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Katritsis DG, Marine JE, Latchamsetty R, Zografos T, Tanawuttiwat T, Sheldon SH, Buxton AE, Calkins H, Morady F, Josephson ME. Coexistent Types of Atrioventricular Nodal Re-Entrant Tachycardia: Implications for the Tachycardia Circuit. Circ Arrhythm Electrophysiol 2015; 8:1189-93. [PMID: 26155802 PMCID: PMC4608481 DOI: 10.1161/circep.115.002971] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
Abstract
Background— There is evidence that atypical fast–slow and typical atrioventricular nodal re-entrant tachycardia (AVNRT) do not use the same limb for fast conduction, but no data exist on patients who have presented with both typical and atypical forms of this tachycardia. We compared conduction intervals during typical and atypical AVNRT that occurred in the same patient. Methods and Results— In 20 of 1299 patients with AVNRT, both typical and atypical AVNRT were induced at electrophysiology study by pacing maneuvers and autonomic stimulation or occurred spontaneously. The mean age of the patients was 47.6±10.9 years (range, 32–75 years), and 11 patients (55%) were women. Tachycardia cycle lengths were 368.0±43.1 and 365.8±41.1 ms, and earliest retrograde activation was recorded at the coronary sinus ostium in 60% and 65% of patients with typical and atypical AVNRT, respectively. Thirteen patients (65%) displayed atypical AVNRT with fast–slow characteristics. By comparing conduction intervals during slow–fast and fast–slow AVNRT in the same patient, fast pathway conduction times during the 2 types of AVNRT were calculated. The mean difference between retrograde fast pathway conduction during slow–fast AVNRT and anterograde fast pathway conduction during fast–slow AVNRT was 41.8±39.7 ms and was significantly different when compared with the estimated between-measurement error (P=0.0055). Conclusions— Our data provide further evidence that typical slow–fast and atypical fast–slow AVNRT use different anatomic pathways for fast conduction.
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Affiliation(s)
- Demosthenes G Katritsis
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.).
| | - Joseph E Marine
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Rakesh Latchamsetty
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Theodoros Zografos
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Tanyanan Tanawuttiwat
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Seth H Sheldon
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Alfred E Buxton
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Hugh Calkins
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Fred Morady
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
| | - Mark E Josephson
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., A.E.B., M.E.J.); Rhode Island Hospital, Boston, MA (A.E.B.); Athens Euroclinic, Athens, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., T.T., H.C.); and University of Michigan Health System, Ann Arbor (R.L., S.H.S., F.M.)
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Pieragnoli P, Gori AM, Ricciardi G, Carrassa G, Checchi L, Michelucci A, Priora R, Cellai AP, Marcucci R, Padeletti L, Abbate R. Effects of cryoablation and radiofrequency ablation on endothelial and blood clotting activation. Intern Emerg Med 2014; 9:853-60. [PMID: 24950960 DOI: 10.1007/s11739-014-1090-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/22/2014] [Indexed: 11/28/2022]
Abstract
Cryoablation (CA) emerged as an alternative procedure to radiofrequency (RF). The aim of this study was to compare haemostatic system alterations in patients undergoing RF or CA for atrioventricular nodal reentrant tachycardia ablation. von Willebrand factor (vWF), spontaneous whole blood platelet aggregation, prothrombin fragment F1 + 2 (F1 + 2), thrombin-antithrombin complex (TAT), plasminogen activator inhibitor type-1 (PAI-1), and clot lysis time (CLT) were determined in 48 patients (27 CA; 21 RF; 19M/29F, mean age 49.6 ± 17.6 years). Blood samples were obtained before the procedure (T0), immediately after (T1), and 24 h later (T2). At T1 both procedures were associated with a significant increase in levels of the endothelial activation marker vWF. At T2 vWF levels were lower in CA than in RF group. No changes in whole blood platelet aggregation before and after ablation procedures were observed. At T1 both groups determined an increase in blood clotting activation markers, F1 + 2, TAT, and DD. At T2 F1 + 2, TAT and DD levels were similar to baseline values. The comparison between RF and CA showed no significant differences in F1 + 2 and TAT levels, whereas at T1 DD levels were higher in CA group than in RF group. Both procedures induced a significant decrease in CLT, whereas no changes in PAI-1 levels were found. There were no significant differences in CLT and PAI-1 levels. The fibrinolytic efficiency analysis showed that at T1 DD/TAT and DD/F1 + 2 ratios were lower in RF group and remained lower in RF than in CA group at T2. CA procedure may be associated with a lower degree of endothelial damage and with a higher fibrinolytic capacity respect to RF.
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Affiliation(s)
- Paolo Pieragnoli
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy,
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