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Characteristics and Ablation Outcomes of Atrial Tachycardia in Patients with Prior Cardiac Surgery vs. Spontaneous Scars: Where Are the Differences? J Clin Med 2022; 11:jcm11185407. [PMID: 36143054 PMCID: PMC9505833 DOI: 10.3390/jcm11185407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Atrial scars play an important role in atrial tachycardia (AT). They can not only be found in patients with prior cardiac surgery (PCS) but also in patients without PCS or significant structural heart disease, in which case the scar is called a spontaneous scar (SS). This study aims to compare the characteristics, mechanisms and ablation outcomes of AT in patients with PCS and SS. (2) Methods: We retrospectively reviewed electrophysiological and ablative characteristics of ATs in 46 patients with PCS and 18 patients with SS. (3) Results: There were averages of 1.52 and 2.33 ATs per patient in the PCS group and SS group, respectively (p < 0.01). Cavo-tricuspid isthmus dependent atrial flutter (CTI-AFL) was presented in most patients in both groups (93.50% vs. 77.80%, p = 0.17), whereas the SS group had a higher occurrence of scar-mediated reentrant AT (SMAT) and focal AT (FAT) compared with the PCS group (88.90% vs. 39.10%, p < 0.01; 22.2% vs. 2.2%, p < 0.05). There were no significant differences in acute success rate between the two groups, whereas patients with SS had lower long-term success rate (87.0% vs. 61.1%, p < 0.05) and higher occurrence of sinus node dysfunction (SND) (4.3% vs. 22.2%, p < 0.05). (4) Conclusions: CTI-AFL is common in both patients with PCS and SS, and routine CTI ablation is recommended. Compared with patients with PCS, patients with SS have more ATs, especially with higher occurrence of SMAT and FAT, and had a lower long-term success rate and higher incidence of SND.
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2
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Marazzato J, Marazzi R, Doni LA, Blasi F, Angeli F, Bagliani G, Leonelli FM, De Ponti R. Pathophysiology of Atypical Atrial Flutters. Card Electrophysiol Clin 2022; 14:411-420. [PMID: 36153123 DOI: 10.1016/j.ccep.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atypical atrial flutters are complex supraventricular arrhythmias that share different pathophysiological aspects in common. In most cases, the arrhythmogenic substrate is essentially embodied by slow-conducting areas eliciting re-entrant circuits. Although atrial scarring seems to promote slow conduction, these arrhythmias may occur even in the absence of structural heart disease. To set out the ablation strategy in this setting, three-dimensional mapping systems have proved invaluable over the last decades, helping the cardiac electrophysiologist understand the electrophysiological complexity of these circuits and easily identify critical areas amenable to effective catheter ablation.
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Affiliation(s)
- Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
| | - Lorenzo Adriano Doni
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
| | - Federico Blasi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncaccio, 16, Tradate, Varese 21049, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
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3
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Franco E, Lozano Granero C, Matía R, Hernández-Madrid A, Sánchez I, Zamorano JL, Moreno J. High-density mapping with fragmentation analysis in patients with reentrant atrial tachycardias (MAP-FLURHY study). J Interv Card Electrophysiol 2021; 63:513-522. [PMID: 34132924 DOI: 10.1007/s10840-021-01012-z] [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: 10/18/2020] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Reentrant atrial tachycardias (ATs) use areas of slow conduction that can be visualized as fragmented electrograms. We aimed to test an ablation strategy based on the identification and ablation of spots with fragmented electrograms in reentrant ATs, using Rhythmia navigation system. METHODS All consecutive patients from June 2016 to June 2019 were included. The IntellaMap ORION Catheter was used to detect sites with fragmentation, arbitrarily defined as fragmented electrograms > 70 ms. Entrainment was used to check if these areas belonged to the AT circuit. Ablation targeted the longest fragmented electrogram within the circuit: focal ablation for microreentries and lines for macroreentries. Ablation success was defined from each AT as conversion to sinus rhythm or another AT. RESULTS Twenty-seven consecutive patients with 44 mappable ATs were included. All ATs showed sites with fragmented electrograms (104 sites; 2.4 sites per AT); 43/44 ATs had fragmented electrograms within the circuit, which were the target of ablation. Ablation success: 34/36 ATs (94%); success could not be assessed in 8 circuits, in 6 due to mechanical conversion to sinus rhythm at the target fragmented site. Fragmented electrograms within the AT circuits were longer than electrograms outside the circuits (110 ± 30 vs 90 ± 15 ms, p < 0.001). A fragmentation duration > 100 ms/ > 40% of the AT cycle length predicted to be a successful site for ablation with 72.3%/73.8% specificity, respectively. Sixty-two percent of the patients were free from atrial arrhythmias at 1 year. CONCLUSIONS Most ATs had detectable fragmented electrograms within the circuit, which could be the target of ablation with high efficacy.
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Affiliation(s)
- Eduardo Franco
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain.
| | | | - Roberto Matía
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | | | - Inmaculada Sánchez
- Pediatric Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - José Luis Zamorano
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - Javier Moreno
- Arrhythmia Unit, Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
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4
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Okada M, Tanaka K, Tanaka N, Hirao Y, Yoshimoto I, Inoue K. Single-loop incisional atrial tachycardia encircling the entire right atrium: Where is the critical isthmus? HeartRhythm Case Rep 2020; 7:162-166. [PMID: 33786312 PMCID: PMC7987931 DOI: 10.1016/j.hrcr.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Masato Okada
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Yuko Hirao
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Issei Yoshimoto
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
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5
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Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, DE Ponti R. Ablation of atrial tachycardia in the setting of prior mitral valve surgery. Minerva Cardiol Angiol 2020; 69:94-101. [PMID: 33146481 DOI: 10.23736/s2724-5683.20.05405-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients. METHODS Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. re-entrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed. RESULTS Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; P<0.0001). CONCLUSIONS Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macro-reentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.
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Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Roberto DE Ponti
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy -
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6
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Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, De Ponti R. Catheter ablation of atrial tachycardias after mitral valve surgery: A systematic review and meta‐analysis. J Cardiovasc Electrophysiol 2020; 31:2632-2641. [DOI: 10.1111/jce.14666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | | | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
- Department of Medicine and Cardiopulmonary Rehabilitation Maugeri Care and Research Institutes, IRCCS Tradate Varese Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
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7
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Alken FA, Chen S, Masjedi M, Pürerfellner H, Maury P, Martin CA, Sacher F, Jais P, Meyer C. Basket catheter-guided ultra-high-density mapping of cardiac arrhythmias: a systematic review and meta-analysis. Future Cardiol 2020; 16:735-751. [PMID: 32608246 DOI: 10.2217/fca-2020-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Ultra-high-density mapping (HDM) is increasingly used for guidance of catheter ablation in cardiac arrhythmias. While initial results are promising, a systematic evaluation of long-term outcome has not been performed so far. Methods: A systematic review and meta-analysis was conducted on studies investigating long-term outcome after Rhythmia HDM-guided atrial fibrillation (AF) or atrial tachycardia catheter ablation. Results: Beyond multiple studies providing novel insights into arrhythmia mechanisms, follow-up data from 17 studies analyzing Rhythmia HDM-guided ablation (1768 patients, 49% with previous ablation) were investigated. Cumulative acute success was 100/90.2%, while 12 months long-term pooled success displayed at 71.6/71.2% (AF/atrial tachycardia). Prospective data are limited, showing similar outcome between HDM-guided and conventional AF ablation. Conclusion: Acute results of HDM-guided catheter ablation are promising, while long-term success is challenged by complex arrhythmogenic substrates. Prospective randomized trials investigating different HDM-guided ablation strategies are warranted and underway.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Mustafa Masjedi
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Helmut Pürerfellner
- Department of Electrophysiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France
| | - Claire A Martin
- Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, UK
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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8
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Nair GM, Nery PB. Complex Atrial Tachycardias. JACC Clin Electrophysiol 2020; 6:827-829. [DOI: 10.1016/j.jacep.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
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9
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Potapova KV, Nosov VP, Koroleva LY, Amineva NV. [Atrial Flutter: up-to-date Problem Evaluation with Clinical Positions]. ACTA ACUST UNITED AC 2020; 60:70-80. [PMID: 32245357 DOI: 10.18087/cardio.2020.1.n693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
Abstract
The review provides current ideas about the etiology and prevalence of atrial flutter (AF), mechanism and substrate of arrhythmogenesis, and principles of clinical and electrophysiological classification of this arrhythmia. Methods for conservative and surgical treatments of AF, including their comparative aspect, are described in detail. The review presented recent data on efficacy and potential risks of different approaches to reversing the arrhythmia. The authors indicated a need for early diagnosis and strict control of the sinus rhythm in AF, which would help a successful intervention not only to completely cure the existing arrhythmia but also to prevent other heart rhythm disorders, primarily atrial fibrillation.
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Affiliation(s)
| | - V P Nosov
- Privolzhsky Research Medical University
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10
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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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11
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Zhou GB, Ma J, Zhang JL, Guo XG, Yang JD, Liu SW, Ouyang FF. Catheter ablation of supraventricular tachycardia in patients with dextrocardia and situs inversus. J Cardiovasc Electrophysiol 2019; 30:557-564. [PMID: 30661266 DOI: 10.1111/jce.13847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Dextrocardia with situs inversus is a rare cardiac positional anomaly. Catheter ablation procedures performed in this set of patients have not been sufficiently reported. METHODS A total of 10 patients with dextrocardia and situs inversus who received catheter ablation for supraventricular tachycardia (SVT) were included from a cohort of over 20 000 cases of catheter ablation for SVT in three centers from 2005 to 2016. All patients underwent electrophysiologic study and catheter ablation of SVT. Ablation targets were selected based on different tachycardia mechanisms with the primary endpoint of noninduction of tachycardia. RESULTS The average age was 32.4 ± 5.6 years. Congenitally corrected transposition of great arteries (TGA) with situs inversus and D-looping of the ventricles and aorta (congenitally corrected TGA {I,D,D}) was found in four patients, while the other six patients exhibited mirror-image dextrocardia {I,L,L}. The mechanisms of SVT were atrioventricular nodal reentrant tachycardia in four patients, atrioventricular reentrant tachycardia in three, typical atrial flutter in one, intra-atrial reentrant tachycardia in one, and focal atrial tachycardia in one. Immediate procedural success was achieved in 9 out of 10 patients with no procedural complications. During a follow-up period of 6.3 ± 3.5 years on average, all patients remained free from recurrent tachycardia. CONCLUSIONS For patients with dextrocardia and situs inversus, catheter ablation of SVT is safe and feasible. Differences in catheter maneuver and fluroscopy projection, along with difficulties in distorted anatomy are major obstacles for successful ablation.
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Affiliation(s)
- Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China
| | - Jian Ma
- Arrthythmia Center State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Lin Zhang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan, Hubei, China
| | - Xiao-Gang Guo
- Arrthythmia Center State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Du Yang
- Arrthythmia Center State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Wang Liu
- Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China
| | - Fei-Fan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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12
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Liu XY, Jacobsen PK, Pehrson S, Chen X. Catheter ablation of incisional atrial tachycardia using remote magnetic navigation in patients after heart surgery: comparison between acquired and congenital heart disease. Europace 2018; 20:ii33-ii39. [DOI: 10.1093/europace/euy005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/09/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xiao-yu Liu
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, No 299, Qingyang Road, 214023 Wuxi, China
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Steen Pehrson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Xu Chen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
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13
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Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Luo B, Wei HQ, Santangeli P, Liang JJ, Ma J. Right atrial dual-loop reentrant tachycardia after cardiac surgery: Prevalence, electrophysiological characteristics, and ablation outcomes. Heart Rhythm 2018; 15:1148-1157. [PMID: 29625278 DOI: 10.1016/j.hrthm.2018.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Right atrial (RA) dual-loop reentrant tachycardia has been described in patients who have undergone open heart surgery. However, the prevalence, electrophysiological (EP) substrate, and ablation outcomes have been poorly characterized. OBJECTIVE The purpose of this study was to investigate the prevalence, EP substrate, and ablation outcomes for RA dual-loop reentrant tachycardia after cardiac surgery. METHODS We identified all patients with atrial tachycardia (AT) after cardiac surgery. We compared EP findings and outcomes of those with RA dual-loop reentrant tachycardia to a control group of patients with RA macroreentrant arrhythmias in the setting of linear RA free-wall (FW) scar. RESULTS Of the 127 patients with 152 postsurgical ATs, 28 of the ATs (18.4%) had RA dual-loop reentry and 24 of 28 (85.7%) had tricuspid annular reentry combined with FW incisional reentry. An incision length >51.5 mm along the FW predicted the substrate for a second loop. In 22 of 23 patients (95.7%) with initial ablation in the cavotricuspid isthmus, a change in the interval between Halod to CSp could be recorded, and 15 of 23 patients (65.2%) had coronary sinus activation pattern change. Complete success was achieved in 25 of 28 patients (89.3%) in the dual-loop reentry group and in 64 of 69 patients (92.8%) in the control group. After mean follow-up of 33.9 ± 24.2 months, 24 of 28 patients (85.7%) and 60 of 69 patients (86.95%) were free of arrhythmias after the initial procedure in the 2 groups, respectively. CONCLUSION The prevalence of RA dual-loop reentry is 18.4% of ATs with prior atriotomy scar. A long incision should alert physicians to the possibility of a second loop at the FW. Halo and coronary sinus activation patterns provide important clues to circuit transformation.
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Affiliation(s)
- Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xu Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Tatarskiy R, Garkina S, Lebedev D. Catheter Ablation of Incisional Atrial Tachycardia. J Atr Fibrillation 2017; 9:1476. [PMID: 28496935 DOI: 10.4022/jafib.1476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/19/2016] [Accepted: 10/14/2016] [Indexed: 11/10/2022]
Abstract
Tachycardias after atrial incisions represent frequent and serious problem. The majority of them are based on a re-entry electrical activation around a combination of anatomic and surgically created obstacles. Considering significant progress of cardiovascular surgery during the last decade along with potential large amount of open-heart procedures in the near future the number of incisional tachycardias has a tendency to increase. The aim of this work was to quantify the magnitude of the problem, characterize the tachycardias after different surgical operations and to analyze possible interventional treatment strategies. Nowadays evolution of mapping and ablation technologies may contribute to radically treatment of this type of arrhythmias while there are still a lot of issues that should be solved to improve the results of interventional treatment of incisional tachycardias.
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Affiliation(s)
- Roman Tatarskiy
- Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia
| | - Svetlana Garkina
- Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia
| | - Dmitriy Lebedev
- Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia
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Yazaki K, Ajiro Y, Mori F, Watanabe M, Tsukamoto K, Saito T, Mizobuchi K, Iwade K. Multiple focal and macroreentrant left atrial tachycardias originating from a spontaneous scar at the contiguous aorta-left atrium area in a patient with hypertrophic cardiomyopathy: a case report. BMC Cardiovasc Disord 2017; 17:29. [PMID: 28095774 PMCID: PMC5240401 DOI: 10.1186/s12872-016-0448-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 12/16/2016] [Indexed: 02/04/2023] Open
Abstract
Background Spontaneous scar-related left atrial tachycardia (AT) is a rare arrhythmia. We describe a patient with hypertrophic cardiomyopathy (HCM) who developed multiple, both focal and macroreentrant left ATs associated with a spontaneous scar located at the aorta-left atrium (LA) contiguous area. Case presentation A 65-year-old man with HCM complained of palpitations. Twelve-lead electrocardiogram showed narrow QRS tachycardia with 2:1 atrioventricular conduction. Two sessions of radiofrequency ablation (RFA) were required to eliminate all left ATs. In the first session, 3-dimensional electroanatomical mapping fused with the image constructed by multi-detector computed tomography showed a clockwise macroreentrant AT (AT1) associated with a low-voltage or dense scar area located along the aorta-LA contiguous area. AT1 was eliminated by RFA to the narrow isthmus with slow conduction velocity within the scar. Additional ATs (AT2-AT4) occurred 1 month after the first ablation. In the second session, AT2 and AT3 were identified as focal ATs with centrifugal propagation and few accompanying fragmentations, and AT4 as a macroreentrant AT with features similar to AT1. AT2 and AT3 were successfully eliminated by performing RFA to the earliest activation site, and AT4 was terminated by performing RFA to the narrow isthmus with slow conduction velocity. No ATs have recurred for 11 months after these RFAs. Interestingly, the substrate for all left ATs was associated with the aorta-LA contiguous area. Conclusion To our knowledge, this is the first case of multiple, both focal and macroreentrant left ATs associated with a contiguous aorta-LA spontaneous scar area in a patient with HCM. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0448-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan.
| | - Yoichi Ajiro
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan
| | - Fumiaki Mori
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan
| | - Masahiro Watanabe
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan
| | - Kei Tsukamoto
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan
| | - Takashi Saito
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan
| | - Keiko Mizobuchi
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan
| | - Kazunori Iwade
- Department of Cardiology, National Hospital Organization Yokohama Medical Center, 3-60-2 Harajuku, Totsuka-ku, Yokohama-shi, Kanagawa, 245-8575, Japan
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