1
|
Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
2
|
van Schie MS, Kharbanda RK, Houck CA, Lanters EAH, Taverne YJHJ, Bogers AJJC, de Groot NMS. Identification of Low-Voltage Areas: A Unipolar, Bipolar, and Omnipolar Perspective. Circ Arrhythm Electrophysiol 2021; 14:e009912. [PMID: 34143644 PMCID: PMC8294660 DOI: 10.1161/circep.121.009912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-voltage areas (LVAs) are commonly considered surrogate markers for an arrhythmogenic substrate underlying tachyarrhythmias. It remains challenging to define a proper threshold to classify LVA, and it is unknown whether unipolar, bipolar, and the recently introduced omnipolar voltage mapping techniques are complementary or contradictory in classifying LVAs. Therefore, this study examined similarities and dissimilarities in unipolar, bipolar, and omnipolar voltage mapping and explored the relation between various types of voltages and conduction velocity (CV).
Collapse
Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rohit K Kharbanda
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Charlotte A Houck
- Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eva A H Lanters
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | | | | | | |
Collapse
|
4
|
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| |
Collapse
|
5
|
Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 464] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
6
|
Luther V, Qureshi N, Lim PB, Koa-Wing M, Jamil-Copley S, Ng FS, Whinnett Z, Davies DW, Peters NS, Kanagaratnam P, Linton N. Isthmus sites identified by Ripple Mapping are usually anatomically stable: A novel method to guide atrial substrate ablation? J Cardiovasc Electrophysiol 2018; 29:404-411. [PMID: 29341322 DOI: 10.1111/jce.13425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postablation reentrant ATs depend upon conducting isthmuses bordered by scar. Bipolar voltage maps highlight scar as sites of low voltage, but the voltage amplitude of an electrogram depends upon the myocardial activation sequence. Furthermore, a voltage threshold that defines atrial scar is unknown. We used Ripple Mapping (RM) to test whether these isthmuses were anatomically fixed between different activation vectors and atrial rates. METHODS We studied post-AF ablation ATs where >1 rhythm was mapped. Multipolar catheters were used with CARTO Confidense for high-density mapping. RM visualized the pattern of activation, and the voltage threshold below which no activation was seen. Isthmuses were characterized at this threshold between maps for each patient. RESULTS Ten patients were studied (Map 1 was AT1; Map 2: sinus 1/10, LA paced 2/10, AT2 with reverse CS activation 3/10; AT2 CL difference 50 ± 30 ms). Point density was similar between maps (Map 1: 2,589 ± 1,330; Map 2: 2,214 ± 1,384; P = 0.31). RM activation threshold was 0.16 ± 0.08 mV. Thirty-one isthmuses were identified in Map 1 (median 3 per map; width 27 ± 15 mm; 7 anterior; 6 roof; 8 mitral; 9 septal; 1 posterior). Importantly, 7 of 31 (23%) isthmuses were unexpectedly identified within regions without prior ablation. AT1 was treated following ablation of 11/31 (35%) isthmuses. Of the remaining 20 isthmuses, 14 of 16 isthmuses (88%) were consistent between the two maps (four were inadequately mapped). Wavefront collision caused variation in low voltage distribution in 2 of 16 (12%). CONCLUSIONS The distribution of isthmuses and nonconducting tissue within the ablated left atrium, as defined by RM, appear concordant between rhythms. This could guide a substrate ablative approach.
Collapse
|
7
|
de Groot NMS, Bogers AJJC. Development of Tachyarrhythmias Late After the Fontan Procedure: The Role of Ablative Therapy. Card Electrophysiol Clin 2017; 9:273-284. [PMID: 28457241 DOI: 10.1016/j.ccep.2017.02.009] [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] [Indexed: 10/19/2022]
Abstract
Patients with a Fontan circulation are at a high risk of developing a variety of cardiac dysrhythmias after cardiac surgery. These dysrhythmias are most often supraventricular tachyarrhythmias (SVT), but ventricular tachyarrhythmias (VT) may also occur. Mechanisms underlying SVT are variable, including both ectopic activity and reentry. Over time, successive SVT may be caused by different mechanisms. The acute success rate of ablative therapy of atrial tachyarrhythmias is considerably high yet during long-term follow-up 'recurrences' frequently occur. It is most likely that these 'recurrences' are caused by a progressive atrial cardiomyopathy instead of arrhythmogeneity of prior ablative lesions.
Collapse
Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, s'Gravendijkwal 230, Rotterdam 3015CE, Netherlands.
| | - Ad J J C Bogers
- Department of Cardiology, Erasmus Medical Center, s'Gravendijkwal 230, Rotterdam 3015CE, Netherlands
| |
Collapse
|
8
|
Teuwen CP, Korevaar TIM, Coolen RL, van der Wel T, Houck CA, Evertz R, Yaksh A, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Frequent atrial extrasystolic beats predict atrial fibrillation in patients with congenital heart defects. Europace 2016; 20:25-32. [DOI: 10.1093/europace/euw300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/24/2016] [Indexed: 12/12/2022] Open
|
9
|
Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
10
|
Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11:e102-65. [PMID: 24814377 DOI: 10.1016/j.hrthm.2014.05.009] [Citation(s) in RCA: 371] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/07/2023]
|
11
|
WO HUNGTA, WEN MINGSHIEN, CHANG POCHENG, CHOU CHUNGCHUAN, WANG CHUNCHIEH, YEH SANJOU, WU DELON. Successful Treatment of Macroreentrant Atrial Tachycardia by Radiofrequency Ablation Targeting Channels with Continuous Activation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:927-37. [DOI: 10.1111/pace.12408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- HUNG-TA WO
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - MING-SHIEN WEN
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - PO-CHENG CHANG
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - CHUNG-CHUAN CHOU
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - CHUN-CHIEH WANG
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - SAN-JOU YEH
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - DELON WU
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| |
Collapse
|
12
|
Faustino MM, Capuzzi D, Agricola T, Ciammetti D, Pecce P, Santarella L, Pizzi C. A new approach for catheter ablation of atrial tachycardia following atrial fibrillation ablation. J Cardiovasc Med (Hagerstown) 2012; 13:795-804. [DOI: 10.2459/jcm.0b013e3283569774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
YAP SINGCHIEN, HARRIS LOUISE, DOWNAR EUGENE, NANTHAKUMAR KUMARASWAMY, SILVERSIDES CANDICEK, CHAUHAN VIJAYS. Evolving Electroanatomic Substrate and Intra-Atrial Reentrant Tachycardia Late After Fontan Surgery. J Cardiovasc Electrophysiol 2011; 23:339-45. [DOI: 10.1111/j.1540-8167.2011.02202.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Drago F, Russo MS, Marazzi R, Salerno-Uriarte JA, Silvetti MS, De Ponti R. Atrial tachycardias in patients with congenital heart disease: a minimally invasive simplified approach in the use of three-dimensional electroanatomic mapping. Europace 2011; 13:689-95. [DOI: 10.1093/europace/eur027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
15
|
de Groot NMS, Atary JZ, Blom NA, Schalij MJ. Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences. Circ Arrhythm Electrophysiol 2010; 3:148-54. [PMID: 20194797 DOI: 10.1161/circep.109.909838] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Catheter ablation has evolved as a possible curative treatment modality for atrial tachyarrhythmia (AT) in patients with congenital heart defects (CHD). However, data on long-term outcome are scarce. We examined characteristics of recurrent AT after ablation of postoperative AT during long-term follow-up in CHD patients. METHODS AND RESULTS CHD patients (n=53; 27 men; age, 38+/-15 years) referred for catheter ablation of AT were studied during a follow-up period of 5+/-3 years. After ablative therapy of the first AT (n=53, 27 atrial flutter, cycle length=288+/-81 ms; 22 intra-atrial reentrant tachycardia, cycle length=309+/-81 ms; 5 focal atrial tachycardia, cycle length=380+/-147 ms; success rate, 65%), AT recurred (59% within the first year) in 29 patients; 15 underwent repetitive ablative therapy. Mechanisms underlying recurrent AT were similar in 7 patients (intra-atrial reentrant tachycardia, 2; atrial flutter, 5). The location of arrhythmogenic substrates of recurrent AT (intra-atrial reentrant tachycardia, focal atrial tachycardia) was different for all but 1 patient. After 5+/-3 years, 5 patients died of heart failure, 3 were lost to follow-up, and the remaining patients had sinus rhythm (n=31), AT (n=5), or atrial flutter (n=14). Antiarrhythmic drugs were used by 18 (57%) sinus rhythm patients. CONCLUSIONS Successive postoperative AT in CHD patients developing over time may be caused by different mechanisms, including focal and reentrant mechanisms. Recurrent AT originated from different locations, suggesting that these new AT were not caused by arrhythmogenicity of previous ablative lesions. Long-term outcome is often complicated by development of atrial fibrillation. Despite frequent need for repeat ablative therapy, most patients are in sinus rhythm.
Collapse
Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | | | | |
Collapse
|
16
|
Takahashi K, Cecchin F, Fortescue E, Berul CI, Alexander ME, Walsh EP, Fynn-Thompson F, Triedman JK. Permanent atrial pacing lead implant route after Fontan operation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:779-85. [PMID: 19545341 DOI: 10.1111/j.1540-8159.2009.02365.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial pacing is indicated for sinus node dysfunction (SND) after Fontan surgery; preferred lead implantation technique is debated. We compare outcomes of transvenous (TV) and epicardial (Epi) atrial lead implants in this population. METHODS Retrospective review of Fontan patients undergoing atrial lead implant between 1992 and 2007. Demographics, lead performance data, and outcomes were analyzed. RESULTS 78 patients had 90 leads implanted: 25 via TV route and 65 via Epi route. Median follow-up was 1.6 years (TV) and 3.6 years (Epi). TV leads were implanted in older patients (23.1 vs 9.3 years, P < 0.001) and at longer intervals after Fontan (15.2 vs 4.9 years, P < 0.001). Pacing indication for most TV leads was SND, while Epi leads were also indicated for atrioventricular block. Acute complication rates were similar (8% TV vs 19% Epi, P = 0.23), but median hospital stay was shorter for TV (2 vs 5 days, P = 0.03). Thrombus was observed in five patients (two in TV; three in Epi), but no thromboembolic events were observed. Mean lead survival was similar (TV 9.9 vs Epi 7.8 years, P = NS). Energy threshold was lower at implant for TV leads (0.9 vs 2.2 microJ, P = 0.049), but similar at follow-up (1.2 vs 2.6 microJ, P = 0.35). Atrial sensing was unchanged over time for TV (2.2 to 2.1 mV, P = NS), but decreased for Epi (3.3 to 2.5 mV, P = 0.02). CONCLUSIONS Compared to epicardial leads, transvenous atrial pacing leads may be placed in Fontan patients with lower procedural morbidity and equivalent expectation of lead performance and longevity.
Collapse
Affiliation(s)
- Kazuhiro Takahashi
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Fujita S, Takahashi K, Takeuchi D, Manaka T, Shoda M, Hagiwara N, Kurosawa H, Nakanishi T. Management of late atrial tachyarrhythmia long after Fontan operation. J Cardiol 2009; 53:410-6. [DOI: 10.1016/j.jjcc.2009.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
|
18
|
de Groot NM, Lukac P, Blom NA, van Kuijk JP, Pedersen AK, Hansen PS, Delacretaz E, Schalij MJ. Long-Term Outcome of Ablative Therapy of Postoperative Supraventricular Tachycardias in Patients With Univentricular Heart. Circ Arrhythm Electrophysiol 2009; 2:242-8. [DOI: 10.1161/circep.108.828137] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background—
Catheter ablation has evolved as a possible curative treatment modality for supraventricular tachycardias (SVT) in patients with univentricular heart. However, the long-term outcome of ablation procedures is unknown. We evaluated the procedural and long-term outcome of ablative therapy of late postoperative SVT in patients with univentricular heart.
Methods and Results—
Patients with univentricular heart (n=19, 11 male; age, 29�9 years) referred for ablation of SVT were studied. Ablation was guided by 3D electroanatomic mapping in all but 2 procedures. A total of 41 SVT were diagnosed as intra-atrial reentrant tachycardia (n=30; cycle length, 310�68 ms), typical atrial flutter (n=4; cycle length, 288�42 ms), focal atrial tachycardia (n=6; cycle length, 400�60 ms), and atrial fibrillation (n=1). Ablation was successful in 73% of intra-atrial reentrant tachycardia, 75% of atrial flutter, and all focal atrial tachycardia and focal atrial fibrillation. During the follow-up period of 53�34 months, 2 patients were lost to follow-up, 3 died of heart failure, 2 underwent heart transplantation, and 1 underwent conduit replacement. Of the remaining group, 8 had sinus rhythm and 3 had SVT.
Conclusions—
Focal and reentrant mechanisms underlie postoperative SVT in patients with univentricular heart. Successive SVT developing over time may be caused by different mechanisms. Ablative therapy is potentially curative, with a procedural success rate of 78%. In patients who had multiple ablation procedures, the SVT originated from different atrial sites, suggesting that these new SVT were caused by progressive atrial disease. Despite recurrent SVT, sinus rhythm at the end of the follow-up period was achieved in 72%.
Collapse
Affiliation(s)
- Natasja M.S. de Groot
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Peter Lukac
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Nico A. Blom
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Jan Peter van Kuijk
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Anders K. Pedersen
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Peter S. Hansen
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Etienne Delacretaz
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Martin J. Schalij
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| |
Collapse
|
19
|
de Groot NMS, Zeppenfeld K, Wijffels MC, Chan WK, Blom NA, Van der Wall EE, Schalij MJ. Ablation of focal atrial arrhythmia in patients with congenital heart defects after surgery: role of circumscribed areas with heterogeneous conduction. Heart Rhythm 2006; 3:526-35. [PMID: 16648056 DOI: 10.1016/j.hrthm.2006.01.011] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 01/10/2006] [Indexed: 01/05/2023]
Abstract
BACKGROUND In patients late after surgical repair of congenital heart disease (CHD), areas with abnormal electrophysiologic properties may serve as slow conducting pathways within a macroreentrant circuit or may be the source of focal atrial tachycardia. OBJECTIVES The purpose of this study was to evaluate the role of abnormal areas during focal atrial tachycardia prior to ablation. METHODS Electroanatomic activation mapping of 62 atrial tachycardias was performed in 43 consecutive patients (37 +/- 12 years) after surgical repair of CHD. The mechanism of atrial tachycardia was scar related intra-atrial reentry (n = 27), cavotricuspid-related atrial flutter (n = 21), atrial fibrillation (n = 2), or focal atrial tachycardia (n = 10). During intra-atrial reentry, channels of slow conduction could be identified in all patients. Subsequent ablation was directed toward connecting two nonconductive borders. The site of origin during focal atrial tachycardia showed fractionated potentials and/or continuous electrical activity. RESULTS Ablation directed at isolating the source area resulted in termination of focal atrial tachycardia in all cases. In two patients, ablation of an area showing continuous electrical activity giving rise to fibrillatory conduction resulted in termination of atrial fibrillation. Ablation of intra-atrial reentry was successful in 70%. Atrial flutter and focal atrial tachycardia were successfully ablated in all patients. No complications were observed. CONCLUSION In patients with surgically corrected CHD, atrial tachycardia most often is caused by a macroreentrant mechanism but in some is the result of a focal mechanism. Areas of abnormal conduction may serve not only as a zone of slow conduction within a macroreentrant circuit but also as the site of origin of a focal atrial arrhythmia. Catheter ablation directed at "source isolation" is effective in eliminating focal atrial tachycardia in patients with CHD.
Collapse
MESH Headings
- Adolescent
- Adult
- Atrial Fibrillation/surgery
- Atrial Flutter/surgery
- Body Surface Potential Mapping
- Cardiac Surgical Procedures/adverse effects
- Catheter Ablation
- Electric Impedance
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Conduction System/pathology
- Heart Conduction System/physiopathology
- Heart Conduction System/surgery
- Heart Defects, Congenital/pathology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Male
- Middle Aged
- Reoperation
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Tachycardia, Ectopic Atrial/surgery
- Tachycardia, Supraventricular/etiology
- Tachycardia, Supraventricular/pathology
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Treatment Outcome
Collapse
Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
20
|
Dello Russo A, Pelargonio G, Parisi Q, Santamaria M, Messano L, Sanna T, Casella M, De Martino G, De Ponti R, Pace M, Giglio V, Ierardi C, Zecchi P, Crea F, Bellocci F. Widespread Electroanatomic Alterations of Right Cardiac Chambers in Patients with Myotonic Dystrophy Type 1. J Cardiovasc Electrophysiol 2006; 17:34-40. [PMID: 16426397 DOI: 10.1111/j.1540-8167.2005.00277.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Conduction disturbances and arrhythmias characterize the cardiac feature of myotonic dystrophy type 1 (MD1); a myocardial involvement has been suggested as part of the cardiac disease. The aim of our study was to investigate the underlying myocardial alterations using electroanatomic mapping (CARTO) and their possible correlation with genetic and neurological findings. METHODS AND RESULTS Right atrial and ventricular CARTO maps were obtained in 13 MD1 patients. Thirteen age-matched patients with paroxysmal supraventricular tachycardia and normal heart served as controls. Unipolar voltage (UNI-v), bipolar voltage (BI-v) amplitudes, bipolar potential duration (Bi-dur), and atrial propagation time (A-pt) were measured. UNI-v and BI-v in interatrial septum, anterolateral atrial wall, and right ventricle outflow tract were lower in MD1 patients than controls (P < 0.001). Bi-dur and A-pt were longer in MD1 patients than controls (P < 0.001, P = 0.046, respectively). A significant relationship was documented between CTG triplets and the percentage of Bi-v <0.5 mV in the atrial anteroseptal region (r = 0.6, P = 0.02). CONCLUSIONS Altered electroanatomic patterns are present in the right cardiac chambers in MD1 patients. Widespread myocardial alterations, not necessarily limited to the conduction system, may support the presence of a cardiac myopathy as part of the disease.
Collapse
Affiliation(s)
- Antonio Dello Russo
- Institute of Cardiology, Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Tanner H, Lukac P, Schwick N, Fuhrer J, Pedersen AK, Hansen PS, Delacretaz E. Irrigated-tip catheter ablation of intraatrial reentrant tachycardia in patients late after surgery of congenital heart disease. Heart Rhythm 2004; 1:268-75. [PMID: 15851168 DOI: 10.1016/j.hrthm.2004.04.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 04/14/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate irrigated-tip catheter for ablation of intraatrial reentrant tachycardias late after surgical repair of congenital heart disease. BACKGROUND In congenital heart disease patients, the right atrium can be markedly enlarged with areas of low blood flow. Radiofrequency (RF) lesion creation may be hampered by insufficient electrode cooling at sites with low blood flow. METHODS Thirty-six consecutive patients with intraatrial reentrant tachycardia refractory to antiarrhythmic therapy from two centers were included in the study. Entrainment pacing and electroanatomic mapping (CARTO) were used to delineate reentrant circuits and critical isthmus sites. RF ablation was performed using an irrigated-tip catheter (Navistar Thermocool). RESULTS Fifty-two intraatrial reentrant tachycardia circuits were identified, and 48 were targeted with RF ablation. RF ablation was performed using a mean of 13 +/- 11 irrigated RF applications per tachycardia isthmus with a mean power of 36 +/- 8 W. In a historical control group of congenital heart disease patients managed with conventional catheter ablation, the number of lesions per isthmus was higher (23 +/- 11) and mean power was lower (27 +/- 14 W). Acute success was achieved in 45 intraatrial reentrant tachycardias (94% of targeted tachycardias and 87% of all tachycardias). After a mean follow-up of 17 +/- 7 months, 33 (92%) of 36 patients were free of recurrence. Five patients (14%) developed paroxysmal atrial fibrillation. CONCLUSIONS The combination of modern techniques including electroanatomic mapping and catheter irrigation allows safe and highly effective ablation of intraatrial reentrant tachycardia in patients with surgically repaired congenital heart disease.
Collapse
Affiliation(s)
- Hildegard Tanner
- Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | | | | | | | | | | | | |
Collapse
|
22
|
González-Torrecilla E, Arenal Á, Quiles J, Atienza F, Jiménez-Candil J, del Castillo S, Almendral J. La cartografía electroanatómica no fluoroscópica (sistema CARTO) en la ablación de las taquicardias auriculares. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77059-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Abstract
BACKGROUND Endocardial mapping is mandatory before radiofrequency catheter ablation (RFCA). Mapping can be performed with either unipolar or bipolar recordings. Impact of the recording technique used was studied in patients with and without structural heart disease using the 3D electroanatomic CARTO mapping system. METHODS AND RESULTS Patients (n=44; 16 males; age 43+/-16 years) referred for RFCA of atrial flutter (AFL, n=18), focal atrial tachycardia (FAT, n=4), AV nodal reentrant tachycardia (AVNRT, n=5), or scar-related atrial reentrant tachycardia (IART, n=17) were studied. Voltage and activation maps were constructed. Unipolar and bipolar voltage distribution in the different groups was studied to establish a cutoff voltage value to facilitate delineation of scar tissue. Electrograms were recorded during tachycardia (FAT: n=246, cycle length [CL]=449+/-35 ms; AVNRT: n=182, CL=359+/-47 ms; AFL: n=1164, CL=255+/-56 ms; IART: n=2431, CL=280+/-74 ms). Unipolar voltages were greater than bipolar voltages (P<0.001). Unipolar voltages < or =1.0 mV were equally distributed in both AFL and IART patients. Bipolar voltages < or =0.1 mV were only found in patients with IART, and subsequently 0.1 mV was used as the cutoff value to delineate scar tissue. No unipolar cutoff value could be established. Timing of unipolar and bipolar local activation was correlated in all patient groups. CONCLUSIONS The recording technique used has considerable impact on reconstruction of reentrant pathways and on the outcome of RFCA. In general, unipolar and bipolar recordings provide complementary information; however, only bipolar recordings allow voltage-based scar tissue delineation in patients with congenital heart disease.
Collapse
Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | |
Collapse
|
24
|
Solomon SB, Dickfeld T, Calkins H. Real-time cardiac catheter navigation on three-dimensional CT images. J Interv Card Electrophysiol 2003; 8:27-36. [PMID: 12652174 DOI: 10.1023/a:1022379612437] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Targets for ablation of atrial fibrillation, atrial flutter, and non-idiopathic ventricular tachycardia are increasingly being selected based on anatomic considerations. Because fluoroscopy provides only limited information about the relationship between catheter positions and cardiac structures, and is associated with radiation risk, other approaches to mapping may be beneficial. METHODS The spatial and temporal information of an electromagnetic catheter tip position sensing system (Magellan, Biosense Inc.) was superimposed on a three-dimensional (3D) CT of the chest in swine using fiducial markers for image registration. Position and orientation of a 6 French catheter with an electromagnetic sensor was displayed in real-time on a corresponding 3D-CT. Catheter navigation within the heart and the great vessels was guided by detailed knowledge about catheter location in relation to cardiac anatomy. RESULTS Anatomic structures including the atrial septum, pulmonary veins, and valvular apparatus were easily identified and used to direct catheter navigation. During the right heart examination, the catheter was navigated through the superior and inferior vena cava to predetermined anatomic locations in right atrium, right ventricle and pulmonary artery. The ablation catheter was also navigated successfully from the aorta through the aortic valve in the left ventricle. No complication was encountered during the experiments. The accuracy and precision of this novel approach to mapping was 4.69 +/- 1.70 mm and 2.22 +/- 0.69 mm, respectively. CONCLUSIONS Real-time display of catheter position and orientation on 3D-CT scans allows accurate and precise catheter navigation in the heart. The detailed anatomic information may improve anatomically based procedures like pulmonary vein ablation and has the potential to decrease radiation times.
Collapse
Affiliation(s)
- Stephen B Solomon
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | | | | |
Collapse
|