1
|
Matsui Y, Higuchi S, Yagishita D, Ho RT, Scheinman MM, Mori F, Yamaguchi J, Shoda M. The Masked Right Bundle Branch Block in the Setting of a Wide Complex Tachycardia. JACC Clin Electrophysiol 2024; 10:1760-1769. [PMID: 38752954 DOI: 10.1016/j.jacep.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Yuko Matsui
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan
| | - Satoshi Higuchi
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Daigo Yagishita
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Reginald T Ho
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Melvin M Scheinman
- Division of Cardiology, Section of Cardiac Electrophysiology, University of California-San Francisco, San Francisco, California, USA
| | - Fumiaki Mori
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan
| | - Junichi Yamaguchi
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| |
Collapse
|
5
|
Nazer B, Walters TE, Dewland TA, Naniwadekar A, Koruth JS, Najeeb Osman M, Intini A, Chen M, Biermann J, Steinfurt J, Kalman JM, Tanel RE, Lee BK, Badhwar N, Gerstenfeld EP, Scheinman MM. Variable Presentations and Ablation Sites for Manifest Nodoventricular/Nodofascicular Fibers. Circ Arrhythm Electrophysiol 2019; 12:e007337. [PMID: 31505948 DOI: 10.1161/circep.119.007337] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways. METHODS Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4). RESULTS NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT. CONCLUSIONS Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.
Collapse
Affiliation(s)
- Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland (B.N., T.A.D.)
| | - Tomos E Walters
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | - Thomas A Dewland
- Knight Cardiovascular Institute, Oregon Health & Sciences University, Portland (B.N., T.A.D.)
| | - Aditi Naniwadekar
- Division of Cardiology, East Carolina University; Greenville, NC (A.N.)
| | - Jacob S Koruth
- Cardiology Division, Mount Sinai Medical Center; New York (J.S.K.)
| | - Mohammed Najeeb Osman
- Division of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center & Case Western Reserve University, OH (M.N.O., A.I.)
| | - Anselma Intini
- Division of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center & Case Western Reserve University, OH (M.N.O., A.I.)
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, China (M.C.)
| | - Jurgen Biermann
- Department of Cardiology and Angiology, Heart Center Freiburg University, Germany (J.B., J.S.)
| | - Johannes Steinfurt
- Department of Cardiology and Angiology, Heart Center Freiburg University, Germany (J.B., J.S.)
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia (J.M.K.)
| | - Ronn E Tanel
- Pediatric Cardiology Division (R.E.T.), University of California San Francisco
| | - Byron K Lee
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | | | - Edward P Gerstenfeld
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| | - Melvin M Scheinman
- Cardiology Division (T.E.W., B.K.L., E.P.G., M.M.S.), University of California San Francisco
| |
Collapse
|
6
|
Staikou C, Stamelos M, Stavroulakis E. Perioperative management of patients with pre-excitation syndromes. Rom J Anaesth Intensive Care 2018; 25:131-147. [PMID: 30393770 PMCID: PMC6211613 DOI: 10.21454/rjaic.7518.252.stk] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022] Open
Abstract
Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil, alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other pre-excitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.
Collapse
Affiliation(s)
- Chryssoula Staikou
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
| | - Mattheos Stamelos
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
| | | |
Collapse
|
7
|
de Alencar Neto JN, Ramalho de Moraes SR, Back Sternick E, Wellens HJJ. Atypical bypass tracts: can they be recognized during sinus rhythm? Europace 2018; 21:208-218. [DOI: 10.1093/europace/euy079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- José Nunes de Alencar Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Saulo Rodrigo Ramalho de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Eduardo Back Sternick
- Faculdade Ciências Médicas, Belo Horizonte, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte - MG, Brazil
- Arrhythmia Unit, Biocor Hospital, Alameda Oscar Niemeyer, 217 - Vila da Serra, Nova Lima - MG, Brazil
| | - Hein J J Wellens
- Cardiovascular Research Institute, Cardiovascular Research Institute, 6229 HX Maastricht, The Netherlands
| |
Collapse
|
9
|
Sternick EB, Lokhandwala Y, Timmermans C, Gerken L, Soares F, Dias L, Huo Y, Hindricks G, Wellens HJ. Atrial Premature Beats During Decrementally Conducting Antidromic Tachycardia. Circ Arrhythm Electrophysiol 2013; 6:357-63. [DOI: 10.1161/circep.112.000103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eduardo Back Sternick
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Yash Lokhandwala
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Carl Timmermans
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Luiz Gerken
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Frederico Soares
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Liana Dias
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Yan Huo
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Gerhard Hindricks
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| | - Hein J.J. Wellens
- From the Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil (E.B.S., L.G., F.S., L.D.); Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil (E.B.S.); Arrhythmia Associates, Mumbai, India (Y.L.); University Hospital, Maastricht, The Netherlands (C.T., H.J.J.W.), Cardiovascular Research Institute, Maastricht, The Netherlands (H.J.J.W.); and Heart Center, University of Leipzig, Leipzig, Germany (Y.H., G.H.)
| |
Collapse
|