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Ermakov S, Scheinman M. Arrhythmogenic Right Ventricular Cardiomyopathy - Antiarrhythmic Therapy. Arrhythm Electrophysiol Rev 2016; 4:86-9. [PMID: 26835106 DOI: 10.15420/aer.2015.04.02.86] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy is an inherited disorder characterised by progressive replacement of ventricular myocardium by fibrofatty tissue that predisposes patients to ventricular arrhythmias, heart failure and sudden death. Treatment focuses on slowing disease progression, decreasing the burden of arrhythmias and preventing sudden cardiac death through placement of implantable cardioverter-defibrillators (ICDs), catheter ablation and the use of antiarrhythmic medication. Although only ICDs have been demonstrated to affect patient mortality, antiarrhythmic medications are important adjuncts in reducing patient morbidity and inappropriate ICD therapy. Of the individual antiarrhythmic agents available, sotalol, beta-blockers and amiodarone appear to be most effective in arrhythmia suppression. Calcium-channel blockers may be effective in selected patients. For patients who are refractory to single agent therapy, combination therapy may be considered with the most effective combinations being sotalol + flecainide and amiodarone + beta-blockers.
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Refaat MM, Tang P, Harfouch N, Wojciak J, Kwok PY, Scheinman M. Arrhythmogenic Right Ventricular Cardiomyopathy Caused by a Novel Frameshift Mutation. Card Electrophysiol Clin 2016; 8:217-21. [PMID: 26920198 DOI: 10.1016/j.ccep.2015.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy is a rare cardiomyopathy that might be asymptomatic or symptomatic, causing palpations or syncope, and might lead to sudden cardiac death. It is recommended that physical exertion be reduced. It is also recommended that those with syncope and ventricular tachycardia/ventricular fibrillation have an implantable cardioverter-defibrillator placed. β-Blockers, antiarrhythmic drugs, and radiofrequency ablation should be used to control the ventricular arrhythmia burden in arrhythmogenic right ventricular cardiomyopathy.
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Shenasa M, Scheinman M. In Memoriam—Rashid A. Massumi, MD 1926–2015. Heart Rhythm 2015; 12:e121. [DOI: 10.1016/j.hrthm.2015.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Indexed: 10/23/2022]
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54
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Scheinman M. The ECG Handbook of Contemporary Challenges. Editors: Mohammad Shenasa, MD; Mark E. Josephson, MD; and N.A. Mark Estes III, MD. Pacing Clin Electrophysiol 2015. [DOI: 10.1111/pace.12669] [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: 11/29/2022]
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55
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Zhang J, Sacher F, Hoffmayer K, O'Hara T, Strom M, Cuculich P, Silva J, Cooper D, Faddis M, Hocini M, Haïssaguerre M, Scheinman M, Rudy Y. Cardiac electrophysiological substrate underlying the ECG phenotype and electrogram abnormalities in Brugada syndrome patients. Circulation 2015; 131:1950-9. [PMID: 25810336 DOI: 10.1161/circulationaha.114.013698] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is a highly arrhythmogenic cardiac disorder, associated with an increased incidence of sudden death. Its arrhythmogenic substrate in the intact human heart remains ill-defined. METHODS AND RESULTS Using noninvasive ECG imaging, we studied 25 BrS patients to characterize the electrophysiological substrate and 6 patients with right bundle-branch block for comparison. Seven healthy subjects provided control data. Abnormal substrate was observed exclusively in the right ventricular outflow tract with the following properties (in comparison with healthy controls; P<0.005): (1) ST-segment elevation and inverted T wave of unipolar electrograms (2.21±0.67 versus 0 mV); (2) delayed right ventricular outflow tract activation (82±18 versus 37±11 ms); (3) low-amplitude (0.47±0.16 versus 3.74±1.60 mV) and fractionated electrograms, suggesting slow discontinuous conduction; (4) prolonged recovery time (381±30 versus 311±34 ms) and activation-recovery intervals (318±32 versus 241±27 ms), indicating delayed repolarization; (5) steep repolarization gradients (Δrecovery time/Δx=96±28 versus 7±6 ms/cm, Δactivation-recovery interval/Δx=105±24 versus 7±5 ms/cm) at right ventricular outflow tract borders. With increased heart rate in 6 BrS patients, reduced ST-segment elevation and increased fractionation were observed. Unlike BrS, right bundle-branch block had delayed activation in the entire right ventricle, without ST-segment elevation, fractionation, or repolarization abnormalities on electrograms. CONCLUSIONS The results indicate that both slow discontinuous conduction and steep dispersion of repolarization are present in the right ventricular outflow tract of BrS patients. ECG imaging could differentiate between BrS and right bundle-branch block.
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Rosso R, Adler A, Strasberg B, Guevara-Valdivia ME, Somani R, Baranchuk A, Halkin A, Márquez MF, Scheinman M, Steinvil A, Belhassen B, Kazatsker M, Katz A, Viskin S. Long QT Syndrome Complicating Atrioventricular Block. Circ Arrhythm Electrophysiol 2014; 7:1129-35. [DOI: 10.1161/circep.114.002085] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The magnitude of QT prolongation in response to bradycardia, rather than the bradycardia per se, determines the risk for torsade de pointes during atrioventricular block (AVB). However, we do not know why some patients develop more QT prolongation than others, despite similar bradycardia. We hypothesized that in patients who develop significant QRS vector changes during AVB, the effects of cardiac memory lead to excessive QT prolongation.
Methods and Results—
We studied 91 patients who presented with AVB and who also had an ECG predating the bradyarrhythmia for comparison. We correlated changes in QRS morphology and axis taking place during AVB with the bradycardia-induced QT prolongation. Patients with and without QRS morphology changes at the time of AVB were of similar age and sex. Moreover, despite similar R-R interval during AVB, cases with a QRS morphology change had significantly longer QT (648±84 versus 561±84;
P
<0.001) than those without. Patients who developed a change in QRS morphology at the time of AVB had a 7-fold higher risk of developing long QT. This risk nearly doubled when the change in QRS morphology was accompanied by a change in QRS axis.
Conclusions—
Cardiac memory resulting from a change in QRS morphology during AVB is independently associated with QT prolongation and may be arrhythmogenic during AVB.
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57
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Refaat M, Steffensen AB, David JP, Mujezinovic A, Calloe K, Wojciak J, Nussbaum RL, Scheinman M, Schmitt N. HIGH INCIDENCE OF FUNCTIONAL ION CHANNEL ABNORMALITIES IN A CONSECUTIVE LONG QT SYNDROME COHORT WITH GENETIC VARIANTS OF UNKNOWN SIGNIFICANCE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60444-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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58
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Lyon R, Mezzano V, Pellman J, Lim B, Iwakuma T, Lee M, Nigam V, Scheinman M, Sheikh F. The COP9 signalosome as a novel mediator of arrhythmogenic cardiomyopathy (404.1). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.404.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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59
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Hu D, Barajas-Martínez H, Terzic A, Park S, Pfeiffer R, Burashnikov E, Wu Y, Borggrefe M, Veltmann C, Schimpf R, Cai JJ, Nam GB, Deshmukh P, Scheinman M, Preminger M, Steinberg J, López-Izquierdo A, Ponce-Balbuena D, Wolpert C, Haïssaguerre M, Sánchez-Chapula JA, Antzelevitch C. ABCC9 is a novel Brugada and early repolarization syndrome susceptibility gene. Int J Cardiol 2014; 171:431-42. [PMID: 24439875 DOI: 10.1016/j.ijcard.2013.12.084] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/17/2013] [Accepted: 12/21/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Genetic defects in KCNJ8, encoding the Kir6.1 subunit of the ATP-sensitive K(+) channel (I(K-ATP)), have previously been associated with early repolarization (ERS) and Brugada (BrS) syndromes. Here we test the hypothesis that genetic variants in ABCC9, encoding the ATP-binding cassette transporter of IK-ATP (SUR2A), are also associated with both BrS and ERS. METHODS AND RESULTS Direct sequencing of all ERS/BrS susceptibility genes was performed on 150 probands and family members. Whole-cell and inside-out patch-clamp methods were used to characterize mutant channels expressed in TSA201-cells. Eight ABCC9 mutations were uncovered in 11 male BrS probands. Four probands, diagnosed with ERS, carried a highly-conserved mutation, V734I-ABCC9. Functional expression of the V734I variant yielded a Mg-ATP IC₅₀ that was 5-fold that of wild-type (WT). An 18-y/o male with global ERS inherited an SCN5A-E1784K mutation from his mother, who displayed long QT intervals, and S1402C-ABCC9 mutation from his father, who displayed an ER pattern. ABCC9-S1402C likewise caused a gain of function of IK-ATP with a shift of ATP IC₅₀ from 8.5 ± 2 mM to 13.4 ± 5 μM (p<0.05). The SCN5A mutation reduced peak INa to 39% of WT (p<0.01), shifted steady-state inactivation by -18.0 mV (p<0.01) and increased late I(Na) from 0.14% to 2.01% of peak I(Na) (p<0.01). CONCLUSION Our study is the first to identify ABCC9 as a susceptibility gene for ERS and BrS. Our findings also suggest that a gain-of-function in I(K-ATP) when coupled with a loss-of-function in SCN5A may underlie type 3 ERS, which is associated with a severe arrhythmic phenotype.
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Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M, Calkins H, Estes NM, Link MS, Maron BJ, Marcus F, Scheinman M, Wilkoff BL, Zipes DP, Berul CI, Cheng A, Law I, Loomis M, Barth C, Brandt C, Dziura J, Li F, Cannom D. Safety of Sports for Athletes With Implantable Cardioverter-Defibrillators. Circulation 2013; 127:2021-30. [DOI: 10.1161/circulationaha.112.000447] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background—
The risks of sports participation for implantable cardioverter-defibrillator (ICD) patients are unknown.
Methods and Results—
Athletes with ICDs (age, 10–60 years) participating in organized (n=328) or high-risk (n=44) sports were recruited. Sports-related and clinical data were obtained by phone interview and medical records. Follow-up occurred every 6 months. ICD shock data and clinical outcomes were adjudicated by 2 electrophysiologists. Median age was 33 years (89 subjects <20 years of age); 33% were female. Sixty were competitive athletes (varsity/junior varsity/traveling team). A pre-ICD history of ventricular arrhythmia was present in 42%. Running, basketball, and soccer were the most common sports. Over a median 31-month (interquartile range, 21–46 months) follow-up, there were no occurrences of either primary end point—death or resuscitated arrest or arrhythmia- or shock-related injury—during sports. There were 49 shocks in 37 participants (10% of study population) during competition/practice, 39 shocks in 29 participants (8%) during other physical activity, and 33 shocks in 24 participants (6%) at rest. In 8 ventricular arrhythmia episodes (device defined), multiple shocks were received: 1 at rest, 4 during competition/practice, and 3 during other physical activity. Ultimately, the ICD terminated all episodes. Freedom from lead malfunction was 97% at 5 years (from implantation) and 90% at 10 years.
Conclusions—
Many athletes with ICDs can engage in vigorous and competitive sports without physical injury or failure to terminate the arrhythmia despite the occurrence of both inappropriate and appropriate shocks. These data provide a basis for more informed physician and patient decision making in terms of sports participation for athletes with ICDs.
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Hoffmayer KS, Scheinman M. Current role of atrioventricular junction (AVJ) ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:257-65. [PMID: 23078186 DOI: 10.1111/pace.12022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 07/29/2012] [Accepted: 08/27/2012] [Indexed: 11/28/2022]
Abstract
Atrioventricular junction ablation with permanent pacemaker insertion is a highly effective treatment approach in patients with atrial fibrillation that is resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. This effect likely reflects reversal of rapid ventricular rates and regularizing ventricular rates. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular node ablation. The limitations of this approach include continued need for anticoagulation and lifelong pacemaker therapy.
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Lampert R, Olshansky B, Heidbuchel H, Lawless C, Saarel E, Ackerman M, Calkins H, Estes M, Link M, Maron B, Marcus F, Scheinman M, Wilkoff B, Zipes D, Berul C, Cheng A, Law I, Loomis M, Barth C, Brandt C, Dziura J, Li F, Cannom D. Safety of Sports for Patients With ICDs: Results of a Prospective Multinational Registry. Heart Rhythm 2012. [DOI: 10.1016/j.hrthm.2012.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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63
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Hoffmayer KS, Scheinman M, Goldschlager N. An ectopic atrial rhythm? J Electrocardiol 2012; 45:384, 410. [DOI: 10.1016/j.jelectrocard.2012.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Di Biase L, Al-Ahamad A, Santangeli P, Hsia HH, Sanchez J, Bai R, Bailey S, Horton R, Gallinghouse GJ, Burkhardt DJ, Lakkireddy D, Yang Y, Badhwar N, Scheinman M, Tung R, Dello Russo A, Pelargonio G, Casella M, Tomassoni G, Shivkumar K, Natale A. Safety and outcomes of cryoablation for ventricular tachyarrhythmias: Results from a multicenter experience. Heart Rhythm 2011; 8:968-74. [DOI: 10.1016/j.hrthm.2011.02.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
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65
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Nguyen DT, Scheinman M, Olgin J, Badhwar N. Wenckebach during supraventricular tachycardia. Circ Arrhythm Electrophysiol 2010; 3:671-3. [PMID: 21156779 DOI: 10.1161/circep.110.959361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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66
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Viswanathan MN, Scheinman M, Badhwar N. Narrow Complex Tachycardia: What is the Mechanism? Card Electrophysiol Clin 2010; 2:203-207. [PMID: 28770751 DOI: 10.1016/j.ccep.2010.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article reports an interesting case of a narrow complex tachycardia presenting the diagnostic dilemma of differentiating atrioventricular nodal reentrant tachycardia (AVNRT) from junctional tachycardia. It proposes delivering late-coupled premature atrial complexes during the tachycardia with short ventriculo-atrial interval as a diagnostic maneuver to differentiate AVNRT from junctional tachycardia in the electrophysiology laboratory. Treatments of these arrhythmias vary, and making the appropriate diagnosis of supraventricular tachycardia is essential to providing effective arrhythmia management.
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Nguyen DT, Scheinman M. Supraventricular Tachycardia in Pulmonary Hypertension. Card Electrophysiol Clin 2010; 2:317-319. [PMID: 28770773 DOI: 10.1016/j.ccep.2010.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pulmonary hypertension is a disease with significant morbidity and mortality. It is characterized by right-sided volume and pressure overload, which leads to structural changes and fibrosis in the right atrium, thus predisposing to supraventricular arrhythmias. This article presents a case discussion of supraventricular tachycardia in pulmonary hypertension. A 48-year-old woman, with a history of primary pulmonary hypertension and right heart failure, was admitted with a supraventricular tachycardia, hypotension, and congestive heart failure.
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68
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Yang Y, Scheinman M. An Atrial Flutter Circuit Within the Cavotricuspid Isthmus. Card Electrophysiol Clin 2010; 2:299-303. [PMID: 28770769 DOI: 10.1016/j.ccep.2010.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article discusses the case of a 69-year-old man with hypertension and diabetes who was admitted for recurrent palpitations and documented atrial flutter. The authors describe the electrophysiologic study and ablation of this case.
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69
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Johnson C, Scheinman M. Supraventricular Tachycardia: Where to Ablate? Card Electrophysiol Clin 2010; 2:217-220. [PMID: 28770753 DOI: 10.1016/j.ccep.2010.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article presents a case of typical atrioventricular nodal reentrant tachycardia with eccentric atrial activation where the successful ablation site was within the coronary sinus. Although most typical atrioventricular nodal reentrant tachycardia, regardless of site of earliest retrograde activation, can be modified by traditional right-sided slow pathway modification, it is important to remember that ablation of left posterior nodal extensions within the coronary sinus or over the mitral annulus may afford the key to termination of tachycardia when standard approaches fail.
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Tseng ZH, Scheinman M. Persistent Long R-P Tachycardia. Card Electrophysiol Clin 2010; 2:225-229. [PMID: 28770755 DOI: 10.1016/j.ccep.2010.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A case of persistent, recalcitrant long R-P tachycardia with decremental retrograde conduction consistent with permanent junctional reciprocating tachycardia (PJRT) is presented, refractory to multiple prior attempts at catheter ablation and antiarrhythmic drug therapy trials. During repeat study at their center, the authors demonstrated the conduction properties and oblique course of the accessory pathway (AP) within the coronary sinus (CS) during PJRT. The authors describe their successful approach to catheter ablation, targeting first the AP-atrium interface at a site distal to the AP recording within the CS, then the AP potential itself at the os. The current case highlights the complexity of the AV connection and the importance of careful mapping of the CS in patients with PJRT.
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Scheinman M, Akhtar M. Preface. Card Electrophysiol Clin 2010; 2:xvii. [PMID: 28770775 DOI: 10.1016/j.ccep.2010.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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72
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Nguyen DT, Scheinman M, Badhwar N. Supraventricular tachycardia with alternating cycle lengths: what is the mechanism? Heart Rhythm 2010; 8:478-9. [PMID: 20434588 DOI: 10.1016/j.hrthm.2010.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Indexed: 10/19/2022]
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73
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Turakhia MP, Scheinman M, Badhwar N. Wolff-Parkinson-White syndrome: where is the pathway? Indian Pacing Electrophysiol J 2009; 9:130-3. [PMID: 19308285 PMCID: PMC2655076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.
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74
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Marcus FI, Zareba W, Calkins H, Towbin JA, Basso C, Bluemke DA, Estes NAM, Picard MH, Sanborn D, Thiene G, Wichter T, Cannom D, Wilber DJ, Scheinman M, Duff H, Daubert J, Talajic M, Krahn A, Sweeney M, Garan H, Sakaguchi S, Lerman BB, Kerr C, Kron J, Steinberg JS, Sherrill D, Gear K, Brown M, Severski P, Polonsky S, McNitt S. Arrhythmogenic right ventricular cardiomyopathy/dysplasia clinical presentation and diagnostic evaluation: results from the North American Multidisciplinary Study. Heart Rhythm 2009; 6:984-92. [PMID: 19560088 DOI: 10.1016/j.hrthm.2009.03.013] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 03/06/2009] [Indexed: 01/28/2023]
Abstract
BACKGROUND Prior reports on patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) focused on individuals with advanced forms of the disease. Data on the diagnostic performance of various testing modalities in newly identified individuals suspected of having ARVC/D are limited. OBJECTIVE The purpose of the Multidisciplinary Study of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia was to study the clinical characteristics and diagnostic evaluation of a large group of patients newly identified with ARVC/D. METHODS A total of 108 newly diagnosed patients with suspected ARVC/D were prospectively enrolled in the United States and Canada. The patients underwent noninvasive and invasive tests using standardized protocols that initially were interpreted by the enrolling center and adjudicated by blind analysis in six core laboratories. Patients were followed for a mean of 27 +/- 16 months (range 0.2-63 months). RESULTS The clinical profile of these newly diagnosed patients differs from the profile of reported patients with more advanced disease. There was considerable difference in the initial and final classification of the presence of ARVC/D after the diagnostic tests were evaluated by the core laboratories. Final clinical diagnosis was 73 affected, 28 borderline, and 7 unaffected. Individual tests agreed with the final diagnosis in 50% to 70% of the 73 patients with a final classification of affected. CONCLUSION The clinical profile of 108 newly diagnosed probands with suspected ARVC/D indicates that a combination of diagnostic tests is needed to evaluate the presence of right ventricular structural, functional, and electrical abnormalities. Echocardiography, right ventricular angiography, signal-averaged ECG, and Holter monitoring provide optimal clinical evaluation of patients suspected of ARVC/D.
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Botvinick E, Davis J, Dae M, O'Connell J, Schechtmann N, Abbott J, Morady F, Lanzer P, Iskikian J, Scheinman M. Localization of Ventricular Tachycardia Exit Site and Subsequent Contraction Sequence and Functional Effects With Bedside Radionuclide Angiography. JACC Cardiovasc Imaging 2008; 1:605-13. [DOI: 10.1016/j.jcmg.2008.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 05/13/2008] [Accepted: 05/21/2008] [Indexed: 10/21/2022]
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