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Kong LC, Shuang T, Tan HW, Sun YM, Han B, Wang XH. A novel endocardial activation-derived predictor for focal paraseptal atrial tachycardias: Evidence from a multicenter cohort study. Heart Rhythm 2024:S1547-5271(24)02729-2. [PMID: 38885753 DOI: 10.1016/j.hrthm.2024.06.017] [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: 04/23/2024] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The electrocardiogram-based algorithm for predicting paraseptal atrial tachycardia (PSAT) is limited by the significant overlaps in P-wave morphology originating from various paraseptal sites. OBJECTIVES The goals of this study were to investigate the endocardial activation characteristics of PSAT and to seek an endocardial activation-derived predictor for the ablation site. METHODS Forty-four patients [11 men (25%); mean age 62.6 ± 14.7 years] with PSAT ablation in 4 tertiary medical centers were assigned to 3 groups according to the ablation site: right atrial (RA) para-Hisian region (group 1, n = 10), noncoronary cusp (NCC) (group 2, n = 13), and left atrial (LA) paraseptal area (group 3, n = 21). Multiple-chamber activation mapping was performed guided by a 3-dimensional navigation system. The discrepancies in the earliest activation time between 2 of 3 chambers (ΔRA-LA, ΔRA-NCC, and ΔLA-NCC) were calculated in each group and used for pairwise comparisons. RESULTS There was a significant difference in ΔRA-LA, ΔRA-NCC, and ΔLA-NCC among the 3 groups. ΔRA-LA was the only parameter that could consistently predict the ablation site of PSAT with good accuracy (area under the curve 1.000, sensitivity 100% and specificity 100%, and cutoff value 7 ms for predicting right para-Hisian or NCC ablation; area under the curve 0.974, sensitivity 92.3% and specificity 95.2%, and cutoff value -4 ms for predicting NCC or left paraseptal ablation). Based on 2 cutoff values, a 2-step algorithm was developed to predict the ablation site of PSAT with a positive predictive value of 95.4% and a negative predictive value of 97.0%. CONCLUSION ΔRA-LA is a useful endocardial activation-derived parameter for predicting the successful ablation site of PSAT.
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Affiliation(s)
- Ling-Cong Kong
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Shuang
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-Wei Tan
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu-Min Sun
- Shanghai Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Bing Han
- Division of Cardiology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Institute of Cardiovascular Disease, Xuzhou Central Hospital, Xuzhou, China
| | - Xin-Hua Wang
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Guerra PG, Simpson CS, Van Spall HGC, Asgar AW, Billia P, Cadrin-Tourigny J, Chakrabarti S, Cheung CC, Dore A, Fordyce CB, Gouda P, Hassan A, Krahn A, Luc JGY, Mak S, McMurtry S, Norris C, Philippon F, Sapp J, Sheldon R, Silversides C, Steinberg C, Wood DA. Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive. Can J Cardiol 2024; 40:500-523. [PMID: 37820870 DOI: 10.1016/j.cjca.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Cardiovascular conditions are among the most frequent causes of impairment to drive, because they might induce unpredictable mental state alterations via diverse mechanisms like myocardial ischemia, cardiac arrhythmias, and vascular dysfunction. Accordingly, health professionals are often asked to assess patients' fitness to drive (FTD). The Canadian Cardiovascular Society previously published FTD guidelines in 2003-2004; herein, we present updated FTD guidelines. Because there are no randomized trials on FTD, observational studies were used to estimate the risk of driving impairment in each situation, and recommendations made on the basis of Canadian Cardiovascular Society Risk of Harm formula. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and might transport a larger number of passengers. We provide guidance for individuals with: (1) active coronary artery disease; (2) various forms of valvular heart disease; (3) heart failure, heart transplant, and left ventricular assist device situations; (4) arrhythmia syndromes; (5) implantable devices; (6) syncope history; and (7) congenital heart disease. We suggest appropriate waiting times after cardiac interventions or acute illnesses before driving resumption. When short-term driving cessation is recommended, recommendations are on the basis of expert consensus rather than the Risk of Harm formula because risk elevation is expected to be transient. These recommendations, although not a substitute for clinical judgement or governmental regulations, provide specialists, primary care providers, and allied health professionals with a comprehensive list of a wide range of cardiac conditions, with guidance provided on the basis of the level of risk of impairment, along with recommendations about ability to drive and the suggested duration of restrictions.
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Affiliation(s)
- Peter G Guerra
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
| | | | - Harriette G C Van Spall
- McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada, and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Anita W Asgar
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Phyllis Billia
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Julia Cadrin-Tourigny
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Santabhanu Chakrabarti
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Christopher B Fordyce
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pishoy Gouda
- University of Alberta, Edmonton, Alberta, Canada
| | - Ansar Hassan
- Mitral Center of Excellence, Maine Medical Center, Portland, Maine, USA
| | - Andrew Krahn
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica G Y Luc
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susanna Mak
- University of Toronto, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Francois Philippon
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - John Sapp
- Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - David A Wood
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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3
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Cheung CC, Mori S, Gerstenfeld EP. Iatrogenic Atrioventricular Block. Cardiol Clin 2023; 41:419-428. [PMID: 37321692 DOI: 10.1016/j.ccl.2023.03.009] [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] [Indexed: 06/17/2023]
Abstract
Iatrogenic atrioventricular (AV) block can occur in the context of cardiac surgery, percutaneous transcatheter, or electrophysiologic procedures. In cardiac surgery, patients undergoing aortic and/or mitral valve surgery are at the highest risk for developing perioperative AV block requiring permanent pacemaker implantation. Similarly, patients undergoing transcatheter aortic valve replacement are also at increased risk for developing AV block. Electrophysiologic procedures, including catheter ablation of AV nodal re-entrant tachycardia, septal accessory pathways, para-Hisian atrial tachycardia, or premature ventricular complexes, are also associated with risk of AV conduction system injury. In this article, we summarize the common causes for iatrogenic AV block, predictors for AV block, and general management considerations.
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Affiliation(s)
- Christopher C Cheung
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Center of the Health Science, #46-131, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
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4
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Arps K, Barnett AS, Koontz JI, Pokorney SD, Jackson KP, Bahnson TD, Piccini JP, Sun AY. Use of Ripple mapping to enhance localization and ablation of outflow tract premature ventricular contractions. J Cardiovasc Electrophysiol 2023; 34:1552-1560. [PMID: 37293826 DOI: 10.1111/jce.15963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Accurate localization of septal outflow tract premature ventricular contractions (PVCs) is often difficult due to frequent mid-myocardial or protected origin. Compared with traditional activation mapping, CARTO Ripple mapping provides visualization of all captured electrogram data without assignment of a specific local activation time and thus may enhance PVC localization. METHODS Electroanatomic maps for consecutive catheter ablation procedures for septal outflow tract PVCs (July 2018-December 2020) were analyzed. For each PVC, we identified the earliest local activation point (EA), defined by the point of maximal -dV/dt in a simultaneously recorded unipolar electrogram, and the earliest Ripple signal (ERS), defined as the earliest point at which three grouped simultaneous Ripple bars appeared in late diastole. Immediate success was defined as full suppression of the clinical PVC. RESULTS Fifty-seven unique PVCs in 55 procedures were included. When ERS and EA were in the same chamber (RV, LV, or CS), the odds ratio for the successful procedure was 13.1 (95% confidence interval [CI] 2.2-79.9, p = .005). Discordance between sites was associated with a higher likelihood of needing multi-site ablation (odds ratio [OR] 7.9 [1.4-4.6; p = .020]). Median EA-ERS distance in successful versus unsuccessful cases was 4.6 mm (interquartile range 2.9-8.5) versus 12.5 mm (7.8-18.5); (p = .020). CONCLUSION Greater EA-ERS concordance was associated with higher odds of single-site PVC suppression and successful septal outflow tract PVC ablation. Visualization of complex signals via automated Ripple mapping may offer rapid localization information complementary to local activation mapping for PVCs of mid-myocardial origin.
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Affiliation(s)
- Kelly Arps
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adam S Barnett
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Prisma Health, Greenville, South Carolina, USA
| | - Jason I Koontz
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Durham VA Medical Center, Durham, North Carolina, USA
| | - Sean D Pokorney
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kevin P Jackson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Tristram D Bahnson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Albert Y Sun
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Durham VA Medical Center, Durham, North Carolina, USA
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Kaneko Y, Nakajima T, Tamura S, Nagashima K, Kobari T, Hasegawa H, Ishii H. Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V-A-A-V response. Pacing Clin Electrophysiol 2022; 45:839-852. [PMID: 35661184 DOI: 10.1111/pace.14540] [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: 01/13/2022] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The electrophysiological discrimination between fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (NRT) and atrial tachycardia (AT) originating from the interatrial septum remains challenging. While a V-A-A-V response may occur immediately after ventricular induction or entrainment of either tachycardia, the electrophysiological dissimilarities in that response between the two tachycardias remain unclear. The purpose of this study was to identify a diagnostic indicator discriminating F/S-AVNRT from AT by examining the difference in the V-A-A-V response between the two tachycardias. METHODS This retrospective study included 17 patients with F/S-AVNRT [7 with common-form F/S-AVNRT using a typical slow pathway (SP) and 10 with superior type F/S-AVNRT using a superior SP] and 10 patients with reentrant AT. All 27 patients presented with long RP supraventricular tachycardia and an initial V-A-A-V response upon ventricular induction or entrainment. The V-A-A-V response in patients with F/S-AVNRT was due to dual atrial responses. We measured the interval between the first (A1) and second atrial electrogram (A2) of V-A-A-V and calculated ΔAA by subtracting A1-A2 from the tachycardia cycle length. RESULTS V-A-A-V responses were observed most often upon ventricular induction of F/S-AVNRT (6±5 times) as well as AT (6±6 times; P = 0.87). The V-A-A-V response upon ventricular entrainment was observed in a single patient with F/S-AVNRT versus 10 all patients with AT (P<0.001). ΔAA ranged between -80 and 228 ms in F/S-AVNRT and between -184 and 26 ms in AT. A ΔAA >26 ms predicted a diagnosis of F/S-AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA ←80 ms predicted a diagnosis of AT with a 50% sensitivity and 100% specificity. CONCLUSIONS ΔAA is a useful, confirmatory, diagnostic indicator of F/S-AVNRT versus AT associated with the V-A-A-V response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yoshiaki Kaneko
- 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
| | - Koichi Nagashima
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Kobari
- 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
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Yamabe H, Soejima T, Kajiyama K, Fukami Y, Haraguchi K, Okonogi T, Hirai K, Fukuoka R, Umeji K, Orita Y, Koga H, Kawasaki T. Efficacy of Catheter Ablation From the Non-Coronary Aortic Cusp of Verapamil-Sensitive Atrial Tachycardia Arising Near the Atrioventricular Node. Heart Rhythm 2021; 19:719-727. [PMID: 34968740 DOI: 10.1016/j.hrthm.2021.12.021] [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: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efficacy of catheter ablation from the non-coronary aortic cusp (NCC) of verapamil-sensitive atrial tachycardia arising near the atrioventricular node (AVN-AT) has yet to be fully clarified. OBJECTIVE We elucidated the determinant of an effective AVN-AT ablation from the NCC. METHODS After identifying the earliest atrial activation site (EAAS) during tachycardia, the direction of the slow conduction zone (SCZ) of reentry circuit was identified by demonstrating manifest entrainment in 26 AVN-AT patients. Catheter ablation was initially performed from the NCC irrespective of the local activation time. If the NCC ablation was ineffective, catheter ablation was performed targeting the SCZ entrance. Then the anatomical relationship between the SCZ and successful ablation site was elucidated. RESULTS NCC catheter ablation terminated AVN-AT in 14 patients (NCC Group) but not in 12 (Non-NCC Group). Catheter ablation targeting the SCZ entrance terminated all Non-NCC Group ATs. The local activation time at the NCC relative to the EAAS did not differ between the NCC and Non-NCC Groups (10.1±6.5 vs. 11.2±4.8 msec, p=0.6333). The direction of the SCZ was posterior to the EAAS in all NCC Group patients, however, it was postero-lateral (n=5) and lateral to the EAAS (n=7) in the Non-NCC Group, suggesting that the SCZ existed in the direction of the NCC in NCC Group but was away from the NCC in Non-NCC Group. CONCLUSION A close proximity between the NCC and SCZ of the reentry circuit, but not the local activation time at the NCC, determined the efficacy of NCC catheter ablation in AVN-ATs.
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Affiliation(s)
- Hiroshige Yamabe
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan.
| | - Toshiya Soejima
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kimihiro Kajiyama
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Yurie Fukami
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kazuki Haraguchi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Taichi Okonogi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Keisuke Hirai
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Ryota Fukuoka
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kyoko Umeji
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Yoshiya Orita
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Hisashi Koga
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
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Abstract
Iatrogenic atrioventricular (AV) block can occur in the context of cardiac surgery, percutaneous transcatheter, or electrophysiologic procedures. In cardiac surgery, patients undergoing aortic and/or mitral valve surgery are at the highest risk for developing perioperative AV block requiring permanent pacemaker implantation. Similarly, patients undergoing transcatheter aortic valve replacement are also at increased risk for developing AV block. Electrophysiologic procedures, including catheter ablation of AV nodal re-entrant tachycardia, septal accessory pathways, para-Hisian atrial tachycardia, or premature ventricular complexes, are also associated with risk of AV conduction system injury. In this article, we summarize the common causes for iatrogenic AV block, predictors for AV block, and general management considerations.
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Affiliation(s)
- Christopher C Cheung
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, University of California Los Angeles, Center of the Health Science, #46-131, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California San Francisco, MU-East 4th Floor, 500 Parnassus Avenue, San Francisco, CA 94143, USA.
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Arai H, Mizukami A, Hiroki J, Yamashita S, Matsumura A, Sasano T. A case of re-entrant ventricular tachycardia arising from the vicinity of the his bundle that was successfully ablated from the non-coronary aortic sinus of valsalva. Europace 2021; 23:1436. [PMID: 33351898 DOI: 10.1093/europace/euaa375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/20/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hirofumi Arai
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - Jiro Hiroki
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - Shu Yamashita
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - Akihiko Matsumura
- Department of Cardiology, Kameda Medical Center, 929 Higashi-cho, Kamogawa City, Chiba, 296-8602, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8510, Japan
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Sakai S, Takitsume A, Kawata H. Adenosine-sensitive atrial tachycardia originating from the para-Hisian region with a slow conduction zone in the anteroseptal left atrium. J Cardiol Cases 2021; 24:52-55. [PMID: 34354777 DOI: 10.1016/j.jccase.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Adenosine-sensitive atrial tachycardias (ATs) originating from the para-Hisian region have been reported, and the responsible mechanism is considered to be reentry. As an alternative strategy to ablation at the earliest activation site (EAS) close to the atrioventricular node, previous reports safely eliminated these ATs at the entrance of the slow conduction zone, indicated by a manifest entrainment-guided strategy, but no report has successfully ablated those ATs using the same strategy in the left atrium. We describe a case of adenosine-sensitive AT originating from the para-Hisian region that could be eliminated at a remote site from the EAS indicated by the demonstration of manifest entrainment from the high anteroseptal left atrium. <Learning objective: Previous reports safely eliminated adenosine-sensitive atrial tachycardias (ATs) originating from the vicinity of the atrioventricular (AV) node at the entrance of the slow conduction zone (SCZ), indicated by a manifest entrainment-guided strategy. There may be cases with the SCZ in the left atrium (LA), but radiofrequency application on the anteroseptum of the LA near the AV annulus has a potential risk of causing an AV block. Therefore, that strategy in the LA can be a reasonable option.>.
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Affiliation(s)
- Satoshi Sakai
- Department of Cardiology, Nara Prefecture General Medical Center, 2-897-5, Shichijo-nishi-machi, Nara 630-8581, Japan
| | - Akihiro Takitsume
- Department of Cardiology, Nara Prefecture General Medical Center, 2-897-5, Shichijo-nishi-machi, Nara 630-8581, Japan
| | - Hiroyuki Kawata
- Department of Cardiology, Nara Prefecture General Medical Center, 2-897-5, Shichijo-nishi-machi, Nara 630-8581, Japan
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10
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Cheung CC, Kim E, Tseng ZH, Gerstenfeld EP, Anderson RH, Sanchez-Quintana D, Sternick EB, Hsia HH. Atrial Tachycardia Ablation at the Pulmonic Valve in a Patient With Congenitally Corrected Transposition of Great Arteries. JACC Clin Electrophysiol 2021; 7:1473-1481. [PMID: 34330669 DOI: 10.1016/j.jacep.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher C Cheung
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Eunjeong Kim
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | | | - Henry H Hsia
- Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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11
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Campbell T, Bennett RG, Kumar S. Intracardiac Echocardiography to Guide the Ablation of Parahisian Arrhythmias. Card Electrophysiol Clin 2021; 13:e1-e16. [PMID: 35365247 DOI: 10.1016/j.ccep.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Arrhythmias from the perinodal region have been described for accessory pathways (APs), atrial tachycardias (AT), premature ventricular complexes (PVCs), and ventricular tachycardia (VT). The parahisian (PH) region encompasses anatomic structures that include the atrioventricular (AV) node and His-Bundle (HB). These locations are at high-risk for inducing AV block during catheter ablation in the electrophysiology laboratory. PH arrhythmias were initially defined as having sites of origin within 10 mm of the largest HB potential (>0.1 mV) recording site, but more recent definitions have included any site that has an HB potential at the ablation site. Intracardiac echocardiography (ICE) use offers real-time visualization of the catheter tip-to-tissue contact and can monitor for acute complications during atrial and ventricular procedures. ICE also enables a broad appreciation of real-time cardiac structures, which is invaluable in navigating the complex anatomy of the PH region.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
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12
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Toniolo M. Para-Hisian Atrial Tachycardia and Atrioventricular Nodal Reentry Tachycardia: After 25 Years The Same History? Arq Bras Cardiol 2021; 116:127-128. [PMID: 33566976 PMCID: PMC8159513 DOI: 10.36660/abc.20201149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mauro Toniolo
- Divisão de Cardiologia, Hospital Universitário "S. Maria della Misericordia", Udine - Itália
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13
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Chokr M, Moura LGD, Sousa IBDS, Pisani CF, Hardy CA, Melo SLD, Ponte Filho ADD, Costa IP, Tavora RV, Sacilotto L, Wu TC, Darrieux FCDC, Hachul DT, Aiello V, Scanavacca M. Catheter Ablation of Focal Atrial Tachycardia with Early Activation Close to the His-Bundle from the Non Coronary Aortic Cusp. Arq Bras Cardiol 2021; 116:119-126. [PMID: 33566975 PMCID: PMC8159493 DOI: 10.36660/abc.20180449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022] Open
Abstract
Fundamento A ablação da taquicardia atrial (TA) com local de ativação mais precoce próxima ao feixe de His é um desafio, devido ao risco de bloqueio de AV completo por sua proximidade ao sistema de His-Purkinje (SHP). Uma alternativa para minimizar esse risco é posicionar o cateter na cúspide não coronária (CNC), que é anatomicamente contígua à região para-Hissiana. Objetivos O objetivo deste estudo foi fazer uma revisão de literatura e avaliar as características eletrofisiológicas, a segurança e o índice de sucesso de aplicação de radiofrequência (RF) por cateter na CNC para o tratamento de TA para-Hissiana em uma série de casos. Métodos Avaliamos retrospectivamente dez pacientes (Idade: 36±10 anos) que foram encaminhados para ablação de taquicardia paroxística supraventricular (TPSV) e haviam sido diagnosticados com TA focal para-Hissiana confirmada por manobras eletrofisiológicas clássicas. Para a análise estatística, um P valor d <0.05 foi considerado estatisticamente significativo. Resultados A ativação atrial mais precoce na posição His foi de 28±12ms da onda P, e a CNC foi 3±2ms antes da posição His, sem evidência de potencial His em todos os pacientes. Foi aplicada RF à CNC (cateter de ponta de 4-mm; 30W, 55°C) e a taquicardia foi interrompida em 5±3s sem aumento no intervalo PR ou evidência de um ritmo juncional. Os testes eletrofisiológicos não induziram novamente a taquicardia em 9/10 pacientes. Não houve complicações em nenhum procedimento. Durante o período de acompanhamento de 30 ± 12 meses, nenhum paciente apresentou recorrência de taquicardia. Conclusão O tratamento percutâneo de TA para-Hissiana por meio de CNC é uma estratégia segura e eficiente, tornando-se uma opção interessante para o tratamento de arritmia complexa. (Arq Bras Cardiol. 2021; 116(1):119-126)
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Affiliation(s)
- Muhieddine Chokr
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Lucas G de Moura
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Italo Bruno Dos Santos Sousa
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Cristiano Faria Pisani
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Carina Abigail Hardy
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Sissy Lara de Melo
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | | | | | | | - Luciana Sacilotto
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Tan Chen Wu
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | | | - Denise Tessariol Hachul
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Vera Aiello
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
| | - Mauricio Scanavacca
- Universidade de São Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brasil
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Markowitz SM, Thomas G, Liu CF, Cheung JW, Ip JE, Lerman BB. Atrial Tachycardias and Atypical Atrial Flutters: Mechanisms and Approaches to Ablation. Arrhythm Electrophysiol Rev 2019; 8:131-137. [PMID: 31114688 PMCID: PMC6528065 DOI: 10.15420/aer.2019.17.2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Atrial tachycardias (ATs) may be classified into three broad categories: focal ATs, macroreentry and localised reentry – also known as ‘microreentry’. Features that distinguish these AT mechanisms include electrogram characteristics, responses to entrainment and pharmacological sensitivities. Focal ATs may occur in structurally normal hearts but can also occur in patients with structural heart disease. These typically arise from preferential sites such as the valve annuli, crista terminalis and pulmonary veins. Macro-reentrant ATs occur in the setting of atrial fibrosis, often after prior catheter ablation or post atriotomy, but also de novo in patients with atrial myopathy. High-resolution mapping techniques have defined details of macro-reentrant circuits, including zones of conduction block, scar and slow conduction. Localised reentry occurs in the setting of diseased atrial myocardium that supports very slow conduction. A characteristic feature of localised reentry is highly fractionated, low-amplitude electrograms that encompass most of the tachycardia cycle length over a small diameter. Advances in understanding the mechanisms of ATs and their signature electrogram characteristics have improved the efficacy and efficiency of catheter ablation.
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Affiliation(s)
- Steven M Markowitz
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center New York, US
| | - George Thomas
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center New York, US
| | - Christopher F Liu
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center New York, US
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center New York, US
| | - James E Ip
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center New York, US
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Weill Cornell Medical Center New York, US
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Franco E, Rodríguez Muñoz D, Matía Francés R, Hernández-Madrid A, Sánchez Pérez I, Moreno J. Ablación con catéter de taquicardia auricular perihisiana desde el seno de Valsalva no coronario tras reemplazo de válvula aórtica. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Focal atrial tachycardia ablation: Highly successful with conventional mapping. J Interv Card Electrophysiol 2018; 55:35-46. [PMID: 30506176 DOI: 10.1007/s10840-018-0493-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND/OBJECTIVE Radiofrequency catheter ablation (RFCA) of focal atrial tachycardia (FAT) traditionally is guided by conventional endocardial mapping of earliest atrial activation; however, more recently electro-anatomical mapping is heralded as a more effective, albeit more expensive, tool to guide ablation. Herein we present the results of conventional mapping-guided RFCA. Apropos, we conducted a literature search of studies reporting > 10 FAT patients submitted to RFCA. METHODS AND RESULTS Conventional mapping-guided RFCA, performed in 63 FAT patients (aged 42.4 + 17.3 years; 14 with incessant tachycardia and 12 with tachycardiomyopathy (TCM)), was successful in 61 (96.8%) patients, applied for single foci in 59 (93.7%) and two foci in 4 patients, right (n = 46) or left sided (n = 17). The earliest atrial activation time at the ablation site was 41.3 ± 16.2 ms. Fluoroscopy time averaged 27.3 + 18.7 min, and procedure lasted 2.6 + 1.7 h. Complications occurred in two patients (sinus pauses in one needing a pacemaker and a large inguinal hematoma in one). Over 29.0 + 22.9 months, four patients (6.5%) had recurrences, of whom three were successfully re-ablated. All patients with TCM showed gradual improvement to normalization over 4-6 months. Literature search showed that RFCA success is equally high when guided with either conventional (88.5%) or electro-anatomical mapping (90%) with similar recurrences (9.6% vs. 9.5%). CONCLUSION Conventional mapping-guided RFCA of FAT had high success (96.8%) with low complication (3.2%) and recurrence rates (6.5%). TCM was fully reversible. These results are comparable to those achieved with the more expensive electro-anatomical mapping, which may be reserved for more complex cases or for those failing the conventional approach.
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17
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A case of successful radiofrequency catheter ablation of ventricular tachycardia from the noncoronary cusp. J Electrocardiol 2018; 52:66-69. [PMID: 30476642 DOI: 10.1016/j.jelectrocard.2018.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 11/22/2022]
Abstract
Idiopathic ventricular tachycardias (VTs) originating from the non-coronary cusp (NCC) are very rare. The previous reports suggested NCC-VTs were characterized by a narrower QRS duration and smaller III/II ratio than VTs originating from other coronary-cusps. We present a rare case of an NCC-VT with a local fragmented potential recorded at the NCC inconsistent with the known ECG characteristics of NCC-VTs.
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Franco E, Rodríguez Muñoz D, Matía Francés R, Hernández-Madrid A, Sánchez Pérez I, Moreno J. Catheter Ablation of Peri-Hisian Atrial Tachycardia From the Noncoronary Sinus of Valsalva After Aortic Valve Replacement. ACTA ACUST UNITED AC 2018; 72:355-357. [PMID: 30042048 DOI: 10.1016/j.rec.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/02/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Eduardo Franco
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | | | | | | | - Javier Moreno
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Namdar M, Shah DC. Function follows form: When electrophysiology derives from anatomy. Heart Rhythm 2017. [DOI: 10.1016/j.hrthm.2017.06.024] [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: 10/19/2022]
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Catheter ablation of para-Hisian atrial tachycardias: Is "earliest" still synonymous with "best"? Heart Rhythm 2017; 14:1006-1007. [PMID: 28347834 DOI: 10.1016/j.hrthm.2017.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/23/2022]
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