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Arai H, Nakamura R, Sagawa Y, Oda A, Murata K, Okishige K, Goya M, Sasano T, Aonuma K, Yamauchi Y. Retrograde fast pathway cryoablation inside the coronary sinus for slow-fast atrioventricular nodal reentrant tachycardia in a patient with persistent left superior vena cava. J Cardiovasc Electrophysiol 2023; 34:478-482. [PMID: 36579408 DOI: 10.1111/jce.15795] [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: 08/23/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Persistent left superior vena cava (PLSVC) is accompanied by enlarged coronary sinus (CS) and deformation of the triangle of Koch. This makes anatomical evaluation of the atrioventricular (AV) nodal pathways difficult. METHODS We attempted cryoablation of retrograde fast pathway located in the enlarged CS roof of PLSVC for slow-fast AV nodal reentrant tachycardia (AVNRT) induced by inadvertent antegrade fast pathway elimination during ablation of left atrial tachycardia. RESULTS Slow-fast AVNRT was successfully eliminated without AV block progression. CONCLUSIONS This is the first case of successful retrograde fast pathway ablation of the CS ostial roof for slow-fast AVNRT with PLSVC.
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Affiliation(s)
- Hirofumi Arai
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Rena Nakamura
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Atsuhito Oda
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Kazuya Murata
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Kaoru Okishige
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Ibaraki, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
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Matsumoto K, Tobiume T, Matsuura T, Ise T, Kusunose K, Yamaguchi K, Yagi S, Fukuda D, Wakatsuki T, Yamada H, Soeki T, Sata M. Evaluation of the input site and characteristics of the antegrade fast pathway based on three-dimensional bi-atrial stimulus-ventricle mapping. J Interv Card Electrophysiol 2021; 63:417-424. [PMID: 34231099 PMCID: PMC8983517 DOI: 10.1007/s10840-021-01026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
Purpose Previous studies examined the right atrial (RA) input site of the antegrade fast pathway (AFp) (AFpI). However, the left atrial (LA) input to the atrioventricular (AV) node has not been extensively evaluated. In this study, we created three-dimensional (3-D) bi-atrial stimulus-ventricle (St-V) maps and analyzed the input site and characteristics of the AFp in both the RA and LA. Methods Forty-four patients diagnosed with atrial fibrillation or WPW syndrome were included in this study. Three-dimensional bi-atrial St-V mapping was performed using an electroanatomical mapping system. Sites exhibiting the minimal St-V interval (MinSt-V) were defined as AFpIs and were classified into seven segments, four in the RA (F, S, M, and I) and three in the LA (M1, M2, and M3). By combining the MinSt-V in the RA and LA, the AFpIs were classified into three types: RA, LA, and bi-atrial (BA) types. The clinical and electrophysiological characteristics were compared. Results AFpIs were most frequently observed at site S in the RA (34%) and M2 in the LA (50%), and the BA type was the most common (57%). AFpIs in the LA were recognized in 75% of the patients. There were no clinical or electrophysiological indicators for predicting AFpI sites. Conclusions Three-dimensional bi-atrial St-V maps could classify AFpIs in both the RA and LA. AFpIs in the LA were frequently recognized. There were no significant clinical or electrophysiological indicators for predicting AFpI sites, and 3-D bi-atrial St-V mapping was the only method to reveal the precise AFp input site.
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Affiliation(s)
- Kazuhisa Matsumoto
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan.
| | - Takeshi Tobiume
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Tomomi Matsuura
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Takayuki Ise
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Kenya Kusunose
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Koji Yamaguchi
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Shusuke Yagi
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Daijyu Fukuda
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Hirotsugu Yamada
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Takeshi Soeki
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
| | - Masataka Sata
- Department of Cardiology, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8501, Japan
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Abstract
The term paroxysmal supraventricular tachycardia encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each supraventricular tachycardia is important in determining management in the office, at the bedside, and in the electrophysiology laboratory. Paroxysmal supraventricular tachycardias have an abrupt onset and offset, typically initiating and terminating with premature atrial ectopic beats. In the acute setting, both vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter ablation has revolutionized therapy for many supraventricular tachycardias, and newer techniques have significantly improved ablation efficacy and decreased periprocedural complications and procedure times.
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Affiliation(s)
- Arun Umesh Mahtani
- Department of Cardiac Electrophysiology, St. Bernard's Heart and Vascular Center, Jonesboro, AR, USA
| | - Devi Gopinath Nair
- Department of Cardiac Electrophysiology, St. Bernard's Heart and Vascular Center, Jonesboro, AR, USA.
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Kiuchi K, Fukuzawa K, Shumpei M, Nishii T. The inferior displacement of the His bundle and fast pathway in a patient with common type atrioventricular nodal tachycardia: Three-dimensional computed tomography analysis. J Arrhythm 2017; 33:147-149. [PMID: 28416984 PMCID: PMC5388057 DOI: 10.1016/j.joa.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/13/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022] Open
Abstract
A 66-year-old woman with palpitations was referred to our center for catheter ablation due to drug-refractory, common type atrioventricular nodal tachycardia (AVNRT). A selective slow pathway ablation was attempted. A fast junctional rhythm with transient ventriculoatrial block followed by transient prolongation of the A–H interval occurred immediately after the radiofrequency (RF) application at the coronary sinus ostium (CSOS) level. To assess the location of the fast pathway and His bundle, we sought to visualize the anatomy of the triangle of Koch (TOK) by three-dimensional computed tomography (CT).
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Affiliation(s)
- Kunihiko Kiuchi
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku, Kobe, Hyogo, Japan
- Corresponding author. Fax: +81 78 382 5859.
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku, Kobe, Hyogo, Japan
| | - Mori Shumpei
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku, Kobe, Hyogo, Japan
| | - Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou chuou-ku, Kobe, Hyogo, Japan
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Giedrimas E, Goldberger JJ. Catheter ablation for supraventricular tachycardias: contemporary issues. Future Cardiol 2014; 9:581-96. [PMID: 23834697 DOI: 10.2217/fca.13.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The treatment of cardiac arrhythmias has evolved significantly over the last 30 years. Understanding of arrhythmia mechanisms has led to pharmacologic therapies, surgical interventions and the widely used percutaneous catheter ablation techniques. The focus of this review is centered on the current catheter ablation therapies available for supraventricular tachycardia. We will discuss current management strategies including challenges when considering catheter ablation therapy for management of supraventricular tachycardias: atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia utilizing an accessory pathway, atrial tachycardia and atrial flutter. Selected contemporary issues related to supraventricular tachycardia physiology, ablation approaches and ablation outcomes and complications will be discussed. Future goals for electrophysiologists are to continue to improve procedural safety and efficiency, while maintaining the impressive success rates that have been achieved.
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Affiliation(s)
- Evaldas Giedrimas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg 8-503E, Chicago, IL 60611, USA
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SUZUKI ATSUSHI, YOSHIDA AKIHIRO, TAKEI ASUMI, FUKUZAWA KOJI, KIUCHI KUNIHIKO, TANAKA SATOKO, ITOH MITSUAKI, IMAMURA KIMITAKE, FUJIWARA RYUDO, NAKANISHI TOMOYUKI, YAMASHITA SOICHIRO, MATSUMOTO AKINORI, KONISHI HIROKI, ICHIBORI HIROTOSHI, HIRATA KENICHI. Visualization of the Antegrade Fast and Slow Pathway Inputs in Patients with Slow-Fast Atrioventricular Nodal Reentrant Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:874-83. [DOI: 10.1111/pace.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 12/30/2013] [Accepted: 01/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- ATSUSHI SUZUKI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - AKIHIRO YOSHIDA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
- Section of Arrhythmia; Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Chuo-ku Kobe Japan
| | - ASUMI TAKEI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - KOJI FUKUZAWA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
- Section of Arrhythmia; Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Chuo-ku Kobe Japan
| | - KUNIHIKO KIUCHI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - SATOKO TANAKA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - MITSUAKI ITOH
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - KIMITAKE IMAMURA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - RYUDO FUJIWARA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - TOMOYUKI NAKANISHI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - SOICHIRO YAMASHITA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - AKINORI MATSUMOTO
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - HIROKI KONISHI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - HIROTOSHI ICHIBORI
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
| | - KEN-ICHI HIRATA
- Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine
- Section of Arrhythmia; Division of Cardiovascular Medicine; Department of Internal Medicine; Kobe University Graduate School of Medicine; Chuo-ku Kobe Japan
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