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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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Liao Z, Dai S, Nie Z, Song X, Huang X, Wang J, Yang F, Liu X, Du Z, Wei H, Liu F, Zhan X, Xue Y, Yang P, Ma J, Ouyang F, Ge J, Wu S. Reappraisal and New Observations on Idiopathic Ventricular Arrhythmias Ablated From the Noncoronary Aortic Sinus. JACC Clin Electrophysiol 2023; 9:1279-1291. [PMID: 36951815 DOI: 10.1016/j.jacep.2023.01.028] [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: 10/26/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The electrophysiological characteristics of idiopathic ventricular arrhythmias (VAs) from the noncoronary sinus (NCS) have not been fully described. OBJECTIVES This study sought to investigate electrophysiological characteristics and catheter ablation in patients with idiopathic NCS-VA. METHODS This study comprised 11 patients undergoing radiofrequency (RF) catheter ablation for idiopathic NCS-VA. Angiography was performed to confirm the origin in the aortic sinus before RF ablation. RESULTS Clinical arrhythmias presented left bundle block/inferior axis morphology in all patients. QRS morphology of R' and R/s' pattern was dominantly found in lead III. Mapping in the right ventricle demonstrated the earliest ventricular activation (EVA) site at the His Bundle region, whereas mapping in the NCS demonstrated that the EVA preceded the activation at the His Bundle region by 12.1 ± 7.9 milliseconds. All VAs were successfully ablated in <2.5 seconds within the NCS with 1 RF application. The successful ablation site was at the nadir of NCS in 10 patients, and near the junction of NCS and the right coronary sinus in the remaining one. A discrete potential can be observed at the EVA site within the NCS in 10 patients (91%); however, an excellent pace mapping at the EVA site was obtained in only 2 patients. Junctional beats did not occur during RF application in all 11 patients. There were no complications or clinical recurrence during a mean follow-up of 26.0 ± 9.8 months. CONCLUSIONS NCS-VA presents a peculiar electrocardiogram. A discrete potential can be mapped within the NCS during VA and sinus rhythm, and can be used in guiding ablation.
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Affiliation(s)
- Zili Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Shimo Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Zhenning Nie
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Xudong Song
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xingfu Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jing Wang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Fei Yang
- Department of Cardiology, the Third People's Hospital, Huizhou, People's Republic of China
| | - Xu Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhongpeng Du
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huiqiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Fangzhou Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Xianzhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
| | - Pingzhen Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Feifan Ouyang
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany/Hongkong Asian Medical Group, Hong Kong, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
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Raina A, Tan NY, Fatunde OA, Asirvatham SJ, DeSimone CV. Case report: A case of perinodal atrial tachycardia and review of the relevant clinical anatomy surrounding the retroaortic node. Front Cardiovasc Med 2023; 10:1143409. [PMID: 37273874 PMCID: PMC10235778 DOI: 10.3389/fcvm.2023.1143409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
A 70-year-old female presented with incessant supraventricular tachycardia that was refractory to metoprolol and sotalol. ECG revealed a narrow complex tachycardia with a rate of 163 beats per minute with a short RP relationship. She had salvos of atrial tachycardia which led to a severe reduction in ejection fraction as noted on echocardiography and hemodynamic instability. An electrophysiological study was performed, and findings suggested this to be an atrial tachycardia with earliest activation in the perinodal area. Radiofrequency ablation was carried out along the septum and associated structures to surround this region including the right atrium, non-coronary sinus of Valsalva, and the left atrium (anterior wall outside of the right superior pulmonary vein) to isolate this area and surround the focus with ablation lesions. The patient has done well post-procedure and continues to do well without any recurrence on low-dose flecainide at 8 months.
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Affiliation(s)
- Anvi Raina
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Nicholas Y. Tan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Olubadewa A. Fatunde
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Phoenix, AZ, United States
| | - Samuel J. Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Christopher V. DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
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Wang S, Yang G, Ju W, Sun X, Chen H, Chen M. Catheter ablation of atrial tachycardia originated from the left atrial epicardium. Pacing Clin Electrophysiol 2022; 45:1303-1305. [PMID: 35713398 DOI: 10.1111/pace.14553] [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: 04/05/2022] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
A patient was referred with frequent atrial tachycardia attacks. Activation mapping showed that the LA roof was earlier activated with a broad region, and right atrial activation was delayed. The far-field A wave corresponding to the pulmonary artery area was advanced with failed ablation. Therefore, the atrial tachycardia could be left atrial epicardial origin, which was further confirmed by the successful ablation at earliest activated site at the epicardium. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shixin Wang
- Cardiology Division, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Gang Yang
- Cardiology Division, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Weizhu Ju
- Cardiology Division, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xingxing Sun
- Cardiology Division, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongwu Chen
- Cardiology Division, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Minglong Chen
- Cardiology Division, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Atrial tachycardia eliminated at the ventricular side in patients with congenitally corrected transposition of the great arteries: Electrophysiological findings and anatomical concerns. Heart Rhythm 2020; 17:1337-1345. [DOI: 10.1016/j.hrthm.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/06/2020] [Indexed: 01/26/2023]
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6
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Ho RT, Logue JP. Supraventricular tachycardia with VA Linking: What is the mechanism? J Cardiovasc Electrophysiol 2019; 30:1172-1175. [PMID: 30884020 DOI: 10.1111/jce.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Reginald T Ho
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jonathan P Logue
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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7
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Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Luo B, Wei HQ, Liang JJ, Zhang S, Ma J. Focal atrial tachycardias from the parahisian region: Strategies for mapping and catheter ablation. Heart Rhythm 2017; 14:1344-1350. [PMID: 28476679 DOI: 10.1016/j.hrthm.2017.04.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Focal atrial tachycardias (ATs) from the parahisian region can be successfully ablated from the right atrial septum (RAS), noncoronary cusp (NCC), and right middle septum (RMS). The optimal mapping and ablation strategy for ATs from these sites remains unclear. OBJECTIVE The purpose of this study was to investigate the electrophysiologic characteristics and optimal ablation sites of parahisian ATs from the RAS, RMS, and NCC. METHODS A total of 362 patients with ATs undergoing radiofrequency catheter ablation of ATs were included. A detailed examination including ECG analysis and electrophysiologic study was performed. RESULTS Overall, 91 patients had a parahisian site of AT origin, and ablation was successful in 86 (94.5%). ATs were successfully eliminated from the RAS in 23, RMS in 19, and NCC in 44. The earliest "A" potential was recorded at the distal His catheter in 69.4% of NCC ATs vs the proximal His catheter in 83.3% of RAS ATs and 86.7% of RMS ATs. Mean timing of the "A" potential of RMS ATs recorded at the His-bundle catheter was -18.25 ± 7.20 ms, which was later than ATs from the RAS (-24.59 ± 8.73 ms) or NCC (-27.08 ± 5.63 ms). For ATs originating from the RAS and RMS, an A/V ratio <1.22 predicted safe and successful ablation (sensitivity 88.4%, specificity 91.7%). CONCLUSION For parahisian ATs, activation sequence and timing of the "A" on the His catheter can provide clues for the origin of ATs. When ablating at the RAS and RMS, an A/V ratio >1.22 identified safe and effective ablation sites.
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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
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shu Zhang
- 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
| | - 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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8
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Macroreentrant form of an adenosine 5'-triphosphate-sensitive atrial tachycardia arising from the vicinity of the atrioventricular node involving the tricuspid and mitral annuli as its reentrant circuit. HeartRhythm Case Rep 2017. [PMID: 28649499 PMCID: PMC5469278 DOI: 10.1016/j.hrcr.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Comparison of strategies for catheter ablation of focal atrial tachycardia originating near the His bundle region. Heart Rhythm 2017; 14:998-1005. [PMID: 28259696 DOI: 10.1016/j.hrthm.2017.02.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent studies have suggested that para-Hisian atrial tachycardia (AT) can be successfully ablated from the right atrium (RA), left atrium (LA), or noncoronary cusp (NCC) in the aorta; however, the best approach remains unclear. OBJECTIVE This study aimed to compare different approaches to radiofrequency catheter ablation (RFCA) of para-Hisian AT. METHODS We retrospectively analyzed 68 consecutive patients (49[72%] women; mean age 61 ± 13 years) treated with RFCA for this type of AT. Mapping of the RA (n = 68), LA (n = 21), and NCC (n = 52) was performed during AT to identify the earliest activation site and to apply RFCA. RESULTS RFCA successfully terminated AT in the RA in 13 of 28 patients (46.4%), in the LA in 4 of 16 patients (25.0%), and in the NCC in 46 of 52 patients (88.5%) after 1 procedure (P < .05). Atrioventricular block occurred only during RFCA in the RA in 4 of 28 patients (14.3%). After a mean follow-up of 33.5 ± 25.4 months, AT recurrence was observed in 5 of 13 patients (38.5%) ablated in the RA, 1 of 4 (25.0%) ablated in the LA, and 2 of 46 (4.4%) ablated in the NCC (P < .05). RFCA in the LA was effective only if the local activation time (LAT) was earlier than that in the RA. RFCA in the NCC was successful regardless of the LAT (P < .05). CONCLUSION Mapping and ablation in the NCC should be always considered in cases of AT originating from the His bundle region, regardless of the LAT.
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Toniolo M, Rebellato L, Poli S, Daleffe E, Proclemer A. Efficacy and Safety of Catheter Ablation of Atrial Tachycardia Through a Direct Approach from Noncoronary Sinus of Valsalva. Am J Cardiol 2016; 118:1847-1854. [PMID: 27842698 DOI: 10.1016/j.amjcard.2016.08.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 10/20/2022]
Abstract
Noncoronary aortic cusp (NCAC) in the aorta represents a challenging location for catheter ablation of focal atrial tachycardias (ATs) arising near the His-bundle region. The purpose of this study was to provide an updated report on the methods, efficacy, and safety of catheter ablation of ATs originating from NCAC. The study population includes 23 patients (18 women [78%], mean age 65 ± 12 years) with highly symptomatic AT. The atrial mapping was performed during tachycardia to define the earliest atrial activation site. Electrophysiological mapping of the right atrium was initially performed, followed by aortic root mapping when earliest activation was recorded in the proximal electrode of the His-bundle catheter. A direct ablation approach from NCAC was used in every patient independently by the local activation time. Ablations were performed using a steerable 4-mm tip nonirrigated catheter in all patients. Radiofrequency energy resulted in the disappearance of arrhythmias in 22 of the 23 patients (95%). In all procedures, there were no complications. During a mean follow-up of 41 ± 25 months, no patient presented with a recurrence, except the 1 patient where the ablation was not effective. In conclusion, catheter ablation of para-hisian ATs through a direct approach from NCAC shows to be safe and effective after 1 procedure per patient.
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11
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Bohora S, Lokhandwala Y, Sternick EB, Anderson RH, Wellens HJJ. Reappraisal and new observations on atrial tachycardia ablated from the non-coronary aortic sinus of Valsalva. Europace 2016; 20:124-133. [DOI: 10.1093/europace/euw324] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/21/2016] [Indexed: 11/14/2022] Open
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BARKAGAN MICHAEL, MICHOWITZ YOAV, GLICK AHARON, TOVIA-BRODIE OHOLI, ROSSO RAPHAEL, BELHASSEN BERNARD. Atrial Tachycardia Originating in the Vicinity of the Noncoronary Sinus of Valsalva: Report of a Series Including the First Case of Ablation-Related Complete Atrioventricular Block. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1165-1173. [DOI: 10.1111/pace.12941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/09/2016] [Accepted: 08/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- MICHAEL BARKAGAN
- Department of Cardiology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- the Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - YOAV MICHOWITZ
- Department of Cardiology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- the Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - AHARON GLICK
- Department of Cardiology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- the Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - OHOLI TOVIA-BRODIE
- Department of Cardiology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- the Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - RAPHAEL ROSSO
- Department of Cardiology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- the Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - BERNARD BELHASSEN
- Department of Cardiology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- the Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
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13
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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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Markowitz SM. What Is the Optimal Approach to Ablation of Para-Hisian Atrial Tachycardias? JACC Clin Electrophysiol 2016; 2:200-202. [DOI: 10.1016/j.jacep.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
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Pap R, Makai A, Szilágyi J, Klausz G, Bencsik G, Forster T, Sághy L. Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node?: Support From Intracardiac Echocardiography. JACC Clin Electrophysiol 2015; 2:193-199. [PMID: 29766869 DOI: 10.1016/j.jacep.2015.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. BACKGROUND Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. METHODS We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. RESULTS Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. CONCLUSIONS Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.
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Affiliation(s)
- Robert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
| | - Attila Makai
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Judit Szilágyi
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gergely Klausz
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gábor Bencsik
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
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MADAFFARI ANTONIO, GROßE ANETT, BRUNELLI MICHELE, FROMMHOLD MARKUS, DÄHNE TANJA, ORETO GIUSEPPE, RAFFA SANTI, GELLER JCHRISTOPH. Electrocardiographic and Electrophysiological Characteristics of Atrial Tachycardia With Early Activation Close to the His-Bundle. J Cardiovasc Electrophysiol 2015; 27:175-82. [DOI: 10.1111/jce.12847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/18/2015] [Accepted: 09/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- ANTONIO MADAFFARI
- Division of Cardiology, Department of Arrhythmia and Electrophysiology; Zentralklinik Bad Berka; Bad Berka Germany
- Department of Clinical and Experimental Medicine; University Hospitals; Messina Italy
| | - ANETT GROßE
- Division of Cardiology, Department of Arrhythmia and Electrophysiology; Zentralklinik Bad Berka; Bad Berka Germany
| | - MICHELE BRUNELLI
- Division of Cardiology, Department of Arrhythmia and Electrophysiology; Zentralklinik Bad Berka; Bad Berka Germany
| | - MARKUS FROMMHOLD
- Division of Cardiology, Department of Arrhythmia and Electrophysiology; Zentralklinik Bad Berka; Bad Berka Germany
| | - TANJA DÄHNE
- Division of Cardiology, Department of Arrhythmia and Electrophysiology; Zentralklinik Bad Berka; Bad Berka Germany
| | - GIUSEPPE ORETO
- Department of Clinical and Experimental Medicine; University Hospitals; Messina Italy
| | - SANTI RAFFA
- Division of Cardiology, Department of Arrhythmia and Electrophysiology; Zentralklinik Bad Berka; Bad Berka Germany
| | - J. CHRISTOPH GELLER
- Division of Cardiology, Department of Arrhythmia and Electrophysiology; Zentralklinik Bad Berka; Bad Berka Germany
- Otto-von-Guericke University; School of Medicine; Magdeburg Germany
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Kaneko Y, Naito S, Okishige K, Morishima I, Tobiume T, Nakajima T, Irie T, Ota M, Iijima T, Iizuka T, Tamura M, Tamura S, Saito A, Igawa O, Kato R, Matsumoto K, Suzuki F, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Incorporating a "Superior" Slow Pathway: A Distinct Supraventricular Tachyarrhythmia. Circulation 2015; 133:114-23. [PMID: 26541829 DOI: 10.1161/circulationaha.115.018443] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The existence of an atypical fast-slow (F/S) atrioventricular nodal reentrant tachycardia (AVNRT) including a superior (sup) pathway with slow conductive properties and an atrial exit near the His bundle has not been confirmed. METHODS AND RESULTS We studied 6 women and 2 men (age, 74 ± 7 years) with sup-F/S-AVNRT who underwent successful radiofrequency ablation near the His bundle. Programmed ventricular stimulation induced retrograde conduction over a superior SP with an earliest atrial activation near the His bundle, a mean shortest spike-atrial interval of 378 ± 119 milliseconds, and decremental properties in all patients. sup-F/S-AVNRT was characterized by a long-RP interval; a retrograde atrial activation sequence during tachycardia identical to that over a sup-SP during ventricular pacing; ventriculoatrial dissociation during ventricular overdrive pacing of the tachycardia in 5 patients or atrioventricular block occurring during tachycardia in 3 patients, excluding atrioventricular reentrant tachycardia; termination of the tachycardia by ATP; and a V-A-V activation sequence immediately after ventricular induction or entrainment of the tachycardia, including dual atrial responses in 2 patients. Elimination or modification of retrograde conduction over the sup-SP by ablation near the right perinodal region or from the noncoronary cusp of Valsalva eliminated and confirmed the diagnosis of AVNRT in 4 patients each. CONCLUSIONS sup-F/S-AVNRT is a distinct supraventricular tachycardia, incorporating an SP located above the Koch triangle as the retrograde limb, that can be eliminated by radiofrequency ablation.
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Affiliation(s)
- Yoshiaki Kaneko
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.).
| | - Shigeto Naito
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Kaoru Okishige
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Itsuro Morishima
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Takeshi Tobiume
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Tadashi Nakajima
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Tadanobu Irie
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Masaki Ota
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Takafumi Iijima
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Takashi Iizuka
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Mio Tamura
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Shuntaro Tamura
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Akihiro Saito
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Osamu Igawa
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Ritsushi Kato
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Kazuo Matsumoto
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Fumio Suzuki
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
| | - Masahiko Kurabayashi
- From Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan (Y.K., T.N., T.I., M.O., T.I., T.I., M.T., S.T., A.S., M.K.); Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan (S.N.); Heart Center, Yokohama-City Bay Red Cross Hospital, Japan (K.O.); Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan (I.M.); Department of Cardiology, Tokushima University, Japan (T.T.); Division of Cardiology, International Medical Center, Saitama Medical University, Hidaka, Japan (T.T., R.K., K.M.); Department of Internal Medicine and Cardiology, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan (O.I.); and Department of Cardiology, Fukujuji Hospital, Kiyose, Tokyo, Japan (F.S.)
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Wang Y, Li D, Zhang J, Han Z, Wang Y, Ren X, Li X, Chen F. Focal atrial tachycardia originating from the septal mitral annulus: electrocardiographic and electrophysiological characteristics and radiofrequency ablation. Europace 2015; 18:1061-8. [PMID: 26450844 DOI: 10.1093/europace/euv256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/06/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS This study sought to investigate electrocardiographic characteristics, electrophysiological features, and radiofrequency ablation in patients with focal atrial tachycardia (AT) originating from the septal mitral annulus. METHODS AND RESULTS In 13 patients with AT originating from the septal mitral annulus, activation mapping was performed to identify the earliest activation site. Successful ablation was performed through either a transseptal (n = 12) or a retrograde aortic approach (n = 1). As confirmed by electrogram recordings, fluoroscopy, and three-dimensional (3D) mapping, successful ablation sites were located in the anterior paraseptal, mid- to anteroseptal, and posterior septal mitral annulus in eight, three, and two patients, respectively. Foci for all locations demonstrated a negative/positive appearance in lead V1. Mapping in the right atrium demonstrated that the earliest right atrial activation was near the septum (His-bundle region or proximal coronary sinus). The electrograms at the successful ablation sites were fractionated in 9 patients, and presented with an atrial:ventricular ratio of <1 in all 13 patients. There were no complications in any patients and long-term success was achieved in 12 of 13 patients during the 23 ± 6 months following ablation. CONCLUSION The area surrounding the septal mitral annulus, most commonly the anterior paraseptal, is an unusual, but important site of origin for focal AT, which is associated with a distinctive P-wave morphology and atrial endocardial activation sequence. Radiofrequency ablation of AT originating from the septal mitral annulus, through either a transseptal or a retrograde aortic approach appears to be safe and effective.
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Affiliation(s)
- Yunlong Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, 2 Anzhen Rd, Beijing 100029, China
| | - Ding Li
- Department of Cardiology, People's Hospital, Peking University, 11 S Xizhimen St, Beijing 100044, China
| | - Junmeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, 2 Anzhen Rd, Beijing 100029, China
| | - Zhihong Han
- Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, 2 Anzhen Rd, Beijing 100029, China
| | - Ye Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, 2 Anzhen Rd, Beijing 100029, China
| | - Xuejun Ren
- Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, 2 Anzhen Rd, Beijing 100029, China
| | - Xuebin Li
- Department of Cardiology, People's Hospital, Peking University, 11 S Xizhimen St, Beijing 100044, China
| | - Fang Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, 2 Anzhen Rd, Beijing 100029, China
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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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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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Taylor CM, Samardhi H, Haqqani HM. Atrial tachycardias arising from the atrial appendages and aortic sinus of valsalva. Curr Cardiol Rev 2015; 11:118-26. [PMID: 25308812 PMCID: PMC4356718 DOI: 10.2174/1573403x10666141013121631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 04/05/2014] [Indexed: 11/22/2022] Open
Abstract
Focal atrial tachycardias arising from the atrial appendages and the aortic sinuses of Valsalva are less frequently encountered in clinical practice. This review article describes the clinical presentation, surface P wave morphology, electrophysiologic characteristics and treatment of these arrhythmias. Catheter ablation of these focal tachycardias has a high success rate. It is however important to be aware of specific anatomic considerations in these locations for optimal treatment outcomes with low complication rates.
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Affiliation(s)
| | | | - Haris M Haqqani
- Department of Cardiology, Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD Australia 4032.
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Wang Z, Ouyang J, Liang Y, Jin Z, Yang G, Liang M, Li S, Yu H, Han Y. Focal atrial tachycardia surrounding the anterior septum: strategy for mapping and catheter ablation. Circ Arrhythm Electrophysiol 2015; 8:575-82. [PMID: 25908691 PMCID: PMC4467584 DOI: 10.1161/circep.114.002281] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
Background— Focal atrial tachycardias (ATs) surrounding the anterior atrial septum (AAS) have been successfully ablated from the right atrial septum (RAS), the aortic cusps, and the aortic mitral junction. However, the strategy for mapping and ablation of AAS-ATs has not been well defined. Methods and Results— Of 227 consecutive patients with AT, 47 (20.7%; mean age, 56.3±11.6 years) with AAS-ATs were studied; among them, initial ablation was successful at RAS in only 5 of 14 patients and at noncoronary cusp (NCC) in 28 of 33 patients. In 45 of the 47 patients, the 46 of 48 AAS-ATs were eliminated at RAS in 8 patients, NCC in 35 patients (earliest activation time at NCC was later than that at RAS by 5–10 ms in 6 patients), and aortic mitral junction in 3 patients (all with negative P wave in lead aVL and positive P wave in the inferior leads), including 1 patient whose 2 ATs were eliminated separately from the NCC and the aortic mitral junction. Conclusions— Most of the ATs surrounding the AAS can be eliminated from within the NCC, which is usually the preferential ablation site. Ablation at the RAS and aortic mitral junction should be considered when supported by P-wave morphologies on surface ECG and results of activation mapping and ablation.
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Affiliation(s)
- Zulu Wang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Jinge Ouyang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Yanchun Liang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Zhiqing Jin
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Guitang Yang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Ming Liang
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Shibei Li
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Haibo Yu
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.)
| | - Yaling Han
- From the Department of Cardiology, Shenyang Northern Hospital, Shenyang, China (Z.W., Y.L., Z.J., G.Y., M.L., S.L., H.Y., Y.H.); and Department of Cardiology, Fuzhou General Hospital of Nanjing Command, Fuzhou, China (J.O.).
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26
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Atrial pacing during radiofrequency deliveries for catheter ablation of para-Hisian arrhythmias. J Cardiol 2015; 66:411-6. [PMID: 25600431 DOI: 10.1016/j.jjcc.2014.12.013] [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: 11/06/2014] [Revised: 12/09/2014] [Accepted: 12/18/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atrial pacing during radiofrequency (RF) deliveries is a technique to facilitate rapid recognition of impaired atrioventricular (AV) conduction during slow pathway ablation of AV nodal reentrant tachycardia. The objective of our study was to report this technique in the catheter ablation of para-Hisian arrhythmias. METHODS The study included a total of 48 patients who underwent ablation of para-Hisian arrhythmias including accessory pathways (APs), atrial tachycardias (ATs), and ventricular arrhythmias (VAs) in 6, 9, and 33 patients, respectively. RESULTS AT was successfully eliminated in all cases without any accelerated junctional rhythm (JR) occurring. JR appeared during RF deliveries in 20 patients (3 with APs, 17 with VAs). In 11 of 20 patients, RF deliveries were terminated when JR appeared and restarted during atrial pacing at a faster rate than the JR. No transient complete AV block was observed in the 11 patients, however it occurred in 1 of the remaining 9 without atrial pacing (p=0.25). Small His bundle potentials were recorded at the effective ablation site before the RF delivery in 11 (55%) patients. No patients had any AV conduction disturbances at the end of and after the procedure. APs were successfully eliminated in 2 of 3 patients. VAs were completely and partially eliminated in 10 and 4 of 17 patients, respectively. CONCLUSIONS Atrial pacing during RF applications might be helpful to avoid AV conduction disturbances during catheter ablation of APs close to the His bundle and idiopathic VAs originating in the vicinity of the His bundle.
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LONG DEYONG, SALIM MOHAMED, DONG JIANZENG, SANG CAIHUA, JIANG CHENXI, TANG RIBO, LI SONGNAN, YU RONGHUI, YAO YAN, NING MAN, SHENG CHANG. Electroanatomical Mapping of the Right Atrium during Atrial Tachycardia Originating from Right Superior Pulmonary Vein: Additional Insights on Differential Diagnosis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:91-8. [PMID: 25298212 DOI: 10.1111/pace.12510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/12/2014] [Accepted: 08/03/2014] [Indexed: 11/30/2022]
Affiliation(s)
- DE YONG LONG
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - MOHAMED SALIM
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - JIAN ZENG DONG
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - CAI HUA SANG
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - CHEN XI JIANG
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - RI BO TANG
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - SONG NAN LI
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - RONG HUI YU
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - YAN YAO
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - MAN NING
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
| | - CHANG SHENG
- Cardiology Department; Beijing An Zhen Hospital; Capital Medical University; Beijing China
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Beukema RJ, Smit JJJ, Adiyaman A, Van Casteren L, Delnoy PPH, Ramdat Misier AR, Elvan A. Ablation of focal atrial tachycardia from the non-coronary aortic cusp: case series and review of the literature. ACTA ACUST UNITED AC 2014; 17:953-61. [DOI: 10.1093/europace/euu227] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/31/2014] [Indexed: 11/12/2022]
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Aras D, Cay S, Topaloglu S, Cagirci G, Ozeke O. Parahisian atrial tachycardia: cryoablation from the aortic cusp. Indian Pacing Electrophysiol J 2014; 14:49-52. [PMID: 24493917 PMCID: PMC3878588 DOI: 10.1016/s0972-6292(16)30716-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dursun Aras
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Goksel Cagirci
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey
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Kaneko Y, Nakajima T, Irie T, Suzuki F, Ota M, Iijima T, Tamura M, Iizuka T, Tamura S, Saito A, Kurabayashi M. Successful Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia From a Noncoronary Sinus of Valsalva. Int Heart J 2014; 55:84-6. [DOI: 10.1536/ihj.13-218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yoshiaki Kaneko
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Tadanobu Irie
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | | | - Masaki Ota
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Takafumi Iijima
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Mio Tamura
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Takashi Iizuka
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Akihiro Saito
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
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Zhang S, Lin N. Another step forward: Journal of Cardiovascular Electrophysiology special issue for electrophysiology research from China. J Cardiovasc Electrophysiol 2013; 23 Suppl 1:S2-4. [PMID: 23140345 DOI: 10.1111/jce.12011] [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: 11/29/2022]
Affiliation(s)
- Shu Zhang
- National Center for Cardiovascular Diseases, Beijing, China
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32
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Mano H, Okumura Y, Watanabe I, Sasaki N, Kogawa R, Sonoda K, Nagashima K, Haruta H, Kofune M, Ohkubo K, Nakai T, Hirayama A. Potential anatomic substrate of peri-atrioventricular nodal atrial tachycardia ablated from the noncoronary sinus of Valsalva. J Interv Card Electrophysiol 2013; 38:27-34. [DOI: 10.1007/s10840-013-9798-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
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Ju W, Chen M, Yang B, Chen H, Zhang F, Li M, Yu J, Cao K. The role of noncoronary cusp ablation approach in the treatment of perinodal atrial tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:811-8. [PMID: 22671853 DOI: 10.1111/j.1540-8159.2012.03425.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ablation in the noncoronary aortic cusp (NCC) potentially has a role in the treatment of perinodal atrial tachycardias (ATs). The objective of the study was to characterize clinical and electrophysiological properties of perinodal ATs between two groups of requiring and not requiring NCC ablation. METHODS A total of 113 patients with focal ATs who underwent electrophysiologic study and radiofrequency catheter ablation were enrolled in the study. The clinical and electrophysiological characteristics of ATs that need and not need NCC ablation were compared. RESULTS Totally 20 cases were revealed to have the focal ATs located in the perinodal area. Among them, only five cases (25%) warrant ablation in the NCC, whereas the remainder could be successfully eliminated by ablation from the endocardial right atrium at the perinodal region. There were no clinical and electrophysiological clues observed to have the potential to predict the true original site, including the activation mode, the three-dimensional mapping characteristics of earliest activation site in the right atrium, as well as the time of termination during the ablation in the perinodal area. CONCLUSIONS Approximately, one-fourth of the perinodal ATs warrant ablation in the NCC. However, no clinical and electrophysiological clues could predict the potential site of the perinodal ATs.
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Affiliation(s)
- Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Affiliation(s)
- Hiroshi Tada
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
- Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
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Wang Z, Liu T, Shehata M, Liang Y, Jin Z, Liang M, Han Y, Amorn A, Liu X, Liu E, Chugh SS, Wang X. Electrophysiological characteristics of focal atrial tachycardia surrounding the aortic coronary cusps. Circ Arrhythm Electrophysiol 2011; 4:902-8. [PMID: 21985795 DOI: 10.1161/circep.111.965640] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catheter ablation of atrial tachycardia (AT) arising near the coronary cusps has been reported in limited numbers of patients. We investigated the electrophysiological characteristics of these ATs in 22 consecutive patients. METHODS AND RESULTS This study included 22 patients (mean age ± SD, 53 ± 11 years; 86% female) with ATs arising near the aortic coronary cusps who underwent successful ablation. Activation mapping was performed during tachycardia to identify the earliest activation site. All patients achieved successful ablation through either a retrograde aortic (n=19) or a transseptal (n=3) approach. The successful ablation sites were located in the noncoronary cusp (NCC) (n=16), including 3 near the junction between the NCC and right coronary cusp. The remaining 6 cases were ablated from the left coronary cusp (LCC) (n=3) or the left atrium posterior to the LCC (n=3). For most tachycardias, there were distinctive P-wave morphological features recorded for each cusp location. Furthermore, analysis of the electrogram morphological features recorded during tachycardia at successful ablation sites revealed an atrial/ventricular (A/V) ratio >1 in 14 of 16 NCC ATs; the remaining 2, from the NCC near the junction with the right coronary cusp, showed an A/V ratio ≤ 1. At ablation sites in the LCC, the A/V ratio was <1 (4 of 6 patients) or 1 (remaining 2 patients). During a follow-up duration of 30 ± 13 months, all patients were free of arrhythmias without antiarrhythmic drugs. CONCLUSIONS ATs surrounding the aortic coronary cusps can be safely and effectively ablated, with good long-term outcomes. In addition to the P-wave morphological features, the A/V ratio of the local electrogram recording during tachycardia facilitated the localization of successful sites.
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Affiliation(s)
- Zulu Wang
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, People's Republic of China
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Godin B, Guiot A, Savoure A, Anselme F. The left coronary cusp as an unusual location for accessory pathway ablation. Heart Rhythm 2011; 8:1769-72. [PMID: 21699859 DOI: 10.1016/j.hrthm.2011.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Bénédicte Godin
- Cardiology Department, Rouen University Hospital, Roeun, France
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