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von Olshausen G, Drca N, Paul-Nordin A, Bourke T, Bastani H, Saygi S, Svennberg E, Åkerström F, Saluveer O, Jensen-Urstad M, Braunschweig F. Incidence of atrial fibrillation in patients with atrioventricular nodal re-entrant tachycardia and its association with long-term outcome. Heart Rhythm O2 2024; 5:538-542. [PMID: 39263614 PMCID: PMC11385394 DOI: 10.1016/j.hroo.2024.07.005] [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] [Indexed: 09/13/2024] Open
Abstract
Background Atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common paroxysmal supraventricular tachycardia. We sought to investigate the incidence of atrial fibrillation in patients with electrophysiologically confirmed/ablated AVNRT and its association with transient ischemic attack (TIA)/stroke as well as mortality during long-term follow-up. Methods From the Karolinska Ablation Registry, 2855 consecutive patients with a first-time ablation for AVNRT between 2005 and 2018 were analyzed. Results Patients were 52.1 ± 15.9 years old and 59.3% were women. During follow-up of up to 10 years (median 6.0 years; interquartile range 3.3 to 9.2 years), new onset or recurrence of atrial fibrillation occurred in 317 (11.1%) patients (incidence rate 19 cases per 1000 person-years). Excluding those with history of atrial fibrillation, new onset of atrial fibrillation occurred in 153 (6.1%) patients. In multivariable analysis, history of atrial fibrillation, arterial hypertension, history of TIA/stroke, and heart failure remained independently associated with new onset or recurrence of atrial fibrillation during follow-up. Death of any cause and TIA/stroke occurred in 141 (4.9%) patients and 107 (3.7%) patients, respectively. In multivariable analysis, occurrence of atrial fibrillation during follow-up remained independently associated with both outcomes. The prevalence of atrial fibrillation according to age at the end of follow-up was high among young patients (<60 years of age: 12.7%; 60-69 years of age: 10.6%). Conclusion In this large cohort of patients with diagnosed AVNRT, the incidence of atrial fibrillation was high (11.1%) during long-term follow-up. Occurrence of atrial fibrillation during follow-up remained independently associated with death for any cause as well as with TIA/stroke. Therefore, a closer monitoring for atrial fibrillation in patients with AVNRT including those at young age is advisable.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Medical Department I (Cardiology, Angiology, Pneumology), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Serkan Saygi
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Emma Svennberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Finn Åkerström
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Heart and Lung Disease Unit, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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González-Casal D, Pérez-Castellanos A, Flores NS, Carta-Bergaz A, González-Torrecilla E, Bruña Fernández V, Ávila P, Atienza F, Arenal Á, González-Panizo J, Fernández-Avilés F, Cabrera JA, Datino T. Cannon A wave validation as a diagnostic tool in paroxysmal supraventricular tachycardias. Pacing Clin Electrophysiol 2024; 47:383-391. [PMID: 38348921 DOI: 10.1111/pace.14946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The presence of cannon A waves, the so called "frog sign", has traditionally been considered diagnostic of atrioventricular nodal re-entrant tachycardia (AVNRT). Nevertheless, it has never been systematically evaluated. The aim of this study is to assess the independent diagnostic utility of cannon A waves in the differential diagnosis of supraventricular tachycardias (SVTs). METHODS We prospectively included 100 patients who underwent an electrophysiology (EP) study for SVT. The right jugular venous pulse was recorded during the study. In 61 patients, invasive central venous pressure (CVP) was registered as well. CVP increase is thought to be related with the timing between atria and ventricle depolarization; two groups were prespecified, the short VA interval tachycardias (including typical AVNRT and atrioventricular reciprocating tachycardia (AVRT) mediated by a septal accessory pathway) and the long VA interval tachycardias (including atypical AVNRT and AVRT mediated by a left free wall accessory pathway). RESULTS The relationship between cannon A waves and AVNRT did not reach the statistical significance (OR: 3.01; p = .058); On the other hand, it was clearly associated with the final diagnosis of a short VA interval tachycardia (OR: 10.21; p < .001). CVP increase showed an inversely proportional relationship with the VA interval during tachycardia (b = -.020; p < .001). CVP increase was larger in cases of AVNRT (4.0 mmHg vs. 1.2 mmHg; p < .001) and short VA interval tachycardias (3.9 mmHg vs. 1.2 mmHg; p < .001). CONCLUSION The presence of cannon A waves is associated with the final diagnosis of short VA interval tachycardias.
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Affiliation(s)
- David González-Casal
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alberto Pérez-Castellanos
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nina Soto Flores
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alejandro Carta-Bergaz
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Pablo Ávila
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe Atienza
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Arenal
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge González-Panizo
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | | | - José Angel Cabrera
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
| | - Tomás Datino
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
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3
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Kotruchin P, Chaiyakhan IO, Kamonsri P, Chantapoh W, Serewiwattana N, Kaweenattayanon N, Narangsiya N, Lorcharassriwong P, Korsakul K, Thawepornpuriphong P, Tirapuritorn T, Mitsungnern T. Comparison between the double-syringe and the single-syringe techniques of adenosine administration for terminating supraventricular tachycardia: A pilot, randomized controlled trial. Clin Cardiol 2022; 45:583-589. [PMID: 35340059 PMCID: PMC9045080 DOI: 10.1002/clc.23820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine has been recommended as a first-line treatment for stable supraventricular tachycardia (SVT). Standard guidelines recommend 6-mg of adenosine administered intravenously (IV) with an immediate 20-ml IV bolus of normal saline solution (NSS; double syringe technique [DST]). However, a newly proposed single-syringe technique (SST), in which adenosine is diluted with an up to 20 ml IV bolus of NSS, was found to be beneficial. HYPOTHESIS We hypothesized that the SST was noninferior to the DST for terminating stable SVT. METHODS A pilot multicenter, single-blind, randomized controlled study was conducted at nine hospitals in north and northeast Thailand. Thirty patients who were diagnosed with stable SVT were randomized into two groups of 15, with one receiving adenosine via the DST and the other via the SST. We examined SVT termination, the average successful dose, and the complication rate of each group. Analyses were based on the intention-to-treat principle. RESULT The termination rate was 93.3% in the DST and 100% in the SST group (p = 1.000), and the success rate of the first 6-mg dose of adenosine was 73.3% and 80%, respectively (p = 1.000). The total administered dose was 8.6 ± 5.1 mg in the DST group and 7.6 ± 4.5 mg in the SST group (p = .608). No complications were found in either group. CONCLUSIONS The SST was non-inferior to the DST for termination of SVT. However, a further definitive study with a larger sample size is required.
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Affiliation(s)
- Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Muang, Khon Kaen, Thailand
| | - Itchaya-On Chaiyakhan
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Muang, Khon Kaen, Thailand
| | | | | | - Nattapat Serewiwattana
- Emergency Medicine Unit, Queen Sirikit Heart Center of the Northeast, Khon Kaen, Thailand
| | | | | | | | | | | | | | - Thapanawong Mitsungnern
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Muang, Khon Kaen, Thailand
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Murray K, Wahid M, Alagiakrishnan K, Senaratne J. Clinical electrophysiology of the aging heart. Expert Rev Cardiovasc Ther 2022; 20:123-139. [PMID: 35282746 DOI: 10.1080/14779072.2022.2045196] [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: 10/18/2022]
Abstract
INTRODUCTION Advancements in medical and consumer-grade technologies have made it easier than ever to monitor a patient's heart rhythm and to diagnose arrhythmias. Octogenarians with symptomatic arrhythmias have unique management challenges due to their frailty, complex drug interactions, cognitive impairment, and competing comorbidities. The management decisions are further complicated by the lack of randomized evidence to guide treatment. AREAS COVERED A comprehensive literature review was undertaken to outline various tachyarrhythmias and bradyarrhythmias and their management, the role of cardiac implantable electronic devices, cardiac ablations, and specific geriatric arrhythmia considerations as recommended in international guidelines. EXPERT OPINION Atrial fibrillation (AF) is arguably the most important arrhythmia in the elderly and is associated with significant morbidity and mortality. Early diagnosis of AF, potentially with smart devices (wearables), has the potential to reduce the incidence of stroke, systemic emboli, and the risk of dementia. Bradyarrhythmias have a high incidence in the elderly as well, often requiring implantation of a permanent pacemaker. Leadless pacemakers implanted directly into the right ventricle are great options for gaining traction in elderly patients.
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Affiliation(s)
- Kyle Murray
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Muizz Wahid
- Department of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kanna Alagiakrishnan
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Janek Senaratne
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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5
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Hong KL, Verma A, Lee T, Jiang Y, Skobic D, Huang G, Park J, Terricabras M, Malaweera A, Sanhueza E, Korogyi A, Lashevsky I, Crystal E, Glover BM. Age-Related Changes in the Anatomy of the Triangle of Koch: Implications for Catheter Ablation of Atrioventricular Nodal Re-entry Tachycardia. CJC Open 2021; 3:924-928. [PMID: 34401699 PMCID: PMC8348584 DOI: 10.1016/j.cjco.2021.03.007] [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: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Atrioventricular nodal re-entrant tachycardia is the most common type of paroxysmal supraventricular tachycardia. We sought to assess whether important anatomic factors, such as the location of the slow pathway, proximity to the bundle of His, and coronary sinus ostium dimensions, varied with patient age, and whether these factors had an impact on procedural duration, acute success, and complications. Methods Baseline demographic and procedural data were collected, and the maps were analyzed. Linear regression models were performed to evaluate the associations between age and these anatomic variations. Associations were also assessed, with age categorized as being ≥ 60 years or < 60 years. Results The slow pathway was more commonly located in a superior location relative to the coronary sinus ostium in older patients. The location of the slow pathway moved in a superior direction by 1 mm for every increase in 2 years from the mean estimate of age. Additionally the slow pathway tended to be closer to the coronary sinus ostium in older patients, and the diameter of the ostium was larger in older patients. This resulted in longer procedure time, longer ablation times, and a greater need for long sheaths for stability. Conclusions The location of the slow pathway becomes more superior and closer to the coronary sinus ostium with increasing age. Additionally, the coronary sinus diameter increases with age. These factors result in longer ablation and procedural times in older patients.
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Affiliation(s)
- Kathryn L. Hong
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Atul Verma
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
- Southlake Hospital, Toronto, Ontario, Canada
| | - Thea Lee
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Yidi Jiang
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Grace Huang
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joy Park
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maria Terricabras
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anura Malaweera
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo Sanhueza
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Adam Korogyi
- Abbott Laboratories, Mississauga, Ontario, Canada
| | - Ilan Lashevsky
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Crystal
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benedict M. Glover
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Benedict M. Glover, Associate Professor, Division of Cardiology, Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada. Tel.: +1-416-786-5988; fax: +1-416-480-6913.
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Poptani V, Jayaram AA, Jain S, Samanth J. A study of narrow QRS tachycardia with emphasis on the clinical features, ECG, electrophysiology/radiofrequency ablation. Future Cardiol 2020; 17:137-148. [PMID: 32915064 DOI: 10.2217/fca-2020-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are the most common forms of paroxysmal regular supraventricular tachycardias. Materials & methods: The clinical, ECG and electrophysiological findings of 121 patients with narrow QRS tachycardia were evaluated prospectively. Results: A total of 75 (62%) of the patients had AVNRT while 46 (38%) had AVRT. Pounding sensation in the neck (40 vs 15.2%; p = 0.004), presynope (26.7 vs 56.5%; p = 0.001) identifiable P wave after QRS complex (25.3 vs 73.9%; p = 0.001), pseudo r'/s waves (45.3 vs 4.3%; p = 0.001), limb leads ST-T changes (34.7 vs 60.9%; p = 0.004) were the significant changes observed. A total of 94.7% of AVNRT and 87% of AVRT could be diagnosed correctly considering both clinical and ECG criteria. Conclusion: Pounding sensation in the neck and presyncope along with ECG features like identifiable P wave after QRS complex, pseudo r'/s waves and limb lead ST-T changes very accurately differentiate AVNRT and AVRT.
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Affiliation(s)
- Vishal Poptani
- Ex-Assistant Professor, Department of Cardiology, U N Mehta Institute of Cardiology & Research Centre, Ahmadabad, Gujarath, India 380016
| | - Ashwal Adamane Jayaram
- Associate Professor, Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India 576106
| | - Sharad Jain
- Professor, Department of Cardiology, U N Mehta Institute of Cardiology & Research Centre, Ahmadabad, Gujarath, India 380016
| | - Jyothi Samanth
- Assistant Professor, Department of Cardiovascular Technology, School of Allied Health Science (SOAHS), Manipal Academy of Higher Education, Manipal, India 576104
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Ai W, Patel ND, Roop PS, Malik A, Trew ML. Cardiac Electrical Modeling for Closed-Loop Validation of Implantable Devices. IEEE Trans Biomed Eng 2019; 67:536-544. [PMID: 31095474 DOI: 10.1109/tbme.2019.2917212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Evaluating and testing cardiac electrical devices in a closed-physiologic-loop can help design safety, but this is rarely practical or comprehensive. Furthermore, in silico closed-loop testing with biophysical computer models cannot meet the requirements of time-critical cardiac device systems, while simplified models meeting time-critical requirements may not have the necessary dynamic features. We propose a new high-level (abstracted) physiologically-based computational heart model that is time-critical and dynamic. METHODS The model comprises cardiac regional cellular-electrophysiology types connected by a path model along a conduction network. The regional electrophysiology and paths are modeled with hybrid automata that capture non-linear dynamics, such as action potential and conduction velocity restitution and overdrive suppression. The hierarchy of pacemaker functions is incorporated to generate sinus rhythms, while abnormal automaticity can be introduced to form a variety of arrhythmias such as escape ectopic rhythms. Model parameters are calibrated using experimental data and prior model simulations. CONCLUSION Regional electrophysiology and paths in the model match human action potentials, dynamic behavior, and cardiac activation sequences. Connected in closed loop with a pacing device in DDD mode, the model generates complex arrhythmia such as atrioventricular nodal reentry tachycardia. Such device-induced outcomes have been observed clinically and we can establish the key physiological features of the heart model that influence the device operation. SIGNIFICANCE These findings demonstrate how an abstract heart model can be used for device validation and to design personalized treatment.
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8
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Fernando H, Adams N, Mitra B. Review article: The utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia. Emerg Med Australas 2018; 31:35-42. [PMID: 29752780 DOI: 10.1111/1742-6723.12971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (January 1992-March 2017) were searched for randomised controlled trials and observational studies (of sample size greater than 10). Our search strategy yielded no randomised controlled trials and seven observational studies with significant statistical heterogeneity among selected studies (I2 87.3%, P < 0.001). Included studies investigated a total of 1155 patients. All studies reported on the utility of troponin testing in this patient population. The pooled proportion of patients investigated with troponin was 0.66 (95% confidence interval 0.44-0.88). The pooled proportion of positive troponin tests was 0.32 (95% confidence interval 0.23-0.41). Only one study reported on the utility of the remaining four investigations with abnormal results as follows: thyroid stimulating hormone 14%, haemoglobin 6%, white cell count 19% and chest X-ray 22%. Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.
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Affiliation(s)
- Harith Fernando
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Adams
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Marzlin KM, Webner C. Atrioventricular Reentrant Tachycardia. AACN Adv Crit Care 2018; 28:223-228. [PMID: 28592483 DOI: 10.4037/aacnacc2017151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Karen M Marzlin
- Karen M. Marzlin is Cardiology APRN, Aultman Hospital, Canton, Ohio, and Business Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685 . Cynthia Webner is Business Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, North Canton, Ohio
| | - Cynthia Webner
- Karen M. Marzlin is Cardiology APRN, Aultman Hospital, Canton, Ohio, and Business Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685 . Cynthia Webner is Business Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, North Canton, Ohio
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Wells P, Dubuc M, Klein GJ, Dan D, Roux JF, Lockwood E, Sturmer M, Dunbar D, Novak P, Rao A, Peterson BJ, Kueffer F, Ellenbogen KA. Intracardiac ablation for atrioventricular nodal reentry tachycardia using a 6 mm distal electrode cryoablation catheter: Prospective, multicenter, North American study (ICY-AVNRT STUDY). J Cardiovasc Electrophysiol 2017; 29:167-176. [DOI: 10.1111/jce.13367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Wells
- Baylor Heart and Vascular Institute; Dallas TX USA
| | - Marc Dubuc
- Montreal Heart Institute; Montreal Quebec Canada
| | | | - Dan Dan
- Intermountain Healthcare; Ogden UT USA
| | | | | | | | | | - Paul Novak
- University of British Columbia; Vancouver British Columbia Canada
| | - Arun Rao
- Wellmont CVA Heart Institute; Kingsport TN USA
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11
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Affiliation(s)
- Karen M. Marzlin
- Karen M. Marzlin is Cardiology APRN, Aultman Hospital, Canton, Ohio, and Business Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685
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12
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Kim YR. Paroxysmal Supraventricular Tachycardia: the General Principle. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2016. [DOI: 10.18501/arrhythmia.2016.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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Gándara Ricardo JA, Santander Bohórquez D, Mora Pabón G, Amaris Peña Ó. Taquicardias supraventriculares. Estado del arte. REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n1.45072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Las taquicardias supraventriculares son un grupo de entidades clínicas prevalentes en la población general, pero que afectan con mayor frecuencia a la población adulta; son ritmos rápidos y generalmente regulares en los cuales se encuentra implicada alguna estructura por encima de la bifurcación del haz de His para formación o perpetuación. El diagnóstico de estas entidades requiere un abordaje clínico sistemático, siendo el electrocardiograma de superficie la principal herramienta para su adecuada clasificación. El tratamiento de las taquicardias supraventriculares dependerá del estado hemodinámico del paciente, el cual definirá el requerimiento de terapia eléctrica o tratamiento médico. Se debe hacer una selección adecuada de los pacientes que requieren estudio electrofisiológico y ablación.</p>
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Santangeli P, Di Biase L, Basile E, Al-Ahmad A, Natale A. Outcomes in Women Undergoing Electrophysiological Procedures. Arrhythm Electrophysiol Rev 2016; 2:41-4. [PMID: 26835039 DOI: 10.15420/aer.2013.2.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The number of invasive electrophysiological procedures is steadily increasing in Western countries, as the age of the population increases and technologies advance. In recent years, gender-related differences in cardiac rhythm disorders have been increasingly appreciated, which can potentially have a great impact on the outcomes of invasive electrophysiological procedures. Among supraventricular arrhythmias, women have a higher incidence of atrioventricular nodal re-entrant tachycardia and a significantly lower incidence of atrioventricular re-entrant tachycardia compared with males, and present to ablation procedures later and after having failed more antiarrhythmic drugs. The results of catheter ablation of atrial fibrillation in women have been reported worse than in men. This finding is possibly due to a later referral of females to ablation procedures, who present older and with a higher incidence of long-standing persistent atrial fibrillation. With regard to cardiac device implantation procedures, a smaller survival benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation has been shown in women, essentially due to gender-specific differences in the clinical course of patients with severe left ventricular dysfunction, with women dying predominantly from non-arrhythmic causes. On the other side, the clinical outcome of cardiac resynchronisation therapy seems to be more favourable in women, who experience a greater degree of reverse left ventricular remodelling and a striking decrease of heart failure events or mortality after biventricular pacing. This review will summarise the available evidence on gender-related differences in outcomes of invasive electrophysiological procedures.
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Affiliation(s)
- Pasquale Santangeli
- Division of Cardiology, Stanford University School of Medicine, California, US; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Eloisa Basile
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Amin Al-Ahmad
- Division of Cardiology, Stanford University School of Medicine, California, US
| | - Andrea Natale
- Division of Cardiology, Stanford University School of Medicine, California, US; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas, US
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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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REDDY CHARITHAD, SILKA MICHAELJ, BAR-COHEN YANIV. A Comparison of AV Nodal Reentrant Tachycardia in Young Children and Adolescents: Electrophysiology, Ablation, and Outcomes. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1325-32. [DOI: 10.1111/pace.12699] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/15/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- CHARITHA D. REDDY
- Department of Pediatrics; Children's Hospital Los Angeles; Los Angeles California
| | - MICHAEL J. SILKA
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California; and Keck School of Medicine; University of Southern California; Los Angeles California
| | - YANIV BAR-COHEN
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, California; and Keck School of Medicine; University of Southern California; Los Angeles California
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Alihanoglu YI, Yildiz BS, Kilic DI, Evrengul H, Kose S. Clinical and electrophysiological characteristics of typical atrioventricular nodal reentrant tachycardia in the elderly - changing of slow pathway location with aging. Circ J 2015; 79:1031-6. [PMID: 25739340 DOI: 10.1253/circj.cj-14-1320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to retrospectively evaluate the clinical and electrophysiological characteristics of elderly patients with typical atrioventricular nodal reentrant tachycardia (AVNRT), and to assess the acute safety and efficacy of slow-pathway radiofrequency (RF) ablation in this specific group of patients. METHODS AND RESULTS The present study retrospectively included a total of 1,290 patients receiving successful slow-pathway RF ablation for typical slow-fast AVNRT. Patients were divided into 2 groups: group I included 1,148 patients aged <65 years and group II included 142 patients aged >65 years. The required total procedure duration and total fluoroscopy exposure time were significantly higher in group II vs. group I (P=0.005 and P=0.0001, respectively). The number of RF pulses needed for a successful procedural end-point was significantly higher in group II than in group I (4.4 vs. 7.2, P=0.005). While the ratio of the anterior location near to the His-bundle region was significantly higher in group II, the ratio of posterior and midseptal locations were significantly higher in group I (P=0.0001). The overall procedure success rates were similar. There was no significant difference between the 2 groups in respect of the complications rates. CONCLUSIONS This experience demonstrates that RF catheter ablation, targeting the slow pathway, could be considered as first-line therapy for typical AVNRT patients older than 65 years as well as younger patients, as it is very safe and effective in the acute period of treatment.
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Santangeli P, Proietti R, Di Biase L, Bai R, Natale A. Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2013; 39:111-9. [PMID: 24293174 DOI: 10.1007/s10840-013-9842-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation of the slow pathway is an established cure for atrioventricular nodal reentrant tachycardia (AVNRT). Periprocedural damage to the conduction system is a major concern during AVNRT ablation, and cryoablation (CRYO) has been suggested to improve the procedural safety compared to standard radiofrequency (RF) ablation, without reducing the procedural success. OBJECTIVE We performed a systematic review and meta-analysis of studies comparing CRYO with RF ablation of AVNRT. METHODS We searched PubMed, CENTRAL, the BioMed Central, EMBASE, CardioSource, clinicaltrials.gov, and ISI Web of Science (January 1980 to July 2013). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify studies that compared the procedural outcomes of AVNRT ablation with either CRYO or RF energy. Two independent reviewers assessed the risk of bias according to the Cochrane Collaboration, and extracted patient, study characteristics, and procedural outcome data. Results are expressed as odds ratio (OR) or as weighted mean difference (WMD) with their 95 % confidence interval (CI). RESULTS Fourteen studies (5 prospective randomized and 9 observational) with 2,340 patients (mean age range 13 to 53 years, 1,522 (65 %) females) were included in the analysis. RF ablation was performed in 1,262 (54 %) patients, while CRYO in 1,078 (46 %) patients. Acute success (abolition of dual atrioventricular node physiology or single echo beats) was achieved in 88 % of patients treated with RF versus 83 % of those treated with CRYO (OR = 0.72, 95 % CI 0.46 to 1.13; P = 0.157). RF ablation was associated with shorter total procedure time (WMD = -13.7 min, 95 % CI -23 to -4.3 min; P = 0.004), but slightly longer fluoroscopy time (WMD = +4.6 min 95 % CI +1.7 to +7.6 min; P = 0.002). Permanent atrioventricular block occurred in 0.87 % RF cases and in no CRYO case (OR = 3.60, 95 % CI 1.09 to 11.81; P = 0.035). Over a median follow-up of 10.5 months (range 6 to 12 months), freedom from recurrent AVNRT was 96.5 % in the RF group versus 90.9 % in the CRYO group (OR = 0.40, 95 % CI 0.28 to 0.58; P < 0.001). At meta-regression analysis, no clinical or procedural variable had a significant interaction with the results above. CONCLUSIONS In patients undergoing AVNRT ablation, RF significantly reduces the risk of long-term arrhythmia recurrence compared to CRYO, but is associated with a higher risk of permanent atrioventricular block.
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Affiliation(s)
- Pasquale Santangeli
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA,
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Thajudeen A, Namboodiri N, Choudhary D, Valaparambil AK, Tharakan JA. "Classical" response in a pre-excited tachycardia: what are the pathways involved? Circ Arrhythm Electrophysiol 2013; 6:e11-6. [PMID: 23592871 DOI: 10.1161/circep.111.979120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anees Thajudeen
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Von Bergen NH, Law IH. AV nodal reentrant tachycardia in children: Current approaches to management. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.004] [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: 12/01/2022]
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Rationale and design of the NO-PARTY trial: near-zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias in young patients. Cardiol Young 2012; 22:539-46. [PMID: 22325367 DOI: 10.1017/s1047951112000042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Radiofrequency catheter ablation is the mainstay of therapy for supraventricular tachyarrhythmias. Conventional radiofrequency catheter ablation requires the use of fluoroscopy, thus exposing patients to ionising radiation. The feasibility and safety of non-fluoroscopic radiofrequency catheter ablation has been recently reported in a wide range of supraventricular tachyarrhythmias using the EnSite NavX™ mapping system. The NO-PARTY is a multi-centre, randomised controlled trial designed to test the hypothesis that catheter ablation of supraventricular tachyarrhythmias guided by the EnSite NavX™ mapping system results in a clinically significant reduction in exposure to ionising radiation compared with conventional catheter ablation. METHODS The study will randomise 210 patients undergoing catheter ablation of supraventricular tachyarrhythmias to either a conventional ablation technique or one guided by the EnSite NavX™ mapping system. The primary end-point is the reduction of the radiation dose to the patient. Secondary end-points include procedural success, reduction of the radiation dose to the operator, and a cost-effectiveness analysis. In a subgroup of patients, we will also evaluate the radiobiological effectiveness of dose reduction by assessing acute chromosomal DNA damage in peripheral blood lymphocytes. CONCLUSIONS NO-PARTY will determine whether radiofrequency catheter ablation of supraventricular tachyarrhythmias guided by the EnSite NavX™ mapping system is a suitable and cost-effective approach to achieve a clinically significant reduction in ionising radiation exposure for both patient and operator.
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Braunschweig F, Christel P, Jensen-Urstad M, Andersson M, Schwieler J, Tapanainen J, Bastani H, Gadler F, Linde C, Schöls W, Bergfeldt L. Paroxysmal regular supraventricular tachycardia: the diagnostic accuracy of the transesophageal ventriculo-atrial interval. Ann Noninvasive Electrocardiol 2012; 16:327-35. [PMID: 22008487 DOI: 10.1111/j.1542-474x.2011.00459.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To establish the diagnostic accuracy of the transesophageal ventriculo-atrial (VA) interval in patients with paroxysmal supraventricular tachycardia (PSVT) and normal baseline electrocardiogram (ECG). METHODS The transesophageal VA interval during tachycardia was recorded in 318 patients (age 45 ± 17 years, 58% female) with PSVT and a normal surface ECG between attacks. Subsequently, all patients underwent an ablation procedure establishing the correct tachycardia diagnosis. RESULTS AV nodal reentrant tachycardia (AVNRT), AV reentrant tachycardia through a concealed accessory pathway (AVRT), and ectopic atrial tachycardia (EAT) were found in 213, 95, and 10 cases, respectively. Receiver operating characteristic curve analysis identified an optimal cutoff for a binary categorization of AVNRT versus AVRT/EAT at ≤80 ms (area under the curve 0.891). Owing to a biphasic distribution, AVNRT was very likely at VA intervals ≤90 ms with a sensitivity, specificity, and positive predictive value (PPV) of 87%, 91%, and 95%. In the range 91-160 ms the corresponding values for AVRT were 88%, 95%, and 88% (90%, 99%, and 98% in male patients). In the small group with VA intervals >160 ms (n = 29), the diagnosis was less clear (PPV of 67% for AVNRT). CONCLUSIONS In patients with sudden onset regular tachycardia and a normal ECG during sinus rhythm, a transesophageal VA interval of ≤80 ms has the highest diagnostic accuracy to diagnose AVNRT versus AVRT/EAT. Overall, the biphasic distribution of VA intervals suggests considering AVNRT at 90 ms and below and AVRT between 91 and 160 ms (in particular in male patients) while the diagnosis is vague at VA intervals above 160 ms.
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Affiliation(s)
- Frieder Braunschweig
- Electrophysiology & Arrhythmia Service, Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
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Ablation of atrioventricular nodal reentrant tachycardia in the elderly: results from the German Ablation Registry. Heart Rhythm 2011; 8:981-7. [DOI: 10.1016/j.hrthm.2011.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/03/2011] [Indexed: 11/23/2022]
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Santangeli P, di Biase L, Pelargonio G, Natale A. Outcome of invasive electrophysiological procedures and gender: are males and females the same? J Cardiovasc Electrophysiol 2010; 22:605-12. [PMID: 20958833 DOI: 10.1111/j.1540-8167.2010.01920.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this review is to summarize the available evidence on gender-related differences in outcome of invasive electrophysiological procedures. Gender exerts significant influences on the epidemiology, pathophysiology, and clinical presentation of many cardiac rhythm disorders. Women with supraventricular arrhythmias have a higher incidence of atrioventricular nodal reentrant tachycardia, a lower prevalence of atrioventricular accessory pathways, and increased arrhythmia inducibility during luteal phases of the menstrual cycle. Catheter ablation of supraventricular arrhythmias appears equally effective in the 2 genders, although women present to catheter ablation later, with more symptoms, and after having failed more antiarrhythmic drugs. The outcome of catheter ablation of atrial fibrillation in women has been reported worse than in men, which may be explained by a later referral. Accordingly, women present to catheter ablation with a higher incidence of long-standing persistent atrial fibrillation. Of note, the outcome of catheter ablation of atrial flutter does not seem to differ between genders. To date, with regard to ventricular arrhythmias, no gender-related differences in outcome of catheter ablation procedures have been reported. However, pathophysiology and risk factors underlying ventricular arrhythmias appear different in the two genders. Severe left ventricular dysfunction does not perform equally as a predictor for sudden cardiac death in women as compared to men, and the survival benefit of prophylactic implantable cardioverter-defibrillator (ICD) implantation in women is inconclusive. On the other hand, the clinical outcome after cardiac resynchronization therapy seems to be more favorable in women, who experience a greater degree of reverse left ventricular remodeling.
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Affiliation(s)
- Pasquale Santangeli
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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González-Torrecilla E, Almendral J, Arenal A, Atienza F, Atea LF, del Castillo S, Fernández-Avilés F. Combined Evaluation of Bedside Clinical Variables and the Electrocardiogram for the Differential Diagnosis of Paroxysmal Atrioventricular Reciprocating Tachycardias in Patients Without Pre-Excitation. J Am Coll Cardiol 2009; 53:2353-8. [DOI: 10.1016/j.jacc.2009.02.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 01/27/2009] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
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Deneke T, Müller P, Lawo T, Lemke B, Horlitz M, Calcum B, Bösche LI, Mügge A, Grewe PH. Gender differences in onset of symptoms in AV nodal re-entrant and accessory pathway-mediated re-entrant tachycardia. Herzschrittmacherther Elektrophysiol 2009; 20:33-38. [PMID: 19421838 DOI: 10.1007/s00399-009-0036-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 01/08/2009] [Indexed: 05/27/2023]
Abstract
PURPOSE Is onset of symptoms in AV nodal re-entrant tachycardia (AVNRT) and accessory pathway-mediated re-entrant tachycardia (AVRT) patients gender-specific? METHODS Intra- and inter-gender differences in onset of symptoms and mechanism of supraventricular tachycardia in adult patients undergoing catheter ablation for AVNRT or AVRT (N=230) were documented. RESULTS Women with AVNRT were significantly younger at onset of symptoms compared to men (38+/-18, 51+/-18 years, p=0.01). Male AVNRT patients were significantly older at onset of symptoms compared to male AVRT patients (51+/-18, 25+/-11 years, p=0.04) but there was no difference in women. Symptoms beginning <30 years in men predicted AVRT in 73%, and beginning >or=30 years the predominant mechanism was AVNRT (85%). In women AVNRT was the most likely mechanism independent of symptom onset (>75%). CONCLUSIONS Symptoms beginning in patients with AVNRT and AVRT prior to age 30 correlates with a 70% incidence of AVRT in men and a 80% incidence of AVNRT in women. Onset of palpitations >or= age 30 relates to AVNRT in 85% of patients.
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Affiliation(s)
- T Deneke
- BG University Hospital Bergmannsheil, University Heart Center Bochum, Bürkle-de-la-Camp-Platz 2, 44789, Bochum, Deutschland.
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Medi C, Kalman JM, Freedman SB. Supraventricular tachycardia. Med J Aust 2009; 190:255-60. [DOI: 10.5694/j.1326-5377.2009.tb02388.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 10/02/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Caroline Medi
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC
- Department of Medicine, University of Melbourne, Melbourne, VIC
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC
- Department of Medicine, University of Melbourne, Melbourne, VIC
| | - Saul B Freedman
- Department of Cardiology, Concord Clinical School, Concord Hospital, Sydney, NSW
- Vascular Biology Laboratory, ANZAC Research Institute, University of Sydney, Sydney, NSW
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D'Este D, Zoppo F, Bertaglia E, Zerbo F, Picciolo A, Scarabeo V, Pascotto A, Pascotto P. Long-term outcome of patients with atrioventricular node reentrant tachycardia. Int J Cardiol 2007; 115:350-3. [PMID: 16814416 DOI: 10.1016/j.ijcard.2006.04.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 01/26/2006] [Accepted: 04/01/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little information is available on the natural history of patients with AVNRT. The purpose of this study was to compare the outcome of patients with Atrioventricular node reentrant tachycardia (AVNRT) who underwent ablation with those on antiarrhythmic therapy and those not receiving drugs. METHODS 93 consecutive patients (mean age=33.5+/-18.1 years) with AVNRT referred to our institution from 1988 to 1993 were prospectively followed-up for a mean of 13.2+/-2.0 years (range=11.4-16.1 years). RESULTS 18 patients underwent ablation (group 1), 24 received antiarrhythmic therapy (group 2), 38 received no drugs or remained on drug therapy for only few months (group 3), 3 died and 10 were lost to follow-up. The frequency of symptoms at the baseline was higher in group 1 than in groups 2 and 3 (7.8+/-3.7, 3.5+/-2.3, 2.3+/-1.9 episodes/month, respectively; p<0.02 in group 1 vs. group 3). At the end of the follow-up 18/18 (100%) of group 1, 14/23 (61%) of group 2 and 17/38 of group 3 (44.7%) reported being asymptomatic for the previous 3 years. Group 3 patients who became asymptomatic had a shorter duration of symptoms before enrolment (3.7+/-1.5 vs. 7.1+/-3.6 years, p<0.05) and a shorter mean length of the tachycardia episodes (3.8+/-2.4 vs. 42.6+/-17.8 min, p<0.02) than patients from the same group who remained symptomatic. CONCLUSIONS The main result of this study is that during a long-term follow-up a considerable number of untreated patients with AVNRT become asymptomatic. This finding should be considered for choosing treatment modality and for calculating healthcare costs of ablation vs. medical therapy.
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Affiliation(s)
- Daniele D'Este
- Department of Cardiology, Civic Hospital of Mirano, Via Mariutto 14, 30035 Mirano (Venice), Italy.
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Porter MJ, Morton JB, Denman R, Lin AC, Tierney S, Santucci PA, Cai JJ, Madsen N, Wilber DJ. Influence of age and gender on the mechanism of supraventricular tachycardia. Heart Rhythm 2004; 1:393-6. [PMID: 15851189 DOI: 10.1016/j.hrthm.2004.05.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Accepted: 05/14/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to determine the impact of age and gender on the mechanism of paroxysmal supraventricular tachycardia (PSVT). BACKGROUND Previous studies have indicated that PSVT mechanism may be influenced by age and gender, but contemporary data are limited. METHODS In 1,754 patients undergoing catheter ablation of 1,856 PSVTs between 1991 and 2003, the mechanism was classified as atrioventricular reentrant tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), or atrial tachycardia (AT). Patients with inappropriate sinus tachycardia, atrial flutter, atrial fibrillation, and age <5 years were excluded. RESULTS The mean age was 45 +/- 19 years (range 5-96), and the majority were women (62%). Overall, AVNRT was the predominant mechanism (n = 1,042 [56%]), followed by AVRT (n = 500 [27%]) and AT (n = 315 [17%]). There was a strong relationship between age and PSVT mechanism; the proportion of AVRT in both sexes decreased with age, whereas AVNRT and AT increased (PM < .001 by ANOVA). The majority of patients with AVRT were men (273/500 [54.6%]), whereas the majority of patients with AVNRT and AT were women (727/1,042 [70%] and 195/315 [62%], respectively). The distribution of PSVT mechanism was significantly influenced by gender (P < .001). In women, 63% had AVNRT, 20% had AVRT, and 17.0% had AT. In men, 45% had AVNRT, 39% had AVRT, and 17% had AT. AVNRT replaced AVRT as the dominant PSVT mechanism at age 40 in men and at age 10 in women. CONCLUSIONS The mechanism of PSVT in patients presenting for ablation is significantly influenced by both age and gender.
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Affiliation(s)
- Michael J Porter
- Loyola Cardiovascular Institute, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Tada H, Oral H, Greenstein R, Pelosi F, Knight BP, Strickberger SA, Morady F. Analysis of age of onset of accessory pathway-mediated tachycardia in men and women. Am J Cardiol 2002; 89:470-1. [PMID: 11835934 DOI: 10.1016/s0002-9149(01)02274-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Hiroshi Tada
- Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 49109-0022, USA
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Liu S, Yuan S, Kongstad O, Olsson SB. Gender differences in the electrophysiological characteristics of atrioventricular conduction system and their clinical implications. SCAND CARDIOVASC J 2001; 35:313-7. [PMID: 11771822 DOI: 10.1080/140174301317116280] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The underlying mechanisms of the differences in sex distribution of patients with atrioventricular (AV) nodal re-entrant tachycardia and Wolff-Parkinson-White syndrome are poorly understood. The objective of this study was to determine potential gender differences in the electrophysiological properties of the normal AV conduction system that may be attributable to differences in sex distribution. DESIGN The AV conduction properties were studied in 96 patients (52 men and 44 women) who underwent electrophysiological testing, 32 patients with atrial tachycardia, 39 with idiopathic ventricular tachycardia and 25 with unexplained palpitations or syncope. RESULTS The AH (83 +/- 15 ms) and His-ventricular intervals in men (42 +/- 6 ms) were significantly longer than in women (78 +/- 14, 38 +/- 6 ms, p < 0.05, respectively), as was the PR interval (160 +/- 17 vs 152 +/- 13 ms, p = 0.02). The effective refractory period of AV node in men (349 +/- 75 ms) was longer than in women (297 +/- 45 ms, p = 0.03). However, no significant difference was observed between men and women with respect to the incidence of AV nodal dual pathway and the maximum AH interval achieved during premature stimulation or incremental pacing. The AV block cycle length was significantly longer in men (371 +/- 76 ms) than in women (330 +/- 52 ms, p = 0.02). A longer ventriculoatrial block cycle length was also found in men than in women although not at a significant level (436 +/- 107 vs 384 +/- 90 ms. p = 0.08). In addition, men (23%) were twice as likely to have ventriculoatrial dissociation during ventricular pacing as women were (11%, p = 0.2). CONCLUSION The data show that gender-related differences in AV conduction properties may be responsible for the differences in sex distribution observed in patients with AV nodal re-entrant tachycardia and those with ventricular pre-excitation.
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Affiliation(s)
- S Liu
- Department of Cardiology, University Hospital, Lund, Sweden
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Brembilla-Perrot B, Houriez P, Beurrier D, Claudon O, Burger G, Vançon AC, Mock L. Influence of age on the electrophysiological mechanism of paroxysmal supraventricular tachycardias. Int J Cardiol 2001; 78:293-8. [PMID: 11376833 DOI: 10.1016/s0167-5273(01)00392-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to evaluate the influence of age on the mechanism of paroxysmal supraventricular tachycardia (PSVT). Previous studies have shown age and sex differences between certain arrhythmias and especially changes in electrophysiological characteristics of Wolff-Parkinson-White syndrome. Four hundred and eighty five patients aged 9-86 years, with PSVT and without Wolff-Parkinson-White syndrome in sinus rhythm, were studied. The esophageal or intracardiac electrophysiological study used a standardized atrial pacing protocol. Paroxysmal junctional tachycardia was induced in 475 patients. The mechanism of tachycardia was not influenced by age and atrioventricular nodal reentrant tachycardia (AVNRT) was found as the main cause of PSVT in all ranges of age. Atrioventricular reentrant tachycardia (AVRT) using a concealed accessory pathway (AP) had a similar incidence from youth to elderly. The ratio male/female (M/F) and the inducibility of other arrhythmias (atrial flutter/fibrillation) (AF/AFl) were also found to be similar in all ranges of age. The age of the patients did not influence the mechanism of the tachycardia. Most of PVST were related to a AV nodal reentrant tachycardia. Concealed accessory pathway was identified with a similar incidence in young and old patients.
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Affiliation(s)
- B Brembilla-Perrot
- Department of Cardiology, CHU of Brabois, 54500, Vandoeuvre Les Nancy, France.
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Gross GJ, Epstein MR, Walsh EP, Saul JP. Characteristics, management, and midterm outcome in infants with atrioventricular nodal reentry tachycardia. Am J Cardiol 1998; 82:956-60. [PMID: 9794351 DOI: 10.1016/s0002-9149(98)00512-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atrioventricular nodal reentry is a commonly recognized mechanism of supraventricular tachycardia (SVT) in adults, but is only rarely documented in the first year of life. The aim of this study was to elucidate characteristics, management, and outcome in infants with atrioventricular nodal reentrant tachycardia (AVNRT). Electrophysiologic studies performed between January 1988 and June 1996 were reviewed. Fifteen infants with AVNRT at 58 +/- 27 days (mean +/- SEM) were identified. Five had AVNRT detected following palliation of structural cardiac anomalies, including 4 with critical obstructions to left ventricular outflow. Typical AVNRT (ventriculoatrial interval 49 +/- 5 ms) was observed in 14 of 15 patients and atypical AVNRT (ventriculoatrial interval 191 +/- 22 ms) in 4 of 15. All patients received long-term therapy, beginning with digoxin in 13. Eight had symptomatic recurrences on digoxin and 6 of these were given beta blockers, with satisfactory control in 4. Three patients were controlled with class III agents, and 2 underwent slow pathway radiofrequency modification at ages 4.1 and 6.7 years, respectively. AVNRT was still inducible in 6 of 6 asymptomatic patients who underwent follow-up atrial stimulation studies after discontinuation of medical therapy. All 15 patients were alive with either absent or well-controlled AVNRT at age 45 +/- 7 months. We conclude that the course and outcome of AVNRT diagnosed in the first year of life are generally benign, but that a minority of patients have symptoms persisting beyond infancy. Digoxin is of questionable benefit in long-term control. AVNRT often remains inducible in asymptomatic patients, although the significance of this finding remains to be determined by long-term follow-up.
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Affiliation(s)
- G J Gross
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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