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Watanabe T, Hachiya H, Watanabe H, Anno K, Okuyama T, Harunari T, Yokota A, Kamioka M, Komori T, Torigoe‐Kurosu Y, Makimoto H, Kabutoya T, Kimura Y, Imai Y, Kario K. Relationship between the atrial-activation pattern around the triangle of Koch and successful ablation sites in slow-fast atrioventricular nodal reentrant tachycardia. J Arrhythm 2024; 40:363-373. [PMID: 38586857 PMCID: PMC10995602 DOI: 10.1002/joa3.12999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 04/09/2024] Open
Abstract
Background The precise details of atrial activation around the triangle of Koch (ToK) remain unknown. We evaluated the relationship between the atrial-activation pattern around the ToK and success sites for slow-pathway (SP) modification ablation in slow-fast atrioventricular reentrant tachycardia (AVNRT). Methods Thirty patients with slow-fast AVNRT who underwent successful ablation were enrolled. Atrial activation around the ToK during sinus rhythm was investigated using ultra-high-density mapping pre-ablation. The relationships among features of atrial-activation pattern and success sites were examined. Results Of 30 patients (22 cryoablation; 8 radiofrequency ablation), 26 patients had a collision site of two wavefronts of delayed atrial activation within ToK, indicating a success site. The activation-search function of Lumipoint software, which highlights only atrial activation with a spatiotemporal consistency, showed non-highlighted area on the tricuspid-annulus side of ToK. In 23 of the patients, a spiky potential was recorded at that collision site outside the Lumipoint-highlighted area. Fifteen cryoablation patients with a success site coincident with a collision site outside the Lumipoint-highlighted area had significantly more frequent disappearances of SP after initial cryoablation (46.7% vs. 0%, p = .029), fewer cryoablations (3.7 ± 1.8 vs. 5.3 ± 1.3, p = .045), and shorter procedure times (170 ± 57 vs. 228 ± 91 min, p = .082) compared to the seven cryoablation patients without such sites. Four patients had transient AV block by ablation inside the Lumipoint-highlighted area with fractionated signals, but no patient developed permanent AV block or recurrence post-procedure (median follow-up: 375 days). Conclusions SP modification ablation at the collision site of atrial activation of the tricuspid-annulus side along with a spiky potential could provide a better outcome.
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Affiliation(s)
- Tomonori Watanabe
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Hitoshi Hachiya
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
- Cardiovascular Center, Tsuchiura Kyodo HospitalIbarakiJapan
| | - Hiroaki Watanabe
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazunori Anno
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takafumi Okuyama
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomohiko Harunari
- Division of Cardiovascular Medicine, Shin‐Oyama City HospitalTochigiJapan
| | - Ayako Yokota
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Masashi Kamioka
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takahiro Komori
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuko Torigoe‐Kurosu
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Hisaki Makimoto
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yoshifumi Kimura
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yasushi Imai
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
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2
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Peng G, Zei PC. Diagnosis and Management of Paroxysmal Supraventricular Tachycardia. JAMA 2024; 331:601-610. [PMID: 38497695 DOI: 10.1001/jama.2024.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Importance Paroxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy. Observations Approximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options. Conclusion and Relevance Paroxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.
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Affiliation(s)
- Gary Peng
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C Zei
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Alken FA, Scherschel K, Zhu E, Kahle AK, Meyer C. [Long-term results of catheter ablation for AV nodal reentry tachycardias and accessory pathways]. Herzschrittmacherther Elektrophysiol 2023; 34:278-285. [PMID: 37861731 DOI: 10.1007/s00399-023-00965-0] [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] [Received: 07/23/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia in patients with accessory pathways (AP) are common supraventricular tachycardias. High long-term efficacy of about 97% (AVNRT) and 92% (AP) has been observed in children and adults. The risk of occurring atrioventricular block is low (0.4-0.8% during AVNRT, 0.1-0.2% for AP). Catheter ablation shows a lower efficacy of 87-93% and elevated atrioventricular block risk up to 10% in patient groups with complex congenital heart disease. Nonsynchronized ventricular activation during preexcitation or permanent reentrant tachycardias can induce heart failure, and remission of left ventricular function can be expected in > 90% after successful catheter ablation. Therefore, catheter ablation is the long-term therapy of choice for AVNRT and AP with high efficacy and safety for most patient populations.
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Affiliation(s)
- Fares-Alexander Alken
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
| | - Katharina Scherschel
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
- Institut für Neuro- und Sinnesphysiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland
| | - Ernan Zhu
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Christian Meyer
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland.
- Institut für Neuro- und Sinnesphysiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland.
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Doldi F, Geßler N, Anwar O, Kahle AK, Scherschel K, Rath B, Köbe J, Lange PS, Frommeyer G, Metzner A, Meyer C, Willems S, Kuck KH, Eckardt L. In-hospital mortality and major complications related to radiofrequency catheter ablations of over 10 000 supraventricular arrhythmias from 2005 to 2020: individualized case analysis of multicentric administrative data. Europace 2023; 25:130-136. [PMID: 36006798 PMCID: PMC10103566 DOI: 10.1093/europace/euac146] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/11/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS The incidence of in-hospital post-interventional complications and mortality after ablation of supraventricular tachycardia (SVT) vary among the type of procedure and most likely the experience of the centre. As ablation therapy of SVT is progressively being established as first-line therapy, further assessment of post-procedural complication rates is crucial for health care quality. METHODS AND RESULTS We aimed at determining the incidence of in-hospital mortality and bleeding complications from SVT ablations in German high-volume electrophysiological centres between 2005 and 2020. All cases were registered by the German Diagnosis Related Groups-and the German Operation and Procedure Classification (OPS) system. A uniform search for SVT ablations from 2005 to 2020 with the same OPS codes defining the type of ablation/arrhythmia as well as the presence of a vascular complication, cardiac tamponade, and/or in-hospital death was performed. An overall of 47 610 ablations with 10 037 SVT ablations were registered from 2005 to 2020 among three high-volume centres. An overall complication rate of 0.5% (n = 38) was found [median age, 64; ±15 years; female n = 26 (68%)]. All-cause mortality was 0.02% (n = 2) and both patients had major prior co-morbidities precipitating a lethal outcome irrespective of the ablation procedure. Vascular complications occurred in 10 patients (0.1%), and cardiac tamponade was detected in 26 cases (0.3%). CONCLUSION The present case-based analysis shows an overall low incidence of in-hospital complications after SVT ablation highlighting the overall very good safety profile of SVT ablations in high-volume centres. Further prospective analysis is still warranted to guarantee continuous quality control and optimal patient care.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Nele Geßler
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Omar Anwar
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Benjamin Rath
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
| | - Andreas Metzner
- Universitäres Herz- und Gefäßzentrum UKE Hamburg, Klinik und Poliklinik für Kardiologie, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology and Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D-48149 Münster, Germany
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5
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Jansen H, Nürnberg JH, Veltmann C, Hebe J. Anatomy for ablation of atrioventricular nodal reentry tachycardia and accessory pathways. Herzschrittmacherther Elektrophysiol 2022; 33:133-147. [PMID: 35608665 DOI: 10.1007/s00399-022-00860-0] [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] [Received: 03/25/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
The atrioventricular (AV) valve plane and the central septum are of particular importance for electrophysiological diagnosis and interventional therapy of supraventricular tachycardias because accessory electrical connections of various types may be present in addition to the specific conduction system. Although modern 3D electroanatomic reconstruction systems including high-density mapping can be of great assistance, detailed knowledge of the anatomic structures involved, their complex three-dimensional arrangement, and their electrical properties in conjunction with electrophysiological features of supraventricular arrhythmias is essential for safe and efficient electrophysiological treatment. The aim of this article is to present current anatomical, topographical, and electrophysiological findings against the background of historical, seminal, and still indispensable literature.
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6
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Tan ESJ, Chan SP, Seow SC, Teo WS, Ching CK, Chong DTT, Tan VH, Chia PL, Foo DCG, Kojodjojo P. Outcomes of supraventricular tachycardia ablation: Results from the Singapore ablation and cardiac devices registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:50-58. [PMID: 34792208 DOI: 10.1111/pace.14410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/11/2021] [Accepted: 11/14/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Singapore Cardiac Databank was designed to monitor the performance and outcomes of catheter ablation. We investigated the outcomes of paroxysmal supraventricular tachycardia (PSVT)-ablation in a prospective, nationwide, cohort study. METHODS Atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT), or atrial tachycardia (AT)-ablations in Singapore from 2010 to 2018 were studied. Outcomes include acute success, periprocedural-complications, postoperative pacing requirement, arrhythmic recurrence and 1-year all-cause mortality. RESULTS Among 2260 patients (mean age 45 ± 18 years, 50% female, 57% AVNRT, 37% AVRT, 6% AT), overall acute success rates of PSVT-ablation was 98.4% and increased in order of AT, AVRT, and AVNRT (p < .001). Periprocedural cardiac tamponade occurred in two AVRT patients. A total of 15 pacemakers (6 within first 30-days, 9 after 30-days) were implanted (seven AV block, eight sinus node dysfunction [SND]), with the highest incidence of pacemaker implantation after AT-ablation (5% vs. 0.6% AVNRT vs. 0.1% AVRT, p < .001). Repeat ablations (0.9% AVNRT, 7% AVRT, 4% AT, p < .001) were performed in 78 (3.5%) patients and 13 (0.6%) patients died within a year of ablation. Among outcomes considered adjusting for age, sex, PSVT-type and procedure-time, AT was independently associated with 6-fold increased odds of total (adjusted odds ratio [AOR] 6.32, 95% confidence interval [CI] 1.95-20.53) and late (AOR 6.38, 95% CI 1.39-29.29) pacemaker implantation, while AVRT was associated with higher arrhythmic recurrence with repeat ablations (AOR 4.72, 95% CI 2.36-9.44) compared to AVNRT. CONCLUSIONS Contemporary PSVT ablation is safe with high acute success rates. Long-term outcomes differed by nature of the PSVT.
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Affiliation(s)
- Eugene S J Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Siew Pang Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Swee-Chong Seow
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Wee Siong Teo
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Chi Keong Ching
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Daniel T T Chong
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Vern Hsen Tan
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Pow-Li Chia
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - David C G Foo
- Department of Cardiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Department of Cardiology, Ng Teng Fong General Hospital, Singapore, Singapore
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- Department of Cardiology, National University Heart Centre, Singapore, Singapore
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7
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Ávila P, Calvo D, Tamargo M, Uribarri A, Datino T, Arenal A, Atienza F, Soto N, Fernández-Avilés F, González-Torrecilla E. Association of age with clinical features and ablation outcomes of paroxysmal supraventricular tachycardias. Heart 2021; 108:1107-1113. [PMID: 34635482 DOI: 10.1136/heartjnl-2021-319685] [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: 05/12/2021] [Accepted: 09/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The role of age in clinical characteristics and catheter ablation outcomes of atrioventricular nodal re-entrant tachycardia (AVNRT) or orthodromic atrioventricular re-entrant tachycardia (AVRT) has been assessed in retrospective studies categorising age by arbitrary cut-offs, but contemporary analyses of age-related trends are lacking. We aimed to study the relationship of age with epidemiological, clinical features and catheter ablation outcomes of AVNRT and AVRT. METHODS We recruited 600 patients (median age 56 years, 60% female) with a confirmed diagnosis of AVNRT (n=455) or AVRT (n=145) by means of an electrophysiological study. They were interrogated for arrhythmia-related symptoms with a structured questionnaire and followed up to 1 year. We analysed age as a continuous variable using regression models and adjusting for relevant covariables. RESULTS Both typical and atypical forms of AVNRT upraised with age while AVRT decreased (p<0.001 by regression). Female sex predominance in AVNRT was not observed in older patients. Overall, these tachycardias became more symptomatic with ageing despite a longer tachycardia cycle length (p<0.001) and regardless of the presence of structural heart disease, with a higher proportion of dizziness, syncope, chest pain or dyspnoea (p<0.005 for all) and a lower presence of palpitations or neck pounding (p<0.001 for both). Age was not associated with catheter ablation acute success, periprocedural complications or 1-year recurrence rates (p>0.05 for all). CONCLUSIONS Age, evaluated as a continuous variable, had a significant association with the clinical profile of patients with AVNRT and AVRT. Nevertheless, catheter ablation outcomes and complications were not significantly related to patients' age.
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Affiliation(s)
- Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain .,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - David Calvo
- Cardiology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - María Tamargo
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Aitor Uribarri
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Tomas Datino
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Angel Arenal
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Nina Soto
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Fernández-Avilés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban González-Torrecilla
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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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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9
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Iizuka T, Nakajima T, Tamura S, Hasegawa H, Kobari T, Nakahara S, Kurabayashi M, Kaneko Y. Simple differential entrainment screens ablation strategy for slow-fast atrioventricular nodal reentrant tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:671-679. [PMID: 32469105 DOI: 10.1111/pace.13946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/13/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation of slow-fast atrioventricular nodal reentrant tachycardia (S/F-AVNRT) is occasionally refractory. We hypothesized that the site of ablation for curing S/F-AVNRT can be screened by simple differential atrial entrainment pacing (EP) from the high right atrium (HRA) and proximal coronary sinus (prox-CS). METHODS We enrolled 43 patients with S/F-AVNRT who underwent successful differential atrial EP followed by successful ablation of slow pathway (SP) using step-wise approach, and compared the atrio-His (A-H) interval at the recording of His bundle immediately after EP from the HRA [A-H(HRA)], with the interval between atrial deflection at the prox-CS and His bundle electrogram after EP at an identical cycle length from the prox-CS [A-H (prox-CS)]. RESULTS A typical A-H(CS) shorter than A-H(HRA), consistent with typical SP conduction, was observed in 39 patients (91%), and an atypical A-H(HRA) shorter than A-H(CS) was observed in 4 patients (9%). Successful ablation was obtained at the posteroseptum/midseptum in 32/7 patients with typical responses but only at the midseptum in all 4 patients with atypical responses (P = .0027). The atypical responses predicted a necessity for ablation at the midseptum, with positive and negative predictive values of 100% and 82%, respectively. The mechanism of an atypical response remains unclear but may involve an anatomical variation of Koch's triangle and/or the participation of a variant of the SP, including the superior SP, over which retrograde conduction was observed more frequently in patients with atypical responses (P = .0013). CONCLUSIONS Differential atrial EP predicts the ablation site for successfully curing S/F-AVNRT.
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Affiliation(s)
- Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Hospital, Koshigaya, Saitama, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Goldstein K, Hansen C, Lüthje L, Vollmann D. [Safety and efficiency of interventional electrophysiology utilizing the German "Belegarztsystem"]. Herzschrittmacherther Elektrophysiol 2020; 31:210-218. [PMID: 32372229 DOI: 10.1007/s00399-020-00687-7] [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] [Received: 02/17/2020] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Electrophysiology study (EPS) and catheter ablation (abl.), in particular for atrial fibrillation, are increasingly performed in Germany. Therefore, measures and steps to ensure quality assurance are indicated. Most of the procedures are performed by physicians employed by hospitals; however, some are also carried out by attending cardiologists on contract in private practice, applying the so-called Belegarztsystem. The aim of this study was to determine the safety and efficiency of an interventional electrophysiology performed in a German Belegarztsystem. METHODS Based on a prospective registry, we analyzed procedure-related data from 1400 consecutive EPS/abl. performed at our center between 2014 and 2018. One-year follow-up data (arrhythmia recurrences, complications, deaths) were collected for all procedures carried out during the first 2 years. RESULTS In the total study cohort, no periprocedural death occurred, and there was a low cumulative incidence of groin complications (0.9%). The most common procedure (n = 772) was complex ablation for atrial fibrillation/flutter (55%). In this group, the success rate was 98% (acute) and 65% (1 year), and the cumulative rate of complications was 5.0% (transient ischemic attack/stroke 0.1%, pericardial tamponade 0.4%, relevant pericarditis/pericardial effusion 1.1%, groin complication 1.5%, other 1.9%). For the other procedures, rates for success and complications were comparable, and procedure times and x‑ray doses tended to be lower in our analysis as compared to prior reports. CONCLUSION Interventional electrophysiology, carried out by experienced operators and qualified staff, can be performed safely and effectively by attending physicians in a Belegarztsystem.
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Affiliation(s)
- Kathi Goldstein
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Claudius Hansen
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Lars Lüthje
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Dirk Vollmann
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland.
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11
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Symptomatic arrhythmias after catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT): results from the German Ablation Registry. Clin Res Cardiol 2019; 109:858-868. [PMID: 31784903 DOI: 10.1007/s00392-019-01576-x] [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: 07/23/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In atrioventricular nodal reentrant tachycardia (AVNRT), catheter ablation is considered as first-line therapy. Despite high success rates, some patients present with arrhythmia recurrence or develop other types of arrhythmias over time. OBJECTIVE To assess the incidence of symptomatic arrhythmias after initially successful AVNRT ablation and to analyze their clinical implications in a real-world cohort. METHODS We included 2,795 patients from the German Ablation Registry undergoing first ablation of AVNRT between 01/2007 and 01/2010. In patients alive at long-term follow-up, patient-specific characteristics and long-term follow-up data were compared between patients with (group A) and without (group B) any symptomatic arrhythmia during follow-up. RESULTS Symptomatic arrhythmias occurred in 17.2% of patients during a mean follow-up of 678 days after AVNRT ablation. The patients with symptomatic arrhythmias were more often female and suffered from structural heart disease. Arrhythmia occurrence was clinically relevant regarding symptoms and patient satisfaction. Serious adverse events including stroke, transient ischemic attack, pacemaker implantation, as well as continued use of antiarrhythmic medication occurred more often in group A. A second ablation procedure was performed in 26% of symptomatic patients to optimize the symptomatic outcome, whereas cardiovascular events or patient satisfaction were not further improved. CONCLUSION During long-term follow-up, one out of six patients experienced symptomatic arrhythmias after AVNRT ablation, associated with an increase of serious adverse events. A subset of patients required medical or interventional antiarrhythmic therapy, possibly attributable to the co-existence of other arrhythmias. Screening for arrhythmic and cardiac co-morbidity before and after ablation may support comprehensive therapy planning and outcome.
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Sorgente A, Cappato R. Complications of catheter ablation: incidence, diagnosis and clinical management. Herzschrittmacherther Elektrophysiol 2019; 30:363-370. [PMID: 31754784 DOI: 10.1007/s00399-019-00652-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/11/2019] [Indexed: 11/25/2022]
Abstract
Catheter ablation is a well-recognized treatment for a number of cardiac arrhythmias. Initially used to treat supraventricular tachycardia, this technique is now also widely used to treat ventricular arrhythmia and atrial fibrillation. This review aims to describe all the possible types of complication related to this invasive procedure. Definitions according to the current guidelines are provided, as are some details on the frequency of complications and how to diagnose and treat them appropriately. Finally, each section of the review provides guidance on how to prevent the complications associated with catheter ablation.
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Affiliation(s)
| | - Riccardo Cappato
- Humanitas University & Clinical Research Center, Via Manzoni 56, Rozzano (Milano), Italy.
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13
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Frey MK, Richter B, Gwechenberger M, Marx M, Pezawas T, Schrutka L, Gössinger H. High incidence of atrial fibrillation after successful catheter ablation of atrioventricular nodal reentrant tachycardia: a 15.5-year follow-up. Sci Rep 2019; 9:11784. [PMID: 31409803 PMCID: PMC6692351 DOI: 10.1038/s41598-019-47980-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022] Open
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia. Slow pathway (SP) ablation is the treatment of choice with a high acute success rate and a negligible periprocedural risk. However, long-term outcome data are scarce. The aim of this study was to assess long-term outcome and arrhythmia free survival after SP ablation. In this study, 534 consecutive patients with AVNRT, who underwent SP ablation between 1994 and 1999 were included. During a mean follow-up of 15.5 years, 101 (18.9%) patients died unrelated to the procedure or any arrhythmia. Data were collected by completing a questionnaire and/or contacting patients. Clinical information was obtained from 329 patients (61.6%) who constitute the final study cohort. During the electrophysiological study, sustained 1:1 slow AV nodal pathway conduction was eliminated in all patients. Recurrence of AVNRT was documented in 9 patients (2.7%), among those 7 patients underwent a successful repeat ablation procedure. New-onset atrial fibrillation (AF) was documented in 39 patients (11.9%) during follow-up. Pre-existing arterial hypertension (odds ratio 2.61, 95% CI 1.14–5.97, p = 0.023), age (odds ratio 1.05, 95% CI 1.02–1.09, p = 0.003) and the postinterventional AH interval (odds ratio 1.02, 95% CI 1.00–1.04, p = 0.038) predicted the occurrence of AF. The present long-term observational study after successful SP ablation of AVNRT confirms its clinical value reflected by low recurrence and complication rates. The unexpectedly high incidence of new-onset AF (11.9%) may impact long-term follow-up and requires further clinical attention.
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Affiliation(s)
- M K Frey
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - B Richter
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Gwechenberger
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Marx
- Department of Pediatric Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - T Pezawas
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - L Schrutka
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - H Gössinger
- Department of Cardiology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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14
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Lin Y, Wu HK, Wang TH, Chen TH, Lin YS. Trend and risk factors of recurrence and complications after arrhythmias radiofrequency catheter ablation: a nation-wide observational study in Taiwan. BMJ Open 2019; 9:e023487. [PMID: 31152025 PMCID: PMC6549656 DOI: 10.1136/bmjopen-2018-023487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study determined the recurrence and complication rates after radiofrequency catheter ablation (RFCA) for those with paroxysmal supraventricular tachycardia (PSVT), Wolff-Parkinson-White syndrome (WPW), atrial flutter (AFL), atrial fibrillation (AF) and ventricular tachycardia (VT). STUDY DESIGN AND SETTING This retrospective study included RFCAs for 2001-2010 in the Taiwan National Health Insurance Research Database. Primary outcomes included perioperative complications (pericardial effusion and new-onset stroke), RFCA recurrence and long-term outcomes (high-grade atrioventricular block (AVB) and pacemaker implantation). RESULTS Of 19,475 patients who underwent RFCA, prevalence rates were 56.7% for PSVT, 13.5% for WPW, 9.5% for AFL, 5.1% for AF and 2.7% for VT. Prevalence rates increased in AF, AFL and VT over the study years. During an average follow-up period of 4.3 years (SD: 2.8 years), recurrence rates for PSVT, WPW, VT, AFL and AF were 2.0%, 4.9%, 5.7%, 5.8% and 16.1%, respectively. Compared with the PSVT group, the WPW and AF groups had significantly higher risk of pericardial effusion during admission (adjusted OR (aOR) 2.98, 95% CI (CI) 1.24 to 7.15; aOR 4.09, 95% CI 1.90 to 8.79, respectively); the AFL group had a higher risk of new-onset stroke during admission (aOR 4.07, 95% CI 1.39 to 11.91); the WPW group had a lower risk of high-grade AVB during follow-up (adjusted HR (aHR) 0.37, 95% CI 0.19 to 0.71) while the AFL group had a greater risk (aHR 1.74, 95% CI 1.17 to 2.60); and the AFL group had a higher risk of permanent pacemaker (aHR 2.14, 95% CI 1.27 to 3.62). CONCLUSIONS The RFCA rate increased rapidly during 2001-2010 for AF, AFL and VT. Recurrence was associated with congenital heart disease in PSVT and WPW, and with age in AF and AFL. AFL had a higher risk of permanent pacemaker implantation and new stroke. AF had a higher risk of life-threatening pericardial effusion.
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Affiliation(s)
- Yuan Lin
- Emergency Medicine Department, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Hsin-Kuan Wu
- Emergency Medicine Department, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Te-Hsiung Wang
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Tien-Hsing Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Biostatistical Consultation Center, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi, Taiwan
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15
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Yamane T, Inoue K, Kusano K, Takegami M, Nakao YM, Miyamoto Y, Goya M, Uno K, Shoda M, Murakawa Y, Hirao K, Nogami A. Study design of nationwide Japanese Catheter Ablation Registry: Protocol for a prospective, multicenter, open registry. J Arrhythm 2019; 35:167-170. [PMID: 31007779 PMCID: PMC6457368 DOI: 10.1002/joa3.12163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/06/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Catheter ablation has become a popular interventional treatment for cardiac tachyarrhythmias and the number has been on the rise year by year. However, little is known about its efficacy and safety in the real-world settings. METHOD Japanese Catheter Ablation (J-AB) Registry is a nationwide, multicenter, observational registry, performed by Japanese Heart Rhythm Society (JHRS), collaborated with National Cerebral and Cardiovascular Center. This study is a voluntary nationwide registry and data are collected prospectively using a Research Electronic Data Capture (REDCap) system. Detailed data collection including antiarrhythmic medication is also performed every September. The acute success rate at discharge and the complications associated with ablation procedure will be collected in all cases. Major bleeding events are defined according to Bleeding Academic Research Consortium criteria. Based on the provided information, the annual incidence and predictive factors for outcome will be investigated by the Event Assessment Committee. This registry started in August 2017 and the number of participating medical instructions will be more than 250 hospitals and the target procedure number will be 70 000 per year. We will also compare the results with other registries in foreign countries. RESULT The results of this study are currently under investigation. CONCLUSION The J-AB registry will provide a real-world data regarding the acute success and complications in Japan, focusing on various types of catheter ablation for cardiac arrhythmias.
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Affiliation(s)
- Teiichi Yamane
- Division of CardiologyDepartment of Internal MedicineThe Jikei University School of MedicineTokyoJapan
| | - Koichi Inoue
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic InformaticsNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Yoko M. Nakao
- Department of Preventive Medicine and Epidemiologic InformaticsNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease InformationNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Masahiko Goya
- Heart Rhythm CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Kikuya Uno
- Heart Rhythm CenterChiba‐Nishi General HospitalMatsudoJapan
| | - Morio Shoda
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Yuji Murakawa
- Fourth Department of Internal MedicineTeikyo University School of MedicineKawasakiJapan
| | - Kenzo Hirao
- Heart Rhythm CenterTokyo Medical and Dental UniversityTokyoJapan
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
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16
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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17
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Outcome of slow pathway modulation for atrioventricular nodal reentrant tachycardia with 50 versus 30 watts-more power, more effect? J Interv Card Electrophysiol 2018; 52:157-161. [PMID: 29556909 DOI: 10.1007/s10840-018-0360-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Slow pathway modulation is the treatment of choice in patients with atrioventricular nodal reentrant tachycardia (AVNRT). No comparative data on ablation strategies exist. Therefore, we sought to compare two common ablation approaches. METHODS We analyzed prospective ablation databases of two high-volume tertiary centers (> 1000 ablations/year) using either 30 or 50 W for slow pathway modulation from 2012 to 2013. We analyzed procedural characteristics as well as short- and long-term outcomes. Mean follow-up was 36 ± 9 months. RESULTS Six hundred thirty-four patients (50 W center: n = 342, 30 W center: n = 292) were ablated. Slow pathway modulation was successful in 99% in both groups (p = ns). Periprocedural AV block occurred in nine patients (2.6%) in the 50 W and five patients (1.7%) in the 30 W group (p = 0.59), respectively. We documented no permanent higher-degree AV block. The number of RF lesions and seconds of RF delivery was significantly less in the 50 W group (p = 0.04 for number of lesions; p < 0.001 for seconds). AVNRT recurrence was similar (p = 0.23). In males, significantly fewer recurrences accrued in the 50 W group (p = 0.04), while in females less transient AV blocks occurred during the procedure with 30 W (p = 0.07). CONCLUSIONS The 30 and 50 W target power approaches for slow pathway modulation are highly effective and safe. Significantly, fewer RF duration was necessary to modulate the slow pathway with higher power output (50 W). Our subgroup analysis suggests that males and females might benefit most from different modulation approaches.
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18
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Fragakis N, Krexi L, Kyriakou P, Sotiriadou M, Lazaridis C, Karamanolis A, Dalampyras P, Tsakiroglou S, Skeberis V, Tsalikakis D, Vassilikos V. Electrophysiological markers predicting impeding AV-block during ablation of atrioventricular nodal reentry tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:7-13. [DOI: 10.1111/pace.13245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Nikolaos Fragakis
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Lydia Krexi
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Panagiota Kyriakou
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Melani Sotiriadou
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Charalambos Lazaridis
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Athanasios Karamanolis
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Panagiotis Dalampyras
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Stelios Tsakiroglou
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Vassilios Skeberis
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Dimitrios Tsalikakis
- Department of Informatics and Telecommunications; University of Western Macedonia; Macedonia Greece
| | - Vassilios Vassilikos
- Third Department of Cardiology; Hippokration Hospital; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
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Sultan A, Lüker J, Andresen D, Kuck KH, Hoffmann E, Brachmann J, Hochadel M, Willems S, Eckardt L, Lewalter T, Senges J, Steven D. Predictors of Atrial Fibrillation Recurrence after Catheter Ablation: Data from the German Ablation Registry. Sci Rep 2017; 7:16678. [PMID: 29192223 PMCID: PMC5709464 DOI: 10.1038/s41598-017-16938-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/20/2017] [Indexed: 11/09/2022] Open
Abstract
Catheter ablation (CA) for atrial fibrillation (AF) has emerged as a widespread first or second line treatment option. However, up to 45% of patients (pts) show recurrence of AF within 12 month after CA. We present prospective multicenter registry data comparing characteristics of pts with and without recurrence of AF within the first year after CA. This study comprises all pts with complete follow-up one year after CA (1-y-FU; n = 3679). During 1y-FU in 1687 (45.9%) pts recurrence of AF occurred. The multivariate analysis revealed female sex and AF type prior to the procedure as predictors for AF recurrence. Furthermore, comorbidities such as valvular heart disease and renal failure as well as an early AF relapse were also predictors of AF recurrence during 1-y-FU. However, despite an AF recurrence rate of 45.9%, the majority of these pts (72.4%) reported a significant alleviation of clinical symptoms. In conclusion in pts with initially successful CA for AF female sex, AF type, in-hospital AF relapse and comorbidities such as renal failure and valvular heart disease are independent predictors for AF recurrence during 1-y-FU. However, the majority of pts deemed their interventions as successful with significant reduction of symptoms irrespective of AF.
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Affiliation(s)
- A Sultan
- University Heart Center Cologne, Dept. of Electrophysiology, Cologne, Germany.
| | - J Lüker
- University Heart Center Cologne, Dept. of Electrophysiology, Cologne, Germany
| | | | - K H Kuck
- Asklepios Hosp. St. Georg Hamburg, Hamburg, Germany
| | | | | | | | - S Willems
- University Heart Center Hamburg, Dept. of Electrophysiology, Hamburg, Germany
| | - L Eckardt
- University Hosp. Münster, Dept. of Electrophysiology, Münster, Germany
| | - T Lewalter
- Dept. of Medicine-Cardiology, P. Osypka Heart Center Munich, Munich, Germany
| | - J Senges
- IHF Ludwigshafen, Ludwigshafen, Germany
| | - D Steven
- University Heart Center Cologne, Dept. of Electrophysiology, Cologne, Germany
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Patients' and procedural characteristics of AV-block during slow pathway modulation for AVNRT-single center 10year experience. Int J Cardiol 2017; 244:158-162. [PMID: 28663043 DOI: 10.1016/j.ijcard.2017.06.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Permanent AV-block is a recognized and feared complication of slow pathway modulation for AVNRT. We aimed to assess incidence of transient and permanent AV-block as well as consequences of transient AV-block in a large contemporary AVNRT ablation cohort. METHODS We searched our single center prospective ablation database for occurrence of transient and permanent AV-block during slow pathway modulation between January 2004 and October 2015. We analyzed patients' and procedural characteristics as well as outcome of patients in whom transient or permanent AV-block occurred. RESULTS Of 9170 patients who underwent a catheter ablation at our institution between January 2004 and October 2015, 2101 patients (64% women, mean age 50±18years) underwent slow pathway modulation. In three patients, permanent AV-block occurred during RF application. Additional two patients had transient AV-block that recovered (after a few minutes and 25min), but recurred within two days of the procedure. All five patients underwent dual chamber pacemaker implantation (0.2%). Transient AV-block related to RF delivery occurred in 44 patients (2%). Transient mechanical AV-block occurred in additional 17 patients (0.8%). In 12 patients, ablation was continued despite transient AV-block. One of these patients developed permanent AV-block. CONCLUSION Permanent AV-block following slow pathway modulation is a rare event, occurring in 0.2% of patients in a large contemporary single center cohort. Transient AV-block is more frequent (2%).
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Sawan N, Eitel C, Thiele H, Tilz R. [Ablation of supraventricular tachycardias : Complications and emergencies]. Herzschrittmacherther Elektrophysiol 2016; 27:143-50. [PMID: 27206630 DOI: 10.1007/s00399-016-0422-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Catheter ablation is an established treatment of supraventricular tachycardias (SVT) with high success rates of > 95 %. Complication rates range from 3 to 5 %, with serious complications occurring in about 0.8 %. There are general complications caused either by the vascular access or the catheters (e. g. hematomas, hemo-pneumothorax, embolism, thrombosis and aspiration) und specific ablation related complications (e. g. AV block during ablation of the slow pathway). The complication risk is elevated in elderly and multimorbid patients. Furthermore, the experience of the treating physician and the respective team plays an essential role. The purpose of this article is to give an overview on incidences, causes and management as well as prevention strategies of complications associated with catheter ablation of SVT.
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Affiliation(s)
- N Sawan
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - C Eitel
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - H Thiele
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - R Tilz
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation 2016; 133:e506-74. [DOI: 10.1161/cir.0000000000000311] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. Circulation 2016; 133:e471-505. [DOI: 10.1161/cir.0000000000000310] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. J Am Coll Cardiol 2016; 67:1575-1623. [DOI: 10.1016/j.jacc.2015.09.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes III NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm 2016; 13:e136-221. [DOI: 10.1016/j.hrthm.2015.09.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 01/27/2023]
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Cryoablation of an atrioventricular nodal reentrant tachycardia in a patient with an implanted deep brain stimulator. HeartRhythm Case Rep 2016; 2:258-260. [PMID: 28491683 PMCID: PMC5419761 DOI: 10.1016/j.hrcr.2016.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2015; 13:e92-135. [PMID: 26409097 DOI: 10.1016/j.hrthm.2015.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 10/23/2022]
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28
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2015; 67:e27-e115. [PMID: 26409259 DOI: 10.1016/j.jacc.2015.08.856] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Pieragnoli P, Paoletti Perini A, Checchi L, Carrassa G, Giomi A, Carrai P, Michelucci A, Padeletti L, Ricciardi G. Cryoablation of typical AVNRT: Younger age and administration of bonus ablation favor long-term success. Heart Rhythm 2015; 12:2125-31. [PMID: 26031373 DOI: 10.1016/j.hrthm.2015.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cryoablation (CA) is an emerging tool for the treatment of supraventricular tachyarrhythmias. Determinants of long-term success still need clarification. OBJECTIVE The purpose of this study was to assess which patients' and procedural features affect the long-term efficacy of CA for typical atrioventricular nodal reentrant tachycardia (AVNRT). METHODS Eighty-five consecutive patients undergoing CA for typical AVNRT were divided into 3 groups of age: group A, ≤20 years, n = 20 (23.5%); group B, 21-50 years, n = 30 (35.3%); group C, ≥51 years, n = 35 (41.2%). CA was performed for 5 minutes at -75°C in all; 4-minute bonus CA was delivered if not contraindicated (ie, transient PR interval lengthening during the first application and narrow triangle of Koch). The efficacy end point was the absence of recurrences at 12-month follow-up. RESULTS CA was acutely successful in all 85 patients (100%). Bonus ablation was performed in 69 (81.2%). No permanent complications were observed. At follow-up, AVNRT recurrences occurred in 9 patients (10.6%): group A, 0 (0%); group B, 2 (6.7%), group C, 7 (20%). Incidence of recurrences was significantly different between age groups (P = .047) and between patients receiving (7.2%) and not receiving (25.0%) bonus CA (P = .038). In multivariable analysis, age groups (odds ratio [OR] 5.917; 95% confidence interval [CI] 1.372-25.518; P = .017) and bonus CA (OR 0.115; 95% CI 0.018-0.724; P = .021) were the only independent predictors of recurrences. Furthermore, age as a continuous variable remained statistically associated with recurrences (OR 1.046; 95% CI 1.002-1.091; P = .038). CONCLUSION CA is effective and safe for typical AVNRT ablation. Younger age and bonus CA administration are independent predictors of success at 12 months. Incidence of recurrences is low in patients younger than 21 years.
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Affiliation(s)
- Paolo Pieragnoli
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | | | - Luca Checchi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
| | - Gianmarco Carrassa
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Andrea Giomi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Paolo Carrai
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Antonio Michelucci
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Luigi Padeletti
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy; Department of Cardiology, Cliniche Gavazzeni, Bergamo, Italy
| | - Giuseppe Ricciardi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Zalewska KI, Barry J. Case series: Radiofrequency cathether ablation of atrioventricular nodal reentrant tachycardia in octogenerians. JRSM Open 2015; 6:2054270414554247. [PMID: 26085936 PMCID: PMC4458257 DOI: 10.1177/2054270414554247] [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] [Indexed: 11/23/2022] Open
Abstract
Ablation in octogenerians is effective and allows rationalisation of pharmacotherapy. Advancing age should not be a barrier to its use.
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Affiliation(s)
| | - James Barry
- Morriston Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea, SA6 6NL, UK
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Alihanoglu YI, Yildiz BS, Kilic DI, Evrengul H, Kose S. Clinical and electrophysiological characteristics of typical atrioventricular nodal reentrant tachycardia in the elderly - changing of slow pathway location with aging. Circ J 2015; 79:1031-6. [PMID: 25739340 DOI: 10.1253/circj.cj-14-1320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the clinical and electrophysiological characteristics of elderly patients with typical atrioventricular nodal reentrant tachycardia (AVNRT), and to assess the acute safety and efficacy of slow-pathway radiofrequency (RF) ablation in this specific group of patients. METHODS AND RESULTS The present study retrospectively included a total of 1,290 patients receiving successful slow-pathway RF ablation for typical slow-fast AVNRT. Patients were divided into 2 groups: group I included 1,148 patients aged <65 years and group II included 142 patients aged >65 years. The required total procedure duration and total fluoroscopy exposure time were significantly higher in group II vs. group I (P=0.005 and P=0.0001, respectively). The number of RF pulses needed for a successful procedural end-point was significantly higher in group II than in group I (4.4 vs. 7.2, P=0.005). While the ratio of the anterior location near to the His-bundle region was significantly higher in group II, the ratio of posterior and midseptal locations were significantly higher in group I (P=0.0001). The overall procedure success rates were similar. There was no significant difference between the 2 groups in respect of the complications rates. CONCLUSIONS This experience demonstrates that RF catheter ablation, targeting the slow pathway, could be considered as first-line therapy for typical AVNRT patients older than 65 years as well as younger patients, as it is very safe and effective in the acute period of treatment.
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Kirmanoglou K, Peiker C, Clasen L, Shin DI, Kelm M, Meyer C. [Dual AV nodal nonreentry tachycardia (DAVNNT): unrecognized differential diagnosis with far-reaching consequences]. Herzschrittmacherther Elektrophysiol 2014; 25:109-115. [PMID: 24830917 DOI: 10.1007/s00399-014-0310-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The dual atrioventricular nodal nonreentry tachycardia (DAVNNT) is a rare form of tachycardia which occurs due to a time delayed double antegrade conduction via the slow and fast atrioventricular nodal pathways. Its epidemiology is not known so far. The aim of this article is to present the clinical findings in a series of patients with DAVNNT. MATERIALS AND METHODS We retrospectively analyzed our database of patients who successfully underwent radiofrequency catheter ablation between January 2012 and March 2013 due to diagnosed supraventricular tachycardia. RESULTS In 3 out of 231 patients DAVNNT could be successfully treated by slow pathway modulation/ablation. Patients presented with widely varying symptoms including syncope, palpitations which had been mistaken as atrial fibrillation, and inappropriate defibrillator shocks due to suspected ventricular tachycardia. CONCLUSIONS The DAVNNT seems to be more common than previously thought. This important differential diagnosis needs to be taken into consideration as slow pathway modulation can be curative while a misdiagnosis, such as atrial fibrillation or ventricular tachycardia might result in over-treatment in patients with this arrhythmia.
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Affiliation(s)
- Kiriakos Kirmanoglou
- Abteilung für Rhythmologie, Klinik für Kardiologie Pneumologie und Angiologie, Heinrich-Heine Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Insulander P, Bastani H, Braunschweig F, Drca N, Gudmundsson K, Kennebäck G, Sadigh B, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation of substrates adjacent to the atrioventricular node: acute and long-term safety of 1303 ablation procedures. Europace 2013; 16:271-6. [PMID: 23851515 DOI: 10.1093/europace/eut215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Radiofrequency (RF) ablation is effective for ablation of atrial arrhythmias. However, RF ablation in the vicinity of the atrioventricular (AV) node is associated with a risk of inadvertent, irreversible high-grade AV block, depending on the type of substrate. Cryoablation is an alternative method. The objective was to investigate the acute and long-term risks of AV block during cryoablation. METHODS AND RESULTS We studied 1303 consecutive cryoablations of substrates in the vicinity of the AV node in 1201 patients (median age 51 years, range 6-89 years) on acute and long-term impairment to the AV nodal conduction system. The arrhythmias treated were AV nodal reentrant tachycardias (n=1116), paraseptal and superoparaseptal accessory pathways (n=100), and focal atrial tachycardias (n=87). In 158 (12%) procedures, cryomapping (38 cases) or cryoablation (120 cases) were stopped due to transient AV block (first-degree AV block 74 cases, second-degree AV block 67 cases, and third-degree AV block 17 cases) after which another site was tested. Transient AV block occurred within seconds of mapping up to 3 min of ablation. The incidence of AV block was similar for different substrates. In most cases, AV nodal conduction was restored within seconds but in two cases transient AV block lasted 21 and 45 min, respectively. There were no cases of acute permanent AV blocks. No late AV blocks occurred during follow-up (mean 24 months, range 6-96 months). CONCLUSION Cryoablation adjacent to the AV node carries a negligible risk of permanent AV block. Transient AV block during ablation is a benign finding.
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Affiliation(s)
- Per Insulander
- Department of Cardiology, Karolinska University Hospital, S-141 86 Stockholm, Sweden
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Liao JN, Hu YF, Wu TJ, Fong AN, Lin WS, Lin YJ, Chang SL, Lo LW, Tuan TC, Chang HY, Li CH, Chao TF, Chung FP, Hanafy DA, Lin WY, Huang JL, Huang CC, Leu HB, Lee PC, Chiang CE, Chen SA. Permanent pacemaker implantation for late atrioventricular block in patients receiving catheter ablation for atrioventricular nodal reentrant tachycardia. Am J Cardiol 2013; 111:569-73. [PMID: 23219174 DOI: 10.1016/j.amjcard.2012.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 11/03/2012] [Accepted: 11/03/2012] [Indexed: 10/27/2022]
Abstract
The present study investigated the incidence and predictors of permanent pacemaker (PPM) implantation for late atrioventricular block (AVB) in patients with atrioventricular nodal reentrant tachycardia (AVNRT) who received ablation. The data from 3,442 patients with AVNRT who received ablation were analyzed. Those who developed late AVB (>1 month after ablation) and received a PPM were identified. The incidence of PPM implantation in 1,148 matched patients with Wolff-Parkinson-White syndrome and in the whole population of Taiwan were compared. Of the patients with AVNRT receiving ablation (mean follow-up duration 128.3 ± 62.5 months), 15 (0.4%) received PPM implantation for late AVB (mean interval after catheter ablation 95.4 ± 55.0 months). Only age (odds ratio 1.05, p = 0.02) and transient AVB (odds ratio 8.55, p = 0.01) during the procedure were independently associated with PPM implantation for late AVB. The patients with AVNRT had a greater incidence of PPM implantation due to late AVB compared to the matched patients with Wolff-Parkinson-White syndrome. The annual incidence of PPM implantation for AVB was also greater in the patients with AVNRT than in the general population. In conclusion, the incidence of PPM implantation for late AVB in patients with AVNRT who received catheter ablation was low but still greater than that in patients with Wolff-Parkinson-White syndrome and the general population in Taiwan.
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Ablation of atrioventricular nodal re-entrant tachycardia is safe and effective in the elderly. Nat Rev Cardiol 2011; 8:304. [DOI: 10.1038/nrcardio.2011.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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