Registry Study. Circ Arrhythm Electrophysiol 2022; 15:e010954. [PMID: 36074954 DOI: 10.1161/circep.122.010954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on atrial fibrillation (AF) ablation and outcomes are limited in patients with congenital heart disease (CHD). We aimed to investigate the characteristics of patients with CHD presenting for AF ablation and their outcomes. METHODS A multicenter, retrospective analysis was performed of patients with CHD undergoing AF ablation between 2004 and 2020 at 13 participating centers. The severity of CHD was classified using 2014 PACES/HRS guidelines. Clinical data were collected. One-year complete procedural success was defined as freedom from atrial tachycardia or AF in the absence of antiarrhythmic drugs or including previously failed antiarrhythmic drugs (partial success). RESULTS Of 240 patients, 127 (53.4%) had persistent AF, 62.5% were male, and mean age was 55.2±0.9 years. CHD complexity categories included 147 (61.3%) simple, 69 (28.8%) intermediate, and 25 (10.4%) severe. The most common CHD type was atrial septal defect (n=78). More complex CHD conditions included transposition of the great arteries (n=14), anomalous pulmonary veins (n=13), tetralogy of Fallot (n=8), cor triatriatum (n=7), single ventricle physiology (n=2), among others. The majority (71.3%) of patients had trialed at least one antiarrhythmic drug. Forty-six patients (22.1%) had reduced systemic ventricular ejection fraction <50%, and mean left atrial diameter was 44.1±0.7 mm. Pulmonary vein isolation was performed in 227 patients (94.6%); additional ablation included left atrial linear ablations (25.4%), complex fractionated atrial electrogram (19.2%), and cavotricuspid isthmus ablation (40.8%). One-year complete and partial success rates were 45.0% and 20.5%, respectively, with no significant difference in the rate of complete success between complexity groups. Overall, 38 patients (15.8%) required more than one ablation procedure. There were 3 (1.3%) major and 13 (5.4%) minor procedural complications. CONCLUSIONS AF ablation in CHD was safe and resulted in AF control in a majority of patients, regardless of complexity. Future work should address the most appropriate ablation targets in this challenging population.
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Gerstenfeld EP. Should CMR Be Performed for Every Patient With Frequent Premature Ventricular Contractions? JACC Clin Electrophysiol 2022; 8:1133-1135. [PMID: 36137718 DOI: 10.1016/j.jacep.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
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Alhede C, Higuchi S, Hadjis A, Bibby D, Abraham T, Schiller NB, Gerstenfeld EP. Premature Ventricular Contractions Are Presaged by a Mechanically Abnormal Sinus Beat. JACC Clin Electrophysiol 2022; 8:943-953. [PMID: 35843863 DOI: 10.1016/j.jacep.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/22/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Frequent premature ventricular contractions (PVCs) can lead to cardiomyopathy; it is unclear if there are abnormal myocardial mechanics operative in the PVC and non-PVC beats. OBJECTIVES The aim of this study was to investigate regional and global myocardial mechanics, including dyssynchrony, in patients with frequent PVCs. METHODS Fifty-six consecutive patients referred for PVC ablation were prospectively studied. During sinus rhythm (SR) and PVC beats, left ventricular (LV) global longitudinal strain (GLS), LV dyssynchrony (measured as the SD of time to peak GLS), and dyssynergy (measured as maximum regional strain minus minimum regional strain at aortic valve closure) were quantified using 2-dimensional strain echocardiography. GLS, dyssynchrony, and dyssynergy were compared in remote SR, pre-PVC SR, PVC, and post-PVC SR beats. RESULTS In SR beats remote from the PVC, GLS was -17.3% ± 4%, dyssynchrony was 49 ± 14 ms, and dyssynergy was 22% ± 9%. Myocardial mechanics were significantly abnormal during PVCs compared with remote SR beats (GLS -7.7% ± 3% [P < 0.001], dyssynchrony 115 ± 37 milliseconds [P < 0.001], and dyssynergy 26% ± 10% [P < 0.001]). There were significant mechanical abnormalities in the SR beat preceding the PVC, which demonstrated significantly lower LV strain (pre-PVC SR, -13% ± 4%; P < 0.001) and more dyssynchrony (pre-PVC SR, 63 ± 19 milliseconds; P < 0.001) compared with remote SR beats. Dyssynergy was significantly higher for pre-PVC SR and PVC beats compared with remote SR (pre-PVC SR, 25% ± 8% [P < 0.001]; PVC, 26% ± 10% [P < 0.001]). CONCLUSIONS In patients with frequent PVCs, the SR beat preceding the PVC demonstrates significant mechanical abnormalities. This finding suggests that perturbations in cellular physiological processes such as excitation-contraction coupling may underlie the generation of frequent PVCs.
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Howell S, Dukes JW, Vittinghoff E, Tang J, Moss JD, Lee RJ, Lee B, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia HH, Gerstenfeld EP, Marcus GM. PO-683-03 PREMATURE ATRIAL CONTRACTION LOCATION AND ATRIAL FIBRILLATION INDUCIBILITY. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Im SI, Higuchi S, Gerstenfeld EP. CA-534-01 PULSED FIELD ABLATION COMPARED TO RADIOFREQUENCY ABLATION OF LEFT VENTRICULAR MYOCARDIUM IN A SWINE INFARCT MODEL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Higuchi S, Li R, Abreau S, Liem LB, Gerstenfeld EP, Im SI, Barrios J, Tison G, Scheinman MM. DH-575-02 IDENTIFICATION OF SUPRAVENTRICULAR TACHYCARDIA MECHANISMS WITH SURFACE ELECTROCARDIOGRAMS USING A DEEP NEURAL NETWORK. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Higuchi S, Im SI, Stillson C, Buck ED, Jerrell S, Schneider CW, Gerstenfeld EP. PO-649-03 EPICARDIAL PULSED FIELD ABLATION DIRECTLY ON CORONARY ARTERIES LEADS TO ACUTE SPASM FOLLOWED BY GRADUAL SPONTANEOUS RESOLUTION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alhede C, Higuchi S, Bibby D, Abraham TP, Gerstenfeld EP. PO-638-03 ISOLATED PREMATURE VENTRICULAR CONTRACTIONS ARE MORE DYSSYNCHRONOUS THAN PREMATURE VENTRICULAR CONTRACTIONS IN REPEATED PATTERNS. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Higuchi S, Im SI, Bibby D, Stillson C, Lee AC, Marcus GM, Olgin JE, Abraham TP, Gerstenfeld EP. PO-625-01 FIBROSIS AND SLOW CONDUCTION PERSIST AFTER RECOVERY OF PREMATURE ATRIAL CONTRACTION INDUCED ATRIAL MYOPATHY IN A SWINE MODEL. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Higuchi S, Ito H, Gerstenfeld EP, Lee AC, Lee BK, Marcus GM, Hsia HH, Moss JD, Lee RJ, Dewland TA, Vedantham V, Tseng ZH, Patel AR, Tanel RE, Badhwar N, Pellegrini CN, Kawamura M, Shoda M, Hwang C, Refaat MM, Scheinman MM. EN-571-01 THE VALUE OF PROGRAMMED VENTRICULAR EXTRASTIMULI FROM THE RIGHT VENTRICULAR BASAL SEPTUM DURING SUPRAVENTRICULAR TACHYCARDIA. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cheung CC, Vittinghoff E, Marcus GM, Gerstenfeld EP. Beware of the hazards: limitations of the proportional hazards assumption. Europace 2021; 23:2048. [PMID: 34480543 DOI: 10.1093/europace/euab137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Marcus GM, Vittinghoff E, Whitman IR, Joyce S, Yang V, Nah G, Gerstenfeld EP, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia H, Gladstone R, Fan S, Lee E, Fang C, Ogomori K, Fatch R, Hahn JA. Acute Consumption of Alcohol and Discrete Atrial Fibrillation Events. Ann Intern Med 2021; 174:1503-1509. [PMID: 34461028 DOI: 10.7326/m21-0228] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients' self-reports suggest that acute alcohol consumption may trigger a discrete atrial fibrillation (AF) event. OBJECTIVE To objectively ascertain whether alcohol consumption heightens risk for an AF episode. DESIGN A prospective, case-crossover analysis. SETTING Ambulatory persons in their natural environments. PARTICIPANTS Consenting patients with paroxysmal AF. MEASUREMENTS Participants were fitted with a continuous electrocardiogram (ECG) monitor and an ankle-worn transdermal ethanol sensor for 4 weeks. Real-time documentation of each alcoholic drink consumed was self-recorded using a button on the ECG recording device. Fingerstick blood tests for phosphatidylethanol (PEth) were used to corroborate ascertainments of drinking events. RESULTS Of 100 participants (mean age, 64 years [SD, 15]; 79% male; 85% White), 56 had at least 1 episode of AF. Results of PEth testing correlated with the number of real-time recorded drinks and with events detected by the transdermal alcohol sensor. An AF episode was associated with 2-fold higher odds of 1 alcoholic drink (odds ratio [OR], 2.02 [95% CI, 1.38 to 3.17]) and greater than 3-fold higher odds of at least 2 drinks (OR, 3.58 [CI, 1.63 to 7.89]) in the preceding 4 hours. Episodes of AF were also associated with higher odds of peak blood alcohol concentration (OR, 1.38 [CI, 1.04 to 1.83] per 0.1% increase in blood alcohol concentration) and the total area under the curve of alcohol exposure (OR, 1.14 [CI, 1.06 to 1.22] per 4.7% increase in alcohol exposure) inferred from the transdermal ethanol sensor in the preceding 12 hours. LIMITATION Confounding by other time-varying exposures that may accompany alcohol consumption cannot be excluded, and the findings from the current study of patients with AF consuming alcohol may not apply to the general population. CONCLUSION Individual AF episodes were associated with higher odds of recent alcohol consumption, providing objective evidence that a modifiable behavior may influence the probability that a discrete AF event will occur. PRIMARY FUNDING SOURCE National Institute on Alcohol Abuse and Alcoholism.
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Abstract
Iatrogenic atrioventricular (AV) block can occur in the context of cardiac surgery, percutaneous transcatheter, or electrophysiologic procedures. In cardiac surgery, patients undergoing aortic and/or mitral valve surgery are at the highest risk for developing perioperative AV block requiring permanent pacemaker implantation. Similarly, patients undergoing transcatheter aortic valve replacement are also at increased risk for developing AV block. Electrophysiologic procedures, including catheter ablation of AV nodal re-entrant tachycardia, septal accessory pathways, para-Hisian atrial tachycardia, or premature ventricular complexes, are also associated with risk of AV conduction system injury. In this article, we summarize the common causes for iatrogenic AV block, predictors for AV block, and general management considerations.
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Higuchi S, Goldschlager N, Gerstenfeld EP. Atrioventricular Block With Narrow and Wide QRS: The Pause That Refreshes. Circulation 2021; 144:1262-1264. [PMID: 34633865 DOI: 10.1161/circulationaha.121.055990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rosenthal DG, Blusztein D, Mahadevan VS, Gerstenfeld EP. Misleading Placement of a Dual-Chamber Pacemaker. JACC Clin Electrophysiol 2021; 8:136-137. [PMID: 34454877 DOI: 10.1016/j.jacep.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022]
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Voskoboinik A, Im SI, Higuchi S, Lee AC, Rahmutula D, Marcus GM, Olgin JE, Vittinghoff E, Bibby D, Abraham T, Gerstenfeld EP. B-AB04-02 FREQUENT PREMATURE ATRIAL CONTRACTIONS LEAD TO ADVERSE ATRIAL REMODELING AND ATRIAL FIBRILLATION IN A SWINE MODEL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tung M, Vittinghoff E, Nah G, Rosenthal DG, Badhwar N, Dukes JW, Moss JD, Lee RJ, Lee B, Tseng ZH, Walters TE, Vedantham V, Gladstone RA, Mei-ling Fan S, Fang CD, Ogomori K, Lee E, Hue TF, Olgin JE, Scheinman MM, Ramchandani V, Hsia HH, Gerstenfeld EP, Marcus GM. B-PO02-152 ELECTROCARDIOGRAPHIC CHANGES IN A DOUBLE-BLIND, PLACEBO-CONTROLLED RANDOMIZED TRIAL OF ETHANOL VERSUS PLACEBO. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Higuchi S, Il Im S, Voskoboinik A, Lee A, Marcus GM, Olgin J, Bibby D, Abraham T, Gerstenfeld EP. B-PO02-140 EFFECT OF ATRIAL ECTOPY COUPLING INTERVAL ON ATRIAL STRUCTURAL REMODELLING AND ATRIAL FIBRILLATION IN A SWINE MODEL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kalantarian S, Abreau S, Gerstenfeld EP, Tison GH, Scheinman MM. B-PO01-088 LOCALIZATION OF OUTFLOW TRACT PREMATURE VENTRICULAR BEATS OR VENTRICULAR TACHYCARDIA IN SURFACE ELECTROCARDIOGRAMS USING A CONVOLUTIONAL NEURAL NETWORK. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Im SI, Higuchi S, Lee A, Stillson C, Blake Morrow EB, Gerstenfeld EP. B-AB03-03 PULSED FIELD ABLATION OF LEFT VENTRICULAR MYOCARDIUM IN A SWINE INFARCT MODEL. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Flatley EE, Moss JD, Gerstenfeld EP. B-PO01-003 CARDIAC PET IMAGING SHOULD OCCUR EARLY IN THE EVALUATION OF NEW AV BLOCK. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim EJ, Gerstenfeld EP, Pellegrini CN. Use of Adenosine to Release an Entrapped Catheter During Ablation of Premature Ventricular Complexes. JACC Case Rep 2021; 3:610-613. [PMID: 34317587 PMCID: PMC8302799 DOI: 10.1016/j.jaccas.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
Catheter entrapment is a rare complication during catheter ablation that may require surgical intervention. Use of adenosine to prolong diastole can be a safe and effective strategy to free the catheter and avoid significant morbidity. (Level of Difficulty: Advanced.).
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Cheung CC, Kim E, Tseng ZH, Gerstenfeld EP, Anderson RH, Sanchez-Quintana D, Sternick EB, Hsia HH. Atrial Tachycardia Ablation at the Pulmonic Valve in a Patient With Congenitally Corrected Transposition of Great Arteries. JACC Clin Electrophysiol 2021; 7:1473-1481. [PMID: 34330669 DOI: 10.1016/j.jacep.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022]
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