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Callans DJ, Jacobson JT. Nonpharmacologic Treatment of Tachyarrhythmias. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Oddsson H, Walfridsson H, Edvardsson N. Perception and documentation of arrhythmias after successful radiofrequency catheter ablation of accessory pathways. Ann Noninvasive Electrocardiol 2006; 6:216-21. [PMID: 11466140 PMCID: PMC7027629 DOI: 10.1111/j.1542-474x.2001.tb00111.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Some patients continue to have palpitations in spite of successful ablation of Wolff-Parkinson-White (WPW) syndrome. Recurrence of accessory pathways as well as unrelated arrhythmias may explain the symptoms. METHODS We followed 194 consecutive patients after successful radiofrequency catheter ablation of overt (147) or concealed (47) WPW syndrome. The mean duration of symptoms was 16 +/- 13 years. Atrial fibrillation was documented in 54 patients (24%) prior to ablation. 185 patients responded to a questionnaire 24 +/- 12 months after ablation. RESULTS The physical well-being was improved in 94%, unchanged in 5%, and deteriorated in 1%. However, 76 patients (39%) reported arrhythmia symptoms, in 40 patients causing pharmacological treatment (14 patients) and/or continued contact with their doctor. The underlying arrhythmias were orthodromic tachycardia (10), atrial fibrillation (12), premature beats (12), atrial flutter (1), and ventricular tachycardia (1), while in four patients no explanation was found. Minor symptoms in the other 36 patients were explained by premature beats in 29, while unexplained in 7. All patients with atrial fibrillation after ablation had atrial fibrillation before ablation. Ten relapses of WPW syndrome occurred: eight were known before the time of the questionnaire, two were confirmed at transesophageal atrial stimulation. CONCLUSION 94% patients with a long history of tachyarrhythmias due to the WPW syndrome reported improved physical well-being after ablation, but palpitations were common during a 2-year follow-up period; 8% continued to use pharmacological antiarrhythmic treatment. Five percent had symptomatic relapses and in 6% atrial fibrillation episodes reoccurred, i.e., in half of those who had atrial fibrillation before ablation.
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Affiliation(s)
- H Oddsson
- Division of Cardiology, Orebro Medical Center Hospital, 701 85 Orebro, Sweden.
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53
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247-346. [PMID: 16949478 DOI: 10.1016/j.jacc.2006.07.010] [Citation(s) in RCA: 867] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vaseghi M, Cesario DA, Mahajan A, Wiener I, Boyle NG, Fishbein MC, Horowitz BN, Shivkumar K. Catheter Ablation of Right Ventricular Outflow Tract Tachycardia: Value of Defining Coronary Anatomy. J Cardiovasc Electrophysiol 2006; 17:632-7. [PMID: 16836713 DOI: 10.1111/j.1540-8167.2006.00483.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Thermal damage to coronary arteries during catheter ablation has been previously reported. Coronary artery damage during LV outflow tract ventricular tachycardia is well recognized. However, the relationship of the coronary arteries to the RV outflow tract during catheter ablation has not been delineated. The purpose of this study was to define the relationship between the RV outflow tract and the coronary arteries utilizing arteriography, echocardiography, CT angiography, and gross anatomic pathology. METHODS The relationship of the coronaries to the RV outflow tract was analyzed in three patients groups: Group 1: patients (n = 10) undergoing RV outflow tract ventricular tachycardia; Group 2: patients (n = 50) undergoing CT coronary angiography; Group 3: patients (n = 4) undergoing echocardiography during open heart surgery and intracardiac echocardiography (ICE) during catheter ablation of atrial fibrillation (n = 5). RESULTS Group 1: The left main coronary artery was found to be 3.8 +/- 1.2 mm from the right ventricular outflow tract in patients undergoing ablation. Group 2: The minimum distance between the left main, left anterior descending, and right coronary artery to the RV outflow tract endocardial wall were 4.1 +/- 1.9 mm, 2.0 +/- 0.6 mm, and 4.3 +/- 1.9 mm (average +/- SD) respectively. Group 3: During open heart surgery using echocardiography, the minimum distance between the left main and the right coronary artery to the RV outflow tract were 3.4 +/- 0.35 mm and 2.0 +/- 0.1 mm, respectively. The distance between the let main coronary artery and the RVOT by ICE was 3.8 +/- 0.45 mm. CONCLUSIONS The major coronary arteries lie in close proximity of the RVOT, and their anatomic course should be taken into consideration during ablation of ventricular tachycardias arising from the RV outflow tract.
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Affiliation(s)
- Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA
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55
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Patriarca C, Bergamaschi F, Gazzano G, Corrada P, Ordesi G, Zanitzer L, Di Pasquale M, Giunta P, Campo B. Histopathological findings after radiofrequency (RITA) treatment for prostate cancer. Prostate Cancer Prostatic Dis 2006; 9:266-9. [PMID: 16683010 DOI: 10.1038/sj.pcan.4500877] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Radiofrequency interstitial tumor ablation (RITA) is a thermal ablation method that uses needles and low radiofrequency (RF) energy. The aim of our study was to evaluate the histopathology of thermal lesions induced by RF energy delivered interstitially in prostate cancer patients who subsequently underwent prostatectomy, and to determine the feasibility, effectiveness and safety of this new method in a pilot study.
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Affiliation(s)
- C Patriarca
- Pathology Department, Azienda Ospedaliera di Melegnano, Milan, Italy
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56
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Lee PC, Hwang B, Chen YJ, Tai CT, Chen SA, Chiang CE. Electrophysiologic Characteristics and Radiofrequency Catheter Ablation in Children with Wolff-Parkinson-White Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:490-5. [PMID: 16689844 DOI: 10.1111/j.1540-8159.2006.00381.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The majority of cardiac arrhythmias in children are supraventricular tachycardia, which is mainly related to an accessory pathway (AP)-mediated reentry mechanism. The investigation for Wolff-Parkinson-White (WPW) syndrome in adults is numerous, but there is only limited information for children. This study was designed to evaluate the specific electrophysiologic characteristics and the outcome of radiofrequency (RF) catheter ablation in children with WPW syndrome. METHODS From December 1989 to August 2005, a total of 142 children and 1,219 adults with atrioventricular reentrant tachycardia (AVRT) who underwent ablation at our institution were included. We compared the clinical and electrophysiologic characteristics between children and adults with WPW syndrome. RESULTS The incidence of intermittent WPW syndrome was higher in children (7% vs 3%, P=0.025). There was a higher occurrence of rapid atrial pacing needed to induce tachycardia in children (67% vs 53%, P=0.02). However, atrial fibrillation (AF) occurred more commonly in adult patients (28% vs 16%, P=0.003). The pediatric patients had a higher incidence of multiple pathways (5% vs 1%, P<0.001). Both the onset and duration of symptoms were significantly shorter in the pediatric patients. The antegrade 1:1 AP conduction pacing cycle length (CL) and antegrade AP effective refractory period (ERP) in children were much shorter than those in adults with manifest WPW syndrome. Furthermore, the retrograde 1:1 AP conduction pacing CL and retrograde AP ERP in children were also shorter than those in adults. The antegrade 1:1 atrioventricular (AV) node conduction pacing CL, AV nodal ERP, and the CL of the tachycardia were all shorter in the pediatric patients. CONCLUSION This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome.
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Affiliation(s)
- Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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57
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Kistler PM, Schilling RJ. Non-pharmacological treatment of arrhythmias. Br J Hosp Med (Lond) 2006; 66:692-5. [PMID: 16417116 DOI: 10.12968/hmed.2005.66.12.20209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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58
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Risius T, Lewalter T, Lüderitz B, Schwab JO, Spitzer S, Schmitt C, Vester E, Rostock T, Meinertz T, Willems S. Transient ST-segment-elevation during pulmonary vein ablation using circumferential coiled microelectrodes in a prospective multi-centre study†. ACTA ACUST UNITED AC 2006; 8:178-81. [PMID: 16627435 DOI: 10.1093/europace/euj013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Paroxysmal atrial fibrillation (PAF) is predominantly triggered by focal ectopies located within the pulmonary veins (PV). The BITMAP Study (Breakthrough and Isolation Trial: Mapping and Ablation of Pulmonary Veins) investigated prospectively the safety and efficacy of a catheter design with circumferential mapping and ablation electrodes. We report the phenomenon of ST-segment-elevation during catheter placement in the left atrium (LA) and superior PVs in this multi-centre study. METHODS AND RESULTS Forty-three patients (57+/-10 years) with PAF were included in this study. Radiofrequency catheter (RFC) ablation supported by the 4F REVELATION Helix microcatheter (Cardima Inc., Freemont, CA, USA) with eight distal-coiled microelectrodes for bipolar mapping and ablation. RFC was applied at the ostial region of PV (30 W, 45-50 degrees C) with a maximum of four RFC applications per electrode. In four of the 43 patients from three centres, we recorded the occurrence of ST-segment-elevation greater than 0.2 mV and accompanying left thoracic discomfort. The ECG changes and the symptoms started abruptly and lasted for 4.2+/-2.2 min. Pericardial effusion could instantaneously be excluded by echocardiography in all cases. Coronary angiograms were performed in three patients with the longest episodes; no thrombotic material or air emboli were present. The symptoms and the ECG changes resolved completely in all patients. CONCLUSION The phenomenon of ST-segment-elevation during LA- and PV-mapping in patients with PAF may be a common occurrence. In this prospective multi-centre trial, we demonstrated the reversibility of this phenomenon; no cardiovascular or cerebral damage was reported during both the procedure and the follow-up. Although the mechanism is still unclear, vasospasm may contribute to this phenomenon because of autonomic dysregulation.
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Affiliation(s)
- Tim Risius
- Department of Cardiology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
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59
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Kim TS, Choi S, Rhew HY, Ahn JH, Jang JH, Cho MH. Comparative Study on the Treatment Outcome and Safety of TURP, ILC, TUNA and TEAP for Patients with Benign Prostatic Hyperplasia. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.1.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Taek Sang Kim
- Department of Urology, Kosin University Hospital, Busan, Korea
| | - Seong Choi
- Department of Urology, Kosin University Hospital, Busan, Korea
| | - Hyun Yul Rhew
- Department of Urology, Kosin University Hospital, Busan, Korea
| | - Jung Hwan Ahn
- Department of Urology, Kosin University Hospital, Busan, Korea
| | - Jin Ho Jang
- Department of Urology, Kosin University Hospital, Busan, Korea
| | - Moon Hwan Cho
- Department of Urology, Kosin University Hospital, Busan, Korea
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Kriebel T, Broistedt C, Kroll M, Sigler M, Paul T. Efficacy and Safety of Cryoenergy in the Ablation of Atrioventricular Reentrant Tachycardia Substrates in Children and Adolescents. J Cardiovasc Electrophysiol 2005; 16:960-6. [PMID: 16174016 DOI: 10.1111/j.1540-8167.2005.50054.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cryoenergy has evolved as a safe and effective alternative for ablation of arrhythmia substrates in adult patients. Due to two specific features, cryomapping and cryoadhesion, this technique appears very attractive for pediatric patients minimizing complications and fluoroscopy time. The aim of the study was to investigate efficacy and safety of cryoenergy in the ablation of supraventricular tachycardia (SVT) substrates in pediatric patients. PATIENTS AND METHODS Thirty-two patients (mean age: 10.1 +/- 3.5 years) with SVT (accessory pathways: n = 19; atrioventricular nodal reentrant tachycardia (AVNRT): n = 13) underwent electrophysiological study under the guidance of the LocaLisa system. Cryomapping at -30 degrees C was performed to predict cryoablation outcome and to ascertain AV conduction. Cryoenergy was delivered subsequently at the same spot (cryoablation at -70 degrees C) as verified by the LocaLisa system. RESULTS Successful cryoablation was achieved in 24 of 32 patients (75%). A median of two (1-10) cryoablations were delivered. In the remaining 8 patients, radiofrequency (RF) current application was effective in 5 resulting in an overall success rate of 90.6%. In 4 patients with an accessory pathway cryomapping was not predictive for successful cryoablation (negative predictive value 66.6%). In 3 additional patients with AVNRT transient high-grade AV block occurred during cryoablation despite previous "safe" cryomapping at the same location. No other major complications were noted. CONCLUSION Cryoablation of SVT substrates in pediatric patients was associated with a lower success rate compared to RF catheter ablation. Cryomapping decreased the number of permanent lesions but did not predict cryoablation outcome in all tachycardia substrates.
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Affiliation(s)
- Thomas Kriebel
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, FR Germany.
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González-Torrecilla E, Arenal A, Atienza F, Almendral J. Utility of nonfluoroscopic three-dimensional electroanatomical mapping in accessory pathways with prior unsuccessful ablation attempts. Am J Cardiol 2005; 96:564-9. [PMID: 16098312 DOI: 10.1016/j.amjcard.2005.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Revised: 04/05/2005] [Accepted: 04/05/2005] [Indexed: 10/25/2022]
Abstract
Three-dimensional electroanatomic mapping was performed to guide radiofrequency catheter ablation in 17 patients with accessory pathways (APs) who had undergone 2.0 +/- 0.9 previous unsuccessful conventional procedures. In 14 patients, activation mapping was directed at the atrial insertion of the bypass during tachycardia (6 patients) or right ventricular pacing (7 patients) or by mapping atrial stimulus-delta-wave intervals. The ventricular insertion of the bypass was mapped and targeted for ablation in the remaining 3 patients. Successful AP ablation was obtained in all but 1 patient (94%) after a mean of 8 +/- 7 radiofrequency pulses, without recurrences during a mean follow-up of 16 +/- 15 months. On the basis of mapping results and successful ablation outcomes, the most likely causes of previous failed ablation attempts were anatomic or mapping reasons (13 patients), catheter manipulation-related problems (2 patients), and miscellaneous reasons (1 patient).
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Kose S, Amasyali B, Aytemir K, Can I, Kilic A, Kursaklioglu H, Iyisoy A, Isik E. Radiofrequency catheter ablation of accessory pathways during pre-excited atrial fibrillation: acute success rate and long-term clinical follow-up results as compared to those patients undergoing successful catheter ablation during sinus rhythm. Heart Vessels 2005; 20:142-6. [PMID: 16025362 DOI: 10.1007/s00380-005-0819-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Accepted: 11/27/2004] [Indexed: 10/25/2022]
Abstract
The onset of recurrent or sustained atrial fibrillation (AF) is common during electrophysiological (EP) studies of accessory pathways (AP). We report our experience in patients with Wolff-Parkinson-White (WPW) syndrome in whom AF with rapid antegrade conduction over the AP occurred during an EP study and mapping and ablation were done during sustained AF, as compared to patients ablated during sinus rhythm. The study group consisted of 18 patients (group 1) with WPW syndrome who underwent catheter ablation during pre-excited AF. Two hundred and sixty-three patients, comparable for clinical characteristics, whose manifest APs were ablated under sinus rhythm formed the control group (group 2). Bipolar electrogram criteria recorded from the ablation catheter showing early ventricular activation relative to the delta wave on the surface ECG and AP potentials preceding the onset of ventricular activation were used as targets for ablation. Clinically documented atrial fibrillation was significantly more frequent and antegrade ERP of AP was significantly shorter in group 1 than in group 2 (39% vs 14%, P=0.014 and 268+/-37 vs 283+/-16, P<0.001, respectively). Procedure-related variables, acute success rates (17/18 [94%] in group 1, 251/263 [95%] in group 2; P>0.05) and late recurrence rates (0/18 [0%] in group 1 vs 5/263 [2%] in group 2; P>0.05) during a mean follow-up of 25+/-9 months (range 8-52 months) did not differ significantly. Our results show that both right- and left-sided accessory pathways can be mapped and ablated safely during pre-excited AF without delay, and that acute success and recurrence rates and long-term follow-up results are similar to those of pathways ablated during sinus rhythm.
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Affiliation(s)
- Sedat Kose
- Department of Cardiology, Gulhane Military Medical Academy, 06018, Etlik, Ankara, Turkey
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63
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Davlouros PA, Simeonidou E, Tsakas S, Vlachojannis I, Alexopoulos D, Manolis AS. Release of endothelin-1 from human endocardium after radiofrequency catheter ablation and coronary angioplasty: comparative results. Int J Cardiol 2005; 102:187-93. [PMID: 15982483 DOI: 10.1016/j.ijcard.2004.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2004] [Revised: 03/10/2004] [Accepted: 04/26/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND Plasma levels of endothelin-1 (ET-1) increase after coronary angioplasty (PTCA) due to endothelial injury during the procedure. ET-1 has been found in human endocardial and myocardial cells. It is not known whether ET-1 increases after thermal injury induced by radiofrequency catheter ablation (RFA). METHODS We determined plasma ET-1 levels at baseline, immediately after, and at 2 and 6 h post-procedure in 31 patients undergoing PTCA and 16 patients undergoing RFA. Patients subjected to diagnostic coronary angiography (n=15) or electrophysiology study (n=13) served as controls. RESULTS Compared to baseline, ET-1 levels increased significantly immediately post-PTCA (55.1+/-20.1 vs. 42.7+/-14.9 pg/ml, p<0.01) and at 2 h post-RFA (98.0+/-11.7 vs. 53.0+/-17.4 pg/ml, p<0.01) and returned to baseline measurements at 2 h post-PTCA and 6 h post-RFA. There was no change of ET-1 levels in the control groups. ET-1 kinetics curve was significantly higher post-RFA compared to post-PTCA (p<0.001). ET-1 immediately post-PTCA correlated with total pressure-time product applied for balloon inflation during the procedure (r=0.56, p<0.01). There was no correlation between ET-1 levels and the number of RFA applications. No patient developed ischemia post-PTCA. There were no complications or arrhythmia recurrences post-RFA. CONCLUSION Endocardial thermal injury incurred during RFA is another mechanism of endothelin increase apart from mechanical injury of the coronary endothelium during PTCA and represents further evidence for the existence of the peptide in human endocardial endothelial and myocardial cells. ET-1 increase is delayed and more pronounced post-RFA compared to post-PTCA. Despite that, it does not seem to have any clinical impact in the immediate post-RFA period.
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Kono T, Kitahara H, Sakaguchi M, Amano J. Cardiac Rupture After Catheter Ablation Procedure. Ann Thorac Surg 2005; 80:326-7. [PMID: 15975397 DOI: 10.1016/j.athoracsur.2004.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Revised: 01/12/2004] [Accepted: 01/22/2004] [Indexed: 11/24/2022]
Abstract
We describe a patient in whom cardiac tamponade developed owing to left ventricular rupture after a catheter ablation procedure. Rapid surgical exploration and use of cardiopulmonary bypass facilitated safe repair of the injury site and survival of the patient without complications.
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Affiliation(s)
- Tetsuya Kono
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
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65
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Pessey JJ, Rose X, Michenet F, Calmels MN, Lagleyre S. [Treatment of simple snoring by radiofrequency velar coblation]. ACTA ACUST UNITED AC 2005; 122:21-6. [PMID: 15851942 DOI: 10.1016/s0003-438x(05)82314-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Short- and long-term evaluation of the efficacy and safety of radiofrequency velar coblation for simple snoring. MATERIAL AND METHODS From February 2000 to May 2004, 175 patients underwent a single radiofrequency session for velar coblation. All patients suffered from snoring without sleep apnea. They presented modifications of the velo-pharyngeal region but did not have tonsillar or basilingual hypertrophy. Outcome was assessed in terms of pain, changes in snoring, secondary effects and complications at three months and one, two, and three years. Secondary uvulectomy was performed in 28 patients. RESULTS At three months, snoring had decreased in 82% of patients with complete resolution in 12%. Outcome remained unchanged in 70% of patients at one, two, and three years. After uvulectomy, snoring declined in 96% of patients with complete resolution in 48%. Post-treatment pain lasted less than five days in 68% of patients. Mean duration was three days. Fifteen patients developed pharyngeal paresthesia which regressed at one year. Two patients had a nasal voice and three developed necrosis of the uvula. CONCLUSION Velar coblation is a simple treatment for snoring which can be performed in a single session. The best results are achieved in patients whose body mass index is below 25 and after secondary uvulectomy.
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Affiliation(s)
- J-J Pessey
- Service ORL et de Chirurgie Cervico-Faciale, CHU Rangueil-Larrey, 24, chemin de Pouvourville - TDS 30030, 31059 Toulouse
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Kobza R, Kottkamp H, Piorkowski C, Tanner H, Schirdewahn P, Dorszewski A, Wetzel U, Gerds-Li JH, Arya A, Hindricks G. Radiofrequency ablation of accessory pathways. ACTA ACUST UNITED AC 2005; 94:193-9. [PMID: 15747042 DOI: 10.1007/s00392-005-0202-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 11/04/2004] [Indexed: 10/25/2022]
Abstract
INTRODUCTION 17 years ago the first radiofrequency catheter ablation of an accessory pathway (AP) was performed. The aim of this study was to describe the contemporary success rates and procedure related complication rates of radiofrequency (RF) ablation of accessory pathways (APs). In addition, the present study describes the anatomical distribution of APs according to the new nomenclature introduced by NASPE and ESC in 1999. METHODS The analysis included all patients, who underwent RF ablation of an AP in the Heart Center Leipzig between January 2000 and December 2003. RESULTS Over a 4 year period 336 APs were ablated in 323 patients. 201 APs (60%) presented with antegrade and retrograde conduction and showed preexcitation on ECG. For the remaining 135 APs (40%), only retrograde conduction over the AP was documented. According to the new nomenclature APs were classified as left-sided, right sided, septal and paraseptal APs. 188 APs (56%) were located on the left, 41 (12%) on the right, 64 (19%) in the paraseptal space and 31 APs (9%) presented with a septal or parahisian localization, respectively. Because of atypical course and/or characteristics 12 APs (4%) could not be classified. Ablation of all pathways were successful in 315 patients (98%). In 289 patients (89%) success was achieved within a single ablation session. The left-sided pathways had a re-intervention rate of 5%, which was significantly lower compared to the remaining localizations. The highest re-intervention rate was observed in the septal APs (23%). Complications were observed in less than 2% of all treated patients. CONCLUSIONS 17 years after the first RF catheter ablation of an AP this therapy is established as a highly effective procedure. The success rate has improved to 98% and the complication rate has been minimized to less than 2%. The most frequent localization of APs is left posterior. Left sided APs also presented with the lowest re-intervention rate. The introduction of the new nomenclature in 1999 by NASPE and ESC has simplified the description of the exact anatomical localization of an AP.
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Affiliation(s)
- R Kobza
- University of Leipzig Heart Center, Cardiology, Department of Electrophysiology, Struempellstrasse 39, 04289 Leipzig, Germany.
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Manita M, Kaneko Y, Kurabayashi M, Yeh SJ, Wen MS, Wang CC, Lin FC, Wu D. Electrophysiological characteristics and radiofrequency ablation of accessory pathways with slow conductive properties. Circ J 2004; 68:1152-9. [PMID: 15564699 DOI: 10.1253/circj.68.1152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrioventricular accessory pathways (AP) with unusually long ventriculo-atrial (VA) conduction times are present in a significant subset of patients with the Wolff-Parkinson-White (WPW) syndrome, not including patients with the permanent form of atrioventricular junctional reciprocating tachycardia. METHODS AND RESULTS We compared the electrophysiological characteristics and outcomes after radiofrequency (RF) ablation in 34 patients with the WPW syndrome, a VA interval >80 ms, and paroxysmal tachycardia with an RP/PR ratio <1 (the slow group), vs 80 patients with WPW syndrome and a VA interval <80 ms (the fast group). AP were found in the posteroseptal region significantly more often in the slow than in the fast group. In addition, the decremental conductive properties of the AP were more common in the slow than in the fast group. Catheter ablation of AP was highly successful in both groups, although ablation required a greater number of RF applications and longer procedure times in the slow group, especially for AP with decremental conductive properties. CONCLUSIONS A posteroseptal AP location was more common in AP associated with long conduction times than in AP with typical conductive properties. Both types of AP were successfully ablated, although the slow group required longer procedures and more RF energy deliveries.
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Affiliation(s)
- Mamoru Manita
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan.
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68
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Citro R, Ducceschi V, Salustri A, Santoro M, Salierno M, Gregorio G. Intracardiac echocardiography to guide transseptal catheterization for radiofrequency catheter ablation of left-sided accessory pathways: two case reports. Cardiovasc Ultrasound 2004; 2:20. [PMID: 15471551 PMCID: PMC524521 DOI: 10.1186/1476-7120-2-20] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 10/08/2004] [Indexed: 11/19/2022] Open
Abstract
Intracardiac echocardiography (ICE) is a useful tool for guiding transseptal puncture during electrophysiological mapping and ablation procedures. Left-sided accessory pathways (LSAP) can be ablated by using two different modalities: retrograde approach through the aortic valve and transseptal approach with puncture of the fossa ovalis. We shall report two cases of LSAP where transcatheter radiofrequency ablation (TCRFA) was firstly attempted via transaortic approach with ineffective results. Subsequently, a transseptal approach under ICE guidance has been performed. During atrial septal puncture ICE was able to locate the needle tip position precisely and provided a clear visualization of the "tenting effect" on the fossa ovalis. ICE allowed a better mapping of the mitral ring and a more effective catheter ablation manipulation and tip contact which resulted in a persistent and complete ablation of the accessory pathway with a shorter time of fluoroscopic exposure. ICE-guided transseptal approach might be a promising modality for TCRFA of LSAP.
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Affiliation(s)
- Rodolfo Citro
- Department of Cardiology, "San Luca" Hospital, Vallo della Lucania (Salerno), Italy
| | - Valentino Ducceschi
- Department of Cardiology, "San Luca" Hospital, Vallo della Lucania (Salerno), Italy
| | | | - Michele Santoro
- Department of Cardiology, "San Luca" Hospital, Vallo della Lucania (Salerno), Italy
| | | | - Giovanni Gregorio
- Department of Cardiology, "San Luca" Hospital, Vallo della Lucania (Salerno), Italy
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69
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Atienza F, Arenal A, Torrecilla EG, García-Alberola A, Jiménez J, Ortiz M, Puchol A, Almendral J. Acute and long-term outcome of transvenous cryoablation of midseptal and parahissian accessory pathways in patients at high risk of atrioventricular block during radiofrequency ablation. Am J Cardiol 2004; 93:1302-5. [PMID: 15135711 DOI: 10.1016/j.amjcard.2004.02.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2003] [Revised: 02/05/2004] [Accepted: 02/05/2004] [Indexed: 11/27/2022]
Abstract
The ability of transvenous cryothermal catheter ablation to create reversible lesions (cryomapping) and to avoid catheter dislodgment (cryoadherence) has been shown to be safe and highly effective in elimination of atrioventricular nodal reentrant tachycardia. In addition, cryoablation may be useful in the management of perinodal accessory pathways, but its efficacy and safety in patients at high risk of atrioventricular block during radiofrequency catheter ablation is unknown. This study prospectively evaluated the efficacy and safety of cryoablation in patients with midseptal and parahissian accessory pathways.
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Affiliation(s)
- Felipe Atienza
- Electrophysiology Laboratory, Cardiology Department, Hospital General Universitario Gregorio Marañón, C/Dr. Esquerdo 46, 28007 Madrid, Spain
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70
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Blaufox AD, Saul JP. Acute coronary artery stenosis during slow pathway ablation for atrioventricular nodal reentrant tachycardia in a child. J Cardiovasc Electrophysiol 2004; 15:97-100. [PMID: 15028082 DOI: 10.1046/j.1540-8167.2004.03378.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Coronary injury during radiofrequency ablation is a rare but n. potentially life-threatening complication that has been reported for attempted elimination of accessory pathways. This is the first report of coronary artery injury during slow pathway ablation for AV nodal reentrant tachycardia. Manifest signs of injury may be transient or nonexistent and easily missed. Controlled studies are needed to determine the true risk of coronary artery injury during radiofrequency ablation for supraventricular tachycardia, particularly in small children.
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Affiliation(s)
- Andrew D Blaufox
- Children's Heart Program of South Carolina, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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71
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Affiliation(s)
- Fred Morady
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan 48109-0311, USA.
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72
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Affiliation(s)
- C J Anderson
- Department of Urology, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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73
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Brausi M, Castagnetti G, Gavioli M, Peracchia G, de Luca G, Olmi R. Radio Frequency (RF) Ablation of Renal Tumours Does Not Produce Complete Tumour Destruction: Results of a Phase II Study. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.eursup.2004.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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74
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Morady F. Catheter Ablation of Supraventricular Arrhythmias:. State of the Art. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:125-42. [PMID: 14720171 DOI: 10.1111/j.1540-8159.2004.00401.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Fred Morady
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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75
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Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, Stevenson WG, Tomaselli GF, Antman EM, Smith SC, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MAA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JCA, Oto A, Smiseth O, Trappe HJ. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias∗∗This document does not cover atrial fibrillation; atrial fibrillation is covered in the ACC/AHA/ESC guidelines on the management of patients with atrial fibrillation found on the ACC, AHA, and ESC Web sites.—executive summary. J Am Coll Cardiol 2003; 42:1493-531. [PMID: 14563598 DOI: 10.1016/j.jacc.2003.08.013] [Citation(s) in RCA: 379] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
MESH Headings
- Anti-Arrhythmia Agents/therapeutic use
- Atrial Flutter/diagnosis
- Atrial Flutter/therapy
- Cardiac Pacing, Artificial
- Catheter Ablation
- Costs and Cost Analysis
- Diagnosis, Differential
- Electrocardiography
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Conduction System/physiopathology
- Heart Defects, Congenital/complications
- Humans
- Male
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Quality of Life
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/therapy
- Tachycardia, Ectopic Atrial/diagnosis
- Tachycardia, Ectopic Atrial/therapy
- Tachycardia, Ectopic Junctional/diagnosis
- Tachycardia, Ectopic Junctional/therapy
- Tachycardia, Paroxysmal/diagnosis
- Tachycardia, Paroxysmal/therapy
- Tachycardia, Sinus/diagnosis
- Tachycardia, Sinus/therapy
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/therapy
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76
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Kimman GP, Szili-Torok T, Theuns DAMJ, Res JC, Scholten MF, Jordaens LJ. Comparison of radiofrequency versus cryothermy catheter ablation of septal accessory pathways. Heart 2003; 89:1091-2. [PMID: 12923041 PMCID: PMC1767800 DOI: 10.1136/heart.89.9.1091] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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77
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Abstract
The characteristics of multiple accessory pathways in children have not been previously studied. Records were reviewed of 317 consecutive pediatric patients with Wolff-Parkinson-White syndrome who underwent electrophysiologic study and radiofrequency catheter ablation at our institution. Twenty-eight patients (9%) had multiple pathways (a total of 64 pathways: 21 patients had 2, 6 had 3, and 1 patient had 4 pathways). The locations were left free wall (22 pathways), right free wall (19 pathways), posteroseptal (17 pathways), and anteromidseptal (6 pathways). Of these 64 pathways, 55 were ablated successfully without complications, 5 failed ablation, and 4 fasciculoventricular fibers did not require treatment. Three patients had a newly found pathway at the repeat session. Three patients had atrioventricular nodal reentrant tachycardia and the slow pathway area was modified. One patient had failed initial ablation and had a successful ablation using a 3-dimensional electroanatomic mapping system. Compared with patients with a single pathway, those with multiple pathways exhibited a higher incidence of antidromic tachycardia, a shorter anterograde accessory pathway effective refractory period (<250 ms), a longer fluoroscopic time (65 +/- 43 vs 39 +/- 46 minutes, p <0.05), and a larger number of unsuccessful attempts (9 +/- 16 vs 5 +/- 8, p <0.05). Success rate (92% vs 93%) and recurrence rate (1.7% vs 2.1%) were similar in both groups. This study demonstrates that multiple pathways are not rare in pediatric patients and that multiple pathways contrast with a single pathway in a variety of conduction properties.
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Affiliation(s)
- Ken-Pen Weng
- Department of Pediatrics, University of Miami, Florida 33101, USA
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78
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Liberman L, Hordof AJ, Fishberger SB, Pass RH. The role of isoproterenol testing following radiofrequency catheter ablation of accessory pathways in children. Pacing Clin Electrophysiol 2003; 26:559-61. [PMID: 12710314 DOI: 10.1046/j.1460-9592.2003.00094.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Isoproterenol (ISO) testing following radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in children is often performed to assess efficacy. However, its role in postablative testing for this indication has not been previously studied. In view of a recent national shortage of ISO, this study reviewed the results of ISO testing in pediatric patients after acutely successful RFCA to evaluate its role in postablative testing. Seventy patients (median age 13.0 years, range 2.8-24 years) underwent acutely successful RFCA for APs. If AP conduction was not present and tachycardia was not inducible with programmed stimulation 30 minutes following RFCA, repeat testing was performed during continuous infusion ISO. ISO infusion resulted in the induction of arrhythmias in 3 (4%) of 70 patients that required further ablative therapy. None of these patients had inducible arrhythmias or AP conduction during postablative testing without ISO infusion. One patient, with the permanent form of junctional reciprocating tachycardia (PJRT), had persistence of AP conduction requiring further RFCA applications. Two patients had inducible AV nodal reentrant tachycardia (AVNRT) that was treated with slow pathway modification. At a median follow-up of 7.3 months, two (3%) patients had recurrence of tachycardia. These patients did not have inducible tachycardia, AP conduction, or dual AVN physiology with ISO testing. Although ISO may improve AP conduction in patients with PJRT and uncover AVNRT, these results suggest that ISO testing after an apparently successful AP ablation may not be necessary to confirm acute success. In addition, lack of AP conduction on ISO did not rule out the possibility of medium-term recurrence.
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Affiliation(s)
- Leonardo Liberman
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, NY Presbyterian Hospital, Columbia University, New York, USA.
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79
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Raj GV, Reddan DJ, Hoey MF, Hoey MB, Polascik TJ. Management of small renal tumors with radiofrequency ablation. Urology 2003; 61:23-9. [PMID: 12559260 DOI: 10.1016/s0090-4295(02)01850-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Ganesh V Raj
- Division of Urology, Duke University Medical Center, Durham, North Carolina 27704, USA
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80
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Erdogan A, Grumbrecht S, Neumann T, Neuzner J, Pitschner HF. Microwave, irrigated, pulsed, or conventional radiofrequency energy source: which energy source for which catheter ablation? Pacing Clin Electrophysiol 2003; 26:504-6. [PMID: 12687878 DOI: 10.1046/j.1460-9592.2003.00082.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to compare the diameter of endomyocardial lesions induced with the delivery of microwave, cooled, or pulsed energy versus conventional RF energy. In vitro tests were performed in fresh endomyocardial preparations of pig hearts in a 10-L bath of NaCl 0.9% solution at 37 degrees C and constant 1.5 L/min flow. Ablation 7 Fr catheters with 4-mm tip electrodes were used, except for the delivery of microwave energy. Energy delivery time was set to 60 s/50 W in all experiments. Cooled energy delivery was performed with a closed irrigation catheter. Pulsed energy delivery was performed using a special controller with a duty-cycle of 5 ms. Microwave energy was delivered with a 2.5-GHz generator and 10-mm antenna. Electrode temperature and impedance were measured simultaneously. After ablation, lesion length, width, and depth were measured with microcalipers, and volume calculated by a formula for ellipsoid bodies. Each energy delivery mode was tested in ten experiments. The deepest lesions were created with cooled energy delivery, and the largest volume by microwave energy delivery. Pulsed RF produced significantly deeper lesions than conventional RF energy delivery. Cooled or pulsed RF energy delivery created deeper transmural lesions than conventional RF. To create linear lesions at anatomically complex sites (isthmus), microwave energy seemed superior by rapidly creating deep and long lesions.
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Affiliation(s)
- Ali Erdogan
- Justus-Liebig-University of Giessen, Department of Cardiology/Angiology, Giessen, Germany.
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81
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Janzen NK, Perry KT, Schulam PG. Laparoscopic radical nephrectomy and minimally invasive surgery for kidney cancer. Cancer Treat Res 2003; 116:99-117. [PMID: 14650828 DOI: 10.1007/978-1-4615-0451-1_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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82
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Ng GA, Lau EW, Griffith MJ. A streamlined "3-catheter" approach in the electrophysiological study and radiofrequency ablation of narrow complex tachycardia. J Interv Card Electrophysiol 2002; 7:209-14. [PMID: 12510131 DOI: 10.1023/a:1021335912838] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Electrophysiological study (EPS) followed by radiofrequency (RF) ablation has emerged as the treatment of choice for symptomatic narrow complex tachycardia (NCT), for which purpose, 5 catheters are typically used (4 for the initial EPS and an additional one for the subsequent RF ablation). We describe an alternative, streamlined approach using only 3 catheters [2 standard (diagnostic) and 1 deflectable, thermistor tip (mapping)] as the standard configuration for EPS and RF ablation in patients with NCT but no pre-excitation on ECG. METHODS AND RESULTS Diagnosis was obtained in all 250 consecutive patients (mean age 45 years, 174 females): atrio-ventricular nodal re-entrant tachycardia (AVNRT) in 188 (75%), concealed accessory pathways (AP's) in 38 patients (15%), ectopic atrial tachycardia in 19 patients (8%), persistent junctional re-entrant tachycardia (PJRT) in 4 patients (2%) and atrial fibrillation in 1 patient. An additional diagnostic catheter was used for optimising atrial pacing in 3 patients and for ventricular pacing in concealed right postero-septal AP's in another 3. An additional mapping catheter was used in 31 patients with concealed left-sided AP's, 2 with multiple AP's and 1 with PJRT. Three patients had complications (1 pulmonary embolism, 1 pericardial effusion and 1 atrio-ventricular node block). Overall, the immediate success rate was 98% (224/229) with a recurrence rate of 4.4% (10/224), and the total success rate (with repeat RF ablation if necessary) was 99.2% (227/229) over a median follow-up period of 31.4 months. The average cost saving was US$474 per procedure. Procedure duration (2.0 +/- 0.1 hours), fluoroscopy time (13 +/- 1 minutes) and the number of radiofrequency applications (5.4 +/- 0.3) also compared favourably with values reported in the literature for RF ablation of AVNRT. CONCLUSION Compared to the conventional 5-catheter configuration for the combined EPS and RF ablation procedure in treatment of patients with NCT, the described 3-catheter configuration reduces cost, procedure duration and fluoroscopy time without compromising on success rate and safety. On these bases, we advocate its widespread adoption.
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Affiliation(s)
- G André Ng
- Department of Cardiovascular Medicine, Queen Elizabeth Hospital, Birmingham, UK.
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83
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Collins KK, Chiesa NA, Dubin AM, Van Hare GF. Clinical outcomes of children with normal cardiac anatomy having radiofrequency catheter ablation > or =10 years earlier. Am J Cardiol 2002; 89:471-5. [PMID: 11835935 DOI: 10.1016/s0002-9149(01)02275-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kathryn K Collins
- Pediatric Arrhythmia Center at UCSF and Stanford, Department of Pediatrics, University of California San Francisco, San Francisco 94143, USA.
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84
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Janzen N, Zisman A, Pantuck AJ, Perry K, Schulam P, Belldegrun AS. Minimally invasive ablative approaches in the treatment of renal cell carcinoma. Curr Urol Rep 2002; 3:13-20. [PMID: 12084214 DOI: 10.1007/s11934-002-0005-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ablative techniques for the treatment of renal cell carcinoma (RCC) are an extension of nephron-sparing surgery and include cryoablation, radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU). Although experimental, these are evolving treatment modalities. The widespread use of computed tomography scans, ultrasound, and magnetic resonance imaging caused an increase in the diagnosis rate of small renal masses amenable to nephron-sparing surgery. The same imaging modalities permit interactive monitoring both during the delivery of ablative measures and at postoperative follow-up. Cryosurgery is the most studied of the ablative approaches, and clinical studies have demonstrated promising short-term results and a remarkable safety profile. Long-term studies, however, are needed in order to determine the appropriate selection criteria and to confirm a response as durable as that for partial and radical nephrectomy. More data are needed to evaluate the efficacy of RFA. Currently, preclinical results with HIFU do not justify its use for treating RCC in humans.
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Affiliation(s)
- Nicolette Janzen
- UCLA Department of Urology, 10833 Le Conte Ave., CHS 66-118, Los Angeles, CA 90035, USA
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85
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Abstract
Assessment of the timing of electrical activation recorded by multiple electrodes positioned in various locations within the heart has been the conventional method for mapping cardiac arrhythmias. This technique requires fluoroscopy for catheter manipulation, which in addition to being harmful (ionizing radiation), is inadequate for visualizing the complex three-dimensional cardiac anatomy and lacks reproducibility regarding localization of sites of interest. Because of these limitations, several new mapping systems that can function in a complimentary role to the conventional mapping technique, or can be used independently, have been developed. These new mapping strategies have unique advantages. They overcome the limitations of fluoroscopy by creating accurate three-dimensional intracardiac maps. The ability to localize and accurately display intracardiac catheter positioning and ablation lesion sites facilitate increasingly complex catheter ablation procedures.
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Affiliation(s)
- Sanjay Dixit
- Section of Cardiac Electrophysiology, Hospital of The University of Pennsylvania, Philadelphia 19104, USA
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86
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Manolis AS, Vassilikos V, Maounis TN, Chiladakis J, Cokkinos DV. Radiofrequency ablation in pediatric and adult patients: comparative results. J Interv Card Electrophysiol 2001; 5:443-53. [PMID: 11752913 DOI: 10.1023/a:1013254230114] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Radiofrequency (RF) catheter ablation has been widely and successfully employed to cure adult and pediatric patients of a variety of arrhythmias. Only limited data exist which compare the results in these two groups. The aim of this study was to compare the efficacy and safety of RF catheter ablation in pediatric versus adult patients performed by an adult electrophysiology (EP) team. METHODS The study group included 327 consecutive pediatric (n=47) and adult (n=280) patients, aged 7-82 years (mean 40+/-19), with symptomatic tachyarrhythmias, who underwent RF ablation during the last 6 years. All but ten patients underwent a full EP study during the same session. Procedures were performed in all but five patients with use of local anesthesia and deep or light sedation. The left heart was approached with use of transaortic (n=36) or transseptal (n=55) or both (n=6) techniques. RF ablation was performed for manifest or concealed accessory pathways in 132 patients, AV nodal slow pathway in 119, atrial tachycardia in 24, atrial flutter in 15, atrial fibrillation in one, ventricular tachycardia in 29, and AV node/His bundle in 7 patients. RESULTS RF ablation was successful in 271 (96.8%) patients in the adult group and in all patients (100%) in the pediatric group, with a mean of 15+/-18 (median: 8) vs 12+/-10 (median: 8) RF applications respectively (P=NS). Complications occurred in four patients (1.4%) in the adult group and in one patient (2.1%) in the pediatric group (P=NS). Fluoroscopy time averaged 43+/-40 min vs 39+/-27 min and procedures lasted for 3.0+/-1.9 hours vs 2.8+/-1.4 hours respectively (P=NS). During long-term follow-up of 25+/-19 months, there were 12 (4.4%) recurrences among the adult patients, and three (6.4%) recurrences in children, with nine of them successfully treated with repeat RF ablation. Procedural variables were dependent on the type of arrhythmia ablated, rather than on patient's age. Patients with multiple accessory pathways or atrial flutter required the greatest number of RF applications and the longest fluoroscopy exposure and duration of the procedure; the lowest values of these variables concerned ablation of the slow AV nodal pathway or the AV node/His bundle. CONCLUSION RF ablation in adult and pediatric patients performed by an adult EP team is equally efficacious and safe offering cure of symptomatic cardiac tachyarrhythmias in both patient populations.
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Affiliation(s)
- A S Manolis
- Cardiology Division, Patras University, Patras, Greece.
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87
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Yohannes P, Pinto P, Rotariu P, Smith AD, Lee BR. Retroperitoneoscopic radiofrequency ablation of a solid renal mass. J Endourol 2001; 15:845-9. [PMID: 11724127 DOI: 10.1089/089277901753205870] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To report a new technique for radiofrequency (RF) ablation of a solid renal mass. PATIENT AND METHODS An 83-year-old man with a history of chronic renal insufficiency was found to have solid mass in the right kidney. Retroperitoneoscopic localization of the renal mass was accomplished using intraoperative ultrasonography. The lesion was treated with a 14-gauge RITA Starburst XL probe (Rita Medical Systems, Inc., Mountain View, CA). RESULTS The total treatment time included two cycles of 5.5 minutes. There were no intraoperative complications. Tissue desiccation was noted during treatment. A CT scan 48 hours after ablation showed a decrease in the density of the lesion suggestive of coagulation necrosis. The postoperative hospital course was uneventful. CONCLUSION The retroperitoneal laparoscopic technique is a feasible approach to performing RF ablation of a solid renal mass. It facilitates direct insertion of the RF probe, allows viewing and avoidance of adjacent structures such as bowel, and permits better staging by enabling biopsy of perirenal fatty tissue.
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Affiliation(s)
- P Yohannes
- Department of Urology, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
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88
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Benito Bartolomé F, Sánchez Fernández-Bernal C. [Infectious mitral endocarditis after radiofrequency catheter ablation of a left lateral accessory pathway]. Rev Esp Cardiol 2001; 54:999-1001. [PMID: 11481116 DOI: 10.1016/s0300-8932(01)76437-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 2-years-old child with Wolff-Parkinson-White syndrome associated with life-threatening symptoms underwent radiofrequency ablation of a left lateral accessory pathway. A deflectable 5F bipolar electrode catheter positioned above the atrioventricular groove by transeptal approach was used for ablation. The catheters were repeatedly used after ethylene oxide sterilisation. Although immediate post-ablation echocardiography demonstrated no complications, the patient was readmitted two days later with fever and a new mitral murmur. Penicillin-susceptible Staphylococcus aureus was isolated and intravenous antibiotics were administered. In the following weeks, the patient developed constrictive pericarditis requiring surgical treatment and acute hemiplegia caused by brain embolism arising from valvular vegetation. At 5 years of follow-up the patient presents residual hemiparesia and grade II/IV mitral insufficiency.
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Affiliation(s)
- F Benito Bartolomé
- Unidad de Arritmias, Laboratorio de Electrofisiología Clínica Cardíaca, Hospital Universitario La Paz, Madrid.
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89
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Brembilla-Perrot B, Houriez P, Beurrier D, Claudon O, Burger G, Vançon AC, Mock L. Influence of age on the electrophysiological mechanism of paroxysmal supraventricular tachycardias. Int J Cardiol 2001; 78:293-8. [PMID: 11376833 DOI: 10.1016/s0167-5273(01)00392-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the influence of age on the mechanism of paroxysmal supraventricular tachycardia (PSVT). Previous studies have shown age and sex differences between certain arrhythmias and especially changes in electrophysiological characteristics of Wolff-Parkinson-White syndrome. Four hundred and eighty five patients aged 9-86 years, with PSVT and without Wolff-Parkinson-White syndrome in sinus rhythm, were studied. The esophageal or intracardiac electrophysiological study used a standardized atrial pacing protocol. Paroxysmal junctional tachycardia was induced in 475 patients. The mechanism of tachycardia was not influenced by age and atrioventricular nodal reentrant tachycardia (AVNRT) was found as the main cause of PSVT in all ranges of age. Atrioventricular reentrant tachycardia (AVRT) using a concealed accessory pathway (AP) had a similar incidence from youth to elderly. The ratio male/female (M/F) and the inducibility of other arrhythmias (atrial flutter/fibrillation) (AF/AFl) were also found to be similar in all ranges of age. The age of the patients did not influence the mechanism of the tachycardia. Most of PVST were related to a AV nodal reentrant tachycardia. Concealed accessory pathway was identified with a similar incidence in young and old patients.
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Affiliation(s)
- B Brembilla-Perrot
- Department of Cardiology, CHU of Brabois, 54500, Vandoeuvre Les Nancy, France.
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90
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Viskin S, Fish R, Glick A, Glikson M, Eldar M, Belhassen B. The adenosine triphosphate test: a bedside diagnostic tool for identifying the mechanism of supraventricular tachycardia in patients with palpitations. J Am Coll Cardiol 2001; 38:173-7. [PMID: 11451269 DOI: 10.1016/s0735-1097(01)01336-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study assesses the value of the "ATP test" (injection of adenosine triphosphate [ATP] during sinus rhythm) for identifying patients with palpitations of unclear etiology who actually have atrioventricular (AV) nodal re-entry tachycardia (AVNRT) or AV re-entry tachycardia (AVRT). BACKGROUND Because AVNRT and AVRT can be cured with radiofrequency ablation, documentation of spontaneous AVNRT or AVRT usually prompts referral for electrophysiologic (EP) evaluation. However, these paroxysmal arrhythmias may elude clinical diagnosis. We recently showed that administration of ATP during sinus rhythm often reveals dual AV node physiology or a concealed accessory pathway (AP) in patients with documented AVNRT or AVRT. Thus, we postulated that the ATP test could identify patients with palpitations who actually have AVNRT or AVRT and would therefore benefit from EP evaluation. METHODS One hundred forty-six patients (54 with "palpitations without documented arrhythmias" and 92 with "documentation of arrhythmias of unclear mechanism") underwent a noninvasive ATP test. ATP was injected during sinus rhythm using 10 mg increments. The ATP test was considered positive when prospectively defined signs of dual AV node physiology or concealed AP were disclosed in the electrocardiogram. These findings were correlated with the results of EP evaluation. RESULTS A positive ATP test predicted induction of AVNRT or AVRT with a positive predictive value of 93% (sensitivity 71%) but a negative predictive value of 37% (specificity 76%). CONCLUSIONS A bedside ATP test identifies patients with palpitations who are likely to have AVNRT or AVRT (and who are therefore likely to benefit from EP evaluation) with a high positive predictive value.
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Affiliation(s)
- S Viskin
- Department of Cardiology, Sackler School of Medicine, Tel-Aviv University, Israel.
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91
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Blaufox AD, Saul JP. Radiofrequency ablation of right-sided accessory pathways in pediatric patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2001; 13:25-40. [PMID: 11413056 DOI: 10.1016/s1058-9813(01)00081-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Right free-wall and septal accessory pathways encompass the full spectrum of accessory pathway electrophysiology and are situated in complex anatomical arrangements. Understanding this diversity of physiology is necessary for the successful and safe elimination of these connections with transcatheter radiofrequency ablation. When radiofrequency catheter ablation of these pathways is attempted in children, anatomical relationships often become more complex, and spatial constraints require more adaptive techniques than in adults. It is clear that considerable progress has been made with radiofrequency catheter ablation, such that it is now first-line therapy for most children who have been diagnosed with one of the broad spectrum of clinical manifestations that result from the presence of these accessory connections. This review will discuss how accessory pathway electrophysiology and anatomy impact the clinical syndromes observed in children, and how these factors, as well as others particular to children, determine the approach, results and potential long-term consequences of radiofrequency catheter ablation of right-sided accessory pathways in the pediatric population.
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Affiliation(s)
- A D. Blaufox
- Medical University of South Carolina, Charleston, SC, USA
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92
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Abstract
Supraventricular tachycardias (SVT) comprise those tachycardias that originate above the bifurcation of the bundle of His. They can be classified broadly as AV node dependent and AV node independent. The mechanism and clinical manifestation of SVTs, which is essential to their correct diagnosis, is reviewed. The therapeutic management of SVTs, including acute and chronic drug therapy and catheter ablation, is discussed also.
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Affiliation(s)
- V S Chauhan
- Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
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93
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Bäck L, Palomäki M, Piilonen A, Ylikoski J. Sleep-disordered breathing: radiofrequency thermal ablation is a promising new treatment possibility. Laryngoscope 2001; 111:464-71. [PMID: 11224777 DOI: 10.1097/00005537-200103000-00016] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to assess the efficacy and morbidity of radiofrequency thermal ablation of the soft palate in subjects with sleep-disordered breathing. STUDY DESIGN Prospective, nonrandomized study. Outpatient treatment and an extended follow-up time of 12 months. METHODS Twenty-one healthy men who were 18 to 60 years of age (median age, 44 y) with sleep-disordered breathing were enrolled to the study. All the patients had habitual snoring for at least 1 year that was associated with excessive daytime sleepiness interfering with social or professional activities. Radiofrequency energy was delivered to the soft palate in two treatment sessions separated by 1 week at 460 +/- 1 kHz with an energy delivery of 600 and 300 J. Snoring Score, Epworth Sleepiness Scale, and cephalometric analysis were measured preoperatively and postoperatively. Certain inflammatory laboratory parameters and visual analogue scale scores of symptoms were measured related to the procedure. RESULTS The changes in Snoring Score and Epworth Sleepiness Scale scores were statistically significant. The change in the length of the soft palate was statistically significant, whereas the change in palatal width was not. There were no notable changes in the laboratory parameters. The symptom visual analogue scores were low and transient, resolving within days. CONCLUSIONS The radiofrequency thermal ablation of the soft palate in patients with sleep-disordered breathing seems to be effective. It is safe and associated with only a low morbidity. The promising results must be confirmed in a placebo-controlled study with a larger sample size and a long-term follow-up.
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Affiliation(s)
- L Bäck
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Haartmaninkatu 4 E, Post Office Box 220, 00290 Helsinki, Finland
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94
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95
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Lam C, Schweikert R, Kanagaratnam L, Natale A. Radiofrequency ablation of a right atrial appendage-ventricular accessory pathway by transcutaneous epicardial instrumentation. J Cardiovasc Electrophysiol 2000; 11:1170-3. [PMID: 11059983 DOI: 10.1111/j.1540-8167.2000.tb01765.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Epicardial location of accessory AV pathways may be responsible for the failure of conventional endocardial radiofrequency catheter ablation. Transcutaneous epicardial instrumentation provides access to the normal pericardium with no need for invasive thoracotomy or thoracoscopy. We report the case of successful epicardial mapping and ablation of a right atrial appendage-ventricular connection using a percutaneous epicardial approach, after repeated failure of endocardial ablation attempts.
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Affiliation(s)
- C Lam
- Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA
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96
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Iturralde P, Colin L, Kershenovich S, Guevara ME, Medeiros A, Buendia A, Attie F. Radiofrequency catheter ablation for the treatment of supraventricular tachycardias in children and adolescents. Cardiol Young 2000; 10:376-83. [PMID: 10950335 DOI: 10.1017/s1047951100009689] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report our experience in radiofrequency catheter ablation between April, 1992 and December, 1998, in which we treated 287 patients less than 18 years of age (mean 14.3 +/- 3.1 years) with supraventricular tachycardia. Accessory, pathways were the arrhythmic substrate in 252 of the patients (87.8%), the patients having a total of 265 accessory pathways. Atrioventricular nodal re-entry was the cause of tachycardia in 26 patients (9.0%), while atrial flutter was detected in the remaining 9 patients (3.1%). We were able successfully to eliminate the accessory pathway in 236 patients (89%), but 25 patients had recurrent arrhythmias. Ablation proved successful in all cases of atrioventricular node re-entry tachycardia, the slow pathway being ablated in 25 patients, and the fast pathway in only one case. Recurrence of the arrhythmia occurred in three patients (11.5%). We performed a second ablation in these children, all then proving successful. The ablation was successful in all cases of atrial flutter, with one recurrence (11.1%). Overall, therefore, ablation was immediately successful in 271 patients (94.4%), with a recurrence of the arrhythmia in 29 cases (10.7%). The incidence of serious complications was 2.09%. There was one late death due to infective endocarditis, 3 patients suffered complete heart block, 1 had mild mitral regurgitation, and 1 patient developed an haematoma in the groin. We conclude that radiofrequency catheter ablation can now be considered a standard option for the management of paroxysmal supraventricular tachycardias in children and young adults.
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Affiliation(s)
- P Iturralde
- Department of Electrophysiology, Instituto Nacional de Cardiologia Ignacio Chavez, México DF, Mexico
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97
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Echeverría IJ, Merino JL, Peinado R, Ramírez L, Peinado A, Sobrino JA. [Cardioinhibitory vagal response not related to pain, and induced by radiofrequency application during ablation of right posteroseptal accessory pathway]. Rev Esp Cardiol 2000; 53:1399-402. [PMID: 11060260 DOI: 10.1016/s0300-8932(00)75248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inappropriate sinus tachycardia is the most common arrhythmia induced by radiofrequency energy delivery in the posteroseptal area. It has been suggested that this could be secondary to parasymphathetic nerve injury. We report a patient with extreme sinus bradycardia and PR interval prolongation induced by radiofrequency energy delivered in the coronary sinus ostium area, but not related to any other stimulus. The most probable mechanism of the disorder was transient stimulation of the vagal afferent nerve fibers located in this anatomical area.
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Affiliation(s)
- I J Echeverría
- Laboratorio de Electrofisiología. UMQ de Cardiología. Hospital General Universitario La Paz. Madrid.
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98
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Hu D, Guo C, Yang J, Shang L, Xu Y, Ellenbogen KA, Shepard RK, Wood MA. Left ventricular tachycardia originating near the left main coronary artery. J Interv Card Electrophysiol 2000; 4:423-6. [PMID: 10936008 DOI: 10.1023/a:1009802416785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Eight patients with idiopathic ventricular tachycardia (VT) underwent mapping and radiofrequency ablation. Mapping showed VT originating in the high posterolateral left ventricular outflow tract in proximity to the left main and proximal circumflex coronary arteries. Ablation was not attempted due to this proximity to the left main and proximal circumflex coronary arteries. Ablation was not attempted due to this proximity in 2 patients and limited in 1 patient. It was successful in VT suppression in 5 of 6 patients.
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Affiliation(s)
- D Hu
- Red Cross Chao Yang Hospital, Biejing, China
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99
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Kato R, Matsumoto K, Goktekin O, Matsuo H, Watanabe H, Takahama M. Parahisian radiofrequency catheter ablation in dogs: comparison of the above-valve and below-valve approaches. J Interv Card Electrophysiol 2000; 4:359-68. [PMID: 10936002 DOI: 10.1023/a:1009814803581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In patients with an accessory pathway close to the His bundle, radiofrequency catheter ablation (RFCA) requires additional care to avoid damage to the normal conduction system. To assess differences between approaches from above or below the tricuspid valve (TV), we performed RFCA in 20 dogs (from above, group A, n=10; from below, group B, n=10). RF energy with temperature control at 60 degrees 60 seconds was administered at the site where a small His potential was recorded from the ablation catheter guided by fluoroscopy and transesophageal echocardiography (TEE) (in the latter six dogs). Before and after RFCA, electrophysiological testing was performed and histological findings were compared. An ablated lesion was created in 7 of 10 (2 of 2 guided by TEE) dogs in group A and 5 of 10 (3 of 4 TEE) dogs in group B. In group A, an ablated lesion involved the atrium and ventricle in the anterior site of His bundle, but the lesion was only in the ventricle in group B. An atrioventricular block (AVB) and severe damage to the penetrating bundle was observed in one dog of group A. A large hematoma on the TV was made in 2 dogs and the complete right bundle branch block (CRBBB) occurred in 3 dogs of group B. The approach from below the TV was safer than that from above the TV in parahisian RFCA, because it did not create an AVB, although it has a high incidence of CRBBB and associated technical difficulties.
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Affiliation(s)
- R Kato
- 2nd Department of Internal Medicine, and the 2nd Department of Pathology, Saitama Medical School, Japan
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100
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Wang SS, VanderBrink BA, Regan J, Carr K, Link MS, Homoud MK, Foote CM, Estes NA, Wang PJ. Microwave radiometric thermometry and its potential applicability to ablative therapy. J Interv Card Electrophysiol 2000; 4:295-300. [PMID: 10729850 DOI: 10.1023/a:1009842402357] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION [corrected] Current techniques for estimating catheter tip temperature in ablative therapy for cardiac arrhythmias rely on thermocouples or thermistors attached to or embedded in the tip electrode. These methods may reflect the electrode temperature rather than the tissue temperature during electrode cooling so that the highest temperature away from the ablation site may go undetected. A microwave radiometer is capable of detecting microwave radiation as a result of molecular motion. In this study, we evaluated microwave radiometric thermometry as a new technique to monitor temperature away from the electrode tip during ablative therapy utilizing a saline model. METHODS AND RESULTS A microwave radiometer antenna and fluoroptic thermometer were inserted in a test tube with circulating room temperature saline kept constant at 23.5 degrees C while the surrounding saline bath was heated from 37 degrees C to 70 degrees C. For every degree rise in the warm saline bath placed either 5 mm or 8 mm from the radiometer antenna, the radiometer temperature changed 0.26 degrees C and 0.14 degrees C respectively while the fluoroptic temperature probe remained constant at 23.5 degrees C. The radiometer temperature was highly correlated with the warm saline bath temperature (R(2)=0.997 for warm saline 5 mm from the antenna, R(2)=0.991 for warm saline 8 mm from the antenna). CONCLUSIONS Microwave radiometry can estimate distant temperatures by detecting microwave electromagnetic radiation. The sensitivity of the microwave radiometer is also distance-dependent. The microwave radiometer thus serves as a promising instrument for monitoring temperatures at depth away from the catheter-electrode tip in ablative therapy for cardiac arrhythmias.
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Affiliation(s)
- S S Wang
- Microwave Medical Systems, Inc., Acton, Massachusetts, USA
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