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Arai S, Asano T, Nakamura Y, Gokan T, Onishi Y, Shinke T. A rare case of adenosine-sensitive atrial tachycardia originating at the mitral annulus's anterior septum. HeartRhythm Case Rep 2024; 10:533-536. [PMID: 39155907 PMCID: PMC11328559 DOI: 10.1016/j.hrcr.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
- Shuhei Arai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Taku Asano
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuya Nakamura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiko Gokan
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimi Onishi
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Nagamori Y, Kusayama T, Nakagawa Y, Tuda T, Kato T, Takamura M. Target potential for ablation in adenosine-sensitive atrial tachycardia originating from the vicinity of the atrioventricular node identified by the LUMIPOINT software. HeartRhythm Case Rep 2024; 10:203-207. [PMID: 38496741 PMCID: PMC10943559 DOI: 10.1016/j.hrcr.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Yuta Nagamori
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Yoichiro Nakagawa
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Toyonobu Tuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
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Tamura S, Shimeno K, Hayashi Y, Naruko T, Fukuda D. Effective ablation of atrial tachycardia with an epicardial circuit-insights from endocardial scars sites: a case study. J Interv Card Electrophysiol 2024; 67:1-3. [PMID: 37991668 DOI: 10.1007/s10840-023-01687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
A previous study reported primary macroreentrant atrial tachycardia (AT) in the left atrium (LA), including the epicardial circuit on a left atrial anterior wall (LAAW) scar, without any prior cardiac intervention (Miyazawa et al. in J Cardiovasc Electrophysiol 2019; 30: 263-264). However, determining the target for terminating macroreentrant ATs is challenging. The mapping revealed a centrifugal pattern but did not fully elucidate the AT circuit. The reentrant mechanism of these ATs was confirmed using entrainment pacing. The earliest excitation site (EES) was traditionally selected as the ablation site, typically located in healthy tissue. However, our two cases provide new insights into AT termination, including the epicardial bridge across the endocardial LAAW scar, using minimum ablation points, without the need to ablate the healthy EES.
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Affiliation(s)
- Shota Tamura
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Kenji Shimeno
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan.
| | - Yusuke Hayashi
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Takahiko Naruko
- Department of Cardiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-Ku, Osaka, 534-0021, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
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Kaneko Y, Nakajima T, Tamura S, Nagashima K, Kobari T, Hasegawa H, Ishii H. Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V-A-A-V response. Pacing Clin Electrophysiol 2022; 45:839-852. [PMID: 35661184 DOI: 10.1111/pace.14540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The electrophysiological discrimination between fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (NRT) and atrial tachycardia (AT) originating from the interatrial septum remains challenging. While a V-A-A-V response may occur immediately after ventricular induction or entrainment of either tachycardia, the electrophysiological dissimilarities in that response between the two tachycardias remain unclear. The purpose of this study was to identify a diagnostic indicator discriminating F/S-AVNRT from AT by examining the difference in the V-A-A-V response between the two tachycardias. METHODS This retrospective study included 17 patients with F/S-AVNRT [7 with common-form F/S-AVNRT using a typical slow pathway (SP) and 10 with superior type F/S-AVNRT using a superior SP] and 10 patients with reentrant AT. All 27 patients presented with long RP supraventricular tachycardia and an initial V-A-A-V response upon ventricular induction or entrainment. The V-A-A-V response in patients with F/S-AVNRT was due to dual atrial responses. We measured the interval between the first (A1) and second atrial electrogram (A2) of V-A-A-V and calculated ΔAA by subtracting A1-A2 from the tachycardia cycle length. RESULTS V-A-A-V responses were observed most often upon ventricular induction of F/S-AVNRT (6±5 times) as well as AT (6±6 times; P = 0.87). The V-A-A-V response upon ventricular entrainment was observed in a single patient with F/S-AVNRT versus 10 all patients with AT (P<0.001). ΔAA ranged between -80 and 228 ms in F/S-AVNRT and between -184 and 26 ms in AT. A ΔAA >26 ms predicted a diagnosis of F/S-AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA ←80 ms predicted a diagnosis of AT with a 50% sensitivity and 100% specificity. CONCLUSIONS ΔAA is a useful, confirmatory, diagnostic indicator of F/S-AVNRT versus AT associated with the V-A-A-V response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koichi Nagashima
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Yamabe H, Soejima T, Kajiyama K, Fukami Y, Haraguchi K, Okonogi T, Hirai K, Fukuoka R, Umeji K, Orita Y, Koga H, Kawasaki T. Efficacy of Catheter Ablation From the Non-Coronary Aortic Cusp of Verapamil-Sensitive Atrial Tachycardia Arising Near the Atrioventricular Node. Heart Rhythm 2021; 19:719-727. [PMID: 34968740 DOI: 10.1016/j.hrthm.2021.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efficacy of catheter ablation from the non-coronary aortic cusp (NCC) of verapamil-sensitive atrial tachycardia arising near the atrioventricular node (AVN-AT) has yet to be fully clarified. OBJECTIVE We elucidated the determinant of an effective AVN-AT ablation from the NCC. METHODS After identifying the earliest atrial activation site (EAAS) during tachycardia, the direction of the slow conduction zone (SCZ) of reentry circuit was identified by demonstrating manifest entrainment in 26 AVN-AT patients. Catheter ablation was initially performed from the NCC irrespective of the local activation time. If the NCC ablation was ineffective, catheter ablation was performed targeting the SCZ entrance. Then the anatomical relationship between the SCZ and successful ablation site was elucidated. RESULTS NCC catheter ablation terminated AVN-AT in 14 patients (NCC Group) but not in 12 (Non-NCC Group). Catheter ablation targeting the SCZ entrance terminated all Non-NCC Group ATs. The local activation time at the NCC relative to the EAAS did not differ between the NCC and Non-NCC Groups (10.1±6.5 vs. 11.2±4.8 msec, p=0.6333). The direction of the SCZ was posterior to the EAAS in all NCC Group patients, however, it was postero-lateral (n=5) and lateral to the EAAS (n=7) in the Non-NCC Group, suggesting that the SCZ existed in the direction of the NCC in NCC Group but was away from the NCC in Non-NCC Group. CONCLUSION A close proximity between the NCC and SCZ of the reentry circuit, but not the local activation time at the NCC, determined the efficacy of NCC catheter ablation in AVN-ATs.
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Affiliation(s)
- Hiroshige Yamabe
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan.
| | - Toshiya Soejima
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kimihiro Kajiyama
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Yurie Fukami
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kazuki Haraguchi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Taichi Okonogi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Keisuke Hirai
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Ryota Fukuoka
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kyoko Umeji
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Yoshiya Orita
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Hisashi Koga
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
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