51
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Romero J, Diaz JC, Alviz I, Bello J, Purkayastha S, Velasco A, Andrea Natale, Di Biase L. Methodology of Typical Accessory Pathway Catheter Ablation. Card Electrophysiol Clin 2020; 12:541-553. [PMID: 33162002 DOI: 10.1016/j.ccep.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Accessory pathways are abnormal electrical conductions between the atrial and ventricular myocardium, bypassing the atrioventricular node and as such are an important substrate for arrhythmias. Ablation is a curative treatment and should always be offered to symptomatic patients and asymptomatic patients with high risk professions. Adequate knowledge and understanding of different mapping and ablation techniques is pivotal to achieve successful outcomes.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Juan Carlos Diaz
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Isabella Alviz
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Juan Bello
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Sutopa Purkayastha
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Alejandro Velasco
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St Davids Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Luigi Di Biase
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Texas Cardiac Arrhythmia Institute at St Davids Medical Center, 919 East 32nd Street, Austin, TX 78705, USA.
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Pascale P, Hunziker S, Denis A, Gómez Flores JR, Roten L, Shah AJ, Scherr D, Komatsu Y, Ramoul K, Daly M, LeBloa M, Pruvot E, Derval N, Sacher F, Hocini M, Jaïs P, Haïssaguerre M. The 'double transition': a novel electrocardiogram sign to discriminate posteroseptal accessory pathways ablated from the right endocardium from those requiring a left-sided or epicardial coronary venous approach. Europace 2020; 22:1703-1711. [PMID: 32984869 DOI: 10.1093/europace/euaa200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/19/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS The precise localization of manifest posteroseptal accessory pathways (APs) often poses diagnostic challenges considering that a small area may encompass AP that may be ablated from the right or left endocardium, or epicardially within the coronary sinus (CS). We sought to explore whether the QRS transition pattern in the precordial lead may help to discriminate the necessary ablation approach. METHODS AND RESULTS Consecutive patients who underwent a successful ablation of a single manifest AP over a 5-year period were included. Standard 12-lead electrocardiograms were reviewed. A total of 273 patients were identified. Mean age was 31 ± 15 years and 62% were male. Of the 110 identified posteroseptal AP, 64 were ablated from the right endocardium, 33 from the left endocardium, and 13 inside the CS. While a normal precordial QRS transition was most often observed, a subset of 33 patients presented an atypical 'double transition' pattern which specifically identified right endocardial AP. The combination of a q wave in V1 with a proportion of the positive QRS component in V1 < V2 > V3, predicted a right endocardial AP with a 100% specificity. In case of a positive QRS sum in V2, this 'double transition' pattern predicted a posteroseptal right endocardial AP with 99.5% specificity and 44% sensitivity. The positive predictive value was 97%. The only false positive was a midseptal AP. In the case of a negative or isoelectric QRS sum in V2, APs were located more laterally on the tricuspid annulus. CONCLUSION The combination of a q wave in V1 with a double QRS transition pattern in the precordial leads is highly specific of a right endocardial AP and rules out the need for CS or left-sided mapping.
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Affiliation(s)
- Patrizio Pascale
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France.,Arrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland
| | - Samuel Hunziker
- Arrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland
| | - Arnaud Denis
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Jorge Rafael Gómez Flores
- Electrophysiology Department, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Laurent Roten
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Ashok J Shah
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Daniel Scherr
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Yuki Komatsu
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Khaled Ramoul
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Matthew Daly
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Mathieu LeBloa
- Arrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland
| | - Etienne Pruvot
- Arrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland
| | - Nicolas Derval
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Electrophysiology Department, Hôpital Cardiologique du Haut-Lévêque and Université de Bordeaux, IHU LIRYC ANR-10-IAHU-04, Bordeaux-Pessac, France
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53
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Ito R, Kajiyama T, Kondo Y, Nakano M, Kobayashi Y. Simultaneous conduction disturbance of an atrioventricular accessory pathway and nodal pathway after a mitral valve replacement: A case report. HeartRhythm Case Rep 2020; 6:827-830. [PMID: 33204615 PMCID: PMC7653459 DOI: 10.1016/j.hrcr.2020.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ryo Ito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takatsugu Kajiyama
- Department of Advanced Cardio Rhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masahiro Nakano
- Department of Advanced Cardio Rhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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54
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Razeghian-Jahromi I, Natale A, Nikoo MH. Coronary sinus diverticulum: Importance, function, and treatment. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1582-1587. [PMID: 32815147 DOI: 10.1111/pace.14026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 01/01/2023]
Abstract
The importance of venous structure in the heart is usually overshadowed by that of the arterial system. Coronary sinus (CS) is a part of cardiac venous apparatus and connects left atria to the right atria. Other than having role in physiological contractions of both atria, it contributes substantially to cardiac electrical conduction system. Due to unique placement and connections of the CS, it has become growing interest in clinical cardiology. It is used in cardiac resynchronization therapy with biventricular pacing, left-sided catheter ablation of arrhythmias, and administration of retrograde cardioplegia in cardiac surgery. In some individuals, CS is presented with anatomical variants. CS diverticulum is a congenital outpouching that provides muscular connection between atria and ventricle. This connection provides a suitable substrate for occurrence of arrhythmias, which even results in life-threatening events such as sudden cardiac death. Early diagnosis leads to treatment with ablation techniques, which ultimately eliminates origins of arrhythmias.
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Affiliation(s)
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas.,Dell Medical School, University of Texas, Austin, Texas.,Department of Biomedical Engineering, University of Texas, Austin, Texas.,MetroHealth Medical Center, CaseWestern Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Stanford University, Stanford, California.,Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, California
| | - Mohammad Hossein Nikoo
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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55
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Abstract
Supraventricular arrhythmias are the most common cardiac arrhythmias encountered; however, it is uncommon that supraventricular tachycardias require percutaneous epicardial access for successful mapping and ablation. There are particular scenarios where epicardial access and ablation should be considered. Certain accessory pathways particularly in the posteroseptal region may require epicardial access for successful ablation. These pathways may also be approached from within the coronary sinus system. In addition, tachycardias near the phrenic nerve in the right atrium or left atrium may require epicardial access for successful ablation or to allow displacement of the phrenic nerve facilitating safe catheter ablation.
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Affiliation(s)
- Martin Aguilar
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School; Clinical Cardiac Electrophysiology Fellowship; Ventricular Arrhythmia Program.
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56
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Panman SCMD, Ter Maaten JM, Blaauw Y. A young man with out-of-hospital cardiac arrest-it goes round and round. Neth Heart J 2020; 29:475-476. [PMID: 32737678 PMCID: PMC8397803 DOI: 10.1007/s12471-020-01481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- S C M D Panman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - J M Ter Maaten
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Y Blaauw
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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57
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Baek SM, Song MK, Uhm JS, Kim GB, Bae EJ. New algorithm for accessory pathway localization focused on screening septal pathways in pediatric patients with Wolff-Parkinson-White syndrome. Heart Rhythm 2020; 17:2172-2179. [PMID: 32681992 DOI: 10.1016/j.hrthm.2020.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Published algorithms for accessory pathway localization in Wolff-Parkinson-White (WPW) syndrome are inaccurate in pediatric patients, especially for septal pathways. OBJECTIVE We aimed to develop a new algorithm that is sensitive for septal pathways and more applicable in pediatric patients. METHODS In 120 patients (mean age: 11.7 ± 3.9 years) who underwent catheter ablation for WPW syndrome, the candidate criteria for new algorithm were searched by comparing electrocardiography parameters and accessory pathway locations. A new algorithm was designed to increase the sensitivity for septal pathways. For validation, 142 patients (mean age: 15.8 ± 3.7 years) were additionally evaluated. New and published algorithms were applied to electrocardiography of 262 patients and the results were compared. RESULTS The new algorithm achieved its best discrimination by combining several parameters together in each step: (1) QRS polarity in V1 and QRS shape in lead I for left/right discrimination, and (2) delta wave polarity in V1, QRS transition in precordial leads, and delta wave polarity in lead III for septal pathway screening. The new algorithm showed higher sensitivity for septal pathways (95.7%) than 7 published algorithms (average: 62.1%), with satisfactory positive predictive value (77.9%). Delta wave polarity in V1 among septal pathways and QRS axis among right anteroseptal pathway showed age-related trend; this could be the reason for the lower accuracy in localizing septal pathways in children. CONCLUSION The inaccuracy of published algorithms in pediatric patients is due to the age-related trend in the electrocardiography of septal pathways. The new algorithm was superior for localizing septal pathways in pediatric patients.
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Affiliation(s)
- Seung Min Baek
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
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58
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Malkar M, Kannankeril PJ, Radbill AE, Fish FA. Catheter ablation of orthodromic reciprocating tachycardia and atrioventricular nodal reentrant tachycardia in children with hypoplastic left heart syndrome. J Cardiovasc Electrophysiol 2020; 31:2043-2048. [PMID: 32542917 DOI: 10.1111/jce.14619] [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: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Experience with catheter ablation of orthodromic reciprocating tachycardia (ORT) and atrioventricular nodal reentrant tachycardia (AVNRT) in young children with hypoplastic left heart syndrome (HLHS) is limited. We report the feasibility, safety, and outcomes of catheter ablation of ORT and AVNRT in children with HLHS. METHODS AND RESULTS This was a retrospective review of patients with HLHS who underwent catheter ablation for reentrant supraventricular tachycardias (excluding atrial tachycardias) between 2005 and 2017 at a single center. Descriptive data including demographics, clinical history, procedural data, and outcomes were recorded. Ten children with HLHS underwent eleven catheter ablation procedures. Median age and weight at ablation were 2.7 years (range: 0.1-10.5) and 11.4 kg (range: 3.6-30.4), respectively. Tachycardia mechanism was AVNRT in four, ORT in five (two with preexcitation), and both in one. Acute procedural success was 100% and there was no spontaneous recurrence of tachycardia orpreexcitationin median 92 months (range: 21-175 months) follow-up. Five patients underwent subsequent EP studies at catheterization (intracardiac) or after surgery (via epicardial wires): three were noninducible, one after AVNRT ablation had inducible atrial tachycardia, and one after initial ORT ablation had inducible ORT at fenestration closure and underwent successful repeat ablation. Thus, long-term freedom from clinical tachycardia was 100% and from inducible AVNRT or ORT was 80%. CONCLUSION Transcatheter ablation for ORT and AVNRT in children with HLHS can be performed with excellent acute and long-term success without major complications.
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Affiliation(s)
- Manish Malkar
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Prince J Kannankeril
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew E Radbill
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Frank A Fish
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Neto JNDA, Neto RGDA, Cirenza C, Paola AAVD. A New Electrocardiographic Criterium to Estimate a Septal or Lateral Location of a Right-Sided Accessory Pathway. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i1.3387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: There are algorithms to estimate the location of an accessory pathway (AP). However, in right-sided APs, they tend to present low accuracy. This paper presents a new electrocardiographic criterium to estimate the location of a right-sided AP. Materials and methods: Rest ECGs from patients with manifest pre-excitation of right-sided APs were evaluated and the SV2/RV3 ratio was calculated, considering values <1 for lateral (anterior or posterior) and ≥ 1 for septal (anterior or posterior) APs. We compared this ratio with other signs already described in literature. Results: In 175 consecutive patients, 60 met the inclusion criteria. For APs located in superior portions of tricuspid ring, the SV2/RV3 ratio <1 was 80% accurate for anteroseptal location (specificity: 75%), where His electrograms were recorded. For APs located in inferior portions of tricuspid ring A SV2/RV3 < 1 was 82,86% accurate for mid and posteroseptal location (specificity: 95.38%). Conclusion: We report a new and simple criterium that can accurately distinguish right-sided lateral and septal APs with good specificity: SV2/RV3 ratio.
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Affiliation(s)
- José Nunes de Alencar Neto
- Universidade Federal de São Paulo – Escola Paulista de Medicina – Hospital São Paulo – São Paulo (SP), Brasil
| | | | - Claudio Cirenza
- Universidade Federal de São Paulo – Escola Paulista de Medicina – Hospital São Paulo – São Paulo (SP), Brasil
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60
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Evolution of acute ST-segment elevation myocardial infarction in a patient with ventricular preexcitation. J Electrocardiol 2020; 60:188-191. [DOI: 10.1016/j.jelectrocard.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022]
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61
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Shah RL, Badhwar N. Approach to narrow complex tachycardia: non-invasive guide to interpretation and management. BRITISH HEART JOURNAL 2020; 106:772-783. [DOI: 10.1136/heartjnl-2019-315304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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62
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Jáuregui-Abularach M, Merchán-Ortega G, Menéndez-Ramírez D, Martín-Sánchez G, Sánchez-Millán P, Worner-Diz F, Campos-García B. Radiofrequency ablation of superoparaseptal-parahisian accessory pathways from the sinuses of Valsalva region: a three case report. J Interv Card Electrophysiol 2020; 58:119-121. [PMID: 32147800 DOI: 10.1007/s10840-020-00717-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Miguel Jáuregui-Abularach
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Av. Rovira Roure, 80, 25198, Lleida, Lleida, Spain.
| | - Germán Merchán-Ortega
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Av. Rovira Roure, 80, 25198, Lleida, Lleida, Spain
| | - Diego Menéndez-Ramírez
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Av. Rovira Roure, 80, 25198, Lleida, Lleida, Spain
| | - Gabriel Martín-Sánchez
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Av. Rovira Roure, 80, 25198, Lleida, Lleida, Spain
| | - Pablo Sánchez-Millán
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Av. Rovira Roure, 80, 25198, Lleida, Lleida, Spain
| | - Fernando Worner-Diz
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Av. Rovira Roure, 80, 25198, Lleida, Lleida, Spain
| | - Bieito Campos-García
- Department of Cardiology, Hospital Universitari Arnau de Vilanova, IRBLleida, Av. Rovira Roure, 80, 25198, Lleida, Lleida, Spain
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63
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Mohanan Nair KK, Namboodiri N, Valaparambil A. Syncope in a young woman. BMJ 2020; 368:l6877. [PMID: 31974258 DOI: 10.1136/bmj.l6877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Nakamura T, Kanda G, Sasaki Y, Noda R, Hiranuma N, Sumimoto K, Fujii T. Wide QRS tachycardia associated with multiple accessory pathways in a patient with Wolff–Parkinson–White syndrome. J Cardiol Cases 2019; 20:191-196. [DOI: 10.1016/j.jccase.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/16/2019] [Accepted: 04/06/2019] [Indexed: 10/25/2022] Open
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Estimation of the accessory pathway location of the manifest Wolf-Parkinson-White syndrome using synthesized right-sided chest leads. J Interv Card Electrophysiol 2019; 59:43-48. [PMID: 31728876 DOI: 10.1007/s10840-019-00648-2] [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: 06/05/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The classification using QRS morphology of V1 lead is a useful simple predictor of accessory pathway location (type A, R or Rs pattern; type B, rS pattern; type C, QS or Qr pattern), but often leads to misdiagnosis of accessory pathway location, especially in types B and C. The synthesized 18-lead electrocardiography (ECG) derived from standard 12-lead ECG can provide virtual waveforms of right-sided chest leads. This study aimed to evaluate the usefulness of the right-sided chest lead ECG for prediction of accessory pathway location. METHODS This retrospective study included 44 patients in whom successful ablation of manifest Wolff-Parkinson-White (WPW) syndrome was performed. Synthesized ECG waveforms were automatically generated, and ECG data obtained before the procedure. RESULTS There were 26, 4, and 14 patients with left, right, and septal accessory pathways, respectively. All left accessory pathway cases have type A in V1 and syn-V4R leads. Of the 4 right accessory pathway cases, 2 have type B in V1 and syn-V4R leads. Other 2 of 4 cases have type C. In V1 lead, 5 of 14 septal accessory pathway cases have type C, 7 of 14 cases have type B, and 2 of 14cases have type A. In syn-V4R lead, all 14 septal accessory pathway cases have type C. The QRS morphology of V1 and syn-V4 leads could predict the site of accessory pathway with overall accuracy of 79% and 95%, respectively. CONCLUSIONS QRS morphology of syn-V4R lead may be useful for predicting accessory pathway location of manifest WPW syndrome.
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Localized basal left ventricular dyssynchrony induced by manifest accessory pathway: Successful differentiation from cardiac involvement of sarcoidosis with administration of flecainide acetate. J Electrocardiol 2019; 57:87-89. [DOI: 10.1016/j.jelectrocard.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/05/2019] [Indexed: 11/17/2022]
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67
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Management of asymptomatic ventricular preexcitation. Indian Pacing Electrophysiol J 2019; 19:232-239. [PMID: 31669128 PMCID: PMC6904806 DOI: 10.1016/j.ipej.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/19/2019] [Indexed: 11/24/2022] Open
Abstract
An incidental discovery of Wolff Parkinson White (WPW) pattern on the electrocardiogram (ECG) is not an infrequent finding facing the physician. Most patients discovered incidentally are asymptomatic and it is hard to justify further management of such patients given the time-honored adage to “first do no harm.” However, this finding does have implications. This article is an attempt to guide clinicians about this important issue that is often faced in the office.
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Li HY, Chang SL, Chuang CH, Lin MC, Lin YJ, Lo LW, Hu YF, Chung FP, Chang YT, Chung CM, Chen SA, Lee PC. A Novel and Simple Algorithm Using Surface Electrocardiogram That Localizes Accessory Conduction Pathway in Wolff-Parkinson-White Syndrome in Pediatric Patients. ACTA CARDIOLOGICA SINICA 2019; 35:493-500. [PMID: 31571798 DOI: 10.6515/acs.201909_35(5).20190312a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The location of the accessory pathway (AP) can be precisely identified on surface electrocardiography (ECG) in adults with Wolff-Parkinson-White (WPW) syndrome. However, current algorithms to locate the AP in pediatric patients with WPW syndrome are limited. Objective To propose an optimal algorithm that localizes the AP in pediatric patients with WPW syndrome. Methods From 1992 to 2016, 180 consecutive patients aged below 18 years with symptomatic WPW syndrome were included. After the exclusion of patients with non-descriptive electrocardiography (ECG), multiple APs, congenital heart diseases, non-inducible tachycardia, and those who received a second ablation, 104 patients were analyzed retrospectively. Surface ECG was obtained before ablation and evaluated by using previously documented algorithms, from which a new pediatric algorithm was developed. Results Previous algorithms were not highly accurate when used in pediatric patients with WPW syndrome. In the new algorithm, the R/S ratio of V1 and the polarity of the delta wave in lead I could distinguish right from the left side AP with 100% accuracy. The polarity of the delta wave of lead V1 could distinguish free wall AP from septal AP with an accuracy of 100% in left-side AP, compared to 88.6% in leads III and V1 for right-side AP. The overall accuracy was 92.3%. Conclusions This simple, novel algorithm could differentiate left from right AP and septal from free wall AP in pediatric patients with WPW syndrome.
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Affiliation(s)
- Hsing-Yuan Li
- Division of Cardiology, Department of Pediatrics, Taipei Veterans General Hospital.,Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Chi-Hsi Chuang
- Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
| | - Ming-Chih Lin
- Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei.,Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Chieh-Mao Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Department of Pediatric Cardiology, Chinese Medical University Children's Hospital, Taichung, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei
| | - Pi-Chang Lee
- Division of Cardiology, Department of Pediatrics, Taipei Veterans General Hospital.,Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei
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Differentiation of fasciculoventricular fibers from anteroseptal accessory pathways using the surface electrocardiogram. Heart Rhythm 2019; 16:1072-1079. [DOI: 10.1016/j.hrthm.2019.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 11/18/2022]
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Radulescu V, Donnelly J, Willner J, Beldner S, Patel A, Saba SG. Wide complex tachycardia in an elderly woman due to Ebstein’s anomaly with two accessory pathways. HeartRhythm Case Rep 2019; 5:205-208. [PMID: 30997335 PMCID: PMC6453556 DOI: 10.1016/j.hrcr.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Boxhammer E, Goette A, Hammwöhner M, Lüker J, Patscheke M, Pavaci H, Pizzulli L, Razhniova A, Reek D, Schimpf R, Steven D, Wörmann J, Wolpert C, Zrenner B. [Rhythmogenic syncopes and survived sudden cardiac death]. Herzschrittmacherther Elektrophysiol 2019; 30:72-88. [PMID: 30847550 DOI: 10.1007/s00399-019-0614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Elke Boxhammer
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - Andreas Goette
- Arbeitsgruppe Molekulare Elektrophysiologie, Institut für Klinische Chemie und Pathobiochemie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland.
| | - Matthias Hammwöhner
- Arbeitsgruppe Molekulare Elektrophysiologie, Institut für Klinische Chemie und Pathobiochemie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland
| | - Jakob Lüker
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland
| | - Markus Patscheke
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland
| | - Herribert Pavaci
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - L Pizzulli
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland
| | - Alina Razhniova
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland
| | - David Reek
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland.
| | - Rainer Schimpf
- Kardiologische Praxisklinik Ludwigshafen, Standort Neustadt, Schütt 2, 64733, Neustadt a.d. Weinstraße, Deutschland.
| | - Daniel Steven
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland.
| | - Jonas Wörmann
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland
| | - Christian Wolpert
- 2. Medizinische Klinik, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland.
| | - Bernhard Zrenner
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland.
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72
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Melki L, Grubb CS, Weber R, Nauleau P, Garan H, Wan E, Silver ES, Liberman L, Konofagou EE. Localization of Accessory Pathways in Pediatric Patients With Wolff-Parkinson-White Syndrome Using 3D-Rendered Electromechanical Wave Imaging. JACC Clin Electrophysiol 2019; 5:427-437. [PMID: 31000096 DOI: 10.1016/j.jacep.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to demonstrate the feasibility of electromechanical wave imaging (EWI) for localization of accessory pathways (AP) prior to catheter ablation in a pediatric population. BACKGROUND Prediction of AP locations in patients with Wolff-Parkinson-White syndrome is currently based on analysis of 12-lead electrocardiography (ECG). In the pediatric population, specific algorithms have been developed to aid in localization, but these can be unreliable. EWI is a noninvasive imaging modality relying on a high frame rate ultrasound sequence capable of visualizing cardiac electromechanical activation. METHODS Pediatric patients with ventricular pre-excitation presenting for catheter ablation were imaged with EWI immediately prior to the start of the procedure. Two clinical pediatric electrophysiologists predicted the location of the AP based on ECG. Both EWI and ECG predictions were blinded to the results of catheter ablation. EWI and ECG localizations were subsequently compared with the site of successful ablation. RESULTS Fifteen patients were imaged with EWI. One patient was excluded for poor echocardiographic windows and the inability to image the entire ventricular myocardium. EWI correctly predicted the location of the AP in all 14 patients. ECG analysis correctly predicted 11 of 14 (78.6%) of the AP locations. CONCLUSIONS EWI was shown to be capable of consistently localizing accessory pathways. EWI predicted the site of successful ablation more frequently than analysis of 12-lead ECG. EWI isochrones also provide anatomical visualization of ventricular pre-excitation. These findings suggest that EWI can predict AP locations, and EWI may have the potential to better inform clinical electrophysiologists prior to catheter ablation procedures.
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Affiliation(s)
- Lea Melki
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Christopher S Grubb
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Rachel Weber
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Pierre Nauleau
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Elaine Wan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Eric S Silver
- Pediatric Electrophysiology, Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Leonardo Liberman
- Pediatric Electrophysiology, Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Elisa E Konofagou
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York; Department of Radiology, Columbia University Medical Center, New York, New York.
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73
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DeSimone CV, Naksuk N, Asirvatham SJ. Supraventricular Arrhythmias: Clinical Framework and Common Scenarios for the Internist. Mayo Clin Proc 2018; 93:1825-1841. [PMID: 30414732 DOI: 10.1016/j.mayocp.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/18/2018] [Accepted: 07/25/2018] [Indexed: 01/06/2023]
Abstract
Supraventricular arrhythmias can cause uncomfortable symptoms for patients. Often, the first point of contact is in the primary care setting, and thus, it is imperative for the general internist to have a clinical framework in place to recognize this cluster of cardiac arrhythmias, be familiar with immediate and long-term management of supraventricular tachycardias, and understand when cardiac electrophysiologic consultation is necessary. The electrocardiographic characteristics can have subtle but important clues to the diagnosis and initial management. An understanding of the mechanisms of these arrhythmias is essential to provide proper therapy to the patient. In addition, there are common practice strategies that should be emphasized to avoid common misperceptions that could pose risk to the patient. In this review, we provide a framework to more easily recognize and classify these arrhythmias. We also illustrate the mechanism for these arrhythmias to provide an understanding of the interventions generally used.
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Affiliation(s)
| | - Niyada Naksuk
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Samuel J Asirvatham
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN.
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74
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Benhayon D, Sinisterra S, Young ML. Wolff-Parkinson-White syndrome due to a left atrial appendage-to-left ventricular connection: A case of a successful pathway elimination from inside of the left atrial appendage. HeartRhythm Case Rep 2018; 4:519-522. [PMID: 30479950 PMCID: PMC6241166 DOI: 10.1016/j.hrcr.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Daniel Benhayon
- Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, Florida
| | | | - Ming-Long Young
- Division of Pediatric Electrophysiology, Joe DiMaggio Children's Hospital, Hollywood, Florida
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75
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de Alencar Neto JN, Nagahama MV, de Moraes SRR, Magliari RT, Cirenza C, de Paola AAV. Radiofrequency ablation of a middle cardiac vein inserted accessory pathway resulting in posterolateral coronary artery occlusion: A case report. Indian Pacing Electrophysiol J 2018; 19:34-38. [PMID: 30414465 PMCID: PMC6354235 DOI: 10.1016/j.ipej.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/21/2018] [Accepted: 11/05/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Posteroseptal accessory pathways account for 34.5% of the total. Of these, 36% are located within the coronary sinus (CS). Its ablation requires technical alternatives to avoid damage to surrounding tissues, especially branches of the right coronary artery. Case report A 22-year-old man was referred for re-do ablation of an accessory left septal-septal (PSE) pathway. Inside the CS, a precocity of 25 ms was found in the region of the median cardiac vein (VCM) (Fig. 2, panel A). Radiofrequency (RF) was administered with a non-irrigated bidirectional catheter within this vessel with resolution of the pre-excitation after 5 seconds. Immediately after, the patient presented chest pain and revealed a ST segment elevation of 1 mm in the inferior leads of ECG. Coronary angiography showed occlusion of the middle third of the posterior ventricular branch of the right coronary artery, with no signs of thrombus or dissection. Arterial angioplasty was performed with a bare metal stent, followed by TIMI III distal flow. Retrograde aortic mapping was performed and a precocity of 20 ms was found in the PSE region. The RF was applied followed by loss of pre-excitation after 1.5 seconds of application. Conclusion This case demonstrates the risks involving delivering radiofrequency within the coronary sinus. We discuss some strategy that could help electrophysiologists in similar cases.
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Affiliation(s)
| | - Marina Vieira Nagahama
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
| | | | - Rafael Thiesen Magliari
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
| | - Claudio Cirenza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
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76
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Sato E, Yagi T, Ishida A, Mibiki Y, Yamashina Y, Sato H, Nakagawa T, Aoki K, Suzuki K, Takuma I, Yambe T. Idiopathic ventricular arrhythmias arising from the posterior septum of tricuspid and mitral annuli: comparison of electrocardiographic characteristics and outcomes of catheter ablation. J Interv Card Electrophysiol 2018; 54:125-134. [PMID: 30280303 DOI: 10.1007/s10840-018-0456-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Ventricular arrhythmia (VA) arising from the tricuspid annulus in the posterior septum (PS) (TAPS-VA) has similar electrocardiographic characteristics as VA arising from the mitral annulus in the PS (MAPS-VA) because the two locations are adjacent. We examined the electrocardiographic characteristics that differentiate MAPS-VA from TAPS-VA and the efficacy of catheter ablation. METHODS We studied 13 patients whose VAs were successfully ablated in the TAPS (n = 7) and MAPS (n = 6). RESULTS QRS morphologies of both groups were characterized by left and right bundle block morphologies in lead V1, superior axis deviation, and precordial transition at ≤ lead V3 in nine patients. Compared with TAPS-VA, MAPS-VA had (1) R < S wave in lead II, (2) precordial transition in lead V2, (3) s-wave in lead V6, and (4) slurred initial part of the QRS complex in the precordial leads, e.g., [4a] pseudo delta wave ≥ 34 ms, [4b] intrinsicoid deflection time ≥ 85 ms, and [4c] maximum deflection index ≥ 0.55. Patients who met ≥ 2 of (1)-(3) and any of [4a]-[4c] could be classified as having MAPS-VA, with a sensitivity and specificity of 100%. VA recurred in one patient in the TAPS group during the median follow-up of 7 (interquartile range 6 to 15.5) months. CONCLUSIONS VA arising from the PS has superior axis deviation, and left and right bundle block morphologies with relatively early precordial transition. MAPS-VA can be differentiated from TAPS-VA based on electrocardiographic characteristics. This study provides useful information for treatment involving catheter ablation for VA arising from the PS.
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Affiliation(s)
- Eiji Sato
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan.,Department of Medical Engineering and Cardiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tetsuo Yagi
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan.
| | - Akihiko Ishida
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Yoshiaki Mibiki
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Yoshihiro Yamashina
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Hirokazu Sato
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Takashi Nakagawa
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Kosuke Aoki
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Keisuke Suzuki
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Izutsu Takuma
- Division of Cardiology, Sendai City Hospital, Taihaku-ku, Asutonagamachi1-1-1, Sendai, Miyagi, 982-8502, Japan
| | - Tomoyuki Yambe
- Department of Medical Engineering and Cardiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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78
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Leitz P, Wasmer K, Köbe J, Dechering DG, Frommeyer G, Güner F, Ellermann C, Reinke F, Eckardt L. Remaining challenges in catheter ablation of accessory pathways: rare entity of coronary sinus diverticulum-associated pathways. Clin Res Cardiol 2018; 108:388-394. [DOI: 10.1007/s00392-018-1367-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/31/2018] [Indexed: 12/01/2022]
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79
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Pambrun T, El Bouazzaoui R, Combes N, Combes S, Sousa P, Le Bloa M, Massoullié G, Cheniti G, Martin R, Pillois X, Duchateau J, Sacher F, Hocini M, Jaïs P, Derval N, Bortone A, Boveda S, Denis A, Haïssaguerre M, Albenque JP. Maximal Pre-Excitation Based Algorithm for Localization of Manifest Accessory Pathways in Adults. JACC Clin Electrophysiol 2018; 4:1052-1061. [DOI: 10.1016/j.jacep.2018.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/06/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022]
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80
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Delta wave notching time is associated with accessory pathway localization in patients with Wolff-Parkinson-White syndrome. J Interv Card Electrophysiol 2018; 53:73-79. [PMID: 30014371 DOI: 10.1007/s10840-018-0411-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Our aim was to investigate the relation between delta wave notching time (DwNt) and accessory pathway location in patients with Wolff-Parkinson-White (WPW) syndrome. METHODS The retrospective study included 149 WPW patients who underwent ablation therapy. DwNt was defined as the duration between the initial point of QRS and the notching in the delta wave. DwNt was divided by QRS duration to obtain the delta wave index (Dwi). RESULTS Patients with left-sided accessory pathway (AP) had significantly higher DwNt (p < 0.001) and Dwi (p = 0.027) values. The R wave voltage in lead I (p = 0.037) and S wave voltage in lead V1 (p = 0.005) values were significantly higher in patients with right-sided AP compared to patients with left-sided AP. When 27 ms was taken as the DwNt cut-off value, higher durations determined the left-sided AP location with a sensitivity of 91% and a negative predictive value of 91.4%. Dwi cutoff values ≥ 0.29 were accepted to indicate a left-sided AP location with a sensitivity of 91.2% and a NPV of 91.4%. CONCLUSIONS WPW patients with left-sided AP have longer DwNt values than patients with right-sided AP.
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81
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Hasdemir C, Juang JJM, Kose S, Kocabas U, Orman MN, Payzin S, Sahin H, Celen C, Ozcan EE, Chen CYJ, Gunduz R, Turan OE, Senol O, Burashnikov E, Antzelevitch C. Coexistence of atrioventricular accessory pathways and drug-induced type 1 Brugada pattern. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1078-1092. [PMID: 29953624 DOI: 10.1111/pace.13414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/30/2018] [Accepted: 05/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial arrhythmias, particularly atrioventricular nodal reentrant tachycardia, can coexist with drug-induced type 1 Brugada electrocardiogram (ECG) pattern (DI-Type1-BrP). The present study was designed to determine the prevalence of DI-Type1-BrP in patients with atrioventricular accessory pathways (AV-APs) and to investigate the clinical, electrocardiographic, electrophysiologic, and genetic characteristics of these patients. METHODS One-hundred twenty-four consecutive cases of AV-APs and 84 controls underwent an ajmaline challenge test to unmask DI-Type1-BrP. Genetic screening and analysis was performed in 55 of the cases (19 with and 36 without DI-Type1-BrP). RESULTS Patients with AV-APs were significantly more likely than controls to have a Type1-BrP unmasked (16.1 vs 4.8%, P = 0.012). At baseline, patients with DI-Type1-BrP had higher prevalence of chest pain, QR/rSr' pattern in V1 and QRS notching/slurring in V2 and aVL during preexcitation, rSr' pattern in V1 -V2 , and QRS notching/slurring in aVL during orthodromic atrioventricular reentrant tachycardia (AVRT) compared to patients without DI-Type1-BrP. Abnormal QRS configuration (QRS notching/slurring and/or fragmentation) in V2 during preexcitation was present in all patients with DI-Type1 BrP. The prevalence of spontaneous preexcited atrial fibrillation (AF) and history of AF were similar (15% vs 18.3%, P = 0.726) in patients with and without DI-Type1-BrP, respectively. The prevalence of mutations in Brugada-susceptibility genes was higher (36.8% vs 8.3%, P = 0.02) in patients with DI-Type1-BrP compared to patients without DI-Type1-BrP. CONCLUSIONS DI-Type1-BrP is relatively common in patients with AV-APs. We identify 12-lead ECG characteristics during preexcitation and orthodromic AVRT that point to an underlying type1-BrP, portending an increased probability for development of malignant arrhythmias.
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Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | | | | | - Umut Kocabas
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Mehmet N Orman
- Department of Biostatistics and Medical Informatics, Ege University School of Medicine, Izmir, Turkey
| | - Serdar Payzin
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Hatice Sahin
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Candan Celen
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Emin E Ozcan
- Department of Cardiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ching-Yu Julius Chen
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | | | | | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Lankenau Heart Institute, Wynnewood, PA, USA.,Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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82
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[Mapping and ablation of cardiac arrhythmias : Never forget where you are coming from]. Herzschrittmacherther Elektrophysiol 2018; 29:246-253. [PMID: 29946890 DOI: 10.1007/s00399-018-0577-8] [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: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
With the rapid development of new mapping and imaging technologies as well as catheter ablation technologies, it is increasingly important to understand the basic concepts of conventional mapping and ablation of cardiac arrhythmias. Prerequisite for successful ablation is the exact identification of the tachycardia mechanism and subsequent localization of the origin or tachycardic substrate. Only intracardiac electrograms provide decisive information regarding activation time and signal morphology. In some arrhythmias, it is necessary to supplement conventional mapping with so-called pace and/or entrainment mapping. This article aims to discuss and demonstrate the fundamentals of intracardiac mapping as it relates to the mapping and ablation of supraventricular and ventricular arrhythmias based on representative clinical cases. Modern three-dimensional mapping methods make it possible to individually optimize established ablation strategies with significantly better spatial resolution. The authors aimed to demonstrate that intracardiac uni- and bipolar electrograms provide essential information about timing and morphology guiding successful catheter ablation. Furthermore, our article provides useful information about conventional cardiac mapping techniques including activation mapping, pace mapping, and individual substrate mapping.
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83
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Butt MU, Patel R, Darrat YH, Morales GX, Elayi CS. When a Pseudo-Infarct Electrocardiogram (ECG) Pattern in a Posterior Accessory (Wolff-Parkinson-White) Pathway Masks a True Inferior Infarct. Am J Case Rep 2018; 19:685-688. [PMID: 29895817 PMCID: PMC6029515 DOI: 10.12659/ajcr.909189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) pattern is due to a pre-excitation leading to characteristic ECG changes in sinus rhythm as short PR interval, the presence of delta waves, wide QRS complexes, and potentially Q wave-T wave vector discordance (pseudo-infarct pattern). These later changes can mask the underlying ECG depolarizing solely through the His-Purkinje system. Our case highlights how the ECG of a WPW pattern with a pseudo-infarct pattern can in fact mask a true infarct on the underlying ECG without pre-excitation. CASE REPORT A 61-year-old diabetic man with a recent history of supra-ventricular tachycardia (SVT) presented with the ECG characteristic of a Wolff-Parkinson-White pattern i-e short PR interval of 0.10 s (<0.12 s) and the presence of delta waves in sinus rhythm. In addition, there was a wide significant Q wave in the inferior leads meeting the criteria for significant and pathologic Q waves, related to the pre-excitation and known as a pseudo-infarct pattern. The patient underwent successful ablation of his left inferoseptal accessory pathway. The pre-excitation pattern (short PR and delta wave) disappeared after successful ablation revealed a narrower Q wave in inferior leads, likely from unexpected true old inferior infarction, which was later confirmed by 2D echocardiogram and nuclear stress test (fixed inferior defect). CONCLUSIONS The presence of pseudo-infarct pattern due to a WPW does not always preclude the presence of underlying true infarct pattern, especially in the presence of coronary artery disease risk factors.
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Affiliation(s)
- Muhammad U Butt
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Ripa Patel
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Yousef H Darrat
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Gustavo X Morales
- Department of Cardiology, Grandview Medical Center, Birmingham, AL, USA
| | - Claude S Elayi
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
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84
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de Alencar Neto JN, Ramalho de Moraes SR, Back Sternick E, Wellens HJJ. Atypical bypass tracts: can they be recognized during sinus rhythm? Europace 2018; 21:208-218. [DOI: 10.1093/europace/euy079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- José Nunes de Alencar Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Saulo Rodrigo Ramalho de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Eduardo Back Sternick
- Faculdade Ciências Médicas, Belo Horizonte, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte - MG, Brazil
- Arrhythmia Unit, Biocor Hospital, Alameda Oscar Niemeyer, 217 - Vila da Serra, Nova Lima - MG, Brazil
| | - Hein J J Wellens
- Cardiovascular Research Institute, Cardiovascular Research Institute, 6229 HX Maastricht, The Netherlands
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85
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Liu Q, Shehata M, Lan DZ, Ehdaie A, Cingolani E, Chugh SS, Fu G, Jiang C, Wang X. Accurate localization and catheter ablation of superoparaseptal accessory pathways. Heart Rhythm 2018; 15:688-695. [DOI: 10.1016/j.hrthm.2017.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 11/25/2022]
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86
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Viu J, Armengou L, Decloedt A, Jose-Cunilleras E. Investigation of ventricular pre-excitation electrocardiographic pattern in two horses: clinical presentation and potential causes. J Vet Cardiol 2018; 20:213-221. [PMID: 29573995 DOI: 10.1016/j.jvc.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 01/02/2023]
Abstract
Two horses referred to the Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, for unrelated clinical problems, and with no previous history of cardiac disease exhibited an intermittent ventricular pre-excitation electrocardiographic pattern during hospitalization. Both animals showed decreased plasma total and ionized magnesium concentrations, but no other relevant electrolyte disturbances were detected. Altered interventricular septal motion associated with ventricular pre-excitation beats (VPBs) was detected on M-mode echocardiography in both horses. The likely localization of an accessory pathway (AP) was identified in case 2 using pulsed-wave tissue Doppler imaging in the left anterior paraseptal location. Decreased frequency of the VPB was observed with long-term magnesium supplementation and restoration of plasma magnesium concentrations. The presence of ventricular pre-excitation electrocardiographic pattern was attributed to higher sensitivity of the AP to hypomagnesemia in both cases.
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Affiliation(s)
- Judit Viu
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lara Armengou
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annelies Decloedt
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eduard Jose-Cunilleras
- Servei de Medicina Interna Equina, Unitat Equina, Fundació Hospital Clínic Veterinari, Barcelona, Spain; Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.
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87
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Stühlinger MC, Nowak CN, Spuller K, Etsadashvili K, Stühlinger X, Berger T, Dichtl W, Gothe RM, Fischer G, Hintringer F, Rantner LJ. Localizing the Accessory Pathway in Ventricular Preexcitation Patients Using a Score Based Algorithm. Methods Inf Med 2018; 51:3-12. [DOI: 10.3414/me11-01-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 08/23/2011] [Indexed: 11/09/2022]
Abstract
SummaryObjectives: Clinical data was analyzed to find an efficient way to localize the accessory pathway in patients with ventricular preexcitation.Methods: The delta wave morphologies and ablation sites of 186 patients who underwent catheter ablation were analyzed and an algorithm (“locAP”) to localize the accessory pathway was developed from the 84 data sets with a PQ interval ≤ 0.12 s and a QRS width ≥ 0.12 s. Fifty additional patients were included for a prospective validation. The locAP algorithm ranks 13 locations according to the likelihood that the accessory pathway is localized there. The algorithm is based on the locAP score which uses the standardized residuals of the available data sets.Results: The locAP algorithm’s accuracy is 0.54 for 13 locations, with a sensitivity of 0.84, a specificity of 0.97, and a positive likelihood ratio of 24.94. If the two most likely locations are regarded, the accuracy rises to 0.79, for the three most likely locations combined the accuracy is 0.82. This new algorithm performs better than Milstein’s, Fitzpatrick’s, and Arruda’s algorithm both in the original study population as well as in a prospective study.Conclusions: The locAP algorithm is a valid and valuable tool for clinical practice in a cardiac electrophysiology laboratory. It could be shown that use of the locAP algorithm is favorable over the localizing algorithms that are in clinical use today.
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88
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Takahashi K, Nagashima K, Okumura Y, Watanabe I, Iso K, Hirayama A. Resolution of the functional retrograde right bundle branch block during antidromic atrioventricular reciprocating tachycardia. HeartRhythm Case Rep 2017; 3:519-522. [PMID: 29387543 PMCID: PMC5778097 DOI: 10.1016/j.hrcr.2017.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Koichi Nagashima
- Address reprint requests and correspondence: Dr Koichi Nagashima, Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1, Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan.Division of CardiologyDepartment of MedicineNihon University School of Medicine30-1, Ohyaguchi-kamichoItabashi-kuTokyo173-8610Japan
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89
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Abstract
The atrioventricular junction is a pivotal component of the cardiac conduction system, a key electrical relay site between the atria and the ventricles. The sophisticated functions carried out by the atrioventricular junction are possible for the presence of a complex apparatus made of specialized anatomic structures, cells with specific ion-channel expression, a well-organized spatial distribution of intercellular junctions (connexins), cells with intrinsic automatism, and a rich autonomic innervation. This article reviews the main anatomic and electrophysiologic features of the atrioventricular junction, with a focus on cardiac preexcitation.
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90
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Xue Y, Zhan X, Wu S, Wang H, Liu Y, Liao Z, Deng H, Duan X, Zeng S, Liang D, Elvan A, Fang X, Liao H, Ramdat Misier AR, Smit JJJ, Metzner A, Heeger CH, Liu F, Wang F, Zhang Z, Kuck KH, Yen Ho S, Ouyang F. Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans. Circ Arrhythm Electrophysiol 2017. [DOI: 10.1161/circep.116.005207] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ablation of para-Hisian accessory pathway (AP) poses high risks of atrioventricular block. We developed a pacing technique to differentiate the near-field (NF) from far-field His activations to avoid the complication.
Methods and Results—
Three-dimensional mapping of the right ventricle was performed in 15 mongrel dogs and 23 patients with para-Hisian AP. Using different pacing outputs, the NF- and far-field His activation was identified on the ventricular aspect. Radiofrequency application was delivered at the NF His site in 8 (group 1) and the far-field His site in 7 dogs (group 2), followed by pathologic examination after 14 days. NF His activation was captured with 5 mA/1 ms in 10 and 10 mA/1 ms in 5 dogs. In group 1, radiofrequency delivery resulted in complete atrioventricular block in 3, right bundle branch block with HV (His-to-ventricular) interval prolongation in 1, and only right bundle branch block in 2 dogs, whereas no changes occurred in group 2. Pathologic examination in group-1 dogs showed complete or partial necrosis of the His bundle in 4 and complete necrosis of the right bundle branch in 5 dogs. In group 2, partial necrosis in the right bundle branch was found only in 1 dog. Using this pacing technique, the APs were 5.7±1.2 mm away from the His bundle located superiorly in 20 or inferiorly in 3 patients. All APs were successfully eliminated with 1 to 3 radiofrequency applications. No complications and recurrence occurred during a follow-up of 11.8±1.4 months.
Conclusions—
Differentiating the NF His from far-field His activations led to a high ablation success without atrioventricular block in para-Hisian AP patients.
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Affiliation(s)
- Yumei Xue
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Xianzhang Zhan
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Shulin Wu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Hongyue Wang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Yang Liu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Zili Liao
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Hai Deng
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Xuejing Duan
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Shaoying Zeng
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Dongpo Liang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Arif Elvan
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Xianhong Fang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Hongtao Liao
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Anand R. Ramdat Misier
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Jaap Jan J. Smit
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Andreas Metzner
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Christian-Hendrik Heeger
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Fangzhou Liu
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Feng Wang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Zhiwei Zhang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Karl-Heinz Kuck
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Siew Yen Ho
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
| | - Feifan Ouyang
- From the Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, China (Y.X., X.Z., S.W., Y.L., Z.L., H.D., S.Z., D.L., X.F., H.L., F.L., F.W., Z.Z.); Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing (H.W., X.D.); Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (A
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91
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Janson CM, Shah MJ. Supraventricular Tachycardia in Adult Congenital Heart Disease: Mechanisms, Diagnosis, and Clinical Aspects. Card Electrophysiol Clin 2017; 9:189-211. [PMID: 28457235 DOI: 10.1016/j.ccep.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Supraventricular arrhythmias represent a major source of morbidity in adults with congenital heart disease (ACHD). Anatomic variants and post-operative changes contribute to a unique electrophysiologic milieu ripe for the development of supraventricular tachycardia. Intra-atrial reentrant tachycardia is the most prevalent mechanism. Atrioventricular reciprocating tachycardia is common in lesions associated with accessory pathways. Abnormal anatomy complicates the management of atrioventricular nodal reentrant tachycardia. Tachycardia mediated by twin atrioventricular nodes is rare. Focal tachycardias are considerations in the ACHD population. Each of these tachycardia mechanisms is reviewed, focusing on the inherent diagnostic and therapeutic challenges.
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, Bronx, NY 10467, USA.
| | - Maully J Shah
- Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th & Civic Center Boulevard, Philadelphia, PA 19104, USA
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93
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Asirvatham SJ, Stevenson WG. Expecting the Expected. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004726. [DOI: 10.1161/circep.116.004726] [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] [Received: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases, Department of Medicine and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (W.G.S.)
| | - William G. Stevenson
- From the Division of Cardiovascular Diseases, Department of Medicine and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (W.G.S.)
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94
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Voss F, Eckardt L, Busch S, Estner HL, Steven D, Sommer P, von Bary C, Neuberger HR. [AV-reentrant tachycardia and Wolff-Parkinson-White syndrome : Diagnosis and treatment]. Herzschrittmacherther Elektrophysiol 2016; 27:381-389. [PMID: 27878364 DOI: 10.1007/s00399-016-0466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/01/2022]
Abstract
The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/1000. The pathophysiological basis is an accessory atrioventricular pathway (AP). Patients with AVRT typically present with palpitations, an on-off characteristic, anxiety, dyspnea, and polyuria. This type of tachycardia may often be terminated by vagal maneuvers. Although the clinical presentation of AVRT is quite similar to AV-nodal reentrant tachycardias, the correct diagnosis is often facilitated by analyzing a standard 12-lead ECG at normal heart rate showing ventricular preexcitation. Curative catheter ablation of the AP represents the therapy of choice in symptomatic patients. This article is the fourth part of a series written to improve the professional education of young electrophysiologists. It explains pathophysiology, symptoms, and electrophysiological findings of an invasive EP study. It focusses on mapping and ablation of accessory pathways.
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Affiliation(s)
- Frederik Voss
- Innere Medizin III, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54290, Trier, Deutschland.
| | - Lars Eckardt
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Sonia Busch
- Medizinische Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Coburg, Coburg, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Universitätsklinikum München-Großhadern, München, Deutschland
| | - Daniel Steven
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Köln, Deutschland
| | - Philipp Sommer
- Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Deutschland
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95
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Nishiyama T, Kimura T, Nishiyama N, Aizawa Y, Fukuda K, Takatsuki S. Successful catheter ablation of an anteroseptal accessory pathway without impairing the atrioventricular conduction. Int J Cardiol 2016; 222:782-784. [PMID: 27521559 DOI: 10.1016/j.ijcard.2016.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Takahiko Nishiyama
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Nobuhiro Nishiyama
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
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96
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Teixeira CM, Pereira TA, Lebreiro AM, Carvalho SA. Accuracy of the Electrocardiogram in Localizing the Accessory Pathway in Patients with Wolff-Parkinson-White Pattern. Arq Bras Cardiol 2016; 107:331-338. [PMID: 27627222 PMCID: PMC5102479 DOI: 10.5935/abc.20160132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/13/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are currently several electrocardiographic algorithms to locate the accessory pathway (AP) in patients with Wolff-Parkinson-White (WPW) syndrome. OBJECTIVE To compare the ability of electrocardiographic algorithms in identifying the location of the AP in patients with WPW pattern referred for ablation. METHODS Observational, cross-sectional, retrospective study with 111 patients with WPW syndrome referred for AP ablation. The electrocardiogram (ECG) obtained prior to the ablation was analyzed by an experienced observer who consecutively applied seven algorithms to identify non-invasively the AP. We then compared the location estimated with this assessment with that obtained in the electrophysiological study and calculated the agreement rates. RESULTS Among the APs, 59 (53.15%) were distributed around the mitral annulus and the remaining 52 (46.85%) were located around the tricuspid annulus. The overall absolute accuracy of the algorithms evaluated varied between 27% and 47%, increasing to between 40% and 76% when we included adjacent locations. The absolute agreement rate by AP location was 2.00-52.20% for septal APs (n = 51), increasing to 5.90-90.20% when considering adjacent locations; 7.70-69.20% for right APs (n = 13), increasing to 42.90-100% when considering adjacent locations; and 21.70-54.50% for left APs (n = 47), increasing to 50-87% when considering adjacent locations. CONCLUSION The agreement rates observed for the analyzed scores indicated a low discriminative ability of the ECG in locating the AP in patients with WPW.
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Affiliation(s)
- Carlos Manuel Teixeira
- Departamento de Fisiologia Clínica, ESTESC, Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Telmo António Pereira
- Departamento de Fisiologia Clínica, ESTESC, Instituto Politécnico de Coimbra, Coimbra, Portugal
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97
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Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, D'Avila A, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GYH, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace 2016; 18:1455-1490. [PMID: 27402624 DOI: 10.1093/europace/euw161] [Citation(s) in RCA: 429] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andreas Goette
- Departement of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Germany
| | - Jonathan M Kalman
- University of Melbourne, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Sumeet S Chugh
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | | | - Mario Gonzalez
- Penn State Heart and Vascular Institute, Penn State University, Hershey, PA, USA
| | - Stephane N Hatem
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Robert Helm
- Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | | | - Siew Yen Ho
- Royal Brompton Hospital and Imperial College London, London, UK
| | - Brian Hoit
- UH Case Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - William Uribe
- Electrophysiology Deparment at Centros Especializados de San Vicente Fundación and Clínica CES. Universidad CES, Universidad Pontificia Bolivariana (UPB), Medellin, Colombia
| | | | - Stanley Nattel
- Université de Montréal, Montreal Heart Institute Research Center and McGill University, Montreal, Quebec, Canada .,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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Munro J, Shen WK, Srivathsan K. Pre-excited tachycardia: Atrial tachycardia with a bystander left lateral accessory pathway. HeartRhythm Case Rep 2016; 2:334-338. [PMID: 28491704 PMCID: PMC5419890 DOI: 10.1016/j.hrcr.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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WAKABAYASHI YASUSHI, HAYASHI TAKEKUNI, YAMAMOTO SHINGO, SUGAWARA YOSHITAKA, MITSUHASHI TAKESHI, FUJITA HIDEO, MOMOMURA SHINICHI. Third Entrainment Criterion in Wide QRS Tachycardia: Ventricular Tachycardia or Antidromic Atrioventricular Reentrant Tachycardia? J Cardiovasc Electrophysiol 2016; 27:881-3. [DOI: 10.1111/jce.12942] [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] [Received: 01/04/2016] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/27/2022]
Affiliation(s)
- YASUSHI WAKABAYASHI
- Division of Cardiovascular Medicine, Saitama Medical Center; Jichi Medical University, Saitama City; Saitama Japan
| | - TAKEKUNI HAYASHI
- Division of Cardiovascular Medicine, Saitama Medical Center; Jichi Medical University, Saitama City; Saitama Japan
| | - SHINGO YAMAMOTO
- Division of Cardiovascular Medicine, Saitama Medical Center; Jichi Medical University, Saitama City; Saitama Japan
| | - YOSHITAKA SUGAWARA
- Division of Cardiovascular Medicine, Saitama Medical Center; Jichi Medical University, Saitama City; Saitama Japan
| | - TAKESHI MITSUHASHI
- Division of Cardiovascular Medicine, Saitama Medical Center; Jichi Medical University, Saitama City; Saitama Japan
| | - HIDEO FUJITA
- Division of Cardiovascular Medicine, Saitama Medical Center; Jichi Medical University, Saitama City; Saitama Japan
| | - SHIN-ICHI MOMOMURA
- Division of Cardiovascular Medicine, Saitama Medical Center; Jichi Medical University, Saitama City; Saitama Japan
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Ishizu T, Seo Y, Igarashi M, Sekiguchi Y, Machino-Ohtsuka T, Ogawa K, Kuroki K, Yamamoto M, Nogami A, Kawakami Y, Aonuma K. Noninvasive Localization of Accessory Pathways in Wolff-Parkinson-White Syndrome by Three-Dimensional Speckle Tracking Echocardiography. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004532. [PMID: 27307551 DOI: 10.1161/circimaging.116.004532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We have developed a noninvasive isochrone activation imaging (AI) system with 3-dimensional (3D) speckle tracking echocardiography (STE), which allows visualization of the wavefront image of mechanical propagation of the accessory pathway (ACP) in Wolff-Parkinson-White syndrome. METHODS AND RESULTS Patients with manifest Wolff-Parkinson-White syndrome were imaged in 3D-STE AI mode, which quantified the time from QRS onset to regional endocardial deformation. In 2 patients with left- and right-side ACP, we confirmed that intraoperative contact endocardial electric mapping and the 3D-STE AI system showed comparable images pre- and postablation. In normal heart assessment by 3D-echo AI, the earliest activation sites were found at the attachment of the papillary muscles in the left ventricle and midseptum in the right ventricle, and none showed earliest activation at the peri-atrioventricular valve annuli. An analyzer who was unaware of the clinical information assessed 39 ACP locations in 38 Wolff-Parkinson-White syndrome patients using 3D-STE. All showed abnormal perimitral or tricuspid annular activations, and the location of 34 ACP (87%) showed agreement with the successful ablation sites within a 2-o'clock range. Especially for left free wall ACP, 17/18 (94%) showed consistency with the ablation site within a 2 o'clock range. Among 15 ACP at the ventricular septum, 9 (60%) showed early local activation in both right and left sides of the septum. CONCLUSIONS Isochrone AI with 3D-STE may be a promising noninvasive imaging tool to assess cardiac synchronized activation in normal hearts and detect abnormal breakthrough of mechanical activation from both atrioventricular annuli in Wolff-Parkinson-White syndrome.
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Affiliation(s)
- Tomoko Ishizu
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan.
| | - Yoshihiro Seo
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Miyako Igarashi
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Yukio Sekiguchi
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Tomoko Machino-Ohtsuka
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Kojiro Ogawa
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Kenji Kuroki
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Masahiro Yamamoto
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Akihiko Nogami
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Yasushi Kawakami
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Kazutaka Aonuma
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
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