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Voss F, Eckardt L, Busch S, Estner HL, Steven D, Sommer P, von Bary C, Neuberger HR. [AV-reentrant tachycardia and Wolff-Parkinson-White syndrome : Diagnosis and treatment]. Herzschrittmacherther Elektrophysiol 2016; 27:381-389. [PMID: 27878364 DOI: 10.1007/s00399-016-0466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/01/2022]
Abstract
The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/1000. The pathophysiological basis is an accessory atrioventricular pathway (AP). Patients with AVRT typically present with palpitations, an on-off characteristic, anxiety, dyspnea, and polyuria. This type of tachycardia may often be terminated by vagal maneuvers. Although the clinical presentation of AVRT is quite similar to AV-nodal reentrant tachycardias, the correct diagnosis is often facilitated by analyzing a standard 12-lead ECG at normal heart rate showing ventricular preexcitation. Curative catheter ablation of the AP represents the therapy of choice in symptomatic patients. This article is the fourth part of a series written to improve the professional education of young electrophysiologists. It explains pathophysiology, symptoms, and electrophysiological findings of an invasive EP study. It focusses on mapping and ablation of accessory pathways.
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Affiliation(s)
- Frederik Voss
- Innere Medizin III, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54290, Trier, Deutschland.
| | - Lars Eckardt
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Sonia Busch
- Medizinische Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Coburg, Coburg, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Universitätsklinikum München-Großhadern, München, Deutschland
| | - Daniel Steven
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Köln, Deutschland
| | - Philipp Sommer
- Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Deutschland
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[Typical atrial flutter: Diagnosis and therapy]. Herzschrittmacherther Elektrophysiol 2016; 27:46-56. [PMID: 26846223 DOI: 10.1007/s00399-016-0413-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
Typical, cavotricuspid-dependent atrial flutter is the most common atrial macroreentry tachycardia. The incidence of atrial flutter (typical and atypical forms) is age-dependent with 5/100,000 in patients less than 50 years and approximately 600/100,000 in subjects > 80 years of age. Concomitant heart failure or pulmonary disease further increases the risk of typical atrial flutter.Patients with atrial flutter may present with symptoms of palpitations, reduced exercise capacity, chest pain, or dyspnea. The risk of thromboembolism is probably similar to atrial fibrillation; therefore, the same antithrombotic prophylaxis is required in atrial flutter patients. Acutely symptomatic cases may be subjected to cardioversion or pharmacologic rate control to relieve symptoms. Catheter ablation of the cavotricuspid isthmus represents the primary choice in long-term therapy, associated with high procedural success (> 97 %) and low complication rates (0.5 %).This article represents the third part of a manuscript series designed to improve professional education in the field of cardiac electrophysiology. Mechanistic and clinical characteristics as well as management of isthmus-dependent atrial flutter are described in detail. Electrophysiological findings and catheter ablation of the arrhythmia are highlighted.
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von Bary C, Eckardt L, Steven D, Neuberger HR, Tilz RR, Bonnemeier H, Thomas D, Deneke T, Estner HL, Kuniss M, Luik A, Sommer P, Voss F, Meyer C, Shin DI, Kriatselis C. [AV nodal reentrant tachycardia. Diagnosis and therapy]. Herzschrittmacherther Elektrophysiol 2015; 26:351-8. [PMID: 26558907 DOI: 10.1007/s00399-015-0399-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The AV nodal reentrant tachycardia (AVNRT) is one of the most common arrhythmias encountered in clinical practice. It is characterized by a constant heart rate and an on/off phenomenon. The clinical symptoms may include palpitations, anxiety, polyuria, and dyspnea. Typically, tachycardia may be disrupted by vagal maneuvers in many patients. First-line treatment of symptomatic AVNRT is radiofrequency ablation. The present article deals with the characteristics, differential diagnosis and treatment of AVNRT in the EP lab. It is the second part of a series of manuscripts which may facilitate further education in the specific field of electrophysiology.
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Affiliation(s)
- Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München, Nymphenburgerstr. 163, 80634, Munich, Deutschland.
| | - Lars Eckardt
- Abteilung für Rhythmologie Kardiologie und Angiologie, Univeritätsklinikum Münster, Münster, Deutschland
| | - Daniel Steven
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Köln, Deutschland
| | | | - Roland Richard Tilz
- Medizinische Klinik II, Universitätsklinikum Schleswig Holstein, Lübeck, Deutschland
| | - Hendrik Bonnemeier
- Klinik für Kardiologie und Angiologie, Universitätsklinikum Kiel, Kiel, Deutschland
| | - Dierck Thomas
- Abteilung für Kardiologie, Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - Thomas Deneke
- Klinik für Kardiologie II, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Universitätsklinikum München-Großhadern, München, Deutschland
| | - Malte Kuniss
- Abteilung für Kardiologie, Kerckhoff Klinik, Bad Nauheim, Deutschland
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - Philipp Sommer
- Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Frederik Voss
- Innere Medizin III, Krankenhaus der Barmherzigen Brüder, Trier, Deutschland
| | - Christian Meyer
- Klinik für Kardiologie/Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Deutschland
| | - D I Shin
- Klinik für Kardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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