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Franco E, Lozano Granero C, Matía R, Hernández-Madrid A, Sánchez Pérez I, Zamorano JL, Moreno J. Stabilization of unstable reentrant atrial tachycardias via fractionated continuous electrical activity ablation (CHAOS study). Cardiol J 2022; 30:799-809. [PMID: 35578756 PMCID: PMC10635713 DOI: 10.5603/cj.a2022.0036] [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: 08/05/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unstable reentrant atrial tachycardias (ATs) (i.e., those with frequent circuit modification or conversion to atrial fibrillation) are challenging to ablate. We tested a strategy to achieve arrhythmia stabilization into mappable stable ATs based on the detection and ablation of rotors. METHODS All consecutive patients from May 2017 to December 2019 were included. Mapping was performed using conventional high-density mapping catheters (IntellaMap ORION, PentaRay NAV, or Advisor HD Grid). Rotors were subjectively identified as fractionated continuous (or quasi-continuous) electrograms on 1-2 adjacent bipoles, without dedicated software. In patients without detectable rotors, sites with spatiotemporal dispersion (i.e., all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles were targeted. Ablation success was defined as conversion to a stable AT or sinus rhythm. RESULTS Ninety-seven patients with reentrant ATs were ablated. Of these, 18 (18.6%) presented unstable circuits. Thirteen (72%) patients had detectable rotors (median 2 [1-3] rotors per patient); focal ablation was successful in 12 (92%). In the other 5 patients, 17 sites with spatiotemporal dispersion were identified and targeted. Globally, and excluding 1 patient with spontaneous AT stabilization, ablation success was achieved in 16/17 patients (94.1%). One-year freedom from atrial arrhythmias was similar between patients with unstable and stable ATs (66.7% vs. 65.8%, p = 0.946). CONCLUSIONS Most unstable reentrant ATs show detectable rotors, identified as sites with single-bipole fractionated quasi-continuous signals, or spatiotemporal dispersion plus non-continuous fractionation. Ablation of these sites is highly effective to stabilize the AT or convert it into sinus rhythm.
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Carberry T, Tsao S, Chaouki AS. Patient-activated Anti-tachycardia pacing in adult congenital heart disease. Pacing Clin Electrophysiol 2022; 45:711-716. [PMID: 35266171 PMCID: PMC9314925 DOI: 10.1111/pace.14475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
Introduction In adults with congenital heart disease, intra‐atrial reentrant tachycardia (IART) is a common arrhythmia that causes significant morbidity and mortality. One treatment option for IART is antitachycardia pacing. Atrial antitachycardia pacing algorithms deliver therapy for IART with ≥2:1 conduction, but most algorithms will not recognize IART with 1:1 conduction. Temporary Patient Activated Rx (TPARx) is Medtronic software that can be installed in antitachycardia pacemakers allowing patients to deliver therapies on demand for IART with 1:1 conduction. Methods Retrospective chart review at a single institution of all patients who had TPARx installed into their pacemaker. Results Four adults with single ventricle congenital heart disease and IART underwent Fontan conversion, arrhythmia surgery, and placement of an epicardial dual‐chamber antitachycardia pacemaker. They had recurrent IART with a long cycle length and 1:1 conduction that failed to trigger antitachycardia pacing therapies. TPARx software was programmed into their pacemakers to allow recognition and treatment of IART with 1:1 conduction. Mean follow‐up duration after TPARx programming was 4.9 years. Each patient received at least one successful antitachycardia pacing therapy via TPARx – range 0.4–26 treated IART episodes per year. There were no atrial or ventricular arrhythmias induced with antitachycardia pacing. Two patients were able to discontinue anticoagulation after TPARx installation. Conclusion This series demonstrates the use of TPARx software as part of a long‐term IART management strategy in select patients with IART who have failed more conventional therapies.
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Van Steenkiste G, Delhaas T, Hermans B, Vera L, Decloedt A, van Loon G. An Exploratory Study on Vectorcardiographic Identification of the Site of Origin of Focally Induced Premature Depolarizations in Horses, Part I: The Atria. Animals (Basel) 2022; 12:549. [PMID: 35268117 PMCID: PMC8908827 DOI: 10.3390/ani12050549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
In human cardiology, the anatomical origin of atrial premature depolarizations (APDs) is derived from P wave characteristics on a 12-lead electrocardiogram (ECG) and from vectorcardiography (VCG). The objective of this study is to differentiate between anatomical locations of APDs and to differentiate APDs from sinus rhythm (SR) based upon VCG characteristics in seven horses without cardiovascular disease. A 12-lead ECG was recorded under general anaesthesia while endomyocardial atrial pacing was performed (800−1000 ms cycle length) at the left atrial free wall and septum, right atrial free wall, intervenous tubercle, as well as at the junction with the cranial and caudal vena cava. Catheter positioning was guided by 3D electro-anatomical mapping and transthoracic ultrasound. The VCG was calculated from the 12-lead ECG using custom-made algorithms and was used to determine the mean electrical axis of the first and second half of the P wave. An ANOVA for spherical data was used to test if the maximal directions between each paced location and the maximal directions between every paced location and SR were significantly (p < 0.05) different. Atrial pacing data were not available from the LA septum in three horses, the intervenous tubercle in two horses, and from the LA free wall in one horse. The directions of the maximal electrical axes showed significant differences between all paced locations and between the paced locations and SR. The current results suggest that VCG is useful for identifying the anatomical origin of an atrial ectopy.
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Luik A, Schmidt K, Haas A, Unger L, Tzamalis P, Brüggenjürgen B. Ablation of Left Atrial Tachycardia following Catheter Ablation of Atrial Fibrillation: 12-Month Success Rates. J Clin Med 2022; 11:jcm11041047. [PMID: 35207318 PMCID: PMC8874450 DOI: 10.3390/jcm11041047] [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: 12/31/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
The treatment of atrial tachycardia following catheter ablation of atrial fibrillation is often challenging. Electrophysiological studies using high-resolution 3D mapping systems have contributed significantly to their understanding, and new ablation approaches have shown high rates of acute terminations with low recurrences for the clinical AT. However, patient populations are very heterogeneous, and long-term data of the freedom from any atrial tachycardia or any arrhythmia are still sparse. To evaluate long-term success, a unified patient population and predefined ablation strategies are preferred. In this study, we present 12-month success and mean 30 month follow-up data of catheter ablation of left atrial tachycardia. All 35 patients had a history of pulmonary vein isolation (PVI), 71% of which had a previous substrate modification. A total of 54 ATs, with a mean cycle length 297 ± 86 ms, 31 macro-reentries, and 4 localized reentries, were targeted. The ablation strategy to be used was given by the study protocol, depending on the type of reentry and the number of critical isthmuses. All available ablation strategies were included: standard (anatomical) lines, individual lines, critical isthmuses, and focal ablation. All ATs were terminated by ablation. A total of 91% terminated upon the first ablation strategy. Freedom from any AT after 12 months was 82%, and from any arrhythmia, it was 77%. The multi-procedure success after 30 months was 65% for any AT and 55% for any arrhythmia. In conclusion, individual ablation strategies based on the reentry mechanism and the number of critical isthmuses seems promising and demonstrates a high long-term clinical success. Tachycardia comprising a single critical isthmus can be ablated by critical isthmus ablation only. These patients present with the highest 12-month and long-term success rates.
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Nishizaki K, Itoh T, Kimura M, Tomita H. Contrast injection into the right atrial appendage apex using an external irrigation catheter for focal atrial tachycardia ablation. J Arrhythm 2022; 38:157-159. [PMID: 35222763 PMCID: PMC8851579 DOI: 10.1002/joa3.12664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/29/2021] [Accepted: 11/25/2021] [Indexed: 12/02/2022] Open
Abstract
Focal atrial tachycardias (ATs) originating from the right atrial appendage (RAA) apex are refractory to catheter ablation and can cause tachycardia-induced cardiomyopathy. After unsuccessful catheter ablation of these ATs, their elimination sometimes requires atrial appendectomy for treatment of tachycardia-induced cardiomyopathy. This case demonstrates that contrast injection into the RAA apex using an external irrigation catheter can facilitate mapping of such ATs and may provide safe and effective ablation of their sources even in the RAA tip.
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81
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Siroky GP, Mehta D. Diagnosing a wide complex tachycardia using basic electrophysiologic properties of the cardiac conduction system. J Arrhythm 2022; 38:115-117. [PMID: 35222757 PMCID: PMC8851580 DOI: 10.1002/joa3.12657] [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: 08/28/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
65-year-old man with a history of coronary artery disease s/p percutaneous coronary intervention to the left anterior descending artery and atrial fibrillation s/p recent (<3 months) pulmonary vein isolation presented to the emergency department with symptoms of palpitations for 1 day after admittedly forgetting to take his medications found to be in a wide complex tachycardia. We discuss a stepwise approach using properties of the conduction system to diagnose the patient's tachycardia.
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Coluccia G, Accogli M, Guido A, Scarascia A, Palmisano P. An apparent 2:1 atrial tachycardia: what is the mechanism? J Cardiovasc Electrophysiol 2022; 33:751-753. [PMID: 35044006 DOI: 10.1111/jce.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
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Kellnar A, Fichtner S, Mehr M, Czermak T, Sinner MF, Lackermair K, Estner HL. Single-center experience of ultra-high-density mapping guided catheter ablation of focal atrial tachycardia. Clin Cardiol 2022; 45:291-298. [PMID: 35019172 PMCID: PMC8922533 DOI: 10.1002/clc.23774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Catheter ablation is the treatment of choice for recurrent focal atrial tachycardia (FAT) as medical therapy is limited. Routinely, a three‐dimensional mapping system is used. Whether or not optimized signal detection does improve ablation success rates has not yet been investigated. This retrospective cohort study compared ablation procedures using an ultra‐high‐density mapping system (UHDM, Rhythmia, Boston Scientific) with improved signal detection and automatic annotation with procedures using a conventional electroanatomic mapping system (CEAM, Biosense Webster, CARTO). Methods All patients undergoing ablation for FAT using UHDM or CEAM from April 2015 to August 2018 were included. Endpoints comprised procedural parameters, acute success as well as freedom from arrhythmia 12 months after ablation. Results A total of 70 patients underwent ablation (48 with UHDM, 22 with CEAM). No significant differences were noted for parameters like procedural and radiation duration, area dose, and RF applications. Acute success was significantly higher in the UHDM cohort (89.6% vs. 68.2%, p = .03). Nevertheless, arrhythmia freedom 12 months after ablation was almost identical (56.8% vs. 60%, p = .87), as more patients with acute success of ablation presented with a relapse during follow‐up (35.0 vs. 7.7%, p = .05). Conclusion Acute success rate of FAT ablation might be improved by UHDM, without an adverse effect on procedural parameters. Nevertheless, further research is needed to understand the underlying mechanism for increased recurrence rates after acute successful ablation.
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Nakamura K, Sasaki T, Sasaki W, Haraguchi Y, Kimura K, Naito S. Intra-carina reentrant atrial tachycardia after pulmonary vein isolation of atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:700-702. [PMID: 34997965 DOI: 10.1111/pace.14440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/20/2021] [Accepted: 01/02/2022] [Indexed: 11/29/2022]
Abstract
A 77-year-old man underwent catheter ablation of an atrial tachycardia (AT) after a pulmonary vein (PV) isolation of atrial fibrillation. The AT appeared to be a figure-of-eight reentrant AT by high-resolution mapping: one reentrant circuit rotated clockwise within the right PV (RPV) carina and the other rotated counterclockwise via two conduction gaps along the previous RPV isolation line. However, entrainment pacing from the carina and conduction gaps suggested that the AT was an intra-carina localized reentrant AT with a passive loop around the anterior RPV isolation line via those gaps. A radiofrequency application at the RPV carina terminated the AT.
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Albizreh B, Elmagraby A, Asaad N, Hamid S, Al Jefairi N. An Ectopic Primary Pacemaker in Association with Isolated Persistent Left Superior Vena Cava. Heart Views 2022; 23:113-117. [PMID: 36213426 PMCID: PMC9542964 DOI: 10.4103/heartviews.heartviews_90_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
We are reporting a case of a young Nepalese man, who was not known to have any past medical history, and who presented with palpitations. An electrocardiogram showed negative P-waves atrial rhythm in II, III, arteriovenous fistula, and V3-V6 with a variable block at 90-130 bpm. No positive "normal" P-waves were demonstrated in any tracing. He was found to have a congenital absence of the right superior vena cava (RSVC) along with persistent left superior vena cava (PLSVC) a condition also called isolated PLSVC (IPLSC). He underwent a treadmill stress test for further evaluation which showed a normal chronotropic response and the same persistent negative P-waves morphology. An invasive electroanatomical and activation mapping showed an absence of RSVC, the earliest atrial activation site in the anterior side of the inferior vena cava (IVC), and the absence of normal (positive) P-waves/normal sinus node (SN) activation. Considering all the available clinical data together, we believe that the patient was living with an ectopic pacemaker node that acts as a primary node and originated in the IVC/right atrium instead of the normal expected SN position. Given the high risk of complete sinoatrial nodal block in case of radiofrequency ablation, the patient was kept on medical treatment with a beta-blocker which was effective in controlling his symptoms and atrial arrhythmia.
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86
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Yamabe H, Soejima T, Kajiyama K, Fukami Y, Haraguchi K, Okonogi T, Hirai K, Fukuoka R, Umeji K, Orita Y, Koga H, Kawasaki T. Efficacy of Catheter Ablation From the Non-Coronary Aortic Cusp of Verapamil-Sensitive Atrial Tachycardia Arising Near the Atrioventricular Node. Heart Rhythm 2021; 19:719-727. [PMID: 34968740 DOI: 10.1016/j.hrthm.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efficacy of catheter ablation from the non-coronary aortic cusp (NCC) of verapamil-sensitive atrial tachycardia arising near the atrioventricular node (AVN-AT) has yet to be fully clarified. OBJECTIVE We elucidated the determinant of an effective AVN-AT ablation from the NCC. METHODS After identifying the earliest atrial activation site (EAAS) during tachycardia, the direction of the slow conduction zone (SCZ) of reentry circuit was identified by demonstrating manifest entrainment in 26 AVN-AT patients. Catheter ablation was initially performed from the NCC irrespective of the local activation time. If the NCC ablation was ineffective, catheter ablation was performed targeting the SCZ entrance. Then the anatomical relationship between the SCZ and successful ablation site was elucidated. RESULTS NCC catheter ablation terminated AVN-AT in 14 patients (NCC Group) but not in 12 (Non-NCC Group). Catheter ablation targeting the SCZ entrance terminated all Non-NCC Group ATs. The local activation time at the NCC relative to the EAAS did not differ between the NCC and Non-NCC Groups (10.1±6.5 vs. 11.2±4.8 msec, p=0.6333). The direction of the SCZ was posterior to the EAAS in all NCC Group patients, however, it was postero-lateral (n=5) and lateral to the EAAS (n=7) in the Non-NCC Group, suggesting that the SCZ existed in the direction of the NCC in NCC Group but was away from the NCC in Non-NCC Group. CONCLUSION A close proximity between the NCC and SCZ of the reentry circuit, but not the local activation time at the NCC, determined the efficacy of NCC catheter ablation in AVN-ATs.
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Pfaller B, Wichert-Schmitt B, Spears D, D'Souza R, Silversides CK. Tachycardia-induced cardiomyopathy in three consecutive pregnancies. Obstet Med 2021; 14:269-271. [PMID: 34880944 DOI: 10.1177/1753495x20958853] [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: 02/27/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022] Open
Abstract
Tachycardia-induced cardiomyopathy is rare during pregnancy and is reversible when the underlying arrhythmia is effectively treated. Management can be complex due to the risks of antiarrhythmic medications and cardiac interventions on the developing fetus. The care requires a well-coordinated multidisciplinary team of cardiologists, electrophysiologists, and maternal-fetal specialists. In this report, we describe a case of recurrent atrial tachycardia-induced cardiomyopathy in pregnancy.
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Kanjwal K, Kichloo A, Mohiuddin Mir K, Haji AQ. Left-sided Macro-reentry or Right-sided Focal Tachycardia in Patients with Prior Pulmonary Vein Isolation: A Tale of Two Atria. J Innov Card Rhythm Manag 2021; 12:4764-4768. [PMID: 34858670 PMCID: PMC8631371 DOI: 10.19102/icrm.2021.121104] [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: 04/10/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
We report on three patients with prior pulmonary vein isolation who presented with atrial tachycardia/atrial flutter. During electrophysiology study, the whole tachycardia cycle length was mapped to the left atrium. Multiple ablation attempts failed to terminate the tachycardia and, subsequently, right atrial mapping revealed a focal early site of origin near the superior vena cava–right atrial junction in two patients and outside the coronary sinus ostium in one patient. In this report, we discuss the probable mechanism of these tachycardias.
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Shigeta T, Yamauchi Y, Sagawa Y, Oda A, Tachibana S, Sudo K, Nakamura R, Okishige K, Goya M, Sasano T. Cryoballoon ablation of the left atrial posterior wall reduces recurrence of persistent atrial fibrillation in patients with non-paroxysmal atrial fibrillation. J Arrhythm 2021; 37:1477-1487. [PMID: 34887952 PMCID: PMC8637091 DOI: 10.1002/joa3.12654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study aimed to clarify the clinical outcomes of cryoballoon ablation of the left atrial (LA) posterior wall (LAPW), including the LA roof, in patients with non-paroxysmal atrial fibrillation (AF). METHODS We analyzed the outcomes of 284 patients with non-paroxysmal AF, of whom 210 underwent the cryoballoon ablation of the LAPW, including the LA roof, in addition to pulmonary vein isolation with a cryoballoon. RESULTS Complete conduction block at the LA roof was obtained in 95.7% (201/210) of patients, and LAPW was isolated in 83.3% (130/156) of patients. Over 372 (range, 208-477) days of follow-up, atrial arrhythmia recurrence was observed in 84 (29.6%) patients, and atrial tachycardia (AT) recurrence accounted for 27.4% of cases. The prevalence of LA roof cryoballoon ablation was significantly higher in patients without recurrence than in those with recurrence (78.6% vs. 63.1%, respectively; p = .01), especially those with persistent AF recurrence (77.0% vs. 55.0%, p = .01). No significant difference was found in the prevalence of AT recurrence between patients who had undergone additional LAPW ablation and those who had not. Durable LA roof lesions were confirmed in 29 (72.5%) of 40 patients who underwent redo ablation. CONCLUSIONS Cryoballoon ablation of the LAPW leads to a sufficient acute success rate of complete conduction block and durable lesions of the LA roof without increasing AT recurrence risk. The prevalence of persistent AF recurrence decreases after additional cryoballoon ablation of the LAPW in patients with non-paroxysmal AF.
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Giri A, Talwar D, Acharya S, Saggu DK, Kumar S. Atrial Tachycardia Masquerading As Inappropriate Sinus Tachycardia (IST) After COVID-19 Infection: A Matter of Concern? Cureus 2021; 13:e20090. [PMID: 34993037 PMCID: PMC8720136 DOI: 10.7759/cureus.20090] [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] [Accepted: 12/01/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 Infection has wrecked havoc all over the world; the spectrum of this disease ranges from asymptomatic mild cases to severe cases such as acute respiratory distress syndrome (ARDS). Not only the acute infection but post COVID sequelae are also a cause of concern. Post-COVID states or Long COVID are the sequences of complications following the active infection. As post COVID sequelae are unpredictable it is absolutely the need of the hour to educate physicians and make them aware of all possibilities. We report one such case of a post COVID recovered young lady, who presented with drug-refractory recurrent palpitations. She was initially suspected to have inappropriate sinus tachycardia. But electrophysiological study confirmed the diagnosis of atrial tachycardia which was successfully ablated. The patient now has completed six months of follow-up and is off any medication.
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Queirós P, Silva G, Almeida J, Martins D, Primo J. Incessant Atrial Tachycardia: Problem Solving With Minimally Invasive Surgery. Cureus 2021; 13:e18643. [PMID: 34786238 PMCID: PMC8580126 DOI: 10.7759/cureus.18643] [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] [Accepted: 10/10/2021] [Indexed: 11/25/2022] Open
Abstract
A 35-year-old female with sarcoidosis sought medical attention due to palpitations. The ECG showed an atrial tachycardia (AT), apparently originating in the left atrium. A 24-hour Holter monitoring revealed AT to be present during the entire day. Cardiac magnetic resonance exhibited no cardiac involvement by sarcoidosis but registered a mildly depressed left ventricular ejection fraction (LVEF). Atrial electroanatomical mapping showed the earliest activation zone on the distal portion of the left atrial appendage (LAA). Considering the high risk for perforation with catheter ablation in this region, she was sent to thoracoscopic surgical LAA exclusion with a clip device; it was possible to witness the termination of the arrhythmia during the procedure. She was safely discharged two days after surgery and has completed a one-year follow-up without recurrence of AT or symptoms, and with normalization of LVEF.
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Farah N, Trana C. Deglutition-Induced Atrial Tachycardia. Cureus 2021; 13:e18448. [PMID: 34745774 PMCID: PMC8563140 DOI: 10.7759/cureus.18448] [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] [Accepted: 10/02/2021] [Indexed: 12/02/2022] Open
Abstract
While bradyarrhythmia is the most common arrhythmia during deglutition, tachycardias are considered to be a very rare condition with approximately 50 cases documented worldwide. The subjects are usually men with no structural heart disease or gastrointestinal pathology, and symptoms may vary from palpitations to lightheadedness or syncope. Management is based on adapting alimentary habits in combination with agents such as beta-blockers, calcium channel blockers, and class IA, IC, and III drugs. Radiofrequency catheter ablation offers a permanent cure in the majority of the reported cases. We report the case of a 51-year-old male with swallowing-induced palpitations, corresponding to brief episodes of atrial tachycardia. Beta-blockers and calcium channel blockers were interrupted because of intolerance. Lifestyle measures with fractionated meals allowing small boluses significantly reduced symptoms. The patient was reticent to invasive measures.
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Wang W, Norby FL, Zhang MJ, Reyes JL, Shah AM, Soliman EZ, Lutsey PL, Alonso A, Solomon SD, Inciardi RM, Chen LY. Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study. J Am Heart Assoc 2021; 10:e021723. [PMID: 34713724 PMCID: PMC8751819 DOI: 10.1161/jaha.121.021723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
Background Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk. Methods and Results We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2-week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%-47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present. Conclusions Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.
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Krisai P, Cheniti G, Kamakura T, Takagi T, André C, Ramirez FD, Nakatani Y, Nakashima T, Tixier R, Chauvel R, Pillois X, Duchateau J, Pambrun T, Derval N, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Catheter Ablation for Atrial Fibrillation in Hyperthyroid Patients. Circ Arrhythm Electrophysiol 2021; 14:e010200. [PMID: 34693719 DOI: 10.1161/circep.121.010200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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95
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Miyazaki S, Hasegawa K, Yamao K, Mukai M, Aoyama D, Sekihara T, Nodera M, Eguchi T, Iesaka Y, Tada H. High-Resolution Mapping and Ablation of Atrial Tachycardias Involving the Lateral Left Atrium. J Am Heart Assoc 2021; 10:e022384. [PMID: 34581187 PMCID: PMC8751894 DOI: 10.1161/jaha.121.022384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The lateral left atrium (LA) is often associated with atrial tachycardia (AT) because of its complex anatomy. We sought to characterize ATs associated with the lateral LA, including the posterolateral mitral isthmus (MI) and left atrial ridge. Methods and Results Twenty‐eight lateral LA‐associated ATs were mapped with high‐resolution mapping systems and entrainment pacing. The vein of Marshall was mapped with a 1.8‐Fr mapping catheter when possible. ATs were associated with the posterolateral MI in 18 ATs (14 perimitral, 3 small reentry, and 1 focal AT). All patients had undergone MI area ablation, and all ATs were successfully eliminated. During 27.0 (interquartile range, 10.5–40.0) months of follow‐up, all were free from any atrial tachyarrhythmias, with 3 patients on antiarrhythmics. Of 10 ATs involving the ridge or Marshall bundle, 3 were ridge related, 3 were Marshall bundle related based on vein of Marshall mapping, and 1 was a persistent left superior vena cava related AT. All 7 patients had undergone MI linear ablation. The critical isthmus was in the LA‐ridge junction or the LA‐Marshall bundle junction. Bidirectional conduction block between the LA and ridge or Marshall bundle was created. Two patients had the critical isthmus in the other area. The remaining patient had micro‐reentry in the ridge. All 10 ATs were terminated during ablation at the critical isthmus. During 12.0 (5.2–31.7) months of follow‐up, all were free from any atrial tachyarrhythmias, with 7 patients on antiarrhythmics. Conclusions Most ATs occurred after MI area ablation. An high resolution mapping‐guided approach is highly effective for identifying the mechanism.
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Uetake S, Kobayashi N, Arai T, Ito N, Miyauchi Y. An uncommon mechanism of a short RP narrow QRS tachycardia? J Cardiovasc Electrophysiol 2021; 32:3211-3213. [PMID: 34570401 DOI: 10.1111/jce.15256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
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Recurrent Atrial Tachycardias Associated With Implantable Central Venous Access Catheters in Patients With Cancer. JACC Clin Electrophysiol 2021; 7:1482-1483. [PMID: 34454879 DOI: 10.1016/j.jacep.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022]
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98
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Varma N. Bidirectional Atrial Tachycardia Ablated From an Aortic Sinus. JACC Clin Electrophysiol 2021; 7:1326-1327. [PMID: 34454886 DOI: 10.1016/j.jacep.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
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Nakamura K, Sasaki T, Minami K, Sasaki W, Kimura K, Take Y, Naito S. Pseudo-Atrial Parasystoles After Open Heart Surgery and Catheter Ablation. JACC Clin Electrophysiol 2021; 7:431-432. [PMID: 33736762 DOI: 10.1016/j.jacep.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 10/21/2022]
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100
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Nakatani Y, Nakashima T, Duchateau J, Vlachos K, Krisai P, Takagi T, Kamakura T, André C, Goujeau C, Daniel Ramirez F, Chauvel R, Tixier R, Takigawa M, Kitamura T, Cheniti G, Denis A, Sacher F, Hocini M, Haïssaguerre M, Jaïs P, Derval N, Pambrun T. Characteristics of macroreentrant atrial tachycardias using an anatomical bypass: Pseudo-focal atrial tachycardia case series. J Cardiovasc Electrophysiol 2021; 32:2451-2461. [PMID: 34314087 DOI: 10.1111/jce.15186] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Human atria comprise distinct layers. One layer can bypass another, and lead to a downstream centrifugal propagation at their interface. We sought to characterize anatomical substrates, electrophysiological properties, and ablation outcomes of "pseudo-focal" atrial tachycardias (ATs), defined as macroreentrant ATs mimicking focal ATs. METHODS AND RESULTS We retrospectively analyzed left atrial ATs showing centrifugal propagation with postpacing intervals (PPIs) after entrainment pacing suggestive of a macroreentrant mechanism. A total of 22 patients had pseudo-focal ATs consisting of 15 perimitral and 7 roof-dependent flutters. A low-voltage area was consistently found at the collision site and colocalized with distinct anatomical structures like the: (1) coronary sinus-great cardiac vein bundle (27%), (2) vein of Marshall bundle (18%), (3) Bachmann bundle (27%), (4) septopulmonary bundle (18%), and (5) fossa ovalis (9%). The mean missing tachycardia cycle length (TCL) was 65 ± 31 ms (22%) on the endocardial activation map. PPI was 0 [0-15] ms and 0 [0-21] ms longer than TCL at the breakthrough site and the opposite site, respectively. While feasible in 21 pseudo-focal ATs (95%), termination was better achieved by blocking the anatomical isthmus than ablating the breakthrough site [20/21 (95%) vs. 1/5 (20%); p < .001]. CONCLUSION Perimitral and roof-dependent flutters with centrifugal propagation are favored by a low-voltage area located at well-identified anatomical structures. Comprehensive entrainment pacing maneuvers are crucial to distinguish pseudo-focal ATs from true focal ATs. Blocking the anatomical isthmus is a better therapeutic option than ablating the breakthrough site.
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