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Okishige K, Yamauchi Y, Nagase S, Kusano K, Miyamoto K, Ozawa T, Sawayama Y, Takeda H, Manita M, Asahi T, Miwa Y, Soejima K, Sasano T. Transcatheter cryo-ablation of septal accessory pathways, multicenter observational study in Japan. J Cardiol 2020; 77:380-387. [PMID: 33342639 DOI: 10.1016/j.jjcc.2020.10.012] [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: 08/11/2020] [Revised: 09/16/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ablation using radiofrequency energy has to be carefully performed when the arrhythmia substrate is located in close proximity to the atrioventricular (AV) node due to the risk of inadvertent permanent AV block. The aim of this study was to evaluate the efficacy and safety of catheter-based cryo-therapy for septal accessory pathways (APs). METHODS A total of eleven patients (median = 56.3 years, range 13-74 years) with septal APs underwent cryoablation. Ice-mapping was performed during sinus rhythm and an AV reciprocating tachycardia utilizing the APs as a requisite limb with cooling of the catheter tip temperature to a maximum of -30℃ for less than 45 s. Cryo-ablation was performed for 4 min at a temperature of -80℃ only if ice-mapping abolished the pre-excitation or retrograde conduction over the AP without injury to the AV nodal conduction. RESULTS Cryo-ablation was acutely successful in all eleven patients. No permanent cryo-related complications or adverse outcomes were reported. During the follow-up (range 14-26 months), no patients experienced any arrhythmia recurrences. CONCLUSION Ice-mapping was a feasible and reliable method to determine the exact location of the APs owing to the possibility of validating the ablation site. Cryo-ablation of APs located near the AV junction is a safe and efficacious technique with a high success rate over the long term. IRB INFORMATION Ethical Committee of Japan Red Cross Yokohama City Bay Hospital #2018-19.
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Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoya Ozawa
- Cardiovascular Department, Shiga University, School of Medicine, Ohtsu, Japan
| | - Yuichi Sawayama
- Cardiovascular Department, Shiga University, School of Medicine, Ohtsu, Japan
| | - Hiroto Takeda
- Cardiovascular Center, Ohta-Nishinouchi Hospital, Kouriyama, Japan
| | - Mamoru Manita
- Cardiology Department, Naha Municipal Hospital, Naha, Japan
| | - Tomohiro Asahi
- Cardiology Department, Naha Municipal Hospital, Naha, Japan
| | - Yosuke Miwa
- Cardiovascular Department, Kyorin University, School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Cardiovascular Department, Kyorin University, School of Medicine, Mitaka, Japan
| | - Tetsuo Sasano
- Cardiovascular Department, Tokyo Medical and Dental University, Tokyo, Japan
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Okishige K, Shigeta T, Nishimura T, Nakamura RA, Hirao T, Yoshida H, Yamauchi Y, Sasano T, Hirao K. Cryofreezing catheter ablation of adenosine triphosphate sensitive atrial tachycardia. J Cardiovasc Electrophysiol 2019; 30:528-537. [PMID: 30656771 DOI: 10.1111/jce.13844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adenosine triphosphate (ATP) sensitive atrial tachycardia (AT) has been treated by radiofrequency catheter ablation. Cryofreezing energy has emerged as a novel energy source for catheter ablation. The aim of this study was to investigate the efficacy and safety of cryofreezing ablation for ATP-sensitive AT. METHODS AND RESULTS A total of six patients with ATP-sensitive ATs were included in this study. A single atrial extrastimulation was able to initiate and terminate these ATs in all six patients. The electrophysiological findings satisfied the diagnostic criteria of ATP-sensitive AT. The ablation catheter was located at the earliest activation site of atrial excitation during the AT, and cryofreezing energy was delivered through a cryoablation catheter to perform cryomapping at temperature of -30 or -80°C. When cryomapping successfully terminated the ATs, cryoablation at a temperature of -80°C was subsequently performed. The earliest atrial activation during AT was recorded at the Koch's triangle area associated with a distinct intra-atrial activation sequence from that recorded during ventricular pacing. Cryoablation was performed at successful cryomapping sites and resulted in the complete elimination of the AT in all six patients without affecting the bidirectional atrioventricular (AV) nodal conduction. CONCLUSION Cryofreezing energy was safe and effective in treating ATP-sensitive ATs even in patients with its origins located in the vicinity of the AV node.
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Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Takatoshi Shigeta
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Takuro Nishimura
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Rena A Nakamura
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Tatsuhiko Hirao
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Hiroshi Yoshida
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Tetsuo Sasano
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.,Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenzo Hirao
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.,Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
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Chen H, Shi L, Yang B, Ju W, Zhang F, Yang G, Gu K, Li M, Cao K, Ouyang F, Chen M. Electrophysiological Characteristics of Bundle Branch Reentry Ventricular Tachycardia in Patients Without Structural Heart Disease. Circ Arrhythm Electrophysiol 2018; 11:e006049. [PMID: 29986947 DOI: 10.1161/circep.117.006049] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/08/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Linsheng Shi
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Bing Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Fengxiang Zhang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Kai Gu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Kejiang Cao
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (F.O.)
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (H.C., L.S., B.Y., W.J., F.Z., G.Y., K.G., M.L., K.C., M.C.)
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Durrani SA, Sung R, Scheinman M. Bidirectional Ventricular Tachycardia Due to a Mixture of Focal Fascicular Firing and Reentry. Card Electrophysiol Clin 2016; 8:753-764. [PMID: 27837895 DOI: 10.1016/j.ccep.2016.07.007] [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] [Indexed: 11/18/2022]
Abstract
Bidirectional ventricular tachycardia (BDVT) is a well-known phenomenon since it was first described in 1922. Various mechanisms have been proposed for BDVT, including digitalis toxicity, hypokalemia, Anderson-Tawil syndrome, acute myocarditis, and catecholaminergic polymorphic ventricular tachycardia. It is characterized by rapid, wide complex electrocardiogram pattern with alternating QRS morphology and axis. The alternation of the QRS is usually right bundle branch block with 180° swings in the frontal plane axis or, less commonly, alternation of right bundle branch and left bundle branch forms. Most of the proposed mechanisms involve triggered activity or enhanced automaticity. We describe a unique BDVT, with characteristics of both re-entry and triggered activity, which terminated with a focal Rf lesion.
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Affiliation(s)
- Sarfraz A Durrani
- MedStar Heart and Vascular Institute, #501 Hamaker court, Fairfax, VA 22031, USA.
| | - Raphael Sung
- Peninsula Primary Care, Cardiology, 30 Garden Court, Suite B, Monterey, CA 93940, USA
| | - Melvin Scheinman
- University of California San Francisco Medical Center, 500 Parnassus Avenue, MUE 436, San Francisco, CA 94143-1354, USA
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