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Headrick A, Newlon C, Etheridge SP, Asaki SY, Pilcher T, Niu M. Duodromic tachycardia: A case report of a rare presentation of wide complex supraventricular tachycardia. HeartRhythm Case Rep 2024; 10:321-325. [PMID: 38799600 PMCID: PMC11116953 DOI: 10.1016/j.hrcr.2024.02.008] [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: 05/29/2024] Open
Affiliation(s)
- Andrew Headrick
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
| | - Claire Newlon
- Department of Pediatrics, Division of Pediatric Cardiology, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Susan P. Etheridge
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
| | - S. Yukiko Asaki
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
| | - Thomas Pilcher
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
| | - Mary Niu
- Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
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Simpson J, Al-Sadawi M, Deshmukh A, Liang JJ, Latchamsetty R, Crawford T, Jongnarangsin K, Oral H, Bogun F, Ghannam M. Catheter ablation of parahisian premature ventricular complexes in patients with and without cardiac scar. Heart Rhythm 2024:S1547-5271(24)02308-7. [PMID: 38574787 DOI: 10.1016/j.hrthm.2024.03.1813] [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: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Ablation of premature ventricular complexes (PVCs) originating from the parahisian area is challenging. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) scar may influence procedural outcomes; the impact of cardiac scar on parahisian PVCs has not been described. OBJECTIVE The objective of this study was to examine the incidence and significance of LGE-CMR scarring in patients undergoing ablation for parahisian PVCs. METHODS Consecutive patients who underwent preprocedure LGE-CMR imaging and ablation of parahisian PVCs were included. Acute and long-term outcomes were examined. RESULTS Forty-eight patients were included (male, n = 37; age, 66 ± 10 years; ejection fraction, 50% ± 12%; preprocedure PVC burden, 21% ± 12%). Intramural LGE-CMR scar was present in 33 of 48 (69%) patients. Cryoablation was used in 9 patients; ablation in multiple chambers was required in 28 (58%) patients. The PVC site of origin (SOO) was intramural (n = 25 patients), left ventricular (n = 5), and right ventricular (n = 18). Patients with LGE-CMR scar were more likely to have intramural PVCs (64% vs 27%; P < .04) and to require ablation in multiple cardiac chambers (58% vs 13%; P < .02). Patients with intramural scar required longer duration of ablation delivery (31 ± 20 minutes vs 17 ± 8 minutes; P < .02). Acute procedural success was 69%; PVC burden on follow-up was 6% ± 9% and similar for those with and without scar. CONCLUSION Ablation of parahisian PVCs often requires mapping and ablation of multiple cardiac chambers, with an intramural SOO identified in most patients. An intramural scar was associated with an intramural SOO of the PVCs requiring more extensive ablation procedures, with similar long-term outcomes compared with those without scar.
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Affiliation(s)
- Jamie Simpson
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Mohamed Al-Sadawi
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Amrish Deshmukh
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Jackson J Liang
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Thomas Crawford
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Hakan Oral
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Michael Ghannam
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan.
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Nodera M, Igarashi M, Hasegawa K, Aonuma K, Nogami A, Tada H. The R Wave Amplitude in Lead aVL Could Predict Successful Catheter Ablation of Ventricular Arrhythmias Originating below the His Bundle Region of the Right Ventricle. Int Heart J 2023; 64:614-622. [PMID: 37460316 DOI: 10.1536/ihj.23-054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Radiofrequency catheter ablation (RFCA) to treat ventricular arrhythmias (VAs) originating below the His bundle (HB) region of the right ventricular (RV) septum could impair the atrioventricular node conduction. This study aimed to clarify the parameters of the 12-lead electrocardiography that predict successful RFCA of VAs originating from this region. This study included 20 consecutive patients (13 men; mean age, 68 ± 7 years) with monomorphic VAs in whom the earliest ventricular activation during the VA was below the HB region of the RV septum. According to the ablation results, the patients were divided into two groups: successful ablation (S-group; n = 10) and failed ablation groups (F-group; n = 10). The electrocardiographic parameters during the VAs and RFCA results were assessed. The R wave amplitudes in leads aVL (P = 0.001) and I (P = 0.010) in the S-group were both smaller than those in the F-group. In addition, the S-group had smaller negative deflection amplitudes in leads III (P = 0.002) and aVF (P = 0.003) than the F-group. According to the receiver operating characteristic curve analysis, the most useful electrocardiographic parameter for predicting successful ablation was the R wave amplitude in lead aVL (area under the curve, 0.895; P < 0.001); a cutoff value of < 1.3 mV predicted a successful RFCA with the highest accuracy (sensitivity, 90%; specificity, 80%; positive predictive value, 82%; negative predictive value, 89%). The R wave amplitude in lead aVL was the most useful parameter for predicting a successful RFCA to treat VAs originating below the HB region of the RV septum.
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Affiliation(s)
- Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Miyako Igarashi
- Division of Cardiovascular, Faculty of Medicine, University of Tsukuba
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Kazutaka Aonuma
- Division of Cardiovascular, Faculty of Medicine, University of Tsukuba
| | - Akihiko Nogami
- Division of Cardiovascular, Faculty of Medicine, University of Tsukuba
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
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4
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Kong LC, Shuang T, Li Z, Zou ZG, Jiang WL, Pu J, Wang XH. A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation. Front Cardiovasc Med 2022; 9:844320. [PMID: 35310983 PMCID: PMC8924133 DOI: 10.3389/fcvm.2022.844320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCatheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.MethodsForty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.ResultsSequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084–2.676, P = 0.02). “Seeming” right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.ConclusionsThe systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.
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Khan MT, Hameed A, Saeed Y. Interesting presentation of a broad complex tachycardia during the head up tilt table test. BMJ Case Rep 2021; 14:e245083. [PMID: 34607816 PMCID: PMC8491290 DOI: 10.1136/bcr-2021-245083] [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] [Accepted: 09/12/2021] [Indexed: 11/04/2022] Open
Abstract
Broad complex tachycardia (BCT) during head up tilt test (HUTT) is infrequent. Electrophysiology Study (EPS) plays an important part in further differentiation of BCT. We present a case of BCT during HUTT in a patient presenting with presyncope which later on EPS with 3D mapping was diagnosed as ventricular tachycardia. This case highlights the unusual occurrence of BCT during HUTT, the differential diagnosis of BCT and the utility of EPS to reliably identify the type and origin of BCT.
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Affiliation(s)
- Muhammad Taha Khan
- Cardiac Electrophysiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Aamir Hameed
- Medicine, Section of Cardiology, Agha Khan University Hospital, Karachi, Sindh, Pakistan
| | - Yawer Saeed
- Medicine, Section of Cardiology, Agha Khan University Hospital, Karachi, Sindh, Pakistan
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Vezzosi T, Domenech O, Cipollini C, Cantile C, Côté E, Tognetti R. ECG of the Month. J Am Vet Med Assoc 2020; 255:1234-1236. [PMID: 31730434 DOI: 10.2460/javma.255.11.1234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Marinheiro R, Parreira L, Amador P, Lopes C, Farinha J, Caria R. Slow pathway region as the exit site of parahisian premature ventricular contractions: Why choose safety over the earliest activation? J Cardiovasc Electrophysiol 2019; 31:267-270. [PMID: 31840911 DOI: 10.1111/jce.14319] [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: 11/07/2019] [Revised: 11/21/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Rita Marinheiro
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Leonor Parreira
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Pedro Amador
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Cláudia Lopes
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - José Farinha
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Rui Caria
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
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Suzuki G, Yotsukura A, Nanbu T, Sakurai M. Successful catheter cryoablation for premature ventricular contractions originating from the para-Hisian region. Clin Case Rep 2019; 7:1508-1513. [PMID: 31428377 PMCID: PMC6693052 DOI: 10.1002/ccr3.2246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
We achieved successful catheter cryoablation in a patient with para-Hisian premature ventricular contractions (PVCs) without conduction disturbance using the freeze-thaw-freeze method while observing the atrial-His bundle interval. Cryoablation could be considered an alternative to radiofrequency ablation for patients with para-Hisian PVCs.
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Affiliation(s)
- George Suzuki
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Akihiko Yotsukura
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Tadafumi Nanbu
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Masayuki Sakurai
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
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9
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Tzeis S, Asvestas D, Yen Ho S, Vardas P. Electrocardiographic landmarks of idiopathic ventricular arrhythmia origins. Heart 2019; 105:1109-1116. [PMID: 31092549 DOI: 10.1136/heartjnl-2019-314748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 11/03/2022] Open
Abstract
Idiopathic ventricular arrhythmias occur in the absence of underlying structural heart disease and less commonly in the presence of coexistent, but mechanistically unrelated, myocardial scar. These arrhythmias originate from several anatomical sites in both ventricles, with a predilection in outflow tract structures. The 12-lead surface ECG is the initial mapping tool, which is widely used to identify their origin. Specific features can predict the site of idiopathic ventricular arrhythmias, thus differentiating right from left ventricular, as well as endocardial from epicardial origins. In this review, we aim to analyse electrocardiographic landmarks for determination of idiopathic ventricular arrhythmia sources, with specific emphasis on pertinent caveats and anatomical relationships.
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Affiliation(s)
- Stylianos Tzeis
- Cardiology Department, Mitera General Hospital, Athens, Greece
| | | | - Siew Yen Ho
- National Heart and Lung Institute, London, UK
| | - Panos Vardas
- Mitera General Hospital, HYGEIA Group, Athens, Greece
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10
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Hwang J, Han S, Park H, Jun S, Cho Y, Yoon H, Lee CH, Lee SH, Hwang C. Novel method for the prediction of para-Hisian premature ventricular complexes from the electrocardiogram. J Arrhythm 2019; 35:92-98. [PMID: 30805049 PMCID: PMC6373644 DOI: 10.1002/joa3.12139] [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: 08/13/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Catheter ablation of para-Hisian (PH) premature ventricular complexes (PVCs) has a high risk of heart block. This study aimed to find the electrocardiographic (ECG) predictors of PH-PVCs. METHODS We enrolled 47 patients who underwent an electrophysiologic study for catheter ablation of PVCs and analyzed the ECG characteristics, retrospectively. RESULTS The PVC locations were the PH in 14, right ventricular (RV) outflow tract (OT) in 11, left ventricular (LV) OT in 16, LV septum in 5, and LV summit in 1. The QRS width of the PH-PVCs was significantly narrower than that of the rest of PVCs (140.9 ± 17.1 ms vs. 158.9 ± 19.4 ms, P = 0.004). Precordial transition of the PH-PVCs related to sinus rhythm was not helpful in predicting the location. Lead I had monophasic R waves in 100% and lead aVR QS waves in 100%. In aVL, 13 of 14 patients had monophasic R waves, and 1 had biphasic (rS) waves with an initial positive polarity. Among the study cohort, 15 patients had a QS in aVR and R in aVL, including 13 PH-PVCs and 2 PVCs coming from the RVOT septum and LVOT septum, respectively. The QS in aVR and monophasic R in aVL had a sensitivity of 92.8%, specificity of 93.9%, positive predictive value of 86.7%, and negative predictive value of 96.9% for localizing PH-PVCs. CONCLUSIONS A PVC morphology with a QS in aVR and monophasic R in aVL and QRS width <143 msec, could be used as a reliable parameter for predicting the PH location.
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Affiliation(s)
- Jongmin Hwang
- Division of Cardiology, Department of Internal MedicineKeimyung University Dongsan Medical Center, Keimyung University School of MedicineDaeguKorea
| | - Seongwook Han
- Division of Cardiology, Department of Internal MedicineKeimyung University Dongsan Medical Center, Keimyung University School of MedicineDaeguKorea
| | - Hyoung‐Seob Park
- Division of Cardiology, Department of Internal MedicineKeimyung University Dongsan Medical Center, Keimyung University School of MedicineDaeguKorea
| | - Seung‐Woon Jun
- Division of Cardiology, Department of Internal MedicineKeimyung University Dongsan Medical Center, Keimyung University School of MedicineDaeguKorea
| | - Yun‐Kyeong Cho
- Division of Cardiology, Department of Internal MedicineKeimyung University Dongsan Medical Center, Keimyung University School of MedicineDaeguKorea
| | - Hyuck‐Jun Yoon
- Division of Cardiology, Department of Internal MedicineKeimyung University Dongsan Medical Center, Keimyung University School of MedicineDaeguKorea
| | - Cheol Hyun Lee
- Division of Cardiology, Department of Internal MedicineKeimyung University Dongsan Medical Center, Keimyung University School of MedicineDaeguKorea
| | - Sang Hoon Lee
- Division of Cardiology, Department of Internal MedicineSM Christianity HospitalPohangKorea
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Enriquez A, Tapias C, Rodriguez D, Liang J, Marchlinski F, Saenz L, Garcia F. How to map and ablate parahisian ventricular arrhythmias. Heart Rhythm 2018. [DOI: 10.1016/j.hrthm.2018.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Candemir B, Duzen V, Coskun F, Vurgun VK, Goksuluk H, Ozyuncu N, Kurklu ST, Altin AT, Akyurek O, Erol C. Ablation of parahisian premature ventricular extrasystoles by subtricuspid retrograde approach using inverted catheter technique: back to the anatomy. Clin Case Rep 2018; 6:805-809. [PMID: 29744061 PMCID: PMC5930231 DOI: 10.1002/ccr3.1467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 11/30/2022] Open
Abstract
This report illustrates a feasible and anatomical solution aiming to improve the success and decrease the possible hazards such as atrioventricular block during ablation of parahisian PVCs. We tried to illustrate the specific anatomy pertaining parahisian region and to explain a retrograde subvalvular catheter technique to overcome these procedural obstacles.
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Affiliation(s)
- Basar Candemir
- Department of Cardiology Ankara University Ankara Turkey
| | - Veysel Duzen
- Department of Cardiology Gaziantep Ersin Arslan Research Hospital Gaziantep Turkey
| | - Firat Coskun
- Department of Cardiology Ankara University Ankara Turkey
| | | | | | - Nil Ozyuncu
- Department of Cardiology Ankara University Ankara Turkey
| | | | | | - Omer Akyurek
- Department of Cardiology Ankara University Ankara Turkey
| | - Cetin Erol
- Department of Cardiology Ankara University Ankara Turkey
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13
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Enriquez A, Pathak RK, Santangeli P, Liang JJ, Al Rawahi M, Hayashi T, Muser D, Frankel DS, Supple G, Schaller R, Lin D, Nazarian S, Zado E, Marchlinski FE, Garcia FC. Inferior lead discordance in ventricular arrhythmias: A specific marker for certain arrhythmia locations. J Cardiovasc Electrophysiol 2017; 28:1179-1186. [DOI: 10.1111/jce.13287] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/16/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Rajeev K. Pathak
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Jackson J. Liang
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Mohammed Al Rawahi
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Tatsuya Hayashi
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Daniele Muser
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - David S. Frankel
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Gregory Supple
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Robert Schaller
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - David Lin
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Erica Zado
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Francis E. Marchlinski
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
| | - Fermin C. Garcia
- Section of Cardiac Electrophysiology; Hospital of the University of Pennsylvania; Philadelphia PA USA
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14
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Madaffari A, Große A, Raffa S, Frommhold M, Fink A, Geller JC. Catheter ablation of ventricular ectopy with para-hisian origin: importance of mapping both sides of the interventricular septum and understanding when to stop ablating. Clin Case Rep 2016; 4:1195-1200. [PMID: 27980762 PMCID: PMC5134218 DOI: 10.1002/ccr3.739] [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: 03/31/2016] [Revised: 06/28/2016] [Accepted: 10/09/2016] [Indexed: 11/08/2022] Open
Abstract
Catheter ablation of para-Hisian premature ventricular contractions (PVCs) still represents a challenge and is a compromise between success and inadvertent AV block. We describe a possible strategy to address PVCs from this location with high-amplitude His-bundle potentials at the site of earliest activation.
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Affiliation(s)
- Antonio Madaffari
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Anett Große
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Santi Raffa
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Markus Frommhold
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - Agnes Fink
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany
| | - J Christoph Geller
- Department of Arrhythmia and Electrophysiology Division of Cardiology Zentralklinik Bad Berka Bad Berka Germany; Otto-von-Guericke University School of Medicine Magdeburg Germany
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