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Nakashima T, Nagase M, Usui T, Morimoto M, Shibahara T, Ono D, Yamada T, Suzuki K, Yamaura M, Ido T, Takahashi S, Aoyama T. Differential ventricular overdrive pacing during long-RP supraventricular tachycardia: How can we interpret? J Cardiovasc Electrophysiol 2024. [PMID: 38978298 DOI: 10.1111/jce.16371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Takashi Nakashima
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Masaru Nagase
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takahiro Usui
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Mikihito Morimoto
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Taro Shibahara
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Daiju Ono
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Keita Suzuki
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Makoto Yamaura
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Takahisa Ido
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shigekiyo Takahashi
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takuma Aoyama
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
- Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
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2
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Inaba O, Inamura Y, Takagi T, Meguro S, Nakata K, Michishita T, Isonaga Y, Kono T, Tachibana S, Ikenouchi T, Ohya H, Murata K, Takamiya T, Sato A, Sasano T. A Single Atrial Extrastimulation Resetting His Bundle During Supraventricular Tachycardia to Differentiate Atrial Tachycardia. JACC Clin Electrophysiol 2024; 10:1120-1131. [PMID: 38551549 DOI: 10.1016/j.jacep.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/19/2024] [Accepted: 02/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Catheter ablation is the curative treatment for paroxysmal supraventricular tachycardia (SVT). However, atrial tachycardia (AT) diagnosis is often challenging, especially when SVT is terminated by pacing. OBJECTIVES This study sought to develop a novel method for AT diagnosis. METHODS A total of 147 SVTs including 28 ATs, 87 atrioventricular nodal re-entrant tachycardias, and 32 orthodromic reciprocating tachycardias were prospectively studied. Single atrial extrastimulation was performed at the proximal coronary sinus from a coupling interval 20 milliseconds shorter than the tachycardia cycle length and gradually decreased until the His bundle (HB) was first reset and further until the SVT was terminated. The response of the SVT during the first HB resetting and the termination pattern were examined. RESULTS In 27 of 28 ATs, tachycardia was unaffected when HB resetting whereas, in atrioventricular nodal re-entrant tachycardias or orthodromic reciprocating tachycardias (non-AT), tachycardia was simultaneously reset when HB resetting or was terminated with an atrio-Hisian block. When the coupling interval was further shortened for cases in which tachycardia persisted, all 33 SVTs with tachycardia termination with atrio-Hisian block were non-ATs, whereas 5 ATs and 7 non-ATs were terminated with Hisian-atrial block. The sensitivity, specificity, and positive and negative predictive values of the pattern of tachycardia that was unaffected when HB resetting for AT diagnosis were 96%, 100%, 100%, and 99%, respectively. Those of the pattern of tachycardia termination with atrio-Hisian block for non-AT diagnosis were 92%, 100%, 100%, and 42%, respectively. CONCLUSIONS Single atrial extrastimulation from the proximal coronary sinus during tachycardia was useful and effective for AT diagnosis.
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Affiliation(s)
- Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan.
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Takamitsu Takagi
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Shin Meguro
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Kentaro Nakata
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Toshiki Michishita
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yuhei Isonaga
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Toshikazu Kono
- Department of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Shinichi Tachibana
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Ohya
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Kazuya Murata
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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3
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Bouyer B, Derval N, Pambrun T, Tixier R, Arnaud M, Buliard S, Chauvel R, Marchand H, Bouteiller X, Vlachos K, Ascione C, Yokoyama M, Kowalewski C, Hocini M, Jaïs P, Sacher F, Haïssaguerre M, Duchateau J. Local VA index for the differential diagnosis of supraventricular tachycardia. Heart Rhythm 2024; 21:828-835. [PMID: 38286245 DOI: 10.1016/j.hrthm.2024.01.042] [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: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Differentiating between atypical atrioventricular nodal reentrant tachycardia (AVNRT) and orthodromic reciprocating tachycardia utilizing a septal accessory pathway is a complex challenge. OBJECTIVE The purpose of this study was to describe the "local VA index," a straightforward method based on signals from the coronary sinus catheter, to distinguish between these arrhythmias during tachycardia and entrainment. The ventriculoatrial (VA) interval on the coronary sinus catheter is measured during tachycardia and entrainment, at the site of earliest atrial activity. The difference between these 2 situations defines the "local VA index." We also propose a mechanism to clarify the limitations of historical pacing maneuvers, such as postpacing interval minus tachycardia cycle length (PPI-TCL) and stimulus-atrial interval minus ventriculoatrial interval (SA-VA), by examining nodal decrement and intraventricular conduction delay. METHODS In a retrospective study of 75 patients referred for supraventricular tachycardia evaluation, 37 were diagnosed with atrioventricular reentrant tachycardia (AVRT) with orthodromic reciprocating tachycardia, and 38 with AVNRT (27 typical, 11 atypical). RESULTS In comparison to AVRT patients, AVNRT patients exhibited longer PPI-TCL (176 ± 47 ms vs 113 ± 42 ms; P <.01) and SA-VA (138 ± 47 ms vs 64 ± 28 ms; P <.01). The AVRT group had mean local VA index of -1 ± 13 ms, whereas the AVNRT group had a significantly longer index of 91 ± 46 ms (P <.01). An optimal threshold for differentiation was a local VA index of 40 ms. Importantly, there was no significant correlation between pacing cycle length and nodal decrement as well as intraventricular delay related to pathway location. This interindividual variability might explain misleading interpretations of PPI-TCL and SA-VA. CONCLUSION This novel approach is advantageous because of its simplicity and effectiveness, requiring only 2 diagnostic catheters. A local VA interval difference <40 ms provides a clear distinction for AVRT.
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Affiliation(s)
- Benjamin Bouyer
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France.
| | - Nicolas Derval
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Romain Tixier
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Marine Arnaud
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Samuel Buliard
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Hugo Marchand
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Xavier Bouteiller
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Ciro Ascione
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Masaaki Yokoyama
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Christopher Kowalewski
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Pessac, France; IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Université de Bordeaux, Pessac, France
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4
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Takahashi K, Kuwahara T, Makita T, Ito Y, Oyagi Y, Kadono K, Oshio T, Takahashi R. A novel approach to typical atrioventricular nodal reentrant tachycardia with high-resolution mapping using the CARTO 3 cardiac mapping system. J Interv Card Electrophysiol 2024; 67:807-816. [PMID: 37930505 DOI: 10.1007/s10840-023-01688-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND We hypothesized that high-resolution activation mapping during sinus rhythm (SR) in Koch's triangle (KT) can be used to describe the most delayed atrial potential around the atrioventricular node and evaluated whether ablation targeting of this potential is safe and effective for the treatment of patients with typical atrioventricular nodal reentrant tachycardia (AVNRT). METHODS We conducted a prospective, non-randomized, observational study using high-resolution activation mapping from the sinus node to KT with a PENTARAY or OCTARAY catheter using the CARTO 3 cardiac mapping system (Biosense Webster) during SR in 62 consecutive patients (22 men; age [mean ± standard deviation] = 55 ± 14 years) treated for typical AVNRT at our institution from August 2021 to March 2023. RESULTS In all cases, the most delayed atrial potential was observed near the His potential within KT. Ablation targeting of this potential helped successfully treat each case of AVNRT, with a junctional rhythm observed at the ablation site. Initial ablation was deemed successful in 55/62 patients (89%); in the remaining seven patients, lesion expansion resolved AVNRT. One procedural complication occurred, namely, a transient atrioventricular block lasting 45 s. One patient experienced a transient tachycardic episode by the 1-month follow-up, but no further episodes were noted up to the 1-year follow-up. CONCLUSION Activation mapping at KT during SR with the high-resolution CARTO system clearly revealed the most delayed atrial potential near the His potential within KT. Targeting this potential was a safe and effective treatment method for patients with typical AVNRT in our study.
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Affiliation(s)
- Kenta Takahashi
- Department of Cardiology, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan.
| | - Taishi Kuwahara
- Department of Cardiology, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan
| | - Toshio Makita
- Department of Cardiology, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan
| | - Yayoi Ito
- Department of Clinical Engineering and Nursing, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan
| | - Yoshimi Oyagi
- Department of Clinical Engineering and Nursing, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan
| | - Kenta Kadono
- Department of Clinical Engineering and Nursing, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan
| | - Takuya Oshio
- Department of Clinical Engineering and Nursing, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan
| | - Ryo Takahashi
- Department of Clinical Engineering and Nursing, Tokyo Heart Rhythm Clinic, 3-20-1 Kasuya, Setagaya-ku, Tokyo, 157-0063, Japan
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5
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Enriquez A, Gonzalez R, Kumareswaran R, Supple G, Scheinman M. Electrophysiologic diagnosis of narrow and wide complex tachyarrhythmias. Heart Rhythm 2024:S1547-5271(24)02552-9. [PMID: 38734227 DOI: 10.1016/j.hrthm.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
Establishing the precise mechanism of cardiac arrhythmias in the electrophysiology laboratory is one of the main requisites for a successful and safe ablation. This article provides an organized approach to the differential diagnosis of narrow and wide complex tachycardias based on the analysis of electrical activation patterns, followed by specific pacing maneuvers in each case.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Ramanan Kumareswaran
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory Supple
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melvin Scheinman
- Division of Electrophysiology, Department of Cardiology, University of California San Francisco, San Francisco, California
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6
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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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7
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Manickavasagam A, Ahmed J, Patloori SCS, Chase D, Roshan J. Reoccurrence isn't coincidence: Repeated tachycardia termination with His refractory VPD. What is the mechanism? J Cardiovasc Electrophysiol 2024; 35:498-500. [PMID: 38178361 DOI: 10.1111/jce.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Affiliation(s)
| | - Javaid Ahmed
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - David Chase
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Roshan
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
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8
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Nagase M, Nakashima T, Nakatani Y, Vlachos K, Morimoto M, Shibahara T, Ono D, Yamada T, Suzuki K, Yamaura M, Ido T, Takahashi S, Aoyama T. Demonstration of differential ventricular overdrive pacing during long RP' supraventricular tachycardia. Pacing Clin Electrophysiol 2024; 47:45-48. [PMID: 38041801 DOI: 10.1111/pace.14895] [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: 10/28/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
We described the differential ventricular overdrive pacing during long RP' supraventricular tachycardia and discussed about its response leading to the dianosis.
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Affiliation(s)
- Masaru Nagase
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takashi Nakashima
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Yosuke Nakatani
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Konstantinos Vlachos
- IHU LIRYC ANR-10-IAHU-04, Centre Hospitalier Universitaire Bordeaux, Bordeaux University, Bordeaux, France
| | - Mikihito Morimoto
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Taro Shibahara
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Daiju Ono
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Keita Suzuki
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Makoto Yamaura
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Takahisa Ido
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shigekiyo Takahashi
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takuma Aoyama
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
- Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
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9
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Mizutani A, Okada M, Miyazaki N, Tanaka K, Tanaka N. Discrepant results of the total pacing prematurity in orthodromic reciprocating tachycardia with right bundle branch block. J Arrhythm 2023; 39:973-976. [PMID: 38045448 PMCID: PMC10692847 DOI: 10.1002/joa3.12933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 12/05/2023] Open
Abstract
The total pacing prematurity (TPP) is useful for distinguishing orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal re-entrant tachycardia, but it may not be effective in patients with right bundle branch block (RBBB). We faced this challenge in an elderly woman, as RBBB and a prolonged transseptal conduction made it difficult to diagnose the tachycardia using the TPP. It is important to consider the presence or absence of RBBB when evaluating the results of the TPP.
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Affiliation(s)
| | - Masato Okada
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Naoko Miyazaki
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Koji Tanaka
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Nobuaki Tanaka
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
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10
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Higuchi S, Li R, Gerstenfeld EP, Liem LB, Im SI, Kalantarian S, Ansari M, Abreau S, Barrios J, Scheinman MM, Tison GH. Identification of supraventricular tachycardia mechanisms with surface electrocardiograms using a convolutional neural network. Heart Rhythm O2 2023; 4:491-499. [PMID: 37645266 PMCID: PMC10461210 DOI: 10.1016/j.hroo.2023.07.004] [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: 08/31/2023] Open
Abstract
Background It remains difficult to definitively distinguish supraventricular tachycardia (SVT) mechanisms using a 12-lead electrocardiogram (ECG) alone. Machine learning may identify visually imperceptible changes on 12-lead ECGs and may improve ability to determine SVT mechanisms. Objective We sought to develop a convolutional neural network (CNN) that identifies the SVT mechanism according to the gold standard of SVT ablation and to compare CNN performance against experienced electrophysiologists among patients with atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular reciprocating tachycardia (AVRT), and atrial tachycardia (AT). Methods All patients with 12-lead surface ECG during sinus rhythm and SVT and had successful SVT ablation from 2013 to 2020 were included. A CNN was trained using data from 1505 surface ECGs that were split into 1287 training and 218 test ECG datasets. We compared the CNN performance against independent adjudication by 2 experienced cardiac electrophysiologists on the test dataset. Results Our dataset comprised 1505 ECGs (368 AVNRT, 304 AVRT, 95 AT, and 738 sinus rhythm) from 725 patients. The CNN areas under the receiver-operating characteristic curve for AVNRT, AVRT, and AT were 0.909, 0.867, and 0.817, respectively. When fixing the specificity of the CNN to the electrophysiologist adjudicators' specificity, the CNN identified all SVT classes with higher sensitivity: (1) AVNRT (91.7% vs 65.9%), (2) AVRT (78.4% vs 63.6%), and (3) AT (61.5% vs 50.0%). Conclusion A CNN can be trained to differentiate SVT mechanisms from surface 12-lead ECGs with high overall performance, achieving similar performance to experienced electrophysiologists at fixed specificities.
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Affiliation(s)
- Satoshi Higuchi
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Roland Li
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Edward P. Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - L. Bing Liem
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
- Division of Cardiology, San Francisco VA Medical Center, San Francisco, California
| | - Sung Il Im
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Shadi Kalantarian
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Minhaj Ansari
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Sean Abreau
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Joshua Barrios
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Melvin M. Scheinman
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Geoffrey H. Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California
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11
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The Value of Programmed Ventricular Extrastimuli From the Right Ventricular Basal Septum During Supraventricular Tachycardia. JACC Clin Electrophysiol 2023; 9:219-228. [PMID: 36858688 DOI: 10.1016/j.jacep.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND The difference between the right ventricular (RV) apical stimulus-atrial electrogram (SA) interval during resetting of supraventricular tachycardia (SVT) versus the ventriculoatrial (VA) interval during SVT (ΔSA-VAapex) is an established technique for discerning SVT mechanisms but is limited by a significant diagnostic overlap. OBJECTIVES This study hypothesized that the difference between the RV SA interval during resetting of SVTs versus the VA interval during SVTs (ΔSA-VA) would yield a more robust differentiation of atrioventricular nodal re-entrant tachycardia (AVNRT) from atrioventricular reciprocating tachycardia (AVRT) when using the RV basal septal stimulation (ΔSA-VAbase) as compared to the RV apical stimulation (ΔSA-VAapex). Moreover, it was predicted that the ΔSA-VAbase might distinguish septal from free wall accessory pathways (APs) effectively. METHODS In this prospective study, 105 patients with AVNRTs (age 48 ± 20 years, 44% male) and 130 with AVRTs (age 26 ± 18 years, 54% male) underwent programmed ventricular extrastimuli delivered from both the RV basal septum and RV apex. The ΔSA-VA values were compared between the 2 sites. RESULTS The ΔSA-VAbase was shorter than the ΔSA-VAapex during AVRT (44 ± 30 ms vs 58 ± 29 ms; P < 0.001), and the opposite occurred during AVNRT (133 ± 31 ms vs 125 ± 25 ms; P = 0.03). A ΔSA-VAbase of ≧85 milliseconds had a sensitivity of 97% and specificity of 96% for identifying AVNRT. Furthermore, a ΔSA-VAbase of 45-85 milliseconds identified AVRT with left free wall APs (sensitivity 86%, specificity 95%), 20-45 milliseconds for posterior septal APs (sensitivity 72%, specificity 96%), and <20 milliseconds for right free wall or anterior/mid septal APs (sensitivity 86%, specificity 98%). CONCLUSIONS The ΔSA-VAbase during programmed ventricular extrastimuli produced a robust differentiation between AVNRT and AVRT regardless of the AP location with ≧85 milliseconds as an excellent cutoff point. This straightforward technique further allowed localizing 4 general AP sites.
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12
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Iwakawa H, Terata K, Abe Y, Watanabe H. Narrow QRS complex tachycardia with and without ventriculoatrial block: What is the mechanism? Heart Rhythm 2022; 19:1907-1909. [PMID: 35940461 DOI: 10.1016/j.hrthm.2022.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Hidehiro Iwakawa
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Ken Terata
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihisa Abe
- Department of Cardiovascular Medicine, Akita City Hospital, Akita, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan.
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13
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Hadid C, Celano L, Di Toro D, Antezana-Chavez E, Gallino S, Iralde G, Calvo D, Ávila P, Atea L, Gonzalez S, Maldonado S, Labadet C. Variability of the VA interval at tachycardia induction: a simple method to differentiate orthodromic reciprocating tachycardia from atypical atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2022; 66:637-645. [PMID: 36152135 DOI: 10.1007/s10840-022-01376-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The differential diagnosis between orthodromic atrioventricular reentry tachycardia (AVRT) and atypical AV nodal reentrant tachycardia (aAVNRT) is sometimes challenging. We hypothesize that aAVNRTs have more variability in the retrograde conduction time at tachycardia onset than AVRTs. METHODS We aimed to assess the variability in retrograde conduction time at tachycardia onset in AVRT and aAVNRT and to propose a new diagnostic tool to differentiate these two arrhythmia mechanisms. We measured the VA interval of the first beats after tachycardia induction until it stabilized. The difference between the maximum and minimum VA intervals (∆VA) and the number of beats needed for the VA interval to stabilize was analyzed. Atrial tachycardias were excluded. RESULTS A total of 107 patients with aAVNRT (n = 37) or AVRT (n = 64) were included. Six additional patients with decremental accessory pathway-mediated tachycardia (DAPT) were analyzed separately. All aAVNRTs had VA interval variability. The median ∆VA was 0 (0 - 5) ms in AVRTs vs 40 (21 - 55) ms in aAVNRTs (p < 0.001). The VA interval stabilized significantly earlier in AVRTs (median 1.5 [1 - 3] beats) than in aAVNRTs (5 [4 - 7] beats; p < 0.001). A ∆VA < 10 ms accurately differentiated AVRT from aAVNRT with 100% of sensitivity, specificity, and positive and negative predictive values. The stabilization of the VA interval at < 3 beats of the tachycardia onset identified AVRT with sensitivity, specificity, and positive and negative predictive values of 64.1%, 94.6%, 95.3%, and 60.3%, respectively. A ∆VA < 20 ms yielded good diagnostic accuracy for DAPT. CONCLUSIONS A ∆VA < 10 ms is a simple and useful criterion that accurately distinguished AVRT from atypical AVNRT. Central panel: Scatter plot showing individual values of ∆VA in atypical AVNRT and AVRT. Left panel: induction of atypical AVNRT. The VA interval stabilizes at the 5th beat and the ∆VA is 62 ms (maximum VA interval: 172 ms - minimum VA interval: 110 ms). Right panel: induction of AVRT. The tachycardia has a fixed VA interval from the first beat. ∆VA is 0 ms.
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Affiliation(s)
- Claudio Hadid
- Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, 1155, Ciudad Autónoma de Buenos Aires, Argentina. .,Hospital Universitario CEMIC, Ciudad Autónoma de Buenos Aires, Argentina. .,Sanatorio Garat, Concordia, Entre Ríos, Argentina. .,Cardiovascular Chivilcoy, Chivilcoy, Buenos Aires, Argentina.
| | - Leonardo Celano
- Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, 1155, Ciudad Autónoma de Buenos Aires, Argentina.,Hospital Universitario CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Darío Di Toro
- Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, 1155, Ciudad Autónoma de Buenos Aires, Argentina.,Hospital Universitario CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Edgar Antezana-Chavez
- Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, 1155, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Gustavo Iralde
- Cardiovascular Chivilcoy, Chivilcoy, Buenos Aires, Argentina
| | - David Calvo
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria de Asturias, Oviedo, Spain
| | - Pablo Ávila
- Cardiology Department, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.,Centre for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid, Spain
| | | | | | | | - Carlos Labadet
- Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, 1155, Ciudad Autónoma de Buenos Aires, Argentina.,Hospital Universitario CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
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14
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Last Entrainment Sequence. JACC Clin Electrophysiol 2022; 8:1289-1300. [DOI: 10.1016/j.jacep.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 07/03/2022] [Indexed: 11/24/2022]
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15
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Donnelly J, Gabriels J, Bhatia NK, Lloyd MS, El-Chami MF, Merchant FM. Diagnostic Pacing Maneuvers for Supraventricular Tachycardia Discrimination: a Taxonomic Approach. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00961-6] [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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16
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Kawada S, Nishii N, Asada S, Nakagawa K, Morita H, Ito H. Successful ablation of a superior fast-slow atrioventricular reentrant tachycardia in a patient with congenitally corrected transposition of great arteries. HeartRhythm Case Rep 2021; 7:698-701. [PMID: 34712569 PMCID: PMC8530927 DOI: 10.1016/j.hrcr.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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17
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Viswanathan MN, Julie He B, Sung R, Hoffmayer KS, Badhwar N, Lee A, Goldberger JJ, Hsia HH, Jackman WM, Scheinman MM. Importance of the Activation Sequence of the His or Right Bundle for Diagnosis of Complex Tachycardia Circuits. Circ Arrhythm Electrophysiol 2021; 14:e009194. [PMID: 34601885 DOI: 10.1161/circep.120.009194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review, we emphasize the unique value of recording the activation sequence of the His bundle or right bundle branch (RB) for diagnoses of various supraventricular and fascicular tachycardias. A close analysis of the His to RB (H-RB) activation sequence can help differentiate various forms of supraventricular tachycardias, namely atrioventricular nodal reentry tachycardia from concealed nodofascicular tachycardia, a common clinical dilemma. Furthermore, bundle branch reentry tachycardia and fascicular tachycardias often are included in the differential diagnosis of supraventricular tachycardia with aberrancy, and the use of this technique can help the operator make the distinction between supraventricular tachycardias and these other forms of ventricular tachycardias using the His-Purkinje system. We show that this technique is enhanced by the use of multipolar catheters placed to span the proximal His to RB position to record the activation sequence between proximal His potential to the distal RB potential. This allows the operator to fully analyze the activation sequence in sinus rhythm as compared to that during tachycardia and may help target ablation of these arrhythmias. We argue that 3 patterns of H-RB activation are commonly identified-the anterograde H-RB pattern, the retrograde H-RB (right bundle to His bundle) pattern, and the chevron H-RB pattern (simultaneous proximal His and proximal RB activation)-and specific arrhythmias tend to be associated with specific H-RB activation sequences. We show that being able to record and categorize this H-RB relationship can be instrumental to the operator, along with standard pacing maneuvers, to make an arrhythmia diagnosis in complex tachycardia circuits. We highlight the importance of H-RB activation patterns in these complex tachycardias by means of case illustrations from our groups as well as from prior reports.
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Affiliation(s)
| | - Beixin Julie He
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | | | | | - Nitish Badhwar
- Stanford University School of Medicine, CA (M.N.V., N.B.)
| | - Adam Lee
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | | | - Henry H Hsia
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
| | - Warren M Jackman
- University of Oklahoma School of Medicine, Oklahoma City (W.M.J.)
| | - Melvin M Scheinman
- University of California, San Francisco, CA (B.J.H., A.L., H.H.H., M.M.S.)
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18
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Iravanian S, Uzelac I, Kaboudian A, Langberg J, Fenton F. A Network-based Cardiac Electrophysiology Simulator with Realistic Signal Generation and Response to Pacing Maneuvers. COMPUTING IN CARDIOLOGY 2021; 48:10.23919/cinc53138.2021.9662834. [PMID: 35754518 PMCID: PMC9228610 DOI: 10.23919/cinc53138.2021.9662834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Diagnosis and localization of cardiac arrhythmias, especially supraventricular tachycardia (SVT), by inspecting intracardiac signals and performing pacing maneuvers is the core of electrophysiology studies. Acquiring and maintaining complex skill sets can be facilitated by using simulators, allowing the operator to practice in a safe and controlled setting. An electrophysiology simulator should not only display arrhythmias but it has to respond to the user's arbitrary inputs. While, in principle, it is possible to model the heart using a detailed anatomical and cellular model, such a system would be unduly complex and computationally intensive. In this paper, we describe a freely available web-based electrophysiology simulator (http://svtsim.com), which is composed of a visualization/interface unit and a heart model based on a dynamical network. In the network, nodes represent the points of interest, such as the sinus and the atrioventricular nodes, and links model the conduction system and pathways. The dynamics are encoded explicitly in the state machines attached to the nodes and links. Simulated intracardiac signals and surface ECGs are generated from the internal state of the heart model. Reentrant tachycardias, especially various forms of SVT, can emerge in this system in response to the user's actions in the form of pacing maneuvers. Additionally, the resulting arrhythmias respond realistically to various inputs, such as overdrive pacing and delivery of extra stimuli, cardioversion, ablation, and infusion of medications. For nearly a decade, svtsim.com has been used successfully to train electrophysiology practitioners in many institutions. We will present our experience regarding best practices in designing and using electrophysiology simulators for training and testing. We will also discuss the current trends in clinical cardiac electrophysiology and the anticipated next generation electrophysiology simulators.
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Affiliation(s)
| | - Ilija Uzelac
- School of Physics, Georgia Tech, Atlanta, GA, USA
| | | | | | - Flavio Fenton
- Division of Cardiology, Emory University, Atlanta, GA, USA
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19
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Kupó P, Tutuianu CI, Kaninski G, Gingl Z, Sághy L, Pap R. Limitations of ventricular pacing maneuvers to differentiate orthodromic reciprocating tachycardia from atrioventricular nodal reentry tachycardia. J Interv Card Electrophysiol 2021; 63:323-331. [PMID: 33871788 DOI: 10.1007/s10840-021-00993-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Various ventricular pacing maneuvers have been developed to differentiate orthodromic reciprocating tachycardia (ORT) from atrioventricular nodal reentry tachycardia (AVNRT). We aimed to evaluate the diagnostic value of ventricular pacing maneuvers in patients undergoing catheter ablation for AVNRT/ORT. METHODS Sixty patients with supraventricular tachycardia (SVT) undergoing invasive EP study were included (ORT: 31, typical AVNRT: 18, atypical AVNRT: 11). Ventricular overdrive pacing (VOP) and resetting by premature ventricular stimulation (PVS) during SVT were analyzed by 3 independent observers blinded to the ultimate diagnosis. We determined intraclass correlation coefficient (ICC) for interobserver agreement and the diagnostic accuracy of consensual results. RESULTS Although specificity of all parameters was high (96-100%) for ORT, semi-quantitative parameters of VOP (requiring the recognition of specific ECG patterns) had lower interobserver reliability (ICC: 0.32-0.66) and sensitivity (16.1-77.4%). In contrast, most quantitative measurements of VOP and PVS showed good reproducibility (ICC: 0.93-0.95) and sensitivity (74.2-89.3%), but post-pacing interval after VOP needed correction with AV nodal conduction slowing. False negative results for diagnosing ORT were more common with left free wall vs. right free wall or septal, and slowly vs. fast-conducting septal APs. False positivity was only seen with a bystander, concealed nodo-fascicular/nodo-ventricular (NF/NV) AP in a case of AVNRT. CONCLUSIONS No single maneuver is 100% sensitive for ORT. Semi-quantitative features have limited reproducibility and all parameters can be misleading in the case of rate-dependent delay during VOP/PVS, ORT circuits remote from the pacing site, or a bystander, concealed NF/NV AP.
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Affiliation(s)
- Péter Kupó
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary.
| | - Cristina Ioana Tutuianu
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Genadi Kaninski
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Zoltán Gingl
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - László Sághy
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
| | - Róbert Pap
- 2nd Department of Internal Medicine and Cardiology Centre, Medical School, University of Szeged, Semmelweis u. 8, Szeged, H-6725, Hungary
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20
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Hayashi T, Mizukami A, Kuroda S, Tateishi R, Kanehama N, Tachibana S, Hayasaka K, Hiroki J, Arai H, Yoshioka K, Iwatsuka R, Ueshima D, Matsumura A, Goya M, Sasano T. Outcomes of deep sedation for catheter ablation of paroxysmal supraventricular tachycardia, with adaptive servo ventilation. J Arrhythm 2021; 37:33-42. [PMID: 33664884 PMCID: PMC7896470 DOI: 10.1002/joa3.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is an established treatment, but the effect of deep sedation on PSVT inducibility remains unclear. AIM We sought to examine PSVT inducibility and outcomes of catheter ablation under deep sedation using adaptive servo ventilation (ASV). METHODS We retrospectively evaluated consecutive patients who underwent catheter ablation for PSVT under deep sedation (Propofol + Dexmedetomidine) with use of ASV. Anesthetic depth was controlled with BIS™ monitoring, and phenylephrine was administered to prevent anesthesia-induced hypotension. PSVT induction was attempted in all patients using extrastimuli at baseline, and after isoproterenol (ISP) infusion when necessary. RESULTS PSVT was successfully induced in 145 of 147 patients, although ISP infusion was required in the majority (89%). The PSVT was atrioventricular nodal reentrant tachycardia (AVNRT) in 77 (53%), atrioventricular reciprocating tachycardia (AVRT) in 51 (35%), and atrial tachycardia (AT) in 17 (12%). A higher ISP dose was required for AT compared to other PSVT (AVNRT: 0.06 (IQR 0.03-0.06) vs AVRT: 0.03 (0.02-0.06) vs AT: 0.06 (0.03-0.12) mg/h, P = .013). More than half (51%) of the patients developed hypotension requiring phenylephrine; these patients were older. Acute success was obtained in 99% (patients with AVNRT had endpoints with single echo on ISP in 46%). Long-term success rate was 136 of 144 (94%) (AVNRT 96%, AVRT 92%, and AT 93%). There were no complications related to deep sedation. CONCLUSIONS Deep sedation with use of ASV is a feasible anesthesia strategy for catheter ablation of PSVT with good long-term outcome. PSVT remains inducible if ISP is used.
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Affiliation(s)
- Tatsuya Hayashi
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
- Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Akira Mizukami
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Shunsuke Kuroda
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Ryo Tateishi
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Nozomu Kanehama
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | | | - Kazuto Hayasaka
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Jiro Hiroki
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Hirofumi Arai
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Kenji Yoshioka
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Ryota Iwatsuka
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Daisuke Ueshima
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | | | - Masahiko Goya
- Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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21
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Zhang X, Fan D, Srivatsa UN, Oesterle A. Implantable cardioverter-defibrillator shocks due to tachycardia with more atrial depolarizations than ventricular depolarizations with a far-field ventricular morphology shift: What is the mechanism? HeartRhythm Case Rep 2021; 7:59-62. [PMID: 33505858 PMCID: PMC7813785 DOI: 10.1016/j.hrcr.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Xin Zhang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Dali Fan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Adam Oesterle
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, Sacramento, California
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22
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Nagashima K, Kaneko Y, Maruyama M, Nogami A, Kowase S, Mori H, Sumitomo N, Fukamizu S, Hojo R, Kitamura T, Soejima K, Ueda A, Otsuka T, Takami M, Tanimoto K, Asakawa T, Kumagai K, Tamura S, Hasegawa H, Ogura K, Kawamura M, Munetsugu Y, Shoda M, Higuchi S, Kanazawa H, Kusa S, Mizukami A, Miyazaki S, Wakamatsu Y, Okumura Y. Novel Diagnostic Observations of Nodoventricular/Nodofascicular Pathway-Related Orthodromic Reciprocating Tachycardia Differentiating From Atrioventricular Nodal Re-Entrant Tachycardia. JACC Clin Electrophysiol 2020; 6:1797-1807. [PMID: 33357576 DOI: 10.1016/j.jacep.2020.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT). BACKGROUND Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging. METHODS We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference). RESULTS More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT. CONCLUSIONS Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT.
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Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ibaraki, Tokyo, Japan.
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashikosugi Hospital, Tokyo, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Shinya Kowase
- Department of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Hitoshi Mori
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Shibuya, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Shibuya, Tokyo, Japan
| | - Takeshi Kitamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Shibuya, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Akiko Ueda
- Division of Advance Arrhythmia Management, Kyorin University Hospital, Mitaka, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Kobe, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, Tokyo Medical Center, Tokyo, Japan
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Kenta Kumagai
- Department of Cardiology, Odawara Cardiovascular Hospital, Odawara, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kazuyoshi Ogura
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Mitsuharu Kawamura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yumi Munetsugu
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisanori Kanazawa
- Department of Cardiac Arrhythmias, Kumamoto University Hospital, Kumamoto, Japan
| | - Shigeki Kusa
- Division of Cardiology, Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - Akira Mizukami
- Department of Cardiology, Kameda Medical Center, Kamagawa, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ibaraki, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Ibaraki, Tokyo, Japan
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Zhang X, Yang R, Di Biase L. An irregular narrow complex tachycardia. J Cardiovasc Electrophysiol 2020; 32:151-155. [PMID: 33205527 DOI: 10.1111/jce.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaodong Zhang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ruike Yang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Division of Cardiology, Department of Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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24
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Romero J, Diaz JC, Alviz I, Bello J, Purkayastha S, Velasco A, Andrea Natale, Di Biase L. Methodology of Typical Accessory Pathway Catheter Ablation. Card Electrophysiol Clin 2020; 12:541-553. [PMID: 33162002 DOI: 10.1016/j.ccep.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Accessory pathways are abnormal electrical conductions between the atrial and ventricular myocardium, bypassing the atrioventricular node and as such are an important substrate for arrhythmias. Ablation is a curative treatment and should always be offered to symptomatic patients and asymptomatic patients with high risk professions. Adequate knowledge and understanding of different mapping and ablation techniques is pivotal to achieve successful outcomes.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Juan Carlos Diaz
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Isabella Alviz
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Juan Bello
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Sutopa Purkayastha
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Alejandro Velasco
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St Davids Medical Center, 919 East 32nd Street, Austin, TX 78705, USA
| | - Luigi Di Biase
- Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA; Texas Cardiac Arrhythmia Institute at St Davids Medical Center, 919 East 32nd Street, Austin, TX 78705, USA.
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25
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Chan WK, Skanes A, Klein GJ. V‐A‐A‐V response to ventricular entrainment: What is the mechanism of this SVT? J Cardiovasc Electrophysiol 2020; 31:3028-3030. [DOI: 10.1111/jce.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- William K. Chan
- Arrhythmia Service University Hospital, University of Western Ontario, London Health Sciences Centre London Ontario Canada
| | - Allan Skanes
- Arrhythmia Service University Hospital, University of Western Ontario, London Health Sciences Centre London Ontario Canada
| | - George J. Klein
- Arrhythmia Service University Hospital, University of Western Ontario, London Health Sciences Centre London Ontario Canada
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26
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Oesterle A, Lee AC, Voskoboinik A, Moss JD, Vedantham V, Walters TE, Lee BK, Tseng ZH, Gerstenfeld EP, Scheinman MM. Electrophysiologic approach to diagnosis and ablation of patients with permanent junctional reciprocating tachycardia associated with complex anatomy and/or physiology. J Cardiovasc Electrophysiol 2020; 31:3232-3242. [PMID: 33107135 DOI: 10.1111/jce.14788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Permanent junctional reciprocating tachycardia (PJRT) is a rare supraventricular tachycardia (SVT), typically involving a single decremental posteroseptal accessory pathway (AP). METHODS Four patients with long RP SVT underwent electrophysiology (EP) study and ablation. The cases were reviewed. RESULTS Case 1 recurred despite 3 prior ablations at the site of earliest retrograde atrial activation during orthodromic reciprocating tachycardia (ORT). Mapping during a repeat EP study demonstrated a prepotential in the coronary sinus (CS). Ablation over the earliest atrial activation in the CS resulted in dissociation of the potential from the atrium during sinus rhythm. The potential was traced back to the CS os and ablated. Case 2 underwent successful ablation at 6 o'clock on the mitral annulus (MA). ORT recurred and successful ablation was performed at 1 o'clock on the MA. Case 3 had tachycardia with variation in both V-A and A-H intervals which precluded the use of usual maneuvers so we used simultaneous atrial and ventricular pacing and introduced a premature atrial contraction with a closely coupled premature ventricular contraction. Case 4 had had two prior atrial fibrillation ablations with continued SVT over a decremental atrioventricular bypass tract that was successfully ablated at 5 o'clock on the tricuspid annulus. A second SVT consistent with a concealed nodoventricular pathway was successfully ablated at the right inferior extension of the AV nodal slow pathway. CONCLUSION We describe challenging cases of PJRT by virtue of complex anatomy, diagnostic features, and multiple arrhythmia mechanisms.
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Affiliation(s)
- Adam Oesterle
- Division of Cardiovascular Medicine, Department of Medicine, University of California Davis, Sacramento, California, USA
| | - Adam C Lee
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Aleksandr Voskoboinik
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joshua D Moss
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Vasanth Vedantham
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Tomos E Walters
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Byron K Lee
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward P Gerstenfeld
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Melvin M Scheinman
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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27
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Ortman M, Ho RT. Reply to the Editor-Differentiation of atrioventricular nodal reentrant tachycardia and nodofascicular reentrant tachycardia. Heart Rhythm 2020; 17:2021-2022. [PMID: 32526350 DOI: 10.1016/j.hrthm.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Matthew Ortman
- Division of Cardiology, Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey.
| | - Reginald T Ho
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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28
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Letter to the Editor-Differentiation of atrioventricular nodal reentrant tachycardia and nodofascicular reentrant tachycardia. Heart Rhythm 2020; 17:2021. [PMID: 32526352 DOI: 10.1016/j.hrthm.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
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29
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Weiss M, Ho RT. Pathophysiology, Diagnosis, and Ablation of Atrioventricular Node-dependent Long-R-P Tachycardias. J Innov Card Rhythm Manag 2020; 11:4046-4053. [PMID: 32368379 PMCID: PMC7192137 DOI: 10.19102/icrm.2020.110306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/17/2019] [Indexed: 11/15/2022] Open
Abstract
Atrioventricular (AV) node–dependent long-R–P tachycardias are a unique group of supraventricular tachycardias that include atypical AV nodal reentrant tachycardia (AVNRT), atypical AVNRT with a concealed bystander nodofascicular (NF)/nodoventricular (NV) accessory pathway inserting into the slow pathway of the AV node, the permanent form of junctional reciprocating tachycardia, and orthodromic NF/NV reciprocating tachycardia. Here, we discuss the complex pathophysiology, diagnosis, and ablation of these intriguing arrhythmias.
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Affiliation(s)
- Max Weiss
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Reginald T Ho
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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30
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Cardona-Guarache R, Han FT, Nguyen DT, Chicos AB, Badhwar N, Knight BP, Johnson CJ, Heaven D, Scheinman MM. Ablation of Supraventricular Tachycardias From Concealed Left-Sided Nodoventricular and Nodofascicular Accessory Pathways. Circ Arrhythm Electrophysiol 2020; 13:e007853. [DOI: 10.1161/circep.119.007853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Nodoventricular and nodofascicular accessory pathways (AP) are uncommon connections between the atrioventricular node and the fascicles or ventricles.
Methods:
Five patients with nodofascicular or nodoventricular tachycardia were studied.
Results:
We identified 5 patients with concealed, left-sided nodoventricular (n=4), and nodofascicular (n=1) AP. We proved the participation of AP in tachycardia by delivering His-synchronous premature ventricular contractions that either delayed the subsequent atrial electrogram or terminated the tachycardia (n=3), and by observing an increase in VA interval coincident with left bundle branch block (n=2). The APs were not atrioventricular pathways because the septal VA interval during tachycardia was <70 ms in 3, 1 had spontaneous atrioventricular dissociation, and in 1 the atria were dissociated from the circuit with atrial overdrive pacing. Entrainment from the right ventricle showed ventricular fusion in 4 out of 5 cases. A left-sided origin of the AP was suspected after failed ablation of the right inferior extension of atrioventricular node in 3 cases and by observing a VA increase with left bundle branch block in 2 cases. The nodofascicular and 3 of the nodoventricular AP were successfully ablated from within the proximal coronary sinus (CS) guided by recorded potentials at the roof of the CS, and 1 nodoventricular AP was ablated via a transseptal approach near the CS os.
Conclusions:
Left-sided nodofascicular and nodoventricular AP appear to connect the ventricles with the CS musculature in the region of the CS os. Mapping and successful ablation sites can be guided by recording potentials within or near the CS os.
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Affiliation(s)
- Ricardo Cardona-Guarache
- Division of Cardiology, University of California San Francisco, San Francisco, CA (R.C.-G., M.M.S.)
| | - Frederick T. Han
- Division of Cardiology, University of California San Diego, La Jolla (F.T.H.)
| | - Duy T. Nguyen
- Division of Cardiology, Stanford University, Palo Alto, CA (D.T.N., N.B.)
| | - Alexandru B. Chicos
- Division of Cardiology, Northwestern University, Chicago, IL (A.B.C., B.P.K.)
| | - Nitish Badhwar
- Division of Cardiology, Stanford University, Palo Alto, CA (D.T.N., N.B.)
| | - Bradley P. Knight
- Division of Cardiology, Northwestern University, Chicago, IL (A.B.C., B.P.K.)
| | | | - David Heaven
- Division of Cardiology, Middlemore Hospital, Auckland, NZ (D.H.)
| | - Melvin M. Scheinman
- Division of Cardiology, University of California San Francisco, San Francisco, CA (R.C.-G., M.M.S.)
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31
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Nagashima K, Wakamatsu Y, Otsuka N, Okumura Y. His bundle activation during ventricular pacing in long RP tachycardia: What is the mechanism? J Cardiovasc Electrophysiol 2020; 31:1557-1559. [PMID: 32314839 DOI: 10.1111/jce.14506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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32
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Ortman M, Collins JA, Spivack T, Ho RT. An unusual supraventricular tachycardia with discrepant findings: What is the mechanism? Heart Rhythm 2020; 17:669-671. [DOI: 10.1016/j.hrthm.2019.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 11/26/2022]
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33
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Elbatran AI. Response to right ventricular pacing maneuvers for the differential diagnosis of supraventricular tachycardia. Pacing Clin Electrophysiol 2019; 42:1418. [DOI: 10.1111/pace.13785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ahmed I. Elbatran
- Cardiology Clinical Academic GroupSt. George's University Hospitals NHS Foundation TrustSt. George's University of London London UK
- Department of CardiologyAin Shams University Cairo Egypt
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34
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Wakamatsu Y, Nagashima K, Watanabe R, Arai M, Otsuka N, Yagyu S, Kurokawa S, Ohkubo K, Nakai T, Okumura Y. Novel V-V-A response after right ventricular entrainment pacing for narrow QRS tachycardia: What is the mechanism? J Cardiovasc Electrophysiol 2019; 30:2528-2530. [PMID: 31433092 DOI: 10.1111/jce.14131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Seina Yagyu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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35
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Elbatran AI, Zarif JK, Tawfik M. Anterograde His bundle activation during right ventricular overdrive pacing in supraventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1374-1382. [DOI: 10.1111/pace.13779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/31/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmed I. Elbatran
- Department of CardiologyAin Shams University Cairo Egypt
- Cardiology Clinical Academic GroupSt. George's University Hospitals NHS Foundation Trust, St. George's University of London London UK
| | - John K. Zarif
- Department of CardiologyAin Shams University Cairo Egypt
| | - Mazen Tawfik
- Department of CardiologyAin Shams University Cairo Egypt
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36
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Kaiser DW, Nasir JM, Liem LB, Brodt C, Motonaga KS, Ceresnak SR, Turakhia MP, Dubin AM. A novel pacing maneuver to verify the postpacing interval minus the tachycardia cycle length while adjusting for decremental conduction: Using "dual-chamber entrainment" for improved supraventricular tachycardia discrimination. Heart Rhythm 2019; 16:717-723. [PMID: 30465902 PMCID: PMC8648137 DOI: 10.1016/j.hrthm.2018.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (eg, failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI-TCL challenging. OBJECTIVE The purpose of this study was to investigate a novel maneuver to confirm the PPI-TCL value without using either the ventricular PPI or the TCL interval and to assess the ability of this maneuver to identify decremental conduction and differentiate supraventricular tachycardias. METHODS We analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female) who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated the PPI-TCL, the AH-corrected PPI-TCL, and estimated the PPI-TCL using "dual-chamber entrainment" calculated as [PPIV - TCL = Stim(A→V) + Stim(V→A) - PPIA]. RESULTS The PPI-TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI-TCL (R2 = 0.79 and 0.96, respectively; P <.001]. A dual-chamber entrainment PPI-TCL value of 80 ms correctly differentiated all AVNRT from septal ORT cases, whereas the standard PPI-TCL and AH-corrected PPI-TCL methods were incorrect in 14% and 6% of cases, respectively. Dual-chamber entrainment identified 3 ± 10 ms of additional decremental conduction beyond AH prolongation, including 4 pathways with significant (>10 ms) decrement. CONCLUSION Dual-chamber entrainment estimates the PPI-TCL value without using either the ventricular PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including within concealed pathways, where a dual-chamber entrainment PPI-TCL value >80 ms favors AVNRT over ORT. This maneuver can be used to verify the observed PPI-TCL value in challenging cases.
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Affiliation(s)
- Daniel W Kaiser
- El Camino Hospital, Mountain View, California; St Helena Hospital, St Helena, California.
| | - Javed M Nasir
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - L Bing Liem
- El Camino Hospital, Mountain View, California; St Helena Hospital, St Helena, California
| | - Chad Brodt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kara S Motonaga
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Scott R Ceresnak
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Mintu P Turakhia
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Anne M Dubin
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Cunha Guerra M, Lokhandwala Y, Oyarzun R, Vyas A, Soares Correa F, Cruz Filho FE, J Wellens H, Back Sternick E. When and how does a single ventricular premature beat initiate and terminate supraventricular tachycardia? Ann Noninvasive Electrocardiol 2019; 24:e12650. [PMID: 30993813 DOI: 10.1111/anec.12650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The differential diagnosis of a supraventricular tachycardia (SVT) is accomplished using a number of pacing maneuvers. The incidence and mechanism of a single ventricular premature beat (VPB) on initiation and termination of tachycardia were evaluated during programmed electrical stimulation (PES) of the heart in patients with the two most common regular SVTs: atrioventricular re-entrant tachycardia (AVNRT) and orthodromic atrioventricular tachycardia (AVRT). METHODS Three hundred and thirty-seven consecutive patients aged above 18 years with an inducible sustained AVNRT or AVRT were prospectively enrolled. Patients with more than one tachyarrhythmia mechanism were excluded. Two hundred and seventeen patients (64.4%) had typical slow/fast AVNRT and 120 (35.6%) had an orthodromic AVRT using a rapidly conducting accessory pathway for V-A conduction. In this cross-sectional study, we specifically report the analysis of tachycardia induction and termination by a single VPB. RESULTS Tachycardia induction with a single VPB during sinus rhythm was seen in 7 of 120 AVRT and in only one of the 217 patients with AVNRT, (5.8% vs. 0.3%, p < 0.05). When a single VPB was delivered during basic ventricular pacing these values were 28% versus 4%, respectively, (p < 0.001). Termination of tachycardia by a single VPB was observed in nine (4.1%) patients with AVNRT and in 57 (47.5%) with AVRT (p < 0.001). CONCLUSION Initiation of SVT by a single VPB during sinus rhythm was uncommon and favored AVRT. Termination of SVT by a single VPB was commonly seen in AVRT but rarely in AVNRT. These findings can be of help when interpreting a noninvasive arrhythmia event recording.
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Affiliation(s)
| | | | | | | | | | | | - Hein J Wellens
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Faculdade Ciências Médicas, Ciências Médicas-MG, Belo Horizonte, Brazil.,Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Brazil
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Naniwadekar A, Joshi KR, Bhardwaj R, Whang W, Choudry S, Dukkipati S, Reddy VY. Septal accessory pathway and the value of para-Hisian entrainment. HeartRhythm Case Rep 2019; 5:78-79. [PMID: 30820401 PMCID: PMC6379302 DOI: 10.1016/j.hrcr.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Aditi Naniwadekar
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kamal R Joshi
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rahul Bhardwaj
- Loma Linda University Medical Center, Loma Linda, California
| | - William Whang
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Subbarao Choudry
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Srinivas Dukkipati
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Nakashima T, Takasugi N, Sahashi Y, Kubota T, Kawasaki M. Shift in the retrograde atrial activation sequence after radiofrequency catheter ablation in left variant atypical atrioventricular nodal reentrant tachycardia. J Electrocardiol 2018; 52:63-65. [PMID: 30476641 DOI: 10.1016/j.jelectrocard.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
The role of left AV nodal (SVN) connections in the genesis of "left-variant" atypical atrioventricular nodal reentrant tachycardia (AVNRT) and those with multiple retrograde pathways remain unclear. We describe an unusual case of "left-variant" atypical AVNRT, where change in the retrograde earliest atrial activation site (REAAS) at the coronary sinus (CS) following radiofrequency catheter ablation (RFCA) was observed. Our observation suggests that the REAAS, that is, the left AVN connections, could participate in the formation of the reentrant circuit of "left-variant" atypical AVNRT. Furthermore, its atrial breakthroughs involved as a circuit of SVT could be (functionally) multiple.
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Affiliation(s)
- Takashi Nakashima
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Nobuhiro Takasugi
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yuki Sahashi
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Tomoki Kubota
- Department of Cardiology, Gifu Municipal Hospital, 1-7 Kashimacho, Gifu 500-8513, Japan
| | - Masanori Kawasaki
- Department of Cardiology, Gifu University, Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
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40
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Calvo D, Pérez D, Rubín J, García D, Ávila P, Javier García-Fernández F, Pachón M, Bravo L, Hernández J, Miracle ÁL, Valverde I, Gozalez-Vasserot M, Árias MÁ, Jimenez-Candíl J, Morís C. Delta of the local ventriculo-atrial intervals at the septal location to differentiate tachycardia using septal accessory pathways from atypical atrioventricular nodal re-entry. Europace 2018; 20:1638-1646. [PMID: 29300867 DOI: 10.1093/europace/eux368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/05/2017] [Indexed: 12/13/2022] Open
Abstract
Aims Tachycardia mediated by septal accessory pathways (AP) and atypical atrioventricular nodal re-entry (AVNRT) require careful electrophysiologic evaluation for differential diagnosis. We aim to describe the differential behaviour of local ventriculo-atrial (VA) intervals which predicts the tachycardia mechanism. Methods and results The local VA intervals at the para-Hisian septum were measured under three different situations: (i) tachycardia; (ii) sustained entrainment from the right ventricular apex (RVA); and (iii) continuous pacing from the RVA during sinus rhythm. Differences were computed as follows: Δ-VAentr = VA during entrainment - VA during tachycardia; and Δ-VApac = VA while pacing during sinus rhythm - VA during tachycardia. In contrast to AVNRT, we hypothesized that an invariable retrograde conduction through the septal AP will keep the result of the subtractions close to 0 ms in cases of ortodromic atrioventricular re-entrant tachycardia (AVRT). We analysed 55 atypical AVNRT (45% posterior type) and 82 AVRT (10 anteroseptal, 18 para-Hisian, 12 mid-septal, and 42 posteroseptal). Δ-VAentr was longer for AVNRT (98.5 ± 40.3 ms) compared with septal AP (-5.7 ± 19.3 ms; P < 0.001). A value of 50 ms showed 98.7% sensitivity and 92% specificity (AUC 0.99; 95% CI 0.98-1). According to physiological criteria, a negative Δ-VAentr remains unobserved in the case of AVNRT (positive predictive value 100% for septal AP). Δ-VApac was also longer for AVNRT (66.5 ± 14.6 ms) compared with septal AP (-9.7 ± 3.3 ms; P < 0.001). A value of 50 ms showed 100% sensitivity and 74% specificity (AUC 0.86; 95% CI 0.76-0.93). Conclusions Delta of the local VA intervals enables distinction between atypical AVNRT and AVRT mediated by septal AP.
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Affiliation(s)
- David Calvo
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - Diego Pérez
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - José Rubín
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - Daniel García
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
| | - Pablo Ávila
- Arrhythmia Unit, Hospital General Universitario Gregorio Marañón, C/ Doctor Esquerdo 46, CP Madrid, Spain
| | | | - Marta Pachón
- Arrhythmia Unit, Hospital Virgen de la Salud, Avd. de Barber, 30, CP, Toledo, Spain
| | - Loreto Bravo
- Arrhythmia Unit, Hospital Universitario de Salamanca, Avd. Paseo de San Vicente 38, CP, Salamanca, Spain
| | - Jesús Hernández
- Arrhythmia Unit, Hospital Universitario de Salamanca, Avd. Paseo de San Vicente 38, CP, Salamanca, Spain
| | - Ángel L Miracle
- Arrhythmia Unit, Hospital Universitario Fundación Jiménez Díaz-Quironsalud, Avd. Reyes Católicos 2, CP, Madrid, Spain
| | - Irene Valverde
- Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Arrhythmia Unit, Hospital Universitario de Cabueñes, C/ Los Prados 395, CP, Gijón, Spain
| | - Mar Gozalez-Vasserot
- Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Arrhythmia Unit, Hospital Universitario de Cabueñes, C/ Los Prados 395, CP, Gijón, Spain
| | - Miguel Ángel Árias
- Arrhythmia Unit, Hospital Virgen de la Salud, Avd. de Barber, 30, CP, Toledo, Spain
| | - Javier Jimenez-Candíl
- Arrhythmia Unit, Hospital Universitario de Salamanca, Avd. Paseo de San Vicente 38, CP, Salamanca, Spain
| | - César Morís
- Arrhythmia Unit, Hospital Universitario Central de Asturias, Avd. de Roma sn, CP, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Avd. de Roma sn, CP, Oviedo, Spain
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Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
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Use of Programmed Ventricular Extrastimulus During Supraventricular Tachycardia to Differentiate Atrioventricular Nodal Re-Entrant Tachycardia From Atrioventricular Re-Entrant Tachycardia. JACC Clin Electrophysiol 2018; 4:872-880. [PMID: 30025686 DOI: 10.1016/j.jacep.2018.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/16/2018] [Accepted: 01/31/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study hypothesized that early coupled ventricular extrastimuli (V2) stimulation might yield a more robust differentiation between atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT). BACKGROUND Programmed V2 during supraventricular tachycardia are useful to differentiate AVNRT from AVRT by subtracting the ventriculoatrial (VA) interval from the stimulus to atrial depolarization (stimulus atrial [SA]) interval, but all such maneuvers have limitations. METHODS Patients with either AVNRT or AVRT were investigated. The entire tachycardia cycle length (TCL) was scanned with V2 delivered from the right ventricular apex. The SA-VA difference was calculated with V2 clearly resetting the tachycardia. The prematurity of V2 was calculated by dividing the coupling interval (CI) by the TCL. RESULTS A total of 210 patients (102 with AVNRT) were included. The SA-VA difference was >70 ms in all AVNRT patients and was <70 ms in all AVRT patients with right and septal accessory pathways (APs), except for those with decremental APs, in whom there was an overlap between AVNRT and AVRT with left APs. However, a SA-VA difference >110 ms with a CI/TCL of <65% distinguished AVNRT from AVRT using the left AP, with sensitivity and specificity of 87% and 100%, respectively. Ventricular overdrive pacing resulted in tachycardia termination or AV dissociation in 28% of patients compared with 15% of patients using the V2 technique (p = 0.008). CONCLUSIONS A SA-VA of >70 ms using the V2 technique differentiated AVNRT from AVRT using septal and right APs. Use of the V2 technique with a short CI differentiated AVNRT from AVRT using left APs. The V2 technique less frequently resulted in tachycardia termination compared with ventricular entrainment.
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Bennett MT, Leader N, Sapp J, Parkash R, Gardner M, Healey JS, Thibault B, Sterns L, Essebag V, Birnie D, Sivakumaran S, Nery P, Andrade JG, Krahn AD, Tang A. Differentiating Ventricular From Supraventricular Arrhythmias Using the Postpacing Interval After Failed Antitachycardia Pacing. Circ Arrhythm Electrophysiol 2018; 11:e005921. [PMID: 29618476 DOI: 10.1161/circep.117.005921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillator arrhythmia discrimination algorithms often are unable to discriminate ventricular from supraventricular arrhythmias. We sought to evaluate whether the response to antitachycardia pacing (ATP) in patients with an implantable cardioverter defibrillator could further discriminate ventricular from supraventricular arrhythmias in patients receiving ATP. METHODS AND RESULTS All episodes of ventricular or supraventricular tachycardia where ATP was delivered in patients enrolled in RAFT (Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure Trial) were included. RAFT randomized 1798 patients with New York Heart Association class II/III heart failure, left ventricular ejection fraction ≤30%, and QRS duration of ≥120 ms to a implantable cardioverter defibrillator±cardiac resynchronization therapy. The tachycardia cycle lengths (TCLs) before and after the delivery of ATP and the postpacing intervals were assessed. Overall, 10 916 ATP attempts were reviewed for 8150 tachycardia episodes in 924 patients. After excluding tachycardias where ATP terminated the episode or where the specific mechanism of the tachycardia was uncertain, we analyzed 3676 ATP attempts delivered for 2046 tachycardia episodes in 541 patients. A shorter difference between postpacing interval and TCL (PPI-TCL) was more likely to be associated with ventricular tachycardia than with supraventricular tachyarrhythmia (138.1±104.2 versus 277.4±126.9 ms; p<0.001). Analysis of the receiver operator curve for the PPI-TCL revealed an area under the curve of 0.803 (p<0.001; 95% confidence interval, 0.784-0.822). The majority of tachycardias with a PPI-TCL >360 ms were supraventricular with a PPI-TCL value of ≤360 ms having a sensitivity of 97.4% and specificity of 28.3% for ventricular tachycardia. CONCLUSIONS The ATP response, specifically the PPI-TCL, can further discriminate ventricular from supraventricular arrhythmias in patients with implantable cardioverter defibrillators when the currently available discriminators fail. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00251251.
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Affiliation(s)
- Matthew T Bennett
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.).
| | - Nathan Leader
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - John Sapp
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Ratika Parkash
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Martin Gardner
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Jeffrey S Healey
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Bernard Thibault
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Larry Sterns
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Vidal Essebag
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - David Birnie
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Soori Sivakumaran
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Pablo Nery
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Jason G Andrade
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Andrew D Krahn
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
| | - Anthony Tang
- Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.)
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44
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Wang H, Che X. Case report: an unstable wide QRS complexes tachycardia after ablation of a poster-septal accessory pathway: What is the mechanism? Medicine (Baltimore) 2018. [PMID: 29538207 PMCID: PMC5882396 DOI: 10.1097/md.0000000000010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Differentiation of wide QRS complex tachycardia required repeated electrophysiological stimuli and mapping. However, instability of tachycardia would increase the difficulty in differential diagnosis. SYMPTOMS AND CLINICAL FINDINGS In this paper, we reported a wide QRS tachycardia following ablation of an atrioventricular reentrant tachycardia participated by a poster-septal accessory pathway. Limited differentiation strategy was performed because the wide QRS tachycardia was self-limited and with unstable hemodynamics. We analyzed the mechanism of the wide QRS tachycardia by only 4 beats ventricular overpacing. On the basis of the last ventricular pacing, an atypical atrioventricular nodal reentrant tachycardia was confirmed. INTERVENTION AND OUTCOMES After slow-pathway modification, the wide QRS tachycardia was eliminated. CONCLUSION It was an atypical atrial-ventricular node reentrant tachycardia with right bundle branch block. Reasonable analysis based on electrophysiological electrophysiologic knowledge was the basis of successful diagnosis and treatment.
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Affiliation(s)
- Huan Wang
- Department of Cardiology, Zhejiang Province People's Hospital
- Department of Cardiology People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, China
| | - Xiaoru Che
- Department of Cardiology, Zhejiang Province People's Hospital
- Department of Cardiology People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, China
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45
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Chua K, Upadhyay GA, Lee E, Aziz Z, Beaser AD, Ozcan C, Broman M, Nayak HM, Tung R. High-resolution mapping of the triangle of Koch: Spatial heterogeneity of fast pathway atrionodal connections. Heart Rhythm 2018; 15:421-429. [DOI: 10.1016/j.hrthm.2017.10.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 10/18/2022]
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46
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He Q, Lei S, Jia FP, Gao LY, W X Zhu D. A Simple Method to Differentiate Atrioventricular Node Reentrant Tachycardia from Orthodromic Reciprocating Tachycardia. Int Heart J 2018; 59:71-76. [PMID: 29269710 DOI: 10.1536/ihj.17-002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Discrimination between atrioventricular node reentry tachycardia (AVNRT) and orthodromic reciprocating tachycardia (ORT) during an electrophysiological study is sometimes challenging. This study aimed to investigate if the difference in the local VA (ventricle-atrium) interval during ventricular entrainment pacing and during tachycardia (DVA, defined as the shortest local VA interval of coronary sinus [CS] during entrainment minus the shortest local VA interval of CS during tachycardia) was different in patients with AVNRT and patients with ORT.Diagnoses of AVNRT or ORT through a concealed accessory pathway (AP) were made according to conventional electrophysiological criteria and ablation results. Entrainment by right ventricular (RV) pacing was performed in each patient before ablation and patients with successful entrainment were included in the study. The DVA was compared between patients with AVNRT and patients with ORT. The DVA in patients with AVNRT was significantly longer than that in patients with ORT (120 ± 20 versus 5.7 ± 9; P < 0.001). In each patient with AVNRT of slow-fast type, fast-slow type, and slow-slow type, the DVA was more than 48 ms. In each patient with ORT using a left free wall accessory pathway (AP), right free wall AP, and septal AP, the DVA was less than 20 ms.DVA was found to be a rapid, useful test in distinguishing patients with AVNRT from those with ORT.
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Affiliation(s)
- Quan He
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University
| | - Sen Lei
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University
| | - Feng-Peng Jia
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University
| | - Ling-Yun Gao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University
| | - Dennis W X Zhu
- The Heart Center, Regions Hospital, St. Paul.,Department of Medicine, University of Minnesota, Minneapolis
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47
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Poghosyan HR, Danoyan AB, Hovakimyan TB, Kartoyan ZE, Davtyan KV. An Uncommon Case of Incessant Tachycardia-induced Cardiomyopathy in a Child. J Innov Card Rhythm Manag 2018; 9:2982-2987. [PMID: 32477781 PMCID: PMC7252680 DOI: 10.19102/icrm.2018.090105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/02/2017] [Indexed: 11/06/2022] Open
Abstract
The case of a pediatric patient with a history of incessant narrow complex tachycardia is presented. The patient underwent successful catheter ablation for an uncommon concealed slow accessory pathway. The mechanism and ablation location are discussed.
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Affiliation(s)
| | | | | | | | - Karapet V Davtyan
- National Medical Research Center for Preventative Medicine, Moscow, Russia
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48
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Wei W, Xue Y, Tung R, Wang X, Liu Y, Shehata M, Wu S. Tachycardia with varying atrio-ventricular relationships: What is the mechanism? J Cardiovasc Electrophysiol 2017; 29:341-344. [PMID: 29194877 DOI: 10.1111/jce.13398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/27/2007] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Wei Wei
- Guangdong Cardiovascular Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Roderick Tung
- Guangdong Cardiovascular Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China.,Center for Arrhythmia Care, University of Chicago Medicine, Pritzker School of Medicine, Chicago, IL, USA
| | - Xunzhang Wang
- Guangdong Cardiovascular Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China.,Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yang Liu
- Guangdong Cardiovascular Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
| | - Michael Shehata
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China.,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, P.R. China
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Clinical Features and Sites of Ablation for Patients With Incessant Supraventricular Tachycardia From Concealed Nodofascicular and Nodoventricular Tachycardias. JACC Clin Electrophysiol 2017; 3:1547-1556. [PMID: 29759837 DOI: 10.1016/j.jacep.2017.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/22/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to describe the clinical features and sites of successful ablation for incessant nodofascicular (NF) and nodoventricular (NV) tachycardias. BACKGROUND Incessant supraventricular tachycardias have been associated with tachycardia-induced cardiomyopathies and have been previously attributed to permanent junctional reciprocating tachycardias, atrial tachycardias, and atrioventricular nodal re-entrant tachycardias. Incessant concealed NF and NV tachycardias have not been described previously. METHODS Three cases of incessant concealed NF and NV re-entrant tachycardias were identified from 2 centers. RESULTS The authors describe 3 cases with incessant supraventricular tachycardia resulting from NV (2 cases) and NF (1 case) pathways. Atrioventricular nodal re-entrant tachycardia was excluded by His synchronous premature ventricular complexes that either delayed or terminated the tachycardia. Ventricular pacing showed constant and progressive fusion in cases 1 and 3. In 2 cases, there was spontaneous initiation with a 1:2 response (cases 1 and 3); the presence of retrograde longitudinal dissociation or marked decremental pathway conduction in cases 1 and 3 sustains these tachycardias. The NV pathway was successfully ablated in the slow pathway region in case 3 and at the right bundle branch in case 1. The NF pathway was successfully ablated within the proximal coronary sinus in case 2. CONCLUSIONS This is the first report of incessant supraventricular tachycardia using concealed NF or NV pathways. These tachycardias demonstrated spontaneous initiation from sinus rhythm with a 1:2 response and retrograde longitudinal dissociation or marked decremental pathway conduction. Successful ablation was achieved at either right-sided sites or within the coronary sinus.
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50
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Maruyama M, Uetake S, Miyauchi Y, Seino Y, Shimizu W. Analyses of the Mode of Termination During Diagnostic Ventricular Pacing to Differentiate the Mechanisms of Supraventricular Tachycardias. JACC Clin Electrophysiol 2017; 3:1252-1261. [PMID: 29759621 DOI: 10.1016/j.jacep.2017.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/08/2017] [Accepted: 05/30/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The goal of this study was to determine the diagnostic yield of analyzing the mode of termination during ventricular overdrive pacing (VOP) to differentiate the mechanisms of supraventricular tachycardias (SVTs). BACKGROUND The majority of the diagnostic criteria for VOP rely on successful entrainment, but termination of SVTs is common during VOP. METHODS We studied 225 SVTs with a 1:1 atrioventricular relationship, including 34 atrial tachycardias, 67 orthodromic reciprocating tachycardias (ORTs) (including 4 ORTs using accessory pathways [APs] with decremental properties), and 124 atrioventricular nodal re-entrant tachycardias. The total pacing prematurity (TPP) needed to reset or terminate the SVT was calculated by using a simplified method, and the post-pacing interval minus the tachycardia cycle length (PPI - TCL) was predicted from the TPP. RESULTS VOP terminated 87 SVTs (39%). No atrial tachycardias were terminated by VOP in this study. SVT termination occurred after (n = 71) or before (n = 16) atrial resetting. The predicted PPI - TCL was highly correlated with the measured PPI - TCL (r = 0.96; p < 0.001). The TPP had diagnostic accuracy equivalent to the predicted PPI - TCL. The TPP was measurable irrespective of the termination mode and correctly diagnosed ORTs with decremental APs. All ORTs using septal APs and no atrioventricular nodal re-entrant tachycardias had a TPP <125 ms. Considering other criteria evaluable in terminated SVTs, a combined criteria of a TPP <125 ms and atrial capture/termination within the fusion period were specific for ORTs using free-wall APs, except for left anterolateral/lateral sites. CONCLUSIONS The termination analyses were useful for differential diagnoses of SVTs terminated during VOP.
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Affiliation(s)
- Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
| | - Shunsuke Uetake
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yoshihiko Seino
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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