51
|
Te ALD, Chung FP, Lin YJ, Chen SA. Irregular wide QRS complex tachycardia in a patient with pulmonary hypertension: What is the mechanism? HeartRhythm Case Rep 2015; 2:63-66. [PMID: 28491634 PMCID: PMC5412644 DOI: 10.1016/j.hrcr.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Affiliation(s)
- Abigail Louise D Te
- Division of Cardiology Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine National Yang-Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
52
|
Talib AK, Nogami A, Nishiuchi S, Kowase S, Kurosaki K, Matsui Y, Kawada S, Watanabe A, Nozoe M, Uno K, Yagishita A, Yamauchi Y, Takahashi Y, Kuwahara T, Takahashi A, Kumagai K, Naito S, Asakawa T, Sekiguchi Y, Aonuma K. Verapamil-Sensitive Upper Septal Idiopathic Left Ventricular Tachycardia: Prevalence, Mechanism, and Electrophysiological Characteristics. JACC Clin Electrophysiol 2015; 1:369-380. [PMID: 29759464 DOI: 10.1016/j.jacep.2015.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study sought to demonstrate the prevalence, mechanism, and electrocardiographic and electrophysiological characteristics of upper septal idiopathic left fascicular ventricular tachycardia (US-ILVT). BACKGROUND ILVT is classified into left anterior and posterior types with no clear data about US-ILVT. METHODS Among 193 ILVT patients, we identified 12 patients (6.2%; age 41 ± 22 years, 7 men) with US-ILVT. RESULTS Of 12 patients with US-ILVT, 6 patients (50%) had previous history of radiofrequency catheter ablation for common ILVT. Sustained VT (cycle length: 349 ± 53 ms) was seen in all patients with a QRS interval slightly wider (104 ± 18 ms) than that during sinus rhythm (90 ± 19 ms). The VT exhibited an identical QRS configuration as sinus rhythm in 6 (50%) and incomplete right bundle branch block configuration in another 6. His-ventricular interval during VT was always shorter than that during sinus rhythm (27 ± 5 ms vs. 47 ± 10 ms). Purkinje potentials were activated in a reverse direction to that of common ILVT; namely, the diastolic potential (P1) was activated retrogradely but the pre-systolic potential (P2) was activated antegradely. At the left upper-middle ventricular septum, P1 potential was recorded during VT, preceding the QRS by 54 ± 20 ms. Radiofrequency catheter ablation at that site eliminated the VT with no recurrence during a 58 ± 35 months of follow-up. CONCLUSIONS US-ILVT is an identifiable VT that shares common criteria with ILVT and has a narrow QRS interval. Some US-ILVT cases appeared after common ILVT ablation. It is a reverse type of common ILVT (orthodromic form) with baseline morphological abnormalities that might provide a potential substrate for such VT.
Collapse
Affiliation(s)
- Ahmed Karim Talib
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Suguru Nishiuchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shinya Kowase
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kenji Kurosaki
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yumie Matsui
- Department of Cardiology, Saiseikai Izuo Hospital, Osaka, Japan
| | - Satoshi Kawada
- Division of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | | | - Masatsugu Nozoe
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kikuya Uno
- Sapporo Heart Center, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | | | - Yasuteru Yamauchi
- Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan
| | | | - Taishi Kuwahara
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Koji Kumagai
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Tetsuya Asakawa
- Cardiology Division, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
53
|
Liu Y, Fang Z, Yang B, Kojodjojo P, Chen H, Ju W, Cao K, Chen M, Zhang F. Catheter Ablation of Fascicular Ventricular Tachycardia: Long-Term Clinical Outcomes and Mechanisms of Recurrence. Circ Arrhythm Electrophysiol 2015; 8:1443-51. [PMID: 26386017 PMCID: PMC4676513 DOI: 10.1161/circep.115.003080] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence.
Collapse
Affiliation(s)
- Yaowu Liu
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Zhen Fang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Bing Yang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Pipin Kojodjojo
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Hongwu Chen
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Weizhu Ju
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Kejiang Cao
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Minglong Chen
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.)
| | - Fengxiang Zhang
- From the Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China (Y.L., Z.F., B.Y., H.C., W.J., K.C., M.C., F.Z.); and Heart Center, National University Hospital, Singapore, Singapore (P.K.).
| |
Collapse
|
54
|
Puie P, Cismaru G, Muresan L, Rosu R, Puiu M, Andronache M, Gusetu G, Matuz R, Mircea PA, Pop D, Zdrenghea D. Insights into the mechanism of idiopathic left ventricular tachycardia: a case report and literature review. Eur J Med Res 2015; 20:77. [PMID: 26381389 PMCID: PMC4573491 DOI: 10.1186/s40001-015-0156-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 07/24/2015] [Indexed: 11/10/2022] Open
Abstract
Left ventricular posterior fascicular tachycardia (LVPFT) is an idiopathic form of VT characterized by right bundle branch block morphology and left axis deviation. The mechanism of LPFVT is thought to be localized reentry close to the posterior fascicle. We present the case of a 24-year-old medical student who was admitted to the emergency department complaining of palpitations. The ECG showed an aspect suggestive of LVPFT. Vagal maneuvers, adenosine and i.v. Metoprolol were ineffective in terminating the arrhythmia. Conversion to sinus rhythm was obtained 10 h later, with i.v Amiodarone. The ECG in sinus rhythm showed left posterior fascicular block. Because antiarrhythmic drugs were not desired by the patient, VT ablation was proposed. The electrophysiological study identified the mechanism of arrhythmia to be reentry using the slowly conducting verapamil-sensitive fibers as the antegrade limb and the posterior fascicle as the retrograde limb. Radiofrequency applications near the posterior fascicle, in the lower half of the interventricular septum, at the junction of the two proximal thirds with the distal third interrupted the tachycardia and made it non-inducible at programmed stimulation. The case is unusual as the patient had a left posterior fascicular block during sinus rhythm before ablation. This demonstrates that the reentry circuit of VT does not need antegrade conduction through the posterior fascicle for perpetuation.
Collapse
Affiliation(s)
- Paul Puie
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Gabriel Cismaru
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Lucian Muresan
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Radu Rosu
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Mihai Puiu
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Marius Andronache
- Department of Electrophysiology, Institut Lorrain du Coeur et des Vaisseaux «Louis Mathieu», CHU de Nancy, Cluj-Napoca, France.
| | - Gabriel Gusetu
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Roxana Matuz
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Petru-Adrian Mircea
- Department of Internal Medicine, Medical Clinic No 1, "Iuliu Hatieganu", University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Dana Pop
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| | - Dumitru Zdrenghea
- Department of Cardiology, Rehabilitation Hospital, "Iuliu Hatieganu" University of Medicine and Pharmacy, 46-50 Viilor Street, 400347, Cluj-Napoca, Romania.
| |
Collapse
|
55
|
Tanawuttiwat T, Nazarian S, Calkins H. The role of catheter ablation in the management of ventricular tachycardia. Eur Heart J 2015; 37:594-609. [DOI: 10.1093/eurheartj/ehv421] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/07/2015] [Indexed: 12/11/2022] Open
|
56
|
Gopi A, Nair SG, Shelke A, Saggu DK, Yalagudri S, Reddy P, Narasimhan C. A stepwise approach to the induction of idiopathic fascicular ventricular tachycardia. J Interv Card Electrophysiol 2015; 44:17-22. [DOI: 10.1007/s10840-015-0022-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
|
57
|
Aksu T, Guler TE, Golcuk E, Ozcan KS, Erden I. Ablation of idiopathic ventricular tachycardia originating from posterior mitral annulus by using electroanatomical mapping. Int Med Case Rep J 2015; 8:71-5. [PMID: 25784821 PMCID: PMC4356701 DOI: 10.2147/imcrj.s79519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Idiopathic ventricular tachycardia (IVT) is an important type of arrhythmia, which has distinct electrocardiographic features and treatment options. Most of the cases originate from right ventricular outflow tract and less frequently from the left ventricular outflow tract. IVTs originating from mitral annulus are rare, and little is known about the efficacy of radiofrequency catheter ablation in this form. We hereby present a rare case of IVT arising from posterior mitral annulus. The electrocardiographic, electrophysiological, and electroanatomical characteristics of this tachycardia are discussed.
Collapse
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ebru Golcuk
- Department of Cardiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Kazım Serhan Ozcan
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ismail Erden
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| |
Collapse
|
58
|
Lipton J, Klein GJ, Sy RW. Challenges in the diagnosis and management of idiopathic ventricular fibrillation. HeartRhythm Case Rep 2015; 1:269-274. [PMID: 28491566 PMCID: PMC5419528 DOI: 10.1016/j.hrcr.2015.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jonathan Lipton
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | | | - Raymond W. Sy
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Address reprint requests and correspondence: Dr. Raymond W. Sy, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia.
| |
Collapse
|
59
|
Fishberger SB, Olen MM, Rollinson NL, Rossi AF. Creation of partial fascicular block: an approach to ablation of idiopathic left ventricular tachycardia in the pediatric population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:209-15. [PMID: 25469902 DOI: 10.1111/pace.12551] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/19/2014] [Accepted: 10/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter ablation of idiopathic left ventricular tachycardia in the pediatric population remains challenging. A recent multicenter study reported limited success with 14% not undergoing ablation due to inability to induce ventricular tachycardia (VT) or blood pressure instability during tachycardia. Creating complete or partial fascicular block with radiofrequency catheter ablation is a technique that may eliminate VT. This approach is performed during sinus rhythm, enabling atrioventricular conduction monitoring and maintaining stable hemodynamics. Importantly, induction of VT is not necessary for mapping or assessing efficacy of the procedure. METHODS A retrospective review of pediatric patients (3-17 years) with recurrent, documented idiopathic left ventricular tachycardia by electrocardiogram who received catheter ablation by creating fascicular block as a therapeutic endpoint was performed. All had ablation at the site of an identified Purkinje potential. RESULTS There were six patients with idiopathic left ventricular tachycardia, five originating from the posterior fascicle and one from the anterior fascicle. VT was not induced or spontaneous in four patients using programmed stimulation and isoproterenol infusion. All patients had a QRS axis shift following ablation, though none met criteria for fascicular block. At follow up (7-49 months, mean 27 months), all patients had persistence of this shift. There were no recurrences of VT and none of the patients were taking antiarrhythmic medication. CONCLUSION The technique of creating partial fascicular block appears to be a safe and effective approach to ablation of idiopathic left ventricular tachycardia in children.
Collapse
Affiliation(s)
- Steven B Fishberger
- Division of Cardiology, Miami Children's Hospital, Miami, Florida; Division of Pediatric Cardiology, Yale-New Haven Medical Center, New Haven, Connecticut
| | | | | | | |
Collapse
|
60
|
First Case of Left Posterior Fascicle in a Bystander Circuit of Idiopathic Left Ventricular Tachycardia. Can J Cardiol 2014; 30:1460.e11-3. [DOI: 10.1016/j.cjca.2014.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/21/2022] Open
|
61
|
Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|
62
|
|
63
|
Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|
64
|
Liu XY, Wei W, Chu JM, Wang LX, Zhao YJ, Wang J, Pu JL, Zhang S. Variations of electroanatomic substrates and markers of successful ablation in idiopathic left ventricular tachycardia. J Cardiovasc Med (Hagerstown) 2014; 15:659-67. [DOI: 10.2459/jcm.0b013e328365c174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
65
|
He J, Fang PH, Liu Z, Chen XB, Liu J, Tang M, Jia YH, Zhang S. Reversible tachycardia mediated cardiomyopathy after radiofrequency ablation of idiopathic left ventricular tachycardia. Int J Cardiol 2014; 176:e5-8. [PMID: 25042664 DOI: 10.1016/j.ijcard.2014.06.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 06/28/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Jia He
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Pi-Hua Fang
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| | - Zheng Liu
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiong-Biao Chen
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Liu
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Min Tang
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yu-He Jia
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Shu Zhang
- Center for Arrhythmia Diagnosis and Treatment, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
66
|
Okishige K, Sakurada H, Mizusawa Y, Yamauchi Y, Fukamizu S, Aoyagi H, Okano Y, Azegami K, Sasano T, Hirao K. The radio frequency catheter ablation of inter-fascicular reentrant tachycardia: new insights into the electrophysiological and anatomical characteristics. J Interv Card Electrophysiol 2014; 41:39-54. [DOI: 10.1007/s10840-014-9911-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
|
67
|
Ghanbari H, Schmidt M, Machado C, Daccarett M. Catheter ablation of ventricular tachycardia in structurally normal hearts. Expert Rev Cardiovasc Ther 2014; 8:651-61. [DOI: 10.1586/erc.10.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
68
|
Herkommer B, Fiek M, Reithmann C. Findings on magnetic resonance imaging of fascicular ventricular tachycardia. J Interv Card Electrophysiol 2013; 39:77-85. [DOI: 10.1007/s10840-013-9850-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 10/10/2013] [Indexed: 02/06/2023]
|
69
|
Morgera T, Hrovatin E, Mazzone C, Humar F, De Biasio M, Salvi A. Clinical spectrum of fascicular tachycardia. J Cardiovasc Med (Hagerstown) 2013; 14:791-8. [DOI: 10.2459/jcm.0b013e32835ef0b6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
70
|
Successful control of life-threatening polymorphic ventricular tachycardia by radiofrequency catheter ablation in an infant. Heart Vessels 2013; 29:422-6. [PMID: 23836069 DOI: 10.1007/s00380-013-0390-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/21/2013] [Indexed: 10/26/2022]
Abstract
We present a case of a 9-month-old girl in whom malignant polymorphic ventricular tachycardia (VT) was successfully controlled by radiofrequency catheter ablation under guidance with a three-dimensional mapping system. The VTs originated from the left ventricular lateral wall, left ventricular anterior wall, and left ventricular apex. At least six types of VTs were documented during the electrophysiology study. All VTs were successfully controlled after two sessions of radiofrequency catheter ablation, and she was discharged from our hospital on propranolol, mexiletine, flecainide, and aprindine.
Collapse
|
71
|
Intramural haematoma and dissection following idiopathic VT ablation. J Interv Card Electrophysiol 2013; 37:305. [PMID: 23585238 DOI: 10.1007/s10840-013-9785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 01/17/2013] [Indexed: 11/27/2022]
|
72
|
Hoffmayer KS, Gerstenfeld EP. Diagnosis and Management of Idiopathic Ventricular Tachycardia. Curr Probl Cardiol 2013; 38:131-58. [DOI: 10.1016/j.cpcardiol.2013.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
73
|
COLLINS KATHRYNK, SCHAFFER MICHAELS, LIBERMAN LEONARDO, SAAREL ELIZABETH, KNECHT MARIA, TANEL RONNE, BRADLEY DAVID, DUBIN ANNEM, PAUL THOMAS, SALERNO JACK, BAR-COHEN YANIV, SREERAM NARAYANSWAMI, SANATANI SHUBHAYAN, LAW IANH, BLAUFOX ANDREW, BATRA ANJAN, MOLTEDO JOSEM, VAN HARE GEORGEF, REED JOHN, RO PAMELAS, KUGLER JOHN, ANDERSON CHRIS, TRIEDMAN JOHNK. Fascicular and Nonfascicular Left Ventricular Tachycardias in the Young: An International Multicenter Study. J Cardiovasc Electrophysiol 2013; 24:640-8. [DOI: 10.1111/jce.12105] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/30/2022]
Affiliation(s)
- KATHRYN K. COLLINS
- Division of Cardiology, Department of Pediatrics; The Children's Hospital, University of Colorado; Denver Colorado USA
| | - MICHAEL S. SCHAFFER
- Division of Cardiology, Department of Pediatrics; The Children's Hospital, University of Colorado; Denver Colorado USA
| | - LEONARDO LIBERMAN
- Division of Cardiology, Department of Pediatrics; Children's Hospital of NY-Presbyterian; New York New York USA
| | - ELIZABETH SAAREL
- Division of Cardiology, Department of Pediatrics; Primary Children's Hospital; Salt Lake City Utah USA
| | - MARIA KNECHT
- Division of Cardiology, Department of Pediatrics; The Children's Memorial Health Insitute; Warsaw Poland
| | - RONN E. TANEL
- Division of Cardiology, Department of Pediatrics; University of California; San Francisco California USA
| | - DAVID BRADLEY
- Division of Cardiology, Department of Pediatrics; C. S. Mott Children's Hospital; Ann Arbor Michigan USA
| | - ANNE M. DUBIN
- Division of Cardiology, Department of Pediatrics; Stanford University; Palo Alto California USA
| | - THOMAS PAUL
- Division of Cardiology, Department of Pediatrics; Georg-August-University; Göttingen Germany
| | - JACK SALERNO
- Division of Cardiology, Department of Pediatrics; Children's Heart Center; Seattle Washington USA
| | - YANIV BAR-COHEN
- Division of Cardiology, Department of Pediatrics; Children's Hospital; Los Angeles California USA
| | - NARAYANSWAMI SREERAM
- Division of Cardiology, Department of Pediatrics; University Hospital of Cologne; Koln Germany
| | - SHUBHAYAN SANATANI
- Division of Cardiology, Department of Pediatrics; British Columbia Children's Hospital; Vancouver British Columbia Canada
| | - IAN H. LAW
- Division of Cardiology, Department of Pediatrics; University of Iowa Children's Hospital; Iowa City Iowa USA
| | - ANDREW BLAUFOX
- Division of Cardiology, Department of Pediatrics; Steven and Alexandra Cohen Children's Medical Center of New York; New Hyde Park New York USA
| | - ANJAN BATRA
- Division of Cardiology, Department of Pediatrics, Childrens Hospital of Orange County; University of California-Irvine; Orange California USA
| | - JOSE M. MOLTEDO
- Division of Cardiology, Department of Pediatrics; Clinica y Maternidad Suizo Argentina; Buenos Aires Argentina
| | - GEORGE F. VAN HARE
- Division of Cardiology, Department of Pediatrics; Washington University School of Medicine/St. Louis Children's Hospital; St. Louis Missouri USA
| | - JOHN REED
- Division of Cardiology, Department of Pediatrics; Medical University of South Carolina; Charleston South Carolina USA
| | - PAMELA S. RO
- Division of Cardiology, Department of Pediatrics; Nationwide Children's Hospital; Columbus Ohio USA
| | - JOHN KUGLER
- Division of Cardiology, Department of Pediatrics; Nebraska Medical Center; Omaha Nebraska USA
| | - CHRIS ANDERSON
- Division of Cardiology, Department of Pediatrics; Northwest Center for Congenital Heart Disease; Spokane Washington USA
| | - JOHN K. TRIEDMAN
- Division of Cardiology, Department of Pediatrics; Children's Hospital; Boston Massachusetts USA
| | | |
Collapse
|
74
|
Kataria V, Yaduvanshi A, Kumar M, Nair M. Demonstration of posterior fascicle to myocardial conduction block during ablation of idiopathic left ventricular tachycardia: an electrophysiological predictor of long-term success. Heart Rhythm 2013; 10:638-45. [PMID: 23313803 DOI: 10.1016/j.hrthm.2013.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Idiopathic left ventricular tachycardia (ILVT) is a common form of ventricular tachycardia (VT) in structurally normal heart. Different methods have been proposed for radiofrequency ablation (RFA) of ILVT that have good short-term results but recurrence is higher. Termination of tachycardia during RFA and/or noninduciblity has been the procedural end point. OBJECTIVE To describe electrophysiological markers that add to long-term freedom from recurrences. METHODS Fifteen patients with ILVT underwent RFA guided by 3-dimensional electroanatomical mapping. After creating a 3-dimensional geometry of the left ventricle (LV), the conduction system of the LV was mapped by tracing from His recording from the left ventricular outflow tract and distally till the fascicles and perifascicular myocardium. VT was induced by using programmed electrical stimulation. Ablation was done targeting the distal posterior fascicle and extended linearly to the surrounding myocardium till conduction block was achieved between the fascicle-Purkinje network and the left ventricular myocardium. RESULTS All patients (13 men; mean age 32 ± 9 years) had inducible VTs. The mean tachycardia cycle length was 320 ± 28 ms. Radiofrequency energy was given to the distal posterior fascicle and the myocardium, with an aim to achieve a myocardial-fascicular conduction block in addition to the termination of VT and noninducibility. Ablation was successful in all. No recurrence of tachycardia was seen in any patient on follow-up (20.8 ± 8.5 months). CONCLUSIONS Distal posterior fascicle and Purkinje-myocardial junction is an effective target site for ILVT ablation. The demonstration of myocardial to fascicle conduction block serves as an important electrophysiological marker of successful ablation and improved long-term success.
Collapse
Affiliation(s)
- Vikas Kataria
- Institute of Cardiac Sciences, Max Superspecialty Hospital, Patparganj, New Delhi, India
| | | | | | | |
Collapse
|
75
|
SUNG RAPHAELK, KIM ALBERTM, TSENG ZIANH, HAN FREDERICK, INADA KEIICHI, TEDROW USHAB, VISWANATHAN MOHANN, BADHWAR NITISH, VAROSY PAULD, TANEL RONN, OLGIN JEFFREYE, STEPHENSON WILLIAMG, SCHEINMAN MELVIN. Diagnosis and Ablation of Multiform Fascicular Tachycardia. J Cardiovasc Electrophysiol 2012; 24:297-304. [DOI: 10.1111/jce.12020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
76
|
Nakagawa E, Takagi M, Abe Y, Komatsu R, Haze K, Naruko T, Itoh A. The main trunk of the left bundle branch is not part of the re-entry circuit of verapamil-sensitive idiopathic left ventricular tachycardia. J Arrhythm 2012. [DOI: 10.1016/j.joa.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
77
|
Houmsse M, Daoud EG. Biophysics and clinical utility of irrigated-tip radiofrequency catheter ablation. Expert Rev Med Devices 2012; 9:59-70. [PMID: 22145841 DOI: 10.1586/erd.11.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Catheter ablation by radiofrequency (RF) energy has successfully eliminated cardiac tachyarrhythmias. RF ablation lesions are created by thermal energy. Electrode catheters with 4-mm-tips have been adequate to ablate arrhythmias located near the endocardium; however, the 4-mm-tip electrode does not readily ablate deeper tachyarrhythmia substrate. With 8- and 10-mm-tip RF electrodes, ablation lesions were larger; yet, these catheters are associated with increased risk for coagulum, char and thrombus formation, as well as myocardial steam rupture. Cooled-tip catheter technology was designed to cool the electrode tip, prevent excessive temperatures at the electrode tip-tissue interface, and thus allow continued delivery of RF current into the surrounding tissue. This ablation system creates larger and deeper ablation lesions and minimizes steam pops and thrombus formation. The purpose of this article is to review cooled-tip RF ablation biophysics and outcomes of clinical studies as well as to discuss future technological improvements.
Collapse
Affiliation(s)
- Mahmoud Houmsse
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University, Columbus, USA.
| | | |
Collapse
|
78
|
WISSNER ERIK, MENON SYAMKUMARDIVAKARA, METZNER ANDREAS, SCHOONDERWOERD BAS, NUYENS DIETER, MAKIMOTO HISAKI, ZHANG QINGYING, MATHEW SHIBU, FUERNKRANZ ALEXANDER, RILLIG ANDREAS, TILZ ROLANDRICHARD, KUCK KARLHEINZ, OUYANG FEIFAN. Long-Term Outcome After Catheter Ablation for Left Posterior Fascicular Ventricular Tachycardia Without Development of Left Posterior Fascicular Block. J Cardiovasc Electrophysiol 2012; 23:1179-84. [DOI: 10.1111/j.1540-8167.2012.02377.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
79
|
|
80
|
Prystowsky EN, Padanilam BJ, Joshi S, Fogel RI. Ventricular Arrhythmias in the Absence of Structural Heart Disease. J Am Coll Cardiol 2012; 59:1733-44. [PMID: 22575310 DOI: 10.1016/j.jacc.2012.01.036] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 12/22/2011] [Accepted: 01/06/2012] [Indexed: 11/25/2022]
|
81
|
Chu J, Sun Y, Zhao Y, Wei W, Wang J, Liu X, Jia Y, Mao K, Pu J, Zhang S. Identification of the slow conduction zone in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia using electroanatomic mapping. J Cardiovasc Electrophysiol 2012; 23:840-5. [PMID: 22452322 DOI: 10.1111/j.1540-8167.2012.02312.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although idiopathic left ventricular tachycardia (ILVT) has been shown to possess a slow conduction zone (SCZ), the details of the electrophysiological and anatomic aspects are still not well understood. OBJECTIVE We hypothesized that the SCZ can be identified using a 3-dimensional electroanatomic (EA) mapping system. METHODS Ten patients with ILVT were mapped using a 3-dimensional electroanatomic (EA) mapping system. After a 3-dimensional endocardial geometry of the left ventricular was created, the conduction system with left Purkinje potential (PP) and the SCZ with diastolic potential (DP) in LV were mapped during sinus rhythm (SR) and ventricular tachycardia (VT) and were tagged as special landmarks in the geometry. The electrophysiological and anatomic aspects of it were investigated. RESULTS EA mapping during SR and VT was successfully performed in 7 patients, during VT in 3 patients. The SCZ with DPs located at the inferoposterior septum was found in 7 patients during SR and all patients during VT. The length of the SCZ was 25.2 ± 2.3 mm with conduction velocity 0.08 ± 0.01 m/s. No differences in these parameters were found between patients during SR and VT (P > 0.05). An area with PP was found within the posterior septum. A crossover junction area with DP and PP was found in 7 patients during SR and VT. This area with DP and PP during SR coincided or were in proximity to such area during VT and radiofrequency ablation targeting the site within the area abolished VT in all patients. CONCLUSION The ILVT substrate within the junction area of the SCZ and the posterior fascicular can be identified and can be used to guide the ablation of ILVT.
Collapse
Affiliation(s)
- Jianmin Chu
- Clinical EP Laboratory and Arrhythmia Service Center of Fuwai Heart Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
82
|
Park J, Kim YH, Hwang C, Pak HN. Electroanatomical characteristics of idiopathic left ventricular tachycardia and optimal ablation target during sinus rhythm: significance of preferential conduction through Purkinje fibers. Yonsei Med J 2012; 53:279-88. [PMID: 22318814 PMCID: PMC3282975 DOI: 10.3349/ymj.2012.53.2.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We hypothesized that Purkinje potential and their preferential conduction to the left ventricle (LV) posteroseptum during sinus rhythm (SR) are part of reentrant circuits of idiopathic left ventricular tachycardia (ILVT) and reentry anchors to papillary muscle. MATERIALS AND METHODS In 14 patients with ILVT (11 men, mean age 31.5±11.1 years), we compared Purkinje potential and preferential conduction during SR with VT by non-contact mapping (NCM). If clear Purkinje potential(SR) was observed in the LV posteroseptum and the earliest activation site (EA) of preferential conduction at SR (EA(SR)) was well matched with that of VT (EA(VT)), EA(SR) was targeted for radiofrequency catheter ablation (RFCA). Also, the anatomical locations of successful ablation sites were evaluated by echocardiography in five additional patients. RESULTS 1) All induced VTs exhibited clear Purkinje potential(VT) and preferential conduction in the LV posteroseptum. The Purkinje potential(VT) and EA(VT) was within 5.8±8.2 mm of EA(SR). However, the breakout sites of VT were separated by 30.2±12.6 mm from EA(VT) to the apical side. 2) Purkinje potential(SR) demonstrated a reversed polarity to Purkinje potential(VT), and the interval of Purkinje potential(SR)-QRS was longer than the interval of Purkinje potential(VT)-QRS (p<0.02) 3) RFCA targeting EA(SR) eliminated VT in all patients without recurrence within 23.3±7.5 months, and the successful ablation site was discovered at the base of papillary muscle in the five additional (100%) patients. CONCLUSION NCM-guided localization of EA(SR) with Purkinje potential(SR) matches well with EA(VT) with Purkinje potential(VT) and provides an effective target for RFCA, potentially at the base of papillary muscle in patients with ILVT.
Collapse
Affiliation(s)
- Junbeom Park
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | | | - Chun Hwang
- Utah Valley Regional Medical Center, Provo, UT and Krannert Heart Institute, Indiana University, Indianapolis, IN, USA
| | - Hui-Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| |
Collapse
|
83
|
MORISHIMA ITSURO, NOGAMI AKIHIKO, TSUBOI HIDEYUKI, SONE TAKAHITO. Negative Participation of the Left Posterior Fascicle in the Reentry Circuit of Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia. J Cardiovasc Electrophysiol 2012; 23:556-9. [DOI: 10.1111/j.1540-8167.2011.02251.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
84
|
Hamid N, Chia S. Case of Idiopathic Left Ventricular Tachycardia (ILVT). PROCEEDINGS OF SINGAPORE HEALTHCARE 2011. [DOI: 10.1177/201010581102000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The objective of this case report is to illustrate a case of idiopathic left ventricular tachycardia (ILVT). It is important to distinguish key features to differentiate ILVT from other types of ventricular tachycardias. Clinical picture: A 33-year-old male presented with palpitations. Clinical examination was unremarkable, except a heart rate of 170 beats/min. ECG showed a right bundle branch morphology, left superior frontal plane and a relatively narrow QRS duration. A diagnosis of ILVT was made. Treatment: Intravenous verapamil was given and the ILVT was terminated. Conclusion: ILVT differs from other types of VT, such as right ventricular outflow tract (RVOT), in terms of mechanisms, site of origin and management. Overall, ILVT has a good prognosis, compared to VTs seen in ischaemic cardiomyopathy.
Collapse
Affiliation(s)
- Nadira Hamid
- Department of Cardiology, National Heart Centre Singapore
| | - Stanley Chia
- Department of Cardiology, National Heart Centre Singapore
| |
Collapse
|
85
|
Latcu D, Saoudi N. His-Purkinje et arythmies. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2011. [DOI: 10.1016/s1878-6480(11)70390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
86
|
HUELSING DELILAHJ, POLLARD ANDREWE. MEMBRANE AND TISSUE LEVEL CONTRIBUTIONS TO PURKINJE-VENTRICULAR INTERACTIONS: A MODEL STUDY. J BIOL SYST 2011. [DOI: 10.1142/s0218339099000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purkinje-to-ventricular (P-to-V) propagation and electrotonic modulation of repolarization at discrete Purkinje-ventricular junctions (PVJs) depend on differences in the ionic currents and tissue structure of the P network and the V myocardium. We used computer simulations to assess these membrane and tissue level contributions to P-V interactions. At the membrane level, we used the DiFrancesco-Noble membrane equations to model P ionic kinetics and the Luo-Rudy dynamic membrane equations to model V ionic kinetics. At the tissue level, we modeled the P network as a layer of branching cables, and we modeled a single myocardial sheet with an anisotropic layer of excitable cells. P-to-V propagation was enhanced at the tissue level when multiple wavefronts in the branching P network collided at the PVJ. At the membrane level, P-to-V propagation was enhanced by a reduced transient outward current (Ito) in the P layer. Repolarization at the PVJ was also modulated by both membrane and tissue level contributions. Under nominal conditions, action potential duration (APD) shortened in the P layer and prolonged in the V layer. However, when the V mass was reduced, both P and V cell APDs shortened during coupling with nominal Ito. Subsequent Ito inhibition restored coupling-induced prolongation of the V action potential in the reduced V mass. These results suggest that under physiologic conditions, both membrane and tissue level contributions to P-V interactions are important, while membrane level contributions become even more important under pathologies that reduce the difference in P and V tissue size, particularly in the setting of healed myocardial infarction.
Collapse
Affiliation(s)
- DELILAH J. HUELSING
- Cardiac Rhythm Management Lab and Department of Biomedical Engineering, University of Alabama-Birmingham, Birmingham, AL 35294, USA
| | - ANDREW E. POLLARD
- Cardiac Rhythm Management Lab and Department of Biomedical Engineering, University of Alabama-Birmingham, Birmingham, AL 35294, USA
| |
Collapse
|
87
|
Schölzel BE, Balt JC, van Helden GHAM, Wever EFD. [Not Available]. Neth Heart J 2011; 19:56. [PMID: 22020862 DOI: 10.1007/s12471-010-0059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- B E Schölzel
- Department of Cardiology, St Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, the Netherlands,
| | | | | | | |
Collapse
|
88
|
Hu JQ, Ma J, Yang Q, Liao ZL, Hou Y, Zhang S. The characteristics of verapamil-sensitive idiopathic left ventricular tachycardia combined with a left accessory pathway and the effect of radiofrequency catheter ablation. Europace 2011; 14:703-8. [PMID: 22016304 DOI: 10.1093/europace/eur330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) combined with a left accessory pathway (AP) is a relatively rare condition. This study examines the characteristics of patients with this condition and the effect of radiofrequency catheter ablation (RFCA). METHODS AND RESULTS Catheter ablation was performed on 140 ILVT patients at a single centre from January 2004 to December 2009. A concealed left AP was found in seven patients (5%), all of whom were male, with an average age of 21 ± 9 years. Sustained ILVT and orthodromic atrioventricular reentrant tachycardia (AVRT) were induced in all seven patients. Retrograde activation through a bystander AP occurred concomitantly with ILVT, with an average tachycardia length of 346 ± 29 ms (range 310-400 ms). The location of the APs in four patients was left posterior, two of which showed a slow and decremental property, while in three it was left lateral. Ablation via a retrograde transaortic approach was performed in the seven patients. The left AP was ablated first in six patients, but ILVT was no longer induced in one and became non-sustained in another. In the seventh patient, ILVT was ablated first and this proved successful. CONCLUSIONS Among patients with IVLT, 5% had a concomitant left AP, most of who were young men. The location of the left AP was mainly posterior and lateral, with 30% showing a slow and decremental property. Idiopathic left ventricular tachycardia and AP should be ablated simultaneously.
Collapse
Affiliation(s)
- Ji-qiang Hu
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing 100037, China
| | | | | | | | | | | |
Collapse
|
89
|
Von Bergen NH, Bansal S, Gingerich J, Law IH. Nonfluoroscopic and radiation-limited ablation of ventricular arrhythmias in children and young adults: a case series. Pediatr Cardiol 2011; 32:743-7. [PMID: 21442398 DOI: 10.1007/s00246-011-9956-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to report the feasibility and procedural technique of minimal or no fluoroscopy in the ablation of ventricular arrhythmias in the pediatric population. A retrospective review was performed of all patients <21 years old who underwent ablation of ventricular arrhythmias using three-dimensional (3D) mapping with no or minimal fluoroscopy at a single institution. Five patients underwent electrophysiology studies for ventricular tachycardia or frequent premature ventricular complexes. Three patients had right-sided arrhythmias, and two patients had left-sided arrhythmias. Electro-anatomic mapping with the 3D EnSite NavX system and radiofrequency ablation was used in all patients. No fluoroscopy was used in the patients with right-sided arrhythmias. The two patients with left-sided arrhythmias had 1.0 and 1.9 min of fluoroscopy, respectively. The mean procedure time was 168 min (range 95 to 270). There has been no recurrence at mean follow-up of >1 year. Three-dimensional mapping systems have allowed pediatric electrophysiologic procedures to be performed with minimal to no fluoroscopy in patients with challenging arrhythmias, including ventricular arrhythmias. The decrease in radiation exposure decreases the risk of long-term adverse sequelae resulting from radiation exposure, which is especially important in children.
Collapse
Affiliation(s)
- Nicholas H Von Bergen
- The University of Iowa Children's Hospital, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52246, USA.
| | | | | | | |
Collapse
|
90
|
Abstract
Idiopathic ventricular arrhythmias occur in patients without structural heart disease. They can arise from a variety of specific areas within both ventricles and in the supravalvular regions of the great arteries. Two main groups need to be differentiated: arrhythmias from the outflow tract (OT) region and idiopathic left ventricular, so-called fascicular, tachycardias (ILVTs). OT tachycardia typically originates in the right ventricular OT, but may also occur in the left ventricular OT, particularly in the sinuses of Valsalva or the anterior epicardium or the great cardiac vein. Activation mapping or pace mapping for the OT regions and mapping of diastolic potentials in ILVTs are the mapping techniques that are typically used. The ablation of idiopathic ventricular arrhythmias is highly successful, associated with only rare complications. Newly recognized entities of idiopathic ventricular tachycardias are those originating in the papillary muscles and in the atrioventricular annular regions.
Collapse
Affiliation(s)
- Doreen Schreiber
- Department of Electrophysiology, Clinic Hirslanden - Heart Center, Witellikerstrasse 40, CH - 8032, Zurich, Switzerland.
| | | |
Collapse
|
91
|
Jia L, Yue-Chun L, Kang-Ting J, Na-Dan Z, Jia-Xuan L, Wen-Wu Z, Peng-Lin Y, Ji-Fei T, Jia-Feng L. Premature ventricular contractions originating from the left ventricular septum: results of radiofrequency catheter ablation in twenty patients. BMC Cardiovasc Disord 2011; 11:27. [PMID: 21635765 PMCID: PMC3123650 DOI: 10.1186/1471-2261-11-27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 06/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND RFCA has been established as an effective and curative therapy for severely symptomatic PVC from the outflow tract in structurally normal hearts. However, it is unknown whether PVCs originating from the left ventricular septum, are effectively eliminated by RFCA. This study aimed to investigate electrophysiologic characteristics and effects of radiofrequency catheter ablation (RFCA) for patients with symptomatic premature ventricular contraction (PVC) originating from the left ventricular septum without including fascicular PVCs. METHODS Characteristics of body surface electrocardiogram (ECG) and electrophysiologic recordings endocardiogram in a successful RFCA target were analyzed in 20 patients with symptomatic PVCs originating from the left ventricular septum. RFCA was performed using pace mapping and activation mapping. RESULTS The QRS morphology of PVCs originating from the left ventricular septum is similar to that seen in fascicular tachycardia. Most of the PVCs originated from the left septum appears in the form of ventricular parasystole. The incidence of ventricular parasystole was 70%. Sustained ventricular tachycardia was not inducible by electrical stimulation and isoproterenol infusion in all 20 patients, ablation at the site recording the earliest Purkinje potential was not effective in all 20 patients, and Purkinje potentials were not identified at successful sites during point mapping. Sixteen patients were successful with RFCA using pace mapping and activation mapping, 3 failed, and 1 recurrent. CONCLUSION Although the ECG characteristics of the PVCs arising from the left ventricular septum are similar to that seen in fascicular tachycardia, the electrophysiologic characteristics are different between the two types of PVCs. The distinguishing characteristic of the PVCs is that Purkinje potentials were not present at the site of successful ablation, suggesting a myocardial as opposed to fascicular substrate. RFCA is an effective curative therapy for symptomatic PVCs originating from the left ventricular septum (not from the left anterior and posterior fascicle).
Collapse
Affiliation(s)
- Li Jia
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China
| | | | | | | | | | | | | | | | | |
Collapse
|
92
|
Ablation strategies in a patient with Belhassen tachycardia. J Electrocardiol 2011; 44:802-5. [PMID: 21453930 DOI: 10.1016/j.jelectrocard.2011.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Indexed: 11/22/2022]
Abstract
UNLABELLED The verapamil-sensitive Belhassen tachycardia is a ventricular reentrant tachycardia, involving left-sided Purkinje fibers and abnormal Purkinje or myocardial tissue. Ablation is feasible, targeting a diastolic fascicular potential in the apical left ventricle. CASE REPORT We report on a 13-year-old girl with left posterior fascicular ventricular tachycardia. Tachycardia stopped during ablation, targeting a left-sided distal fascicular potential, and afterward, there was no tachycardia inducible, but it reoccurred 2 weeks later. During a second procedure, we transected the left posterior fascicle by a line, also with early success. After a further recurrence, we ablated a longer proximal segment of the left posterior fascicle including its most proximal electrograms. After this ablation, there was no further recurrence. CONCLUSION In refractory patients, proximal ablation of the posterior fascicle might be indicated.
Collapse
|
93
|
NOGAMI AKIHIKO. Purkinje-Related Arrhythmias Part I: Monomorphic Ventricular Tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:624-50. [DOI: 10.1111/j.1540-8159.2011.03044.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
94
|
Roberts-Thomson KC, Lau DH, Sanders P. The diagnosis and management of ventricular arrhythmias. Nat Rev Cardiol 2011; 8:311-21. [DOI: 10.1038/nrcardio.2011.15] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
95
|
Catheter ablation of right ventricular outflow tract tachycardia: a simplified remote-controlled approach. Europace 2011; 13:696-700. [DOI: 10.1093/europace/euq510] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
96
|
Ohe T. Wide QRS Complex Tachycardia in a Young Healthy Man. J Arrhythm 2011. [DOI: 10.1016/s1880-4276(11)80012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
97
|
|
98
|
|
99
|
Feasibility and safety of transradial approach for catheter ablation of idiopathic left ventricular tachycardia. Clin Res Cardiol 2010; 100:37-43. [DOI: 10.1007/s00392-010-0201-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022]
|
100
|
Shin WS, Lee MY, Jang SW, Kim JH, Yoon HJ, Jin SW, Oh YS, Seung KB, Rho TH. The significance of repetitive ventricular responses induced by radiofrequency energy application for idiopathic left ventricular tachycardia. J Korean Med Sci 2010; 25:868-74. [PMID: 20514307 PMCID: PMC2877221 DOI: 10.3346/jkms.2010.25.6.868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 12/07/2009] [Indexed: 11/20/2022] Open
Abstract
In radiofrequency (RF) ablation for idiopathic left ventricular tachycardia (ILVT), the termination of tachycardia during RF ablation is considered a hallmark of success. However, in cases of patients with difficulty of induction of ventricular tachycardia (VT), the evaluation of procedural success can be problematic. We have observed thermal responses reflected as ventricular rhythm change to RF energy delivered on sinus rhythm for ILVT. We therefore describe the significance of repetitive ventricular responses. The study subjects were 11 ILVT patients for whom RF energy was delivered during sinus rhythm because of difficulty in re-induction of tachycardia. During each energy delivery, we focused on the occurrence of repetitive ventricular responses especially exhibiting a similar morphology to clinical VT. The repetitive ventricular responses were noted in 10 of 11 patients. Two patients received a second procedure due to the recurrence of ILVT. The mean follow-up period was 36.2+/-12.8 months. The clinical course of the remaining patients was favorable and without recurrence of ILVT. Based on the favorable clinical outcomes, ablation-induced repetitive ventricular responses with similar QRS morphology to clinical ILVT are useful markers for selecting an ablation site and could be used as an additional mapping method, termed as "thermal mapping".
Collapse
Affiliation(s)
- Woo Seung Shin
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Man Young Lee
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Sung Won Jang
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Hee Jeoung Yoon
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Seung Won Jin
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Yong Seog Oh
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Ki Bae Seung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| | - Tai Ho Rho
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea, School of Medicine, Seoul, Korea
| |
Collapse
|