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Senturk SE, Icen YK, Koc AS, Donmez Y, Baykan AO, Unal İ, Sumbul H, Koc M. Evaluation of coronary sinus morphology by three-dimensional transthoracic echocardiography in patients undergoing electrophysiological study. J Arrhythm 2018; 34:626-631. [PMID: 30555606 PMCID: PMC6288552 DOI: 10.1002/joa3.12122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we aimed to evaluate the coronary sinus (CS) morphology with three-dimensional transthoracic echocardiography (3D-TTE) in patients with supraventricular tachycardia (SVT) who underwent electrophysiological study (EPS). METHODS This cross-sectional study was conducted with 187 patients who underwent EPS between November 2016 and April 2017. Patients were divided into three groups: atrioventricular nodal reentrant tachycardia (AVNRT) (n = 72), non-AVNRT SVT (n = 58), and normal EPS (n = 57). All patients were evaluated with electrocardiography, TTE, and 3D-TTE. RESULTS The CS diameter (CSD) and area (CSA) were found significantly lower in the normal EPS group than in the other groups. There was no significant difference in the CSD between AVNRT and non-AVNRT SVT groups. However, it was found that the CSA was significantly larger in the AVNRT group than in the non-AVNRT SVT group. In linear regression analysis, age and left atrial diameter were determined as independent predictor for CSD and CSA (P < 0.001 for each one). CONCLUSIONS The CSD and CSA assessed by 3D-TTE were different and dilated in the patients with SVT compared to those in the normal individuals. There was no significant difference in the CSD between the AVNRT and non-AVNRT SVT groups. However, the AVNRT group had a larger CSA than the non-AVNRT SVT group.
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Affiliation(s)
- Serhat Emre Senturk
- Adana Health Practices and Research Center Cardiology DepartmentHealth Sciences UniversityAdanaTurkey
| | - Yahya Kemal Icen
- Adana Health Practices and Research Center Cardiology DepartmentHealth Sciences UniversityAdanaTurkey
| | - Ayşe Selcan Koc
- Adana Health Practices and Research Center Radiology DepartmentHealth Sciences UniversityAdanaTurkey
| | - Yurdaer Donmez
- Adana Health Practices and Research Center Cardiology DepartmentHealth Sciences UniversityAdanaTurkey
| | - Ahmet Oytun Baykan
- Adana Health Practices and Research Center Cardiology DepartmentHealth Sciences UniversityAdanaTurkey
| | - İlker Unal
- Department of BiostatisticsFaculty of MedicineCukurova UniversityBalcali, Saricam, AdanaTurkey
| | - Hilmi Erdem Sumbul
- Internal Medicine DepartmentHealth Sciences University Adana City Education and Research HospitalAdanaTurkey
| | - Mevlüt Koc
- Adana Health Practices and Research Center Cardiology DepartmentHealth Sciences UniversityAdanaTurkey
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Coronary sinus morphology in pediatric patients with supraventricular tachycardia. J Interv Card Electrophysiol 2018; 51:163-168. [PMID: 29397525 DOI: 10.1007/s10840-018-0323-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The anatomic basis of atrioventricular node reentrant tachycardia (AVNRT) remains incompletely characterized in children. Differences in coronary sinus (CS) size and morphology have been observed in adults with AVNRT but have not been well characterized in children. METHODS Children (< 18 years) brought to the EP lab with supraventricular tachycardia for ablation underwent CS venography. A blinded pediatric interventional cardiologist performed CS measurements, which were indexed to body surface area. Patients were excluded if they were < 25 kg or had significant congenital heart disease. RESULTS Forty-six patients (age 14.2 ± 3.3 years) met inclusion criteria, 17 with AVNRT and 32 with an accessory pathway (AP). CS ostium (LAO projection, end-systole) was 7.8 ± 2.9 mm/m2 for the AVNRT group versus 6.0 ± 2.5 mm/m2 for the AP group (p = 0.04). CS "windsock" morphology was more prevalent in the AVNRT group (16/17, 94.1%) than the AP group (11/32, 34.3%) (p < 0.001). Within the AVNRT group, there was no correlation between CS ostium size and tachycardia cycle length (R = 0.01, p = 0.96), fast-pathway ERP (FPERP) (R = 0.42, p = 0.12), or A2-H2 at the FPERP (R = 0.25, p = 0.39). CONCLUSIONS Children with AVNRT have larger CS ostia and more prevalent windsock morphology. CS size/morphology did not correlate with EP properties of the AVNRT substrate. These features may explain the basis for the development of the electrophysiologic substrate for dual AV node physiology in children.
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Synthesis and T-type calcium channel blocking activity of novel diphenylpiperazine compounds, and evaluation of in vivo analgesic activity. Bioorg Med Chem 2010; 18:5938-44. [DOI: 10.1016/j.bmc.2010.06.082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/23/2010] [Accepted: 06/24/2010] [Indexed: 11/23/2022]
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Matsuyama TA, Ishibashi-Ueda H, Ikeda Y, Yamada Y, Okamura H, Noda T, Satomi K, Suyama K, Shimizu W, Aihara N, Kamakura S, Inoue S. The positional relationship between the coronary sinus musculature and the atrioventricular septal junction. Europace 2010; 12:719-25. [PMID: 20228078 DOI: 10.1093/europace/euq067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS The atrioventricular (AV) septal junction includes the coronary sinus (CS) and the compact part of the AV node and its posterior extensions. It has been recognized as the target site for ablation therapy of the AV nodal reentrant tachycardia and its variant forms. Despite the clinical significance of this region, the arrangement of the musculature in the AV septal junction, including the CS, has not fully been elucidated. We tried to explore the histological muscular diversity within the AV septal junction. METHODS AND RESULTS Sixteen autopsied human hearts (seven women), mean age 59.8 years, without structural anomalies, were studied. We removed the whole AV septum, including the CS opening after the macroscopic measurements, and prepared serial sections parallel to mitral and tricuspid annuli (short-axis style) to elucidate the positional relationships between the compact AV node and the CS musculature. Out of 16 hearts, the CS musculature extended deeply into the AV septal junction in eight hearts. In the other eight hearts, the CS musculature was located above the AV septal junction. In the former group, we found that the offset of both annuli was wide (mean 3.8 +/- 1.4 vs. 2.4 +/- 1.1 mm), the distance between CS opening and membranous septum was long (mean 14.8 +/- 1.6 vs. 12.3 +/- 2.2 mm), and the CS opening level was lower and closer to the His bundle level (mean 2.8 +/- 1.9 vs. 5.8 +/- 2.9 mm) (P < 0.05). CONCLUSION The deep extension of CS musculature into the AV septal junction seems to increase the tissue non-uniformity in this area.
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Affiliation(s)
- Taka-aki Matsuyama
- Department of Pathology, National Cardiovascular Center, 5-7-1 Fujishirodai Suita-City, 565-8565 Osaka, Japan.
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Wildburger NC, Lin-Ye A, Baird MA, Lei D, Bao J. Neuroprotective effects of blockers for T-type calcium channels. Mol Neurodegener 2009; 4:44. [PMID: 19863782 PMCID: PMC2774686 DOI: 10.1186/1750-1326-4-44] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 10/28/2009] [Indexed: 01/21/2023] Open
Abstract
Cognitive and functional decline with age is correlated with deregulation of intracellular calcium, which can lead to neuronal death in the brain. Previous studies have found protective effects of various calcium channel blockers in pathological conditions. However, little has been done to explore possible protective effects of blockers for T-type calcium channels, which forms a family of FDA approved anti-epileptic drugs. In this study, we found that neurons showed an increase in viability after treatment with either L-type or T-type calcium channel antagonists. The family of low-voltage activated, or T-type calcium channels, comprise of three members (Cav3.1, Cav3.2, and Cav3.3) based on their respective main pore-forming alpha subunits: α1G, α1H, and α1I. Among these three subunits, α1H is highly expressed in hippocampus and certain cortical regions. However, T-type calcium channel blockers can protect neurons derived from α1H-/- mice, suggesting that neuroprotection demonstrated by these drugs is not through the α1H subunit. In addition, blockers for T-type calcium channels were not able to confer any protection to neurons in long-term cultures, while blockers of L-type calcium channels could protect neurons. These data indicate a new function of blockers for T-type calcium channels, and also suggest different mechanisms to regulate neuronal survival by calcium signaling pathways. Thus, our findings have important implications in the development of new treatment for age-related neurodegenerative disorders.
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Affiliation(s)
- Norelle C Wildburger
- Department of Otolaryngology, Center for Aging, Washington University, 4560 Clayton Avenue, St Louis, MO 63110, USA.
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Ong MGY, Lee PC, Tai CT, Lin YJ, Lee KT, Tsao HM, Kuo JY, Chang SL, Hwang B, Chen SA. Coronary sinus morphology in different types of supraventricular tachycardias. J Interv Card Electrophysiol 2006; 15:21-6. [PMID: 16680546 DOI: 10.1007/s10840-006-7619-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 02/05/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrioventricular nodal reentry tachycardia (AVNRT) is based on the concept of dual AV node pathways that are functionally and anatomically distinct. The bigger coronary sinus ostium (CSO) in patients with AVNRT compared to other supraventricular tachycardias (SVTs) may produce separation of atrial inputs into the AV node or create anisotropic conduction, thus giving rise to a different AV nodal physiology. Previous studies measuring the size of the CSO using CS angiography between patients with AVNRT and other SVTs showed conflicting results. Besides, no previous studies have compared the CS morphology of the different forms of AVNRT. OBJECTIVES This study compares the size and morphology of the CS among patients with typical AVNRT, atypical AVNRT and accessory pathways mediated reentrant tachycardia (AVRT). METHODS Ninety-six patients with clinically documented SVTs were divided into three groups. The diameter of the CS was measured in LAO projection during end ventricular systole (by choosing the last ventricular inward motion). The CSO as well as 5, 10 and 15 mm inside the CS were measured. CS morphology is defined as either wind-sock shape or tubular shape. RESULTS The size of the CS ostium was 13.58 +/- 3.98, 15.93 +/- 4.86 and 12.50 +/- 2.83 mm for the atypical AVNRT, typical AVNRT and AVRT, respectively (p = 0.03). There was significant difference in the size of the CS from the ostium until 15 mm into the CS between 1) typical AVNRT and AVRT, 2) typical AVNRT and atypical AVNRT. Typical and atypical AVNRT patients had more windsock morphology CS (13/32, 40.6% and 10/32, 31.2%) compared to AVRT which had only one (1/32, 3.1%) windsock morphology (p = 0.002). CONCLUSION The easier CS cannulation in patients with typical AVNRT could be due to a bigger CS size and to a more windsock morphology. The CS size and morphology may be a very important substrate of tachycardia in patients with AVNRT.
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Ren JF, Marchlinski FE. Intracardiac Ultrasound Catheter Imaging for Electrophysiologic Substrate of AV Nodal Reentrant Tachycardia:. J Cardiovasc Electrophysiol 2004; 15:274-5. [PMID: 15030414 DOI: 10.1046/j.1540-8167.2004.03588.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Okumura Y, Watanabe I, Yamada T, Ohkubo K, Masaki R, Sugimura H, Hashimoto K, Kofune T, Takagi Y, Wakita R, Oshikawa N, Saito S, Ozawa Y, Kanmatsuse K, Yoshikawa Y, Asakawa Y. Comparison of Coronary Sinus Morphology in Patients With and Without Atrioventricular Nodal Reentrant Tachycardia by Intracardiac Echocardiography. J Cardiovasc Electrophysiol 2004; 15:269-73. [PMID: 15030413 DOI: 10.1046/j.1540-8167.2004.03114.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Dual AV nodal physiology is the electrophysiologic substrate for AV nodal reentrant tachycardia (AVNRT), but the anatomic basis for this arrhythmia remains to be elucidated. Atrial flutter (AFL) has been shown to be more frequently inducible in patients with AVNRT. METHODS AND RESULTS A 3.2-French, 20-MHz intracardiac ultrasound (ICUS) catheter was introduced into the coronary sinus (CS), and two-dimensional ICUS images were recorded during transducer pullback in 21 patients with AVNRT and 18 control patients. Three-dimensional reconstruction of the CS was created using the TomTec Imaging system. The area of the CS lumen at 15 mm within the CS ostium (os) was not significantly different in patients with and without AVNRT (54.4 +/- 34.7 mm2 vs 39.1 +/- 28.5 mm2). However, the area of the CS os was significantly larger in patients with AVNRT than in those without (112.1 +/- 60.9 mm2 vs 71.7 +/- 44.4 mm2, P < 0.05). Three-dimensional morphology of the CS os revealed flaring in patients with AVNRT, giving it a "windsock" appearance. Sustained AFL was induced in 10 of 21 patients with AVNRT, but in none of 18 control patients (P < 0.005). CONCLUSION The CS os was significantly wider in patients with AVNRT than in those without. These findings may have important implications for arrhythmia pathogenesis in AVNRT as well as AFL.
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Affiliation(s)
- Yasuo Okumura
- The Second Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Abstract
Intracardiac echocardiography, defined as ultra-sonographic navigation and visualization within large blood-filled cavities or vessels of the cardio-vascular system, has recently undergone refinement as a clinical tool through technologic advances in transducer miniaturization. Intra-cardiac ultra-sound catheters image at lower frequencies than current conventional intravascular ultrasound catheters used for intracoronary imaging. The lower imaging frequency enables greater tissue penetration, permitting whole-heart evaluation from a right-sided catheter position. Newer devices are steerable, have variable imaging frequency (5.5 to 10 MHz), and full Doppler capability (pulsed, continuous wave, and tissue Doppler). These advances have made intracardiac high-resolution imaging as well as hemodynamic assessment possible. A historical perspective, current capabilities and limitations, and potential clinical and research applications of this new imaging technique are discussed.
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Affiliation(s)
- C J Bruce
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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Mera F, DeLurgio DB, Langberg JJ, Moss EA, Léon AR. Transvenous cardioverter defibrillator lead malfunction due to terminal connector damage in pectoral implants. Pacing Clin Electrophysiol 1999; 22:1797-801. [PMID: 10642134 DOI: 10.1111/j.1540-8159.1999.tb00413.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lead failure places patients with implantable cardioverter defibrillators (ICD) at risk for sudden cardiac death or results in delivery of inappropriate shocks. This study describes a mechanism of lead malfunction occurring at the junction of the terminal ring with the conductor coil of the rate sensing terminal connector in one specific model of a transvenous ICD lead. We detected the problem in a population of 179 patients with a mean age of 61 +/- 10 years and a mean lead implant duration of 16 +/- 11 months. All patients underwent pectoral ICD implantation using a submuscular approach. The implanting physician chose to place the ICD on the left side in 155 patients (87%) and on the right side in 24 patients (13%). Cephalic vein cutdown provided central venous access in 147 patients (82%), and subclavian vein puncture provided access in 32 patients (18%). Follow-up examination detected lead failure in six patients (3.5% over 31 months) due to insulation damage with or without conductor coil fracture at the junction of the terminal ring and conductor coil of the IS-1 rate sense terminal. We detected lead disruption 17 +/- 9 months (range 5-31 months) after implantation. Multiple nonsustained arrhythmia episodes exhibiting nonphysiologic intervals associated with noisy rate sensing electrograms during pocket manipulation led to discovery in three patients. The other three patients presented with inappropriate device discharges confirmed by stored high-energy lead electrograms showing normal rhythm. Pacing lead impedance abnormally dropped in two patients. Impedance remained stable in the other four patients. In conclusion, the generator pocket represents an important site of ICD transvenous lead vulnerability. Lead failure may result from conductor coil and/or insulation disruption at the interface with the rate sensing terminal connector.
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Affiliation(s)
- F Mera
- Carlyle Fraser Heart Center at Crawford Long Hospital, Emory University School of Medicine, Atlanta, Georgia 30365, USA
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Bruce CJ, Packer DL, Seward JB. Transvascular Imaging: Feasibility Study Using a Vector Phased Array Ultrasound Catheter. Echocardiography 1999; 16:425-430. [PMID: 11175171 DOI: 10.1111/j.1540-8175.1999.tb00086.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Transvascular imaging is defined as the acquisition of anatomic and functional information of structures lying beyond the confines of a vascular conduit within which the imaging device resides. Interrogating structures surrounding the vascular conduit is the subject of this feasibility study using a novel underblood, phased array ultrasound-tipped catheter. METHODS: An intravascular catheter (10-F, 3.2-mm-diameter, four-way articulation) tipped with a 5.5- to 10-MHz frequency agile, vector phased array transducer with full Doppler capability (Sequoia, Acuson) was used. The imaging transducer has a wide range of tissue penetration (2 mm to >10 cm from the lens). The catheter was introduced via an 11-Fr femoral venous sheath into the inferior and superior vena cavae and right heart chambers. As the catheter was advanced, attention was directed to visualization of structures surrounding the vessel in which the catheter resided. RESULTS: From the cavae and femoral vein the thoracic, abdominal and femoral arteries could be easily imaged. Anatomy that was visualized included the liver, hepatic veins, gallbladder, and mesenteric vessels. Normal and pathological anatomy and Doppler physiology could be readily appreciated. Doppler (i.e., pulsed- and continuous-wave, color flow, and tissue Doppler) fostered unique transvascular physiological hemodynamic and flow assessment. CONCLUSION: Transvascular imaging is feasible in human subjects using this 10-Fr catheter tipped with a 5.5- to 10-MHz vector phased array transducer. Intravascular navigation to a desired location within the body and the performance of diagnostic or therapeutic procedures at a remote site under direct ultrasound visualization are possible. Full Doppler capability extends the concept of transvascular hemodynamic and physiological assessment.
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Affiliation(s)
- Charles J. Bruce
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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