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Matta M, Marazzato J, De Ponti R, Gaita F, Anselmino M. Ablation of Accessory Pathways with Uncommon Electrophysiologic Properties. Card Electrophysiol Clin 2020; 12:567-581. [PMID: 33162004 DOI: 10.1016/j.ccep.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In rare cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic features that may be related to their specific anatomy. Most of these bundles show decremental nodelike conduction properties and sustain peculiar forms of arrhythmias that require careful differential diagnosis. On the other hand, some pathways do not actively sustain any reentrant circuit and should nevertheless be promptly recognized to avoid unnecessary ablation attempts. Although rare, these variants of accessory pathway should be known to warrant a safe and effective catheter ablation procedure.
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Affiliation(s)
- Mario Matta
- Cardiology Division, Sant'Andrea Hospital, corso Mario Abbiate, 21, Vercelli 13100, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fiorenzo Gaita
- Cardiology Unit, J Medical Via Druento, 153/56, Turin 10151, Italy
| | - Matteo Anselmino
- Cardiology Division, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Turin, Corso Bramante, 88, Turin 10126, Italy.
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2
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Abstract
In some cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic properties related to their specific anatomy. Most of these fibers, which may be responsible for variants of ventricular preexcitation, show decremental conduction properties due to a nodelike aspect or a peculiar tortuous anatomic route across the atrioventricular groove. Moreover, some fibers do not actively sustain any reentrant circuit and can be only involved as bystander in other arrhythmias. Although rare, these accessory pathway variants should be properly diagnosed using noninvasive and invasive methods to guide catheter ablation procedures when needed.
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De Ponti R, My I, Vilotta M, Caravati F, Marazzato J, Bagliani G, Leonelli FM. Advanced Cardiac Signal Recording. Card Electrophysiol Clin 2019; 11:203-217. [PMID: 31084847 DOI: 10.1016/j.ccep.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Implantable loop recorders allow prolonged and continuous single-lead electrocardiogram recording, with the pivotal addition of remote monitoring. They have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias/tachyarrhythmias and proved helpful in arrhythmia burden definition, offering invaluable information in the diagnostic workup for syncope and atrial fibrillation. Advanced cardiac signal recording is also possible by transesophageal catheters. They have been used to orient diagnosis during wide and narrow QRS complex tachycardias and also to perform minimally invasive pacing. Intracardiac electrophysiologic study remains, however, essential for diagnosis of several arrhythmias in the perspective of curative catheter ablation.
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Affiliation(s)
- Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy.
| | - Ilaria My
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, 06034 Perugia, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
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Tordini A, Leonelli FM, De Ponti R, Bagliani G, Donzelli S, Lazzari L, Marini C, Pirrami MM, Carreras G. Challenging Cases of Wide Complex Tachycardias: Use and Limits of Algorithms. Card Electrophysiol Clin 2019; 11:301-314. [PMID: 31084852 DOI: 10.1016/j.ccep.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Electrocardiographic algorithms are particularly useful to differentiate, in the presence of a wide complex tachycardia, between supraventricular aberrancy and ventricular tachycardias (VT). There are numerous limitations to the sensitivity and specificity of these algorithms including the presence of accessory pathways, use of antiarrhythmic drugs, congenital heart diseases, electrolytes impairments, and artificial pacing. Once the diagnosis of VT has been reached, other algorithms can help in localizing the origin of the ventricular arrhythmia. These approaches are also limited by the anatomic structure of where the arrhythmia originates. This article illustrates the difficulties in applying common algorithms in many clinical circumstances.
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Affiliation(s)
- Alessandra Tordini
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy.
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University South Florida, Tampa, FL, USA
| | - Roberto De Ponti
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, Perugia 06034, Italy
| | - Stefano Donzelli
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Ludovico Lazzari
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Chiara Marini
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Marco M Pirrami
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Giovanni Carreras
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
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Bagliani G, De Ponti R, Leonelli FM. Precision Electrocardiology: A Rational Approach for Simple and Complex Arrhythmias. Card Electrophysiol Clin 2019; 11:175-187. [PMID: 31084845 DOI: 10.1016/j.ccep.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Electrocardiography (ECG) in all its forms, from 12-lead ECG to long-term monitoring, is considered, an old and increasingly irrelevant test in this high technology era. This article reviews the clinical utility of this tool and argues that the obsolescence is due to an increasing inability to read electrocardiographic tracings. The usual interpretative pitfalls are discussed and a logical approach is proposed with illustrative examples. Finally, the concept of precision ECG is presented and its meaning reviewed.
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Affiliation(s)
- Giuseppe Bagliani
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Foligno, Italy; Cardiovascular Diseases Department, University of Perugia, Perugia, Italy.
| | - Roberto De Ponti
- Cardiology Department, University of Insubria, Varese 21100, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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Sciarra L, Nesti M, Palamà Z, Marazzato J, Bagliani G, Leonelli FM, De Ponti R. Arrhythmias in Patients with Implantable Devices. Card Electrophysiol Clin 2019; 11:363-373. [PMID: 31084856 DOI: 10.1016/j.ccep.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pacemakers, cardioverter/defibrillators, and implantable loop recorders with their continuously improved diagnostic capabilities offer detailed information that can help interpreting a cardiac arrhythmia in implanted patients. Nevertheless, in some cases, analysis of the electrical signals stored in the device memory may not be easy. An accurate knowledge of the company-specific software and the meaning of the different markers used are necessary to correctly interpret the arrhythmia or diagnose an inappropriate device intervention due to under- or oversensing. This new technology does not replace the "old" surface electrocardiogram but supplements it to improve arrhythmia diagnosis.
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Affiliation(s)
- Luigi Sciarra
- Cardiology Unit, Policlinico Casilino, Via Casilina 1049, Rome 00169, Italy.
| | - Martina Nesti
- Cardiovascular and Neurological Department, Ospedale San Donato, Via Nenni, 20/22, Arezzo 52100, Italy
| | - Zefferino Palamà
- Cardiology Unit, Ospedale SS. Annunziata, Via Bruno 1, Taranto 74100, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation, University of Insubria, Viale Borri 57, Varese 21100, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, Perugia 06129, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation, University of Insubria, Viale Borri 57, Varese 21100, Italy
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