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Rodriguez Muñoz D, Ramos Jimenez J, Marco Del Castillo Á, Lozano Granero C, García Alberola A, Jiménez Sánchez D, Guntúriz Beltrán C, Ramos Ruiz P, Arias MÁ, Di Nubila B, Betancur A, González Torrecilla E, Dallaglio P, Alonso Fernández P, Ayala More HD, Calero S, Lumia G, Salgado Aranda R, Lázaro Rivera C, Rodríguez Mañero M, Syed A, Arribas Ynsaurriaga F, Salguero-Bodes R. Symptom burden guiding invasive electrophysiological study in paroxysmal supraventricular tachycardia: The believe SVT registry. Am Heart J 2024; 269:15-24. [PMID: 38042457 DOI: 10.1016/j.ahj.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/04/2023] [Accepted: 11/18/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with palpitations clinically suggestive of paroxysmal supraventricular tachycardia (PSVT) are often managed conservatively until ECG-documentation of the tachycardia, leading to high impact on life quality and healthcare resource utilization. We evaluated results of electrophysiological study (EPS), and ablation when appropriate, among these patients, with special focus on gender differences in management. METHODS BELIEVE SVT is a European multicenter, retrospective registry in tertiary hospitals performing EPS in patients with palpitations, without ECG-documentation of tachycardia or preexcitation, and considered highly suggestive of PSVT by a cardiologist or cardiac electrophysiologist. We analyzed clinical characteristics, results of EPS and ablation, complications, and clinical outcomes during follow-up. RESULTS Six-hundred eighty patients from 20 centers were included. EPS showed sustained tachycardia in 60.9% of patients, and substrate potentially enabling AVNRT in 14.7%. No major/permanent complications occurred. Minor/transient complications were reported in 0.84% of patients undergoing diagnostic-only EPS and 1.8% when followed by ablation. During a 3.4-year follow-up, 76.2% of patients remained free of palpitations recurrence. Ablation (OR: 0.34, P < .01) and male gender (OR: 0.58, P = .01) predicted no recurrence. Despite a higher female proportion among patients with recurrence, (77.2% vs 63.5% among those asymptomatic during follow-up, P < .01), 73% of women in this study reported no recurrence of palpitations after EPS. CONCLUSIONS EPS and ablation are safe and effective in preventing recurrence of nondocumented palpitations clinically suggestive of PSVT. Despite a lower efficacy, this strategy is also highly effective among women and warrants no gender differences in management.
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Affiliation(s)
- Daniel Rodriguez Muñoz
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.
| | - Javier Ramos Jimenez
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Álvaro Marco Del Castillo
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Pablo Ramos Ruiz
- Cardiology Department, University Hospital Santa Lucía, Cartagena, Spain
| | | | - Bruna Di Nubila
- Cardiology Department, St. Bartholomew's Hospital, London, United Kingdom
| | - Andrés Betancur
- Cardiology Department, University Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Paolo Dallaglio
- Cardiology Department, Bellvitge University Hospital, Barcelona, Spain
| | | | | | - Sofía Calero
- Cardiology Department, University Hospital Albacete, Albacete, Spain
| | - Giuseppe Lumia
- Cardiology Department, University Hospital Sant'Eugenio, Rome, Italy
| | | | - Carla Lázaro Rivera
- Cardiology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Moisés Rodríguez Mañero
- Cardiology Department, University Hospital Santiago de Compostela, Santiago de Compostela, Spain
| | - Ahsan Syed
- Cardiology Department, St. Bartholomew's Hospital, London, United Kingdom
| | - Fernando Arribas Ynsaurriaga
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, University Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
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2
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Pachchipulusu VK, Paudel Y, Patel A, Najam B, Desai HN, Illango J, Seffah KD, Kumar M, Naveen N, Khan S. Efficacy of Adenosine Versus Verapamil in Terminating Acute Attacks of Paroxysmal Supraventricular Tachycardia: A Systematic Review. Cureus 2023; 15:e45946. [PMID: 37885520 PMCID: PMC10599651 DOI: 10.7759/cureus.45946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Paroxysmal supraventricular arrhythmias are a group of common rhythm disturbances that are often prevalent, frequently recurrent, sporadic, and life-threatening. These arrhythmias are precipitated by factors such as age, sex, and associated comorbidities. Typically, patients with paroxysmal arrhythmias are asymptomatic during evaluation, and the condition is often detected incidentally. Symptoms associated with these arrhythmias include palpitations, fatigue, light-headedness, chest discomfort, dyspnea, presyncope, and, less commonly, polyuria and serious psychological distress. In terms of treatment, common modalities include antiarrhythmic drug therapy and catheter ablation. When selecting drug therapy, factors such as comorbidities, patient-specific modifiers, preferences, follow-up frequency, and cost-effectiveness are taken into account. For long-term treatment, calcium channel blockers are often used instead of adenosine, while adenosine is preferred for acute attacks due to its higher efficacy. Comparatively, adenosine and verapamil are commonly used drugs in the emergency setting to treat paroxysmal supraventricular tachycardia (PSVT). Adenosine exhibits a faster onset of action, but adverse effects occur more commonly, whereas verapamil has a slower onset of action and a lower incidence of adverse effects. We searched for articles from PubMed, PubMed Central (PMC), and Science Direct, and these articles were reviewed systematically. After applying the search strategy to these databases, 195 articles were identified. Fourteen of these were finalized for review. The efficacy of adenosine versus verapamil in terminating acute attacks of PSVT is reviewed in our article.
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Affiliation(s)
| | - Yubraj Paudel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anandkumar Patel
- Neurology, Shalby Hospitals Naroda, Ahmedabad, IND
- Medicine, Maharshi Hospital Private Limited, Surendranagar, IND
| | - Beenish Najam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Heet N Desai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Janan Illango
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kofi D Seffah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Piedmont Athens Regional Medical, Athens, USA
| | - Mahendar Kumar
- Anaesthesia, Royal College of Surgeons in Ireland, Drogheda, IRL
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Namballa Naveen
- Internal Medicine, Steel Authority of India (SAIL) Hospital, Dhanbad, IND
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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3
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Gerguri S, Jathanna N, Lin T, Müller P, Clasen L, Schmidt J, Kurt M, Shin DI, Blockhaus C, Kelm M, Fürnkranz A, Makimoto H. Clinical impact of "pure" empirical catheter ablation of slow-pathway in patients with non-ECG documented clinical on-off tachycardia. Eur J Med Res 2018; 23:16. [PMID: 29580297 PMCID: PMC5870342 DOI: 10.1186/s40001-018-0314-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022] Open
Abstract
Background Catheter ablation of slow-pathway (CaSP) has been reported to be effective in patients with dual atrioventricular nodal conduction properties (dcp-AVN) and clinical ECG documentation but without the induction of tachycardia during electrophysiological studies (EPS). However, it is unknown whether CaSP is beneficial in the absence of pre-procedural ECG documentation and without the induction of tachycardia during EPS. The aim of this study was to evaluate long-term results after a “pure” empirical CaSP (peCaSP). Methods 334 consecutive patients who underwent CaSP (91 male, 47.5 ± 17.6 years) were included in this study. Sixty-three patients (19%) who had no pre-procedural ECG documentation, and demonstrated dcp-AVN with a maximum of one echo-beat were assigned to the peCaSP group. The remaining 271 patients (81%) were assigned to the standard CaSP group (stCaSP). Clinical outcomes of the two groups were compared, based on ECG documented recurrence or absence of tachycardia and patients’ recorded symptoms. Results CaSP was performed in all patients without any major complications including atrioventricular block. During follow-up (909 ± 435 days), 258 patients (77%) reported complete cessation of clinical symptoms. There was no statistically significant difference in the incidence of AVNRT recurrence between the peCaSP and stCaSP groups (1/63 [1.6%] vs 3/271 [1.1%], P = 0.75). Complete cessation of clinical symptoms was noted significantly less frequently in patients after peCaSP (39/63 [62%] vs 219/271 [81%], P = 0.0013). The incidence of non-AVNRT atrial tachyarrhythmias (AT) was significantly higher in patients after peCaSP (5/63 [7.9%] vs 1/271 [0.4%], P = 0.0011). Conclusion A higher incidence of other AT and subjective symptom persistence are demonstrated after peCaSP, while peCaSP improves clinical symptoms in 60% of patients with non-documented on–off tachycardia.
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Affiliation(s)
- Shqipe Gerguri
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Nikesh Jathanna
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Tina Lin
- Heart Care Victoria, Victoria, Australia
| | - Patrick Müller
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Lukas Clasen
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Jan Schmidt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Muhammed Kurt
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Dong-In Shin
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Christian Blockhaus
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Alexander Fürnkranz
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany
| | - Hisaki Makimoto
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany. .,Medical Faculty, Cardiovascular Research Institute Duesseldorf (CARID), University Duesseldorf, Duesseldorf, Germany.
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4
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Wegner FK, Bögeholz N, Leitz P, Frommeyer G, Dechering DG, Kochhäuser S, Lange PS, Köbe J, Wasmer K, Mönnig G, Eckardt L, Pott C. Occurrence of primarily noninducible atrioventricular nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation. Clin Cardiol 2017; 40:1112-1115. [PMID: 29166545 DOI: 10.1002/clc.22797] [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: 01/02/2017] [Revised: 07/31/2017] [Accepted: 08/11/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The first-line therapy for atrioventricular nodal reentry tachycardia (AVNRT) is catheter-based slow pathway modulation. If AVNRT is not inducible during an electrophysiological study, an empirical slow pathway modulation (ESPM) may be considered in patients with dual atrioventricular nodal physiology and/or a typical electrocardiogram (ECG). METHODS We screened 149 symptomatic patients who underwent ESPM in our department between 1993 and 2013. All patients fulfilled the following criteria: (1) either dual atrioventricular nodal (AVN) physiology with up to 2 AVN echo beats or characteristic ECG documentation or both, (2) noninducibility of AVNRT by programmed stimulation, and (3) completion of a telephone questionnaire for long-term follow-up. Out of this population we retrospectively investigated 13 patients who were primarily noninducible but in whom an AVNRT occurred during or after radiofrequency (RF) delivery. RESULTS When AVNRT occurred, the procedure lost its empirical character, and RF delivery was continued until the procedural endpoint of noninducibility of AVNRT. This endpoint was reached in all but one patient (92%). After a follow-up of 73 ± 15 months, this patient was the only one who reported no benefit from the procedure. CONCLUSIONS Out of 149 initially noninducible patients, a considerable number (9%) exhibited AVNRT during or after RF delivery. These patients crossed over from empirical to controlled slow pathway modulation resulting in a good clinical outcome. Our observations should encourage electrophysiologists to repeat programmed stimulation even after initial empirical RF delivery to retest for inducibility.
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Affiliation(s)
- Felix Konrad Wegner
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Nils Bögeholz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Patrick Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Dirk Georg Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Philipp Sebastian Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Kristina Wasmer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerold Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.,Current address: Department of Cardiology, Schuechtermann-Klinik, Bad Rothenfelde, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Christian Pott
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.,Current address: Department of Cardiology, Schuechtermann-Klinik, Bad Rothenfelde, Germany
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5
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Moss JD, Scheinman MM. Electrocardiographic Findings of Fascicular Ventricular Tachycardia Versus Supraventricular Tachycardia With Aberrancy: Why the Difference? Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005698. [PMID: 28899957 DOI: 10.1161/circep.117.005698] [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: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Joshua D Moss
- From the Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco
| | - Melvin M Scheinman
- From the Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco.
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6
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Wegner FK, Silvano M, Bögeholz N, Leitz PR, Frommeyer G, Dechering DG, Zellerhoff S, Kochhäuser S, Lange PS, Köbe J, Wasmer K, Mönnig G, Eckardt L, Pott C. Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats. J Cardiol 2016; 69:471-475. [PMID: 27021469 DOI: 10.1016/j.jjcc.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/30/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Slow pathway modification (SPM) is the therapy of choice for AV-nodal reentry tachycardia (AVNRT). When AVNRT is not inducible, empirical ablation can be considered, however, the outcome in patients with two AV nodal echo beats (AVNEBs) is unknown. METHODS Out of a population of 3003 patients who underwent slow pathway modification at our institution between 1993 and 2013, we retrospectively included 32 patients with a history of symptomatic tachycardia, lack of paroxysmal supraventricular tachycardia (pSVT) inducibility but occurrence of two AVNEBs. RESULTS pSVT documentation by electrocardiography (ECG) was present in 20 patients. The procedural endpoint was inducibility of less than two AVNEBs. This was reached in 31 (97%) patients. Long-term success was assessed by a telephone questionnaire (follow-up time 63±9 months). A total 94% of the patients benefited from the procedure (59% freedom from symptoms; 34% improvement in symptoms). Among those patients in whom ECG documentation was not present, 100% benefited (58% freedom from symptoms, 42% improvement). CONCLUSION This is the first collective analysis of a group of patients presenting with symptoms of pSVT and inducibility of only two AVNEBs. Procedural success and clinical long-term follow-up were in the range of the reported success rates of slow pathway modification of inducible AVNRT, independent of whether ECG documentation was present. Thus, SPM is a safe and effective therapy in patients with two AVNEBs.
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Affiliation(s)
- Felix K Wegner
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Maria Silvano
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Nils Bögeholz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Patrick R Leitz
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Stephan Zellerhoff
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Philipp S Lange
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Kristina Wasmer
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Gerold Mönnig
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Christian Pott
- Division of Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany.
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7
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Outcome predictors of empirical slow pathway modulation: clinical and procedural characteristics and long-term follow-up. Clin Res Cardiol 2015; 104:946-54. [DOI: 10.1007/s00392-015-0862-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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8
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Shurrab M, Szili-Torok T, Akca F, Tiong I, Kagal D, Newman D, Lashevsky I, Onalan O, Crystal E. Empiric slow pathway ablation in non-inducible supraventricular tachycardia. Int J Cardiol 2015; 179:417-20. [PMID: 25464497 DOI: 10.1016/j.ijcard.2014.10.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/05/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The data supporting the practice of empiric slow pathway ablation (ESPA) in patients with documented supraventricular tachycardia (SVT) who are non-inducible at electrophysiology study (EPS) is limited. The aim of this study is to assess the efficacy of ESPA in adults. METHODS A multi-center cohort study of patients who had ESPA between January 2008 and October 2013 was performed. Patients were identified by screening sequential SVT ablation procedures. RESULTS Forty-three (5%) out of 859 SVT ablation procedures were identified as ESPA. The median age was 53 (IQR: 24) years; 63% were female. All patients had pre-EPS documentation of SVT (either strip or ECG). In 23 (53.5%) cases, pre-EPS ECG showed short RP tachycardia. Thirty-two (74.4%) patients had dual atrioventricular nodal physiology (DAVNP) plus echo beats. Junctional rhythm (JR) as procedural endpoint was noted in 39 (90.7%) patients. In 18 (41.9%) patients, the abolishment of DAVNP was achieved. No complications were encountered. A median follow-up of 17 months (range: 6 to 31 months) revealed 83.7% (36 of 43) success rate, defined as the absence of pre-procedural symptoms and any documented sustained arrhythmia. As compared to patients with recurrence (n=7), patients with no recurrence (n=36) had significantly higher prevalence of clinical short RP tachycardia (61.1% vs. 14.3%, p=0.038), and EPS finding of DAVNP plus echo beats (80.6% vs. 42.9%, p=0.034). CONCLUSIONS ESPA is a reasonable approach in patients with documented SVT, in particular in short RP tachycardia, who are not inducible at EPS. Larger studies are required to assess this practice.
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Affiliation(s)
- Mohammed Shurrab
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Tamas Szili-Torok
- Clinical Electrophysiology, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ferdi Akca
- Clinical Electrophysiology, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Irving Tiong
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Darren Kagal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David Newman
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ilan Lashevsky
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Orhan Onalan
- Department of Cardiology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Eugene Crystal
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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9
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Laish-Farkash A, Shurrab M, Singh S, Tiong I, Verma A, Amit G, Kiss A, Morriello F, Birnie D, Healey J, Lashevsky I, Newman D, Crystal E. Approaches to empiric ablation of slow pathway: results from the Canadian EP web survey. J Interv Card Electrophysiol 2012; 35:183-7. [PMID: 22833011 DOI: 10.1007/s10840-012-9696-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
Abstract
AIM Dual atrioventricular nodal physiology (DAVNP) is a frequent finding in patients with suspected or documented supraventricular tachycardia (SVT). Empiric slow pathway ablation (ESPA) is sometimes performed in patients with DAVNP without inducible SVT at the time of electrophysiological study. Evidence to guide this practice in the adult population is limited. This study was aimed to assess the practice of ESPA by adult electrophysiologists in Canada. METHODS All Canadian interventional electrophysiologists (n = 81) were invited to complete a web-based questionnaire assessing their practice of ESPA in patients with suspected and documented SVT. Operator experience, reimbursement models, diagnostic, and treatment decisions regarding ESPA were assessed with case scenarios. RESULTS Forty-one responses (50 %) were obtained. Ninety-five percent of the responders stated that the evidence for ESPA is lacking or limited. Responders were more likely to perform ESPA in the setting of non-inducible SVT when there was documentation of the clinical arrhythmia (64 vs. 31 % (p = 0.017)). The threshold to perform ESPA was highly variable. Longer time in practice (r = 0.38, p = 0.017) and less perceived complications with ESPA (r = 0.31, p = 0.05) were correlated with the practice of ESPA, whereas length of ablation waiting lists (r = -0.15, p = 0.38), number of procedures performed per day (r = 0.11, p = 0.51) and type of reimbursement (p = 0.24) were not associated with the practice of ESPA. The perceived complication rate with ESPA was <1 %. CONCLUSION Variability in the practice of ESPA in cases of non-inducible SVT exists. Documentation of the clinical arrhythmia, operator experience, and perceived low complication rates positively influence this practice.
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Affiliation(s)
- Avishag Laish-Farkash
- Arrhythmia Services, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite D-377, Toronto, ON, M4N 3M5, Canada
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10
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Pulmonary Thromboembolism Following Radio-Frequency Ablation of the Atrioventricular Node in a Patient Heterozygous for the Factor V Leiden and the Mthfr C677T Mutations. Balkan J Med Genet 2011; 14:51-6. [PMID: 24052703 PMCID: PMC3776686 DOI: 10.2478/v10034-011-0018-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patients who undergo radiofrequency ablation of the atrioventricular (AV) node rarely develop acute major complications. A 41-year-old Caucasian male smoker, was admitted to the Pulmology Teaching Hospital at Belgrade, Serbia, for sharp persistent chest pain, fever and fatigue following AV node radiofrequency ablation for arrhythmia. Chest X-ray showed obtuse right costo-phrenic angle and laminar atelectasis in the right lower lung lobe. The plasma D-dimer level was elevated. A perfusion lung scan showed multiple bilateral perfusion defects and multislice computed tomography showed thrombotic mass in the right pulmonary artery. Genetic analysis revealed that he was heterozygous for the prothrombin Factor V (FV) Leiden and MTHFR C677T mutations. Therapy started with intravenous heparin, followed by warfarin. He had no other episodes over a 2-year follow-up. Lifelong oral anticoagulant therapy was recommended.
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Alvarez M, Tercedor L, Almansa I, Ros N, Galdeano RS, Burillo F, Santiago P, Peñas R. Safety and feasibility of catheter ablation for atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance. Heart Rhythm 2009; 6:1714-20. [PMID: 19959117 DOI: 10.1016/j.hrthm.2009.08.037] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 08/31/2009] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nonfluoroscopic intracardiac navigation systems reduce the dose of radiation in most ablation procedures. However, they have not been sufficiently studied as a sole guidance tool for electrode catheter handling. OBJECTIVE The purpose of our study was to assess the feasibility and safety of catheter ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) without the use of fluoroscopy. METHODS We prospectively enrolled all of the patients with AVNRT (Group A) treated by catheter ablation guided only by a nonfluoroscopic intracardiac navigation system. These patients were compared with a matched control group of patients (Group B) who had undergone an ablation procedure for AVNRT guided only by fluoroscopy in the preceding months. We compared the success rate and the rate of complications and recurrences. We also compared the procedure and radiofrequency times. RESULTS Fifty patients were enrolled in each group. The procedure was successful in 100% in Group A versus 96% in Group B (P = .15). One patient in Group A and 4 patients in Group B suffered nonserious complications (P = NS). The mean fluoroscopy time in Group B was 18 +/- 16 min (range 3.5 to 77, total 924). In 1 case in Group A (2%), the use of fluoroscopy was required. Procedure and radiofrequency times did not differ between the 2 groups. A recurrence developed in 2 patients in each group (P = NS). CONCLUSIONS Catheter ablation for AVNRT without fluoroscopic guidance is feasible and safe, and does not prolong procedure time. The reduction in radiation dose is considerable for patients and professionals.
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Affiliation(s)
- Miguel Alvarez
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
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Luis Merino J. Ablación de la taquicardia intranodal: cuando la fisiología cuenta en la era de la anatomía. Rev Esp Cardiol (Engl Ed) 2007. [DOI: 10.1016/s0300-8932(07)74978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kantharia BK, Padder FA, Kutalek SP. Decremental Ramp Atrial Extrastimuli Pacing Protocol for the Induction of Atrioventricular Nodal Re-entrant Tachycardia and Other Supraventricular Tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1096-104. [PMID: 17038142 DOI: 10.1111/j.1540-8159.2006.00503.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The primary aim of this study was to evaluate the utility of decremental ramp atrial extrastimuli pacing protocol (PRTCL) for induction of atrioventricular nodal re-entrant tachycardia (AVNRT), and other supraventricular tachycardias (SVTs), compared to standard (STD) methods. METHODS The study cohort of 121 patients (age 57.51 +/- 14.02 years) who presented with documented SVTs and/or symptoms of palpitations and dizziness, and underwent invasive electrophysiological evaluation was divided into Group I (AVNRT, n = 42) and Group II (Control, n = 79). The PRTCL involved a train of six atrial extrastimuli, delivered in a decremental ramp fashion. The STD methods included continuous burst and rapid incremental pacing up to atrioventricular (AV) block cycle length, and single and occasionally double atrial extrastimuli. Prolongation in the Atrio-Hisian (Delta-AH) intervals achieved by both methods were compared, as were induction frequencies. RESULTS In Group I, three categories of responses--(1) induction of AVNRT, (2) induction of echo beats only, and (3) none--were observed in 29 (69%), 11 (26%), and 2 (5%) patients with the PRTCL, when compared with 14 (33%), 16 (38%), and 12 (29%) patients with STD methods in the baseline state without the use of pharmacological agents. The Delta-AH intervals for each of these three categories were larger using PRTCL versus STD methods; 293.3 +/- 95.2 ms versus 192.9 +/- 61.4 ms (P < 0.005), 308.6 +/- 68.5 ms versus 189. 9 +/- 64.9 ms (P < 0.0005), and 203.0 +/- 86.3 ms versus 145.8 +/- 58.9 ms (P = NS), respectively. In Group II, in one patient with dual AV nodal physiology but no clinical tachycardia, the PRTCL induced nonsustained (12 beats) AVNRT. Additionally, in this group, both PRTCL and STD methods induced atrial tachycardia in two patients and orthodromic AV re-entrant tachycardia in one patient. CONCLUSION Decremental ramp atrial extrastimuli pacing PRTCL demonstrates a superior response for induction of typical AVNRT as compared to STD techniques. Because of easy and reliable induction of AVNRT and echo beats by the PRTCL, we recommend it as a method to increase the likelihood of induction of AVNRT. For induction of other SVTs, the PRTCL and the STD methods are comparable.
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Affiliation(s)
- Bharat K Kantharia
- Department of Internal Medicine, Division of Cardiac Electrophysiology, Cardiac Electrophysiology Fellowship Training Program, Cardiac Electrophysiology Laboratories, Ohio State University Medical Center, Columbus, Ohio 43210, USA.
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Fish FA. Step Away from the Jump: Sustained Slow Conduction in Pediatric Atrioventricular Nodal Reentrant Tachycardia. J Cardiovasc Electrophysiol 2006; 17:645-7. [PMID: 16836715 DOI: 10.1111/j.1540-8167.2006.00490.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maggi R, Quartieri F, Donateo P, Bottoni N, Solano A, Lolli G, Tomasi C, Croci F, Oddone D, Puggioni E, Menozzi C, Brignole M. Seven-year follow-up after catheter ablation of atrioventricular nodal re-entrant tachycardia. J Cardiovasc Med (Hagerstown) 2006; 7:39-44. [PMID: 16645358 DOI: 10.2459/01.jcm.0000199784.56642.f7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation is considered to be a curative therapy for patients with atrioventricular nodal re-entrant tachycardia (AVNRT). Nevertheless, there is little information available with respect to long-term results and the consequences of catheter ablation. The present study aimed to assess the long-term results (a minimum of 5 years) and clinical events. PATIENTS AND METHODS The recurrence rate of AVNRT, the development of late atrioventricular block and the presence of other arrhythmias (atrial flutter and fibrillation) were assessed in 131 consecutive patients who were undergoing catheter ablation between January 1992 and December 1998. RESULTS During a mean follow-up of 7.2 +/- 2.5 years, tachycardia recurred in 13 patients (10%) after a median time of 6 months (interquartile range 4-24 months) and a second procedure was perfomed. Atrioventricular block occurred in two patients (1.5%) after 1 and 13 months. Atrial fibrillation recurred in seven (44%) of 16 patients in whom atrial fibrillation or flutter was present before ablation after a median of 12 months (interquartile range 9-15 months). Overall, all these events occurred after a median of 9 months (interquartile range 4-17 months). Subsequently, no event related to the arrhythmia or to the procedure was observed. A new onset atrial fibrillation, probably not related to AVNRT, occurred late in the follow-up in a further three patients. CONCLUSIONS Arrhythmic events are not infrequent after catheter ablation of AVNRT during the early years after ablation, but they are unlikely during the subsequent long-term follow-up.
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Affiliation(s)
- Roberto Maggi
- Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
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Emmel M, Brockmeier K, Sreeram N. Slow pathway ablation in children with documented reentrant supraventricular tachycardia not inducible during invasive electrophysiologic study. ACTA ACUST UNITED AC 2005; 94:808-12. [PMID: 16382381 DOI: 10.1007/s00392-005-0305-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 07/22/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Radiofrequency catheter ablation (RFA) has become the procedure of choice for permanent therapy of atrioventricular nodal reentrant tachycardia (AVNRT). This report presents our experience with atrio-ventricular node (AVN) modification in patients with documented narrow complex reentrant SVT, but no evidence for an accessory pathway, and no inducible tachyarrhythmia during invasive electrophysiology (EP) study. METHODS The study population consists of nine children, age range 6-13 years (median 9) with previously documented SVT who had no tachyarrhythmia inducible during EP study (at baseline and following isoprenaline infusion). Eight of the 9 EP studies were performed under general anesthesia, and one under conscious sedation. An accessory pathway was excluded in all patients by appropriate atrial and ventricular extrastimulus pacing techniques. Eight of the nine patients had dual AV nodal physiology, and one had single AV nodal echo beats. The slow AV nodal pathway was empirically ablated, by applying RF lesions in the right inferoseptal AV groove, achieving catheter tip temperature of 50 degrees C. The appearance of an accelerated junctional rhythm during RF application was deemed to denote a successful application site. AV conduction during RF application was confirmed by incremental atrial pacing. The catheter position, and its relation to the compact AV node was constantly monitored using the LocaLisa navigation system. The end-point was absence of dual AVN physiology, and/or AV nodal echo beats. RESULTS Successful slow pathway ablation was achieved in all patients. One patient appeared to have two separate slow pathways with different locations and two AH-jumps, which were both successfully ablated. None of the patients had evidence of temporary or permanent AV block at follow-up (median duration 9 months, range 4 to 36 months); none has had recurrence of symptoms or documented tachyarrhythmia. CONCLUSIONS In children with structurally normal hearts, a previously documented SVT, absence of an accessory pathway and noninducibility of SVT during EP study, empirical slow pathway ablation appears to be justified.
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Affiliation(s)
- M Emmel
- Department Paediatric Cardiology, University Hospital of Cologne, Kerpener Str. 62, 50924 Köln, Germany
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Wang L, Yang H, Han Z, Zhang Y. Long-term efficacy of slow-pathway catheter ablation in patients with documented but noninducible supraventricular tachycardia. Arch Med Res 2005; 35:507-10. [PMID: 15631875 DOI: 10.1016/j.arcmed.2004.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Accepted: 06/18/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND The long-term efficacy of radiofrequency catheter ablation of slow pathway in patients with dual atrioventricular node pathway and a documented but noninducible paroxysmal supraventricular tachycardia (PSVT) is not entirely clear. METHODS Forty nine patients (Group A) with documented but noninducible PSVT and dual atrioventricular node pathway were prospectively studied. Programmed electrical stimulation induced a single atrioventricular node echo beat in 13 patients, and double echo beats in 9 at baseline or during isoproterenol infusion. Clinical and electrophysiological characteristics of Group A patients were compared with that of age- and gender-matched patients with dual atrioventricular node pathway but inducible PSVT (Group B). RESULTS There was no significant difference in the electrophysiological properties of the fast and slow pathways between the two groups. Catheter ablation eliminated the slow pathway in all patients. There was no recurrence of PSVT in either Group A or Group B during the follow-up of 38 +/- 5 months. CONCLUSIONS In patients with dual atrioventricular node pathway and a documented but noninducible PSVT, catheter ablation of slow pathway is highly effective in preventing tachycardia in long term.
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Affiliation(s)
- Lexin Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China.
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Fishberger SB. Radiofrequency ablation of probable atrioventricular nodal reentrant tachycardia in children with documented supraventricular tachycardia without inducible tachycardia. Pacing Clin Electrophysiol 2003; 26:1679-83. [PMID: 12877700 DOI: 10.1046/j.1460-9592.2003.t01-1-00252.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The reproducible induction of supraventricular tachycardia (SVT) during electrophysiological study is critical for the diagnosis of atrioventricular nodal reentry tachycardia (AVNRT), and for determining a therapeutic endpoint for catheter ablation. In the sedated state, there are patients with reentry SVT due to AVNRT who are not inducible at electrophysiological study. This article reports on the empiric slow pathway modification for AVNRT in six pediatric patients (age 6-17, mean 13.3 years) with documented, recurrent, paroxysmal SVT in the setting of a structurally normal heart who were not inducible at electrophysiological study. Atrial and ventricular burst and extrastimulus pacing at multiple drive cycle lengths were performed in the baseline state, during an isuprel infusion, and during isuprel elimination. Single AV nodal (AVN) echo beats were present in all patients, while classic dual AVN physiology was present in three of six patients. Radiofrequency energy was administered in the right posteroseptal AV groove resulting in accelerated junctional rhythm in five of six patients. Postablation testing demonstrated the elimination of echo beats in four patients, while dual AVN physiology and echo beats persisted in two patients. At follow-up (22-49 months, mean 29.5 months), all patients are asymptomatic without recurrence of SVT and are not taking any antiarrhythmic medication. In selected patients, empiric slow pathway modification may be offered as a potential cure in children with recurrent paroxysmal SVT who are not inducible at electrophysiological study. Elimination of slow pathway conduction may serve as a surrogate endpoint, though is not necessary for long-term success.
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Affiliation(s)
- Steven B Fishberger
- Division of Pediatric Cardiology, Schneider Children's Hospital, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA.
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Weismüller P, Kuly S, Brandts B, Kattenbeck K, Ranke C, Trappe HJ. Is electrical stimulation during administration of catecholamines required for the evaluation of success after ablation of atrioventricular node re-entrant tachycardias? J Am Coll Cardiol 2002; 39:689-94. [PMID: 11849870 DOI: 10.1016/s0735-1097(01)01798-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to answer the question of whether stimulation after administration of catecholamines is mandatory for identifying unsuccessful ablations of atrioventricular node re-entrant tachycardia (AVNRT). BACKGROUND The success of radiofrequency (RF) catheter ablation in AVNRT is confirmed in many centers by noninducibility of tachycardias during stimulation after the administration of catecholamines. METHODS A total of 131 patients (81 women and 50 men; mean age 53.6 +/- 13.7 years [range 20 to 77]) were studied. Electrical stimulation was performed without and with the beta-adrenergic amine Orciprenaline (metaproterenol) before and after RF catheter ablation. RESULTS In 100 patients (76.3%; confidence interval [CI] 68.1% to 83.3%) an AVNRT was inducible without administration of Orciprenaline. Thirty minutes after the initially successful ablation in 95 patients, tachycardia was inducible in none of these patients, not even after Orciprenaline administration. In the 31 patients (23.7%; CI 16.7% to 31.9%) in whom there was no tachycardia inducible before ablation, Orciprenaline was given, and the stimulation protocol was repeated. In only five patients (3.8%; CI 1.3% to 8.7%) was there still no tachycardia inducible. After an initially successful ablation in the 26 patients who had inducible tachycardias with Orciprenaline before ablation, no tachycardia could be re-induced. After Orciprenaline, the tachycardia was inducible again in only one patient. CONCLUSIONS Only patients who require catecholamines for tachycardia induction before ablation need catecholamines for control of the success of the ablation of AVNRT.
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Affiliation(s)
- Peter Weismüller
- Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Herne, Germany.
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Belhassen B, Fish R, Eldar M, Glick A, Glikson M, Viskin S. Simplified "ATP test" for noninvasive diagnosis of dual AV nodal physiology and assessment of results of slow pathway ablation in patients with AV nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2000; 11:255-61. [PMID: 10749348 DOI: 10.1111/j.1540-8167.2000.tb01794.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We recently reported that administration of adenosine triphosphate (ATP) during sinus rhythm identifies dual AV nodal physiology (DAVNP) in 76% of patients with inducible sustained AV nodal reentrant tachycardia (AVNRT) at electrophysiologic (EP) study. In that report, however, the ATP test was considered positive for DAVNP only when the results were reproducible at a given dose of ATP. The aim of the present study was to assess the value of a simplified ATP test for noninvasive diagnosis of DAVNP and abolition or modification of the slow pathway (SP) after radiofrequency ablation (RFA) in patients with inducible sustained AVNRT. METHODS AND RESULTS The value of a single dose of ATP was studied in 105 patients with inducible sustained AVNRT and in 31 control patients before placement of EP catheters in the cardiac chambers. ATP (10 to 60 mg, in 10-mg increments) was injected during sinus rhythm until ECG signs of DAVNP (> or = 50 msec increase or decrease in PR interval in two consecutive beats, or occurrence of > or = 1 AV nodal echo beat) or > or = second-degree AV block was observed. DAVNP was observed in only 1 (3.2%) control patient. The test could be completed in 96 study patients. DAVNP was found by ATP test in 72 (75%) patients, whereas it was diagnosed by EP criteria in 82 (85%) patients. DAVNP by ATP test disappeared in 27 (96%) of 28 patients who underwent SP abolition and in 18 (60%) of 30 patients who underwent SP modification. In the 12 patients with persistent DAVNP determined by ATP test after SP modification, the number of beats conducted over the SP was significantly reduced (from 6.3+/-3.3 to 2.5+/-2.2 beats; P = 0.002). CONCLUSION A single administration of ATP during sinus rhythm (at a given dose) enables noninvasive diagnosis of DAVNP in a high percentage of patients with inducible AVNRT and reliably confirms the results of RFA of the SP.
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Affiliation(s)
- B Belhassen
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Israel.
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Huang YC, Yeh JL, Wu BN, Lo YC, Liang JC, Lin YT, Sheu SH, Chen IJ. Ferulidilol: A vasodilatory and antioxidant adrenoceptor and calcium entry blocker, with ancillary ?2-agonist activity. Drug Dev Res 1999. [DOI: 10.1002/(sici)1098-2299(199906)47:2<77::aid-ddr3>3.0.co;2-q] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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