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Nageh MF, Tang S. Endocardial ablation at the mitral valve vestibule and its surroundings for the treatment of arrhythmias linked to the greater cardiac vasculature. Pacing Clin Electrophysiol 2022; 45:1263-1267. [PMID: 36082476 DOI: 10.1111/pace.14589] [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: 05/16/2022] [Revised: 08/02/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of the epicardial vasculature in supraventricular and ventricular arrhythmias was described in clinical studies as well as its treatment by intravascular point ablation or alcohol injection. We report on a case series of patients with different arrhythmias linked to an epicardial site of origin with evidence supporting transmural extensions that were targeted for ablation with successful outcomes. METHODS The records of patients who has catheter ablation for Supraventricular or Ventricular arrhythmias between 2015-2020 was searched for patients with (1) arrhythmias linked to the epicardial vasculature and (2) findings to support an endocardial connection to the epicardial vasculature by activation mapping, pace mapping, or differential pacing, and (3) were successfully ablated via an endocardial approach only. RESULTS From the data searched, we identified 5 patients with the following arrhythmias left ventricular summit ectopy, peri-mitral atrial flutter, preexcitation with inducible atrioventricular reentry tachycardia (AVRT) and a concealed left side accessory pathway with inducible AVRT that were linked to the following vessels: Great Cardiac vein, persistent left superior vena cava, left coronary cusp and left ventricular outflow tract. Endocardial connections were supported by a combination of electro anatomical activation mapping, pace-mapping, and differential pacing. Endocardial ablations performed in all patients were successful without complications CONCLUSION: : This report highlights a subset of patients with arrhythmias linked to the greater cardiac vascular system that can be safely and effectively ablated endocardially, given the limitations and possible complications of epicardial ablation within or in the proximity of the epicardial vasculature. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maged F Nageh
- Department of Electrophysiology, Los Angeles Medical Center-Regional arrhythmia center, Kaiser Permanente Southern California, Los Angeles, USA
| | - Stephen Tang
- Department of Electrophysiology, Los Angeles Medical Center-Regional arrhythmia center, Kaiser Permanente Southern California, Los Angeles, USA
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Wang F, Song X, Dang Y, Shu S, Li S. Successful ablation of a left anterior accessory pathway from the left coronary sinus of Valsalva near the aortic-mitral continuity. J Int Med Res 2021; 49:300060521990249. [PMID: 33682506 PMCID: PMC7944529 DOI: 10.1177/0300060521990249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Catheter ablation of accessory pathways can be challenging depending on the location of these pathways, and accessory pathways are rare through the aortic cusps. We report a patient who underwent radiofrequency catheter ablation for manifestation of a left anterior accessory pathway from the left coronary sinus of Valsalva near the aortic–mitral continuity. Anterior accessory pathways can be safely and effectively ablated from the aortic cusps with favorable long-term outcomes.
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Affiliation(s)
- Fan Wang
- Department of Cardiovascular Disease Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Xuelian Song
- Department of Cardiovascular Disease Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yi Dang
- Department of Cardiovascular Disease Center, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shangzhi Shu
- Department of Cardiovascular Disease Center, First Hospital of Jilin University, Jilin University, Jilin, China
| | - Shuyan Li
- Department of Cardiovascular Disease Center, First Hospital of Jilin University, Jilin University, Jilin, China
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Li MM, Long DY, Sang CH, Jiang CX, Guo XY, Zhao X, Li SN, Wang W, Tang RB, Li JY, Dai WL, Kong XY, Zuo S, Ning M, Li X, Wu JH, Dong JZ, Du X, Ma CS. Left-sided accessory pathways successfully ablated from the aortomitral continuity region: distinctive atrial activation patterns and anatomic concerns. Europace 2020; 22:1712-1717. [PMID: 32830238 DOI: 10.1093/europace/euaa148] [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: 09/26/2019] [Revised: 01/21/2020] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Accessory pathways (APs) successfully ablated at the aortomitral continuity (AMC) were sporadically reported but relevant data are very limited. We aimed to describe the electrophysiological characteristics of AMC-AP and the related anatomy. METHODS AND RESULTS This study involved eight (male/female = 3/5, mean age 42.6 ± 10.5 years) patients with left-sided AP successfully ablated in the AMC region. The retrograde atrial activation sequence was analysed and compared via recordings at the His-bundle (HB), coronary sinus (CS), and roving catheter during tachycardia, and the peak of QRS from the same cardiac circle used as time reference. Of the eight patients, two received prior ablations. During tachycardia, the activation time at the proximal CS (CSp), lateral CS (CSl), and HB region averaged 120 ± 26 ms, 124 ± 29 ms, and 117 ± 21 ms following the reference, respectively (P = 0.86). The latest atrial activation was recorded in the posterior CS which averaged 135 ± 25 ms following the reference. Placing the ablation catheter to AMC via retrograde approach was attempted in all cases but stable positioning achieved in none. Via transseptal approach, the ablation catheter could be easily placed at the AMC and recorded the earliest retrograde atrial activations with 60 ± 27 ms earlier than the relatively 'earliest' CS/HB recordings, and ablation at this site successfully eliminated AP conduction. No patients had recovered AP conduction after at least 12-month follow-up. CONCLUSION AMC-AP is featured by recording comparable retrograde atrial activation times at CSp, CSl, and HB with the latest recordings at the posterior CS. Stable placement and successful ablation in the AMC via retrograde aortic approach was difficult but can be achieved via transseptal approach.
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Affiliation(s)
- Meng-Meng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jing-Ye Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Wen-Li Dai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xiang-Yi Kong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Song Zuo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xu Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, 2# Beijing Anzhen Road, Chaoyang District, Beijing 100029, China
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ROCA-LUQUE IVO, RIVAS NURIA, FRANCISCO JAUME, PEREZ JORDI, ACOSTA GABRIEL, ORISTRELL GERARD, TERRICABRES MARIA, GARCIA-DORADO DAVID, MOYA ANGEL. Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps. J Cardiovasc Electrophysiol 2016; 28:126-131. [PMID: 27759948 DOI: 10.1111/jce.13109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Affiliation(s)
| | - NURIA RIVAS
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - JORDI PEREZ
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - GERARD ORISTRELL
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - MARIA TERRICABRES
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | | | - ANGEL MOYA
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
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Xu G, Liu T, Liu E, Ye L, Shehata M, Wang X, Li G. Radiofrequency catheter ablation at the non-coronary cusp for the treatment of para-hisian accessory pathways. Europace 2015; 17:962-968. [PMID: 25355782 DOI: 10.1093/europace/euu271] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/02/2014] [Indexed: 10/11/2023] Open
Abstract
AIMS Radiofrequency catheter ablation (RFCA) is well established as a definitive therapy of accessory pathways (APs). Successful RFCA of anteroseptal APs at the non-coronary cusp (NCC) have been reported in several case reports. We aimed to evaluate the prevalence, safety, efficacy, and long-term outcome of RFCA at the NCC for the treatment of para-hisian APs. METHODS AND RESULTS Our study included 17 patients (58.8% female, mean age 46.9 ± 15.9 years) with para-hisian APs. We performed two different ablation approaches which targeted at either the right anterior septum (RAS) (n = 10) or the NCC (n = 7) as the initial target. We compared safety, efficacy, and long-term outcome between these two approaches. The para-hisian APs were successfully ablated in 15 patients and damaged in 1 patient, for the remaining patients, the ablation was abandoned for the suspicion of no atrioventricular conduction. Considering all ablation sites of the para-hisian APs, radiofrequency (RF) delivered at the NCC had a higher success rate (11/12 vs. 5/12, P < 0.05) and a lower complication rate (0/12 vs. 4/12, P < 0.05) compared with the RAS. During a mean follow-up period of 22.4 ± 15.0 months, all the patients were free of arrhythmias without any anti-arrhythmic drugs. CONCLUSION Para-hisian APs can be safely and effectively ablated at the NCC. Compared with the ablation at the RAS, RF delivered at the NCC has a higher immediate success, lower complication rate, and good long-term outcome.
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Affiliation(s)
- Gang Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Enzhao Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Lan Ye
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Michael Shehata
- Heart Rhythm Center, the Heart Institute, Cedars-Sinai Health System, Los Angeles, CA 90048, USA
| | - Xunzhang Wang
- Heart Rhythm Center, the Heart Institute, Cedars-Sinai Health System, Los Angeles, CA 90048, USA
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
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Wang Z, Ouyang J, Liang Y, Jin Z, Yang G, Liang M, Li S, Yu H, Han Y. Focal atrial tachycardia surrounding the anterior septum: strategy for mapping and catheter ablation. Circ Arrhythm Electrophysiol 2015; 8:575-82. [PMID: 25908691 PMCID: PMC4467584 DOI: 10.1161/circep.114.002281] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
Background— Focal atrial tachycardias (ATs) surrounding the anterior atrial septum (AAS) have been successfully ablated from the right atrial septum (RAS), the aortic cusps, and the aortic mitral junction. However, the strategy for mapping and ablation of AAS-ATs has not been well defined. Methods and Results— Of 227 consecutive patients with AT, 47 (20.7%; mean age, 56.3±11.6 years) with AAS-ATs were studied; among them, initial ablation was successful at RAS in only 5 of 14 patients and at noncoronary cusp (NCC) in 28 of 33 patients. In 45 of the 47 patients, the 46 of 48 AAS-ATs were eliminated at RAS in 8 patients, NCC in 35 patients (earliest activation time at NCC was later than that at RAS by 5–10 ms in 6 patients), and aortic mitral junction in 3 patients (all with negative P wave in lead aVL and positive P wave in the inferior leads), including 1 patient whose 2 ATs were eliminated separately from the NCC and the aortic mitral junction. Conclusions— Most of the ATs surrounding the AAS can be eliminated from within the NCC, which is usually the preferential ablation site. Ablation at the RAS and aortic mitral junction should be considered when supported by P-wave morphologies on surface ECG and results of activation mapping and ablation.
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Affiliation(s)
- Zulu Wang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Jinge Ouyang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Yanchun Liang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Zhiqing Jin
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Guitang Yang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Ming Liang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Shibei Li
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Haibo Yu
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Yaling Han
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.).
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Hai JJ, Chahal AA, Friedman PA, Vaidya VR, Syed FF, DeSimone CV, Nanda S, Brady PA, Madhavan M, Cha YM, McLeod CJ, Mulpuru S, Munger TM, Packer DL, Asirvatham SJ. Electrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity-potential role of the conduction system. J Cardiovasc Electrophysiol 2015; 26:158-63. [PMID: 25425429 DOI: 10.1111/jce.12587] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 10/02/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Catheter ablation of ventricular arrhythmia (VA) at the fibrous aortic mitral continuity (AMC) has been described, yet the nature of the arrhythmogenic substrate remains unknown. METHODS Procedural records of 528 consecutive patients undergoing ablation of VA at Mayo Clinic, Rochester, MN, were reviewed. The electrocardiographic and electrophysiologic characteristics of patients with successful ablation at the AMC were analyzed to characterize the underlying arrhythmogenic substrate. RESULTS Of the 21 patients (mean age 53.2 ± 13.4 years, 47.6% male) who underwent ablation of VA at the AMC with acute success, prepotentials (PPs) were found at the ablation sites preceding the ventricular electrogram (VEGM) during arrhythmias in 13 (61.9%) patients and during sinus rhythm in 7 (53.8%) patients. VAs with PPs were associated with a significantly higher burden of premature ventricular complexes (PVCs; 26.1 ± 10.9% vs. 14.9 ± 10.1%, P = 0.03), shorter VEGM to QRS intervals (9.0 ± 28.5 milliseconds vs. 33.1 ± 8.8 milliseconds, P = 0.03), lower pace map scores (8.7 ± 1.6 vs. 11.4 ± 0.8, P = 0.001), and a trend toward shorter V-H intervals during VA (32.1 ± 38.6 milliseconds vs. 76.3 ± 11.1 milliseconds, P = 0.06) as compared to those without PP. A strong and positive correlation was found between V-H interval and QRS duration during arrhythmia in those with PPs (B = 2.11, R(2) = 0.97, t = 13.7, P < 0.001) but not in those without PPs. CONCLUSION Local EGM characteristics and relative activation time of the His bundle suggest the possibility of conduction tissue as the origin for VA arising from the fibrous AMC. Specific identification and targeting of PPs when ablating VAs at this location may improve procedural success.
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Affiliation(s)
- Jo Jo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong
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Adenosine-sensitive atrial tachycardia originating from the mitral annulus–aorta junction. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lee SH, Shim J, Pak HN, Lee MH, Joung B. Atrial tachycardia originating from the aortomitral junction. Yonsei Med J 2014; 55:530-4. [PMID: 24532528 PMCID: PMC3936642 DOI: 10.3349/ymj.2014.55.2.530] [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] [Indexed: 11/27/2022] Open
Abstract
Atrial tachycardia (AT) originating from the aortomitral junction is a very rare and challenging disease. Its arrhythmic characteristics have not been described in detail compared with the descriptions of the arrhythmic characteristics of AT originating from the other locations. Only a few case reports have documented successful ablation of this type of AT using transaortic or transseptal approaches. We describe a case with AT that was resistant to right-sided ablation near the His bundle failed and transaortic ablation at the aortomitral junction successfully eliminated.
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Affiliation(s)
- Seung-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Ju W, Chen M, Yang B, Chen H, Zhang F, Li M, Yu J, Cao K. The role of noncoronary cusp ablation approach in the treatment of perinodal atrial tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:811-8. [PMID: 22671853 DOI: 10.1111/j.1540-8159.2012.03425.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ablation in the noncoronary aortic cusp (NCC) potentially has a role in the treatment of perinodal atrial tachycardias (ATs). The objective of the study was to characterize clinical and electrophysiological properties of perinodal ATs between two groups of requiring and not requiring NCC ablation. METHODS A total of 113 patients with focal ATs who underwent electrophysiologic study and radiofrequency catheter ablation were enrolled in the study. The clinical and electrophysiological characteristics of ATs that need and not need NCC ablation were compared. RESULTS Totally 20 cases were revealed to have the focal ATs located in the perinodal area. Among them, only five cases (25%) warrant ablation in the NCC, whereas the remainder could be successfully eliminated by ablation from the endocardial right atrium at the perinodal region. There were no clinical and electrophysiological clues observed to have the potential to predict the true original site, including the activation mode, the three-dimensional mapping characteristics of earliest activation site in the right atrium, as well as the time of termination during the ablation in the perinodal area. CONCLUSIONS Approximately, one-fourth of the perinodal ATs warrant ablation in the NCC. However, no clinical and electrophysiological clues could predict the potential site of the perinodal ATs.
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Affiliation(s)
- Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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11
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Wang Z, Liu T, Shehata M, Liang Y, Jin Z, Liang M, Han Y, Amorn A, Liu X, Liu E, Chugh SS, Wang X. Electrophysiological characteristics of focal atrial tachycardia surrounding the aortic coronary cusps. Circ Arrhythm Electrophysiol 2011; 4:902-8. [PMID: 21985795 DOI: 10.1161/circep.111.965640] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catheter ablation of atrial tachycardia (AT) arising near the coronary cusps has been reported in limited numbers of patients. We investigated the electrophysiological characteristics of these ATs in 22 consecutive patients. METHODS AND RESULTS This study included 22 patients (mean age ± SD, 53 ± 11 years; 86% female) with ATs arising near the aortic coronary cusps who underwent successful ablation. Activation mapping was performed during tachycardia to identify the earliest activation site. All patients achieved successful ablation through either a retrograde aortic (n=19) or a transseptal (n=3) approach. The successful ablation sites were located in the noncoronary cusp (NCC) (n=16), including 3 near the junction between the NCC and right coronary cusp. The remaining 6 cases were ablated from the left coronary cusp (LCC) (n=3) or the left atrium posterior to the LCC (n=3). For most tachycardias, there were distinctive P-wave morphological features recorded for each cusp location. Furthermore, analysis of the electrogram morphological features recorded during tachycardia at successful ablation sites revealed an atrial/ventricular (A/V) ratio >1 in 14 of 16 NCC ATs; the remaining 2, from the NCC near the junction with the right coronary cusp, showed an A/V ratio ≤ 1. At ablation sites in the LCC, the A/V ratio was <1 (4 of 6 patients) or 1 (remaining 2 patients). During a follow-up duration of 30 ± 13 months, all patients were free of arrhythmias without antiarrhythmic drugs. CONCLUSIONS ATs surrounding the aortic coronary cusps can be safely and effectively ablated, with good long-term outcomes. In addition to the P-wave morphological features, the A/V ratio of the local electrogram recording during tachycardia facilitated the localization of successful sites.
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Affiliation(s)
- Zulu Wang
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, People's Republic of China
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12
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Godin B, Guiot A, Savoure A, Anselme F. The left coronary cusp as an unusual location for accessory pathway ablation. Heart Rhythm 2011; 8:1769-72. [PMID: 21699859 DOI: 10.1016/j.hrthm.2011.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Bénédicte Godin
- Cardiology Department, Rouen University Hospital, Roeun, France
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