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Sra J, Vaillant R, Vass M, Krum D, Akhtar M. Feasibility of registration of 3D left atrial images from computed tomography with projection images from fluoroscopy. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.379] [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: 10/25/2022]
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Arora V, Krum D, Bloomgarden D, Kazemi S, Akhtar M, Sra J. Detection of a left atrial appendage thrombus using ECG-gated computed tomography. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.921] [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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78
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Arora V, Krum D, Akhtar M, Sra J. Rotor in a remnant of the left atrial appendage driving left atrial flutter. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.1033] [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: 10/25/2022]
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79
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Badhwar N, Kalman JM, Sparks PB, Kistler PM, Berger MG, Attari M, Sra J, Lee RJ, Scheinman MM. Mechanism and site of origin of atrial tachycardia requiring ablation deep within the coronary sinus. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.469] [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: 10/25/2022]
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80
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Osorio H, Bhatia A, Pubbi D, Blanck Z, Dhala A, Sra J, Berger MG, Cooley R, Akhtar M. Biventricular implantable cardioverter-defibrillator in the elderly. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.305] [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: 11/16/2022]
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81
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Mortada ME, Bhatia A, Bangash A, Nangia V, Sra J, Blanck Z, Dhala A, Berger MG, Cooley R, Akhtar M. Effect of biventricular pacing on plasma B-type natriuretic peptide levels in patients with heart failure. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.312] [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: 11/25/2022]
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82
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Sra J, Krum D, Okerlund D, Thompson H. Endocardial imaging of the left atrium in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2004; 15:247. [PMID: 15028060 DOI: 10.1046/j.1540-8167.2004.03335.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sra J, Krum D, Okerlund D, Pardo K. Three-Dimensional and Endocardial Imaging of the Coronary Sinus for Cardiac Resynchronization Therapy. J Cardiovasc Electrophysiol 2004; 15:1109. [PMID: 15363091 DOI: 10.1046/j.1540-8167.2004.04037.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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86
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Krum D, Olson DL, Bloomgarden D, Sra J. Visualization of remnants of the left atrial appendage following epicardial surgical removal. Heart Rhythm 2004; 1:249. [PMID: 15851163 DOI: 10.1016/j.hrthm.2004.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bhatia A, Cooley R, Berger M, Blanck Z, Dhala A, Sra J, Axtell-Mcbride K, Vandervort C, Akhtar M. The implantable cardioverter defibrillator: technology, indications, and impact on cardiovascular survival*1. Curr Probl Cardiol 2004; 29:303-56. [PMID: 15159713 DOI: 10.1016/j.cpcardiol.2004.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the introduction of the implantable cardioverter defibrillator (ICD) for the management of patients with high risk of arrhythmic SCD, there has been increasing use of this device. Its basic promise to effectively terminate ventricular tachycardia (VT)-ventricular fibrillation (VF) has been repeatedly met. In several randomized trials, the ICD has been shown to be superior to conventional anti-arrhythmic therapy, both in patients with documented VT-VF (secondary prevention) and those with high risk such as left ventricular ejection fraction and no prior sustained VT-VF (primary prevention). In both groups, the ICD showed overall and cardiac mortality reduction. The device now can more accurately detect VT-VF and differentiate these from other arrhythmias through a series of algorithms and direct-chamber sensing. Therapy options include painless antitachycardia pacing, low-energy cardioversion, and high-energy defibrillation. The technique implant is now simple as a pacemaker with one lead attached to an active (hot) can functioning as the other electrode. Among other improvements is its weight, volume, multiprogrammability, and storage of information,dual-chamber pacing and sensing, dual-chamber defibrillation, and addition of biventricular pacing for cardiac synchronization. It is anticipated that further improvement in ICD technology will take place and the list of indications will grow.
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Kumaraswamy N, Kumbar C, Dhala A, Sra J. Noncontact and Electroanatomic Mapping of Atrial Flutter in Surgically Repaired Sinus Venosus Atrial Septal Defect and Rerouting of Anomalous Pulmonary Venous Drainage. Pacing Clin Electrophysiol 2004; 27:526-9. [PMID: 15078408 DOI: 10.1111/j.1540-8159.2004.00474.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atypical atrial flutter with two prior failed ablations, complicating surgically repaired sinus venosus atrial septal defect and partial anomalous pulmonary venous connection, mapped by noncontact and electroanatomic mapping, is described. Electroanatomic and noncontact mapping clearly identified a narrow zone of normal voltage and activation which was targeted, with successful termination of the arrhythmia.
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Sra J, Hauck J, Krum D, Schweitzer J. Three-dimensional right atrial geometry construction and catheter tracking using cutaneous patches. J Cardiovasc Electrophysiol 2003; 14:897. [PMID: 12890057 DOI: 10.1046/j.1540-8167.2003.02524.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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90
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Krum DP, Hare J, Georgakopoulos ND, Cooley R, Akhtar M, Sra J, Sinai A. Can the left atrial appendage be safely closed without removal? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)80787-8] [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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91
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Kress DC, Sra J, Krum D, Goel A, Campbell J, Fox J. Radiofrequency ablation of atrial fibrillation during mitral valve surgery. Semin Thorac Cardiovasc Surg 2002; 14:210-8. [PMID: 12232860 DOI: 10.1053/stcs.2002.35291] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Twenty-three patients underwent endocardial radiofrequency ablation of atrial fibrillation (AF) during mitral valve procedures with a previously described left atrial lesion pattern. A temperature-controlled 7-coil surgical probe delivered 60-second lesions at 80 degrees C. The left atrial appendage was oversewn after ablation. Ages ranged from 28 to 88 years. Nineteen patients had chronic AF that was present for over 1 year in 74%; 12 patients had rheumatic mitral stenosis. Mean left atrial diameter was 5.4 +/- 0.7 cm. There was 1 operative death unrelated to the ablation, and no strokes or ablation-related complications were observed. At mean follow-up of 32.5 weeks, 86% of the 22 survivors were in sinus rhythm. All 18 patients with left atrial diameter <6 cm are in sinus rhythm. All postoperative atrial flutter was transient, and no patients required subsequent transcatheter ablation. This lesion pattern is safe and effective when applied in the method described here. It appears to be a reasonable alternative to the complete Maze 3 lesion pattern in patients with mitral valve disease.
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Kress DC, Krum D, Chekanov V, Hare J, Michaud N, Akhtar M, Sra J. Validation of a left atrial lesion pattern for intraoperative ablation of atrial fibrillation. Ann Thorac Surg 2002; 73:1160-8. [PMID: 11996257 DOI: 10.1016/s0003-4975(01)03586-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence that atrial fibrillation may begin in early stages from triggers or reentry circuits primarily in the left atrium suggests that the entire Maze 3 lesion pattern may be unnecessary. In the present study we describe a new left atrial lesion pattern for intraoperative linear ablation of chronic atrial fibrillation. METHODS Endocardial radiofrequency ablation was performed on 12 dogs with chronic atrial fibrillation. Lesions to isolate pulmonary veins in pairs, the left atrial appendage, and connecting lesions between these structures were administered in a randomized approach. RESULTS Twelve dogs were in chronic atrial fibrillation for 31 +/- 21 days before ablation. Atrial fibrillation was successfully ablated and rendered noninducible in all 12 dogs. All treatment failures observed with less than the full lesion pattern became a success when the remaining lesions were given. CONCLUSIONS Atrial fibrillation ablation using this left atrial lesion pattern is highly successful in this model. This approach may have significant utility as a concomitant procedure for patients with atrial fibrillation undergoing mitral valve procedures.
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Blanck Z, Georgakopoulos ND, Berger M, Cooley R, Dhala A, Sra J, Deshpande S, Akhtar M. Electrical therapy in patients with congestive heart failure introduction. Curr Probl Cardiol 2002; 27:45-93. [PMID: 11893983 DOI: 10.1067/mcn.2002.121818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sra J, Zaidi ST, Krum D, Georgakopoulos N, Ahmad A, Akhtar M. Correlation of spontaneous and induced premature atrial complexes initiating atrial fibrillation in humans: electrophysiologic parameters for guiding therapy. J Cardiovasc Electrophysiol 2001; 12:1347-52. [PMID: 11797990 DOI: 10.1046/j.1540-8167.2001.01347.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The low frequency of spontaneous premature atrial contractions (PACs) may be an impediment to mapping and ablation of atrial fibrillation (AF). It has been shown that PACs following external or internal cardioversion of AF can initiate AF. If this method could reproducibly induce PACs from the same location as spontaneous PACs, it would be clinically significant. High-resolution noncontact mapping can map a single beat, should help identify the sites of spontaneously occurring PACs and PACs induced following cardioversion of spontaneous or induced AF, and could help correlate the trigger sites for AF induction. METHODS AND RESULTS Twelve patients (8 men and 4 women; mean age 49+/-10 years) with spontaneous PACs were included in the study. In all patients, AF was induced and subsequently cardioverted to assess and map isolated PACs or PACs that induced AF. Using the EnSite 3000 noncontact mapping system, mapping was performed of spontaneously occurring isolated PACs and PACs that induced AF and PACs (both with and without AF) that occurred on at least two different occasions following cardioversion. The locations of the spontaneous and the induced PACs were similar; 97% of induced PACs came from the same locations as those of spontaneous PACs (P = 0.5). Radiofrequency lesions guided by this mapping technique were delivered at 14 pulmonary vein sites. Following a single ablation attempt during a mean follow-up of 19+/-4 weeks, 42% of the patients were in sinus rhythm and drug-free, whereas an additional 24% of patients could be maintained in sinus rhythm on drugs that had failed before. CONCLUSION There is a high degree of correlation between spontaneous and induced PACs as the trigger sites for AF initiation. Cardioversion of spontaneous or induced AF could be used as an electrophysiologic parameter for guiding therapy.
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Sra J, Bhatia A, Dhala A, Blanck Z, Deshpande S, Cooley R, Akhtar M. Electroanatomically guided catheter ablation of ventricular tachycardias causing multiple defibrillator shocks. Pacing Clin Electrophysiol 2001; 24:1645-52. [PMID: 11816634 DOI: 10.1046/j.1460-9592.2001.01645.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
With conventional techniques, RF catheter ablation is difficult in patients with unstable VT or with multiple VTs. The feasibility of RF catheter ablation guided by three-dimensional electroanatomic mapping technique in patients whose implanted ICD continued to deliver multiple shocks due to VT despite use of antiarrhythmic medications was assessed in 19 patients (15 men, 4 women; mean age [+/- SD] 70+/-7 years). All had a prior history of MI and subsequently had received an ICD due to VT. During the 12-week preablation period, these patients received 31+/-15 shocks (range 4-62 shocks) due to refractory monomorphic VTs. An electroanatomic mapping technique using the CARTO system was performed to delineate scar tissue. RF catheter ablation was then performed at appropriate sites identified by pace mapping and by substrate mapping. Seventeen patients were on amiodarone at the time of ablation. Twenty-seven VTs were documented clinically, and 45 were induced during electrophysiological evaluation. Of the 45 tachycardias induced, 38 VTs were targeted for ablation. Catheter ablation was performed during sinus rhythm in 31 episodes and during VT in 7 episodes. During a mean follow-up of 26+/-8 weeks (range 18-48 weeks), 13 (66%) patients had no recurrence of VT (P < 0.0001) and antiarrhythmic drugs were discontinued or the number of medications reduced in 17 patients (P < 0.0001). Electroanatomic mapping is helpful in identifying sites for catheter ablation in highly symptomatic patients with refractory VT associated with myocardial scarring.
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Sra J, Bhatia A, Krum D, Akhtar M. Noncontact mapping for radiofrequency ablation of complex cardiac arrhythmias. J Interv Card Electrophysiol 2001; 5:327-35. [PMID: 11500588 DOI: 10.1023/a:1011429119074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Radiofrequency (RF) catheter ablation is the current treatment of choice for several cardiac arrhythmias. The conventional approach utilizing intracardiac electrograms during sinus rhythm and during tachycardia has inherent limitations, including limited two-dimensional fluoroscopic imaging and limited ability to evaluate several potential sites for ablation then go precisely to the most suitable site. Recently, a noncontact mapping system has been developed that can be used to perform single beat high resolution mapping of cardiac arrhythmias. In this report, we describe the advantage of utilizing the system in facilitating a successful outcome in 5 patients with different complex arrhythmias.
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Perez-Lugones A, Schweikert R, Pavia S, Sra J, Akhtar M, Jaeger F, Tomassoni GF, Saliba W, Leonelli FM, Bash D, Beheiry S, Shewchik J, Tchou PJ, Natale A. Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study. J Cardiovasc Electrophysiol 2001; 12:935-8. [PMID: 11513446 DOI: 10.1046/j.1540-8167.2001.00935.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The efficacy of midodrine for the management of patients with neurocardiogenic syncope was assessed prospectively in a randomized control study. METHODS AND RESULTS Patients who had at least monthly occurrences of syncope and a positive tilt-table test were included in the study. A total of 61 patients were randomly allocated to treatment either with midodrine or with fluid, salt tablets, and counseling. Midodrine was given at a starting dose of 5 mg three times a day and increased up to a dose of 15 mg three times a day when required. Midodrine was given during the daytime every 6 hours. Thirty-one patients were assigned to treatment with midodrine; the other 30 patients were advised to increase their fluid intake and were instructed to recognize their prodromes and abort the progression to syncope. Patients were followed-up for at least 6 months. A quality-of-life questionnaire was administered at the time of randomization and 6 months after. At the 6-month follow-up, 25 (81%) of 31 midodrine-treated patients and 4 (13%) of the 30 fluid-therapy patients had remained asymptomatic (P < 0.001). One patient had to discontinue taking midodrine due to severe side effects and another six patients experienced minor side effects that did not require drug discontinuation. CONCLUSION Midodrine appeared to provide a significant benefit in patients with neurocardiogenic syncope. To prevent recurrence of symptoms, dose adjustments were required in about one third of patients.
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Sra J, Thomas JM. New techniques for mapping cardiac arrhythmias. Indian Heart J 2001; 53:423-44. [PMID: 11759932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Panotopoulos P, Krum D, Axtell K, Dhala A, Sra J, Akhtar M, Deshpande S. Ventricular fibrillation sensing and detection by implantable defibrillators: is one better than the others? A prospective, comparative study. J Cardiovasc Electrophysiol 2001; 12:445-52. [PMID: 11332566 DOI: 10.1046/j.1540-8167.2001.00445.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We prospectively compared the performance of the sensing and detection systems of three leading defibrillator manufacturers: Medtronic, Guidant, and Ventritex. METHODS AND RESULTS Ventricular fibrillation signal was digitally recorded during defibrillator implantation and subsequently played back sequentially to a Medtronic Micro Jewel II 7223Cx, a Guidant MINI II 1762, and a Ventritex Cadet V-115C. The devices were programmed for single-zone detection, at nominal settings. Rate cutoff was set at 320 msec (185/min for the MINI). We analyzed 253 episodes from 47 patients. Median undersensing was 0%, 2.1%, and 5.3% for the Jewel, MINI, and Cadet, respectively (P < 0.001 for each paired comparison). Detection time was 4.1 +/- 1.6 seconds, 3.4 +/- 1.6 seconds, and 4.3 +/- 2.2 seconds for the Jewel, MINI, and Cadet, respectively (P < 0.001 between MINI-Jewel and MINI-Cadet; P < 0.01 between Jewel-Cadet). Delayed detection (detection time longer than the mean of all observations + 2 SD) occurred in 3 (1.2%), 7 (2.8%), and 18 (7.1%) episodes for the Jewel, MINI, and Cadet, respectively. Performance for all devices was worse when the short-separation integrated bipolar lead was used and when the episode followed a failed high-energy shock. CONCLUSION Statistically significant differences were seen in sensing and detection performance among the devices and device/lead combinations during ventricular fibrillation. These differences are related to specific features of the respective devices and should be taken into account during clinical practice, as well as in future device development.
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Sra J, Bhatia A, Krum D, Akhtar M. Endocardial noncontact activation mapping of idiopathic left ventricular tachycardia. J Cardiovasc Electrophysiol 2000; 11:1409-12. [PMID: 11196566 DOI: 10.1046/j.1540-8167.2000.01409.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Idiopathic left ventricular tachycardia with a right bundle, left-axis deviation is thought to originate from posterior fascicles. Recently, there has been considerable interest in the anatomic and mechanistic basis of this arrhythmia. We report our experience with a 26-year-old man in whom new noncontact mapping technology was used to acquire detailed data from the left ventricle, identify the mid-diastolic potential and part of the ventricular tachycardia circuit, and perform successful ablation. This information helped define the physiologic aspects of this unique tachycardia.
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