1
|
Paul T, Krause U, Sanatani S, Etheridge SP. Advancing the science of management of arrhythmic disease in children and adult congenital heart disease patients within the last 25 years. Europace 2023; 25:euad155. [PMID: 37622573 PMCID: PMC10450816 DOI: 10.1093/europace/euad155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/26/2023] Open
Abstract
This review article reflects how publications in EP Europace have contributed to advancing the science of management of arrhythmic disease in children and adult patients with congenital heart disease within the last 25 years. A special focus is directed to congenital atrioventricular (AV) block, the use of pacemakers, cardiac resynchronization therapy devices, and implantable cardioverter defibrillators in the young with and without congenital heart disease, Wolff-Parkinson-White syndrome, mapping and ablation technology, and understanding of cardiac genomics to untangle arrhythmic sudden death in the young.
Collapse
Affiliation(s)
- Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Shubhayan Sanatani
- Children’s Heart Centre, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Susan P Etheridge
- Pediatric Cardiology, University of Utah School of Medicine and Primary Children’s Medical Center, Salt Lake City, UT
| |
Collapse
|
2
|
Marazzato J, Marazzi R, Doni LA, Angeli F, Bagliani G, Leonelli FM, De Ponti R. Mapping and Ablation of Atypical Atrial Flutters. Card Electrophysiol Clin 2022; 14:471-481. [PMID: 36153127 DOI: 10.1016/j.ccep.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atypical atrial flutters are complex, hard-to-manage atrial arrhythmias. Catheter ablation has progressively emerged as a successful treatment option with a remarkable role played by irrigated-tip catheters and 3D electroanatomic mapping systems. However, despite the improvement of these technologies, the ablation results may be still suboptimal due to the progressive atrial substrate modification occurring in diseased hearts. Hence, a patient-tailored approach is required to improve the long-term success rate in this scenario, aiming at achieving specific procedure end points and detecting any potential arrhythmogenic substrate in each patient.
Collapse
Affiliation(s)
- Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Lorenzo A Doni
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncacci, 16, Tradate, Varese 21049, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
| |
Collapse
|
3
|
Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
| | | |
Collapse
|
4
|
De Ponti R, Marazzi R, Vilotta M, Angeli F, Marazzato J. Procedural Feasibility and Long-Term Efficacy of Catheter Ablation of Atypical Atrial Flutters in a Wide Spectrum of Heart Diseases: An Updated Clinical Overview. J Clin Med 2022; 11:jcm11123323. [PMID: 35743394 PMCID: PMC9224569 DOI: 10.3390/jcm11123323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Atypical atrial flutters (AAFL) are difficult-to-manage atrial arrhythmias, yet potentially amenable to effective radiofrequency catheter ablation (CA). However, data on CA feasibility are only sparingly reported in the literature in different clinical settings, such as AAFL related to surgical correction of congenital heart disease. The aim of this review was to provide an overview of the clinical settings in which AAFL may occur to help the cardiac electrophysiologist in the prediction of the tachycardia circuit location before CA. Moreover, the role and proper implementation of cutting-edge technologies in this setting were investigated as well as which procedural and clinical factors are associated with long-term failure to maintain sinus rhythm (SR) to find out which patients may, or may not, benefit from this procedure. Not only different surgical and non-surgical scenarios are associated with peculiar anatomical location of AAFL, but we also found that CA of AAFL is generally feasible. The success rate may be as low as 50% in surgically corrected congenital heart disease (CHD) patients but up to about 90% on average after pulmonary vein isolation (PVI) or in patients without structural heart disease. Over the years, the progressive implementation of three-dimensional mapping systems and high-density mapping tools has also proved helpful for ablation of these macro-reentrant circuits. However, the long-term maintenance of SR may still be suboptimal due to the progressive electroanatomic atrial remodeling occurring after cardiac surgery or other interventional procedures, thus limiting the likelihood of successful ablation in specific clinical settings.
Collapse
Affiliation(s)
- Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
- Correspondence:
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
| | - Fabio Angeli
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy;
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
| |
Collapse
|
5
|
Wang NC. Wide QRS complex tachycardia after surgical repair of an isolated atrial septal defect: What is the mechanism? J Arrhythm 2021; 37:464-466. [PMID: 33850595 PMCID: PMC8021990 DOI: 10.1002/joa3.12487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/20/2020] [Accepted: 12/06/2020] [Indexed: 11/16/2022] Open
Abstract
Macroreentrant atrial tachycardia within the right atrium is the dominant mechanism in patients with prior surgical repair of atrial septal defects, with dual-loop circuits much more common than single-loop circuits. This case highlights the importance of clinical history for predicting arrhythmia mechanisms. Considering prior cardiac surgery may assist in preprocedural preparations and discussions regarding potential risks and benefits of catheter ablation.
Collapse
Affiliation(s)
- Norman C. Wang
- Division of CardiologyDepartment of MedicineUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| |
Collapse
|
6
|
Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, DE Ponti R. Ablation of atrial tachycardia in the setting of prior mitral valve surgery. Minerva Cardiol Angiol 2020; 69:94-101. [PMID: 33146481 DOI: 10.23736/s2724-5683.20.05405-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients. METHODS Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. re-entrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed. RESULTS Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; P<0.0001). CONCLUSIONS Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macro-reentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.
Collapse
Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Roberto DE Ponti
- Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy -
| |
Collapse
|
7
|
Compagnucci P, Volpato G, Falanga U, Cipolletta L, Conti M, Grifoni G, Verticelli L, Schicchi N, Giovagnoni A, Casella M, Guerra F, Dello Russo A. Recent advances in three-dimensional electroanatomical mapping guidance for the ablation of complex atrial and ventricular arrhythmias. J Interv Card Electrophysiol 2020; 61:37-43. [PMID: 32451799 DOI: 10.1007/s10840-020-00781-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide a brief overview of some relevant technological advances in the field of three-dimensional electroanatomical mapping (3D-EAM) that have recently entered the clinical arena and their role in guiding catheter ablation (CA) of complex atrial and ventricular arrhythmias. METHODS In this technical report, we describe the general features of three novel algorithms featured in the updated CARTO PRIME™ mapping module for CARTO®3 version 7 3D-EAM system (Biosense Webster Inc., Diamond Bar, CA, USA): local activation time (LAT) hybrid, coherent mapping and map replay modules. We also report three challenging arrhythmia cases in which CA was successfully guided by these softwares. RESULTS The LAT hybrid module was used in a case of premature ventricular complex originating from the right coronary cusp. This algorithm facilitated safe positioning of the ablation catheter away from the right coronary ostium, avoiding potential harm to this vital structure. The coherent mapping module helped to identify the critical as well as a bystander isthmus of an atrial macro-re-entrant tachycardia in a grown-up patient with congenital heart disease. The map replay module allowed rapid retrospective activation mapping of two unstable ventricular tachycardias in a case of nonischemic cocaine-associated cardiomyopathy. CONCLUSION 3D-EAM systems offer significant advantages in the management of challenging arrhythmias, and the introduction of novel algorithms underpins improvements in patients' outcomes. Given the increasing sophistication of these systems, however, a close collaboration among cardiac electrophysiologists, engineers and technicians is highly needed in order to get the best from the available technology.
Collapse
Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Umberto Falanga
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Manuel Conti
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Gino Grifoni
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Letizia Verticelli
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Nicolò Schicchi
- Radiology Department, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy
| | - Andrea Giovagnoni
- Radiology Department, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I - Lancisi - Salesi", Ancona, Italy.,Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| |
Collapse
|
8
|
Mantziari L, Butcher C, Shi R, Kontogeorgis A, Opel A, Chen Z, Haldar S, Panikker S, Hussain W, Jones DG, Gatzoulis MA, Markides V, Ernst S, Wong T. Characterization of the Mechanism and Substrate of Atrial Tachycardia Using Ultra-High-Density Mapping in Adults With Congenital Heart Disease: Impact on Clinical Outcomes. J Am Heart Assoc 2020; 8:e010535. [PMID: 30773973 PMCID: PMC6405650 DOI: 10.1161/jaha.118.010535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Atrial tachycardia (AT) is common in patients with adult congenital heart disease and is challenging to map and ablate. We used ultra‐high‐density mapping to characterize the AT mechanism and investigate whether substrate characteristics are related to ablation outcomes. Methods and Results A total of 50 ATs were mapped with ultra‐high‐density mapping in 23 procedures. Patients were followed up for up to 12 months. Procedures were classified to group A if there was 1 single AT induced (n=12) and group B if there were ≥2 ATs induced (n=11 procedures). AT mechanism per procedure was macro re‐entry (n=10) and localized re‐entry (n=2) in group A and multiple focal (n=6) or multiple macro re‐entry (n=5) in group B. Procedure duration, low voltage area (0.05–0.5 mV), and low voltage area indexed for volume were higher in group B (159 [147–180] versus 412 [352–420] minutes, P<0.001, 22.6 [12.2–29.8] versus 54.2 [51.1–61.6] cm2, P=0.014 and 0.17 [0.12–0.21] versus 0.26 [0.23–0.27] cm2/mL, P=0.024 accordingly). Dense scar (<0.05 mV) and atrial volume were similar between groups. Acute success and freedom from arrhythmia recurrence were worse in group B (100% versus 77% P=0.009 and 11.3, CI 9.8–12.7 versus 4.9, CI 2.2–7.6 months, log rank P=0.004). Indexed low voltage area ≥0.24 cm2/mL could predict recurrence with 100% sensitivity and 77% specificity (area under the curve 0.923, P=0.007). Conclusions Larger low voltage area but not dense scar is associated with the induction of multiple focal or re‐entry ATs, which are subsequently associated with longer procedure duration and worse acute and midterm clinical outcomes.
Collapse
Affiliation(s)
- Lilian Mantziari
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Charles Butcher
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Rui Shi
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | | | - Aaisha Opel
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Zhong Chen
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Shouvik Haldar
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Sandeep Panikker
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Wajid Hussain
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - David Gareth Jones
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | | | - Vias Markides
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Sabine Ernst
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| | - Tom Wong
- 1 Royal Brompton and Harefield NHS Foundation Trust London United Kingdom
| |
Collapse
|
9
|
De Ponti R, My I, Vilotta M, Caravati F, Marazzato J, Bagliani G, Leonelli FM. Advanced Cardiac Signal Recording. Card Electrophysiol Clin 2019; 11:203-217. [PMID: 31084847 DOI: 10.1016/j.ccep.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Implantable loop recorders allow prolonged and continuous single-lead electrocardiogram recording, with the pivotal addition of remote monitoring. They have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias/tachyarrhythmias and proved helpful in arrhythmia burden definition, offering invaluable information in the diagnostic workup for syncope and atrial fibrillation. Advanced cardiac signal recording is also possible by transesophageal catheters. They have been used to orient diagnosis during wide and narrow QRS complex tachycardias and also to perform minimally invasive pacing. Intracardiac electrophysiologic study remains, however, essential for diagnosis of several arrhythmias in the perspective of curative catheter ablation.
Collapse
Affiliation(s)
- Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy.
| | - Ilaria My
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, 06034 Perugia, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| |
Collapse
|
10
|
De Ponti R, Marazzato J, Bagliani G, Leonelli FM, Padeletti L. Sick Sinus Syndrome. Card Electrophysiol Clin 2019; 10:183-195. [PMID: 29784479 DOI: 10.1016/j.ccep.2018.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The sick sinus syndrome includes symptoms and signs related to sinus node dysfunction. This can be caused by intrinsic abnormal impulse formation and/or propagation from the sinus node or, in some cases, by extrinsic reversible causes. Careful evaluation of symptoms and of the electrocardiogram is of crucial importance, because diagnosis is mainly based on these 2 elements. In some cases, the pathophysiologic mechanism that induces sinus node dysfunction also favors the onset of atrial arrhythmias, which results in a more complex clinical condition, known as "bradycardia-tachycardia syndrome."
Collapse
Affiliation(s)
- Roberto De Ponti
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese, Varese 21100, Italy.
| | - Jacopo Marazzato
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese, Varese 21100, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, Perugia, Perugia 06129, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, Florence, Florence 50134, Italy; Cardiology Department, IRCCS Multimedica, Via Milanese, 300, Sesto San Giovanni, Milan 20099, Italy
| |
Collapse
|
11
|
Roca-Luque I, Rivas-Gándara N, Dos-Subirà L, Francisco-Pascual J, Pijuan-Domenech A, Pérez-Rodon J, Santos-Ortega A, Roses-Noguer F, Ferreira-Gonzalez I, García-Dorado García D, Moya Mitjans A. Predictors of Acute Failure Ablation of Intra-atrial Re-entrant Tachycardia in Patients With Congenital Heart Disease: Cardiac Disease, Atypical Flutter, and Previous Atrial Fibrillation. J Am Heart Assoc 2018; 7:e008063. [PMID: 29602766 PMCID: PMC5907589 DOI: 10.1161/jaha.117.008063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/13/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Intra-atrial re-entrant tachycardia (IART) in patients with congenital heart disease (CHD) increases morbidity and mortality. Radiofrequency catheter ablation has evolved as the first-line treatment. The aim of this study was to analyze the acute success and to identify predictors of failed IART radiofrequency catheter ablation in CHD. METHODS AND RESULTS The observational study included all consecutive patients with CHD who underwent a first ablation procedure for IART at a single center from January 2009 to December 2015 (94 patients, 39.4% female, age: 36.55±14.9 years). In the first procedure, 114 IART were ablated (acute success: 74.6%; 1.21±0.41 IART per patient) with an acute success of 74.5%. Cavotricuspid isthmus-related IART was the only arrhythmia in 51%; non-cavotricuspid isthmus-related IART was the only mechanism in 27.7% and 21.3% of the patients had both types of IART. Predictors of acute radiofrequency catheter ablation failure were as follows: nonrelated cavotricuspid isthmus IART (odds ratio 7.3; confidence interval [CI], 1.9-17.9; P=0.04), previous atrial fibrillation (odds ratio 6.1; CI, 1.3-18.4; P=0.02), transposition of great arteries (odds ratio, 4.9; CI, 1.4-17.2; P=0.01) and systemic ventricle dilation (odds ratio 4.8; CI, 1.1-21.7; P=0.04) with an area under the receiver operating characteristic curve of 0.83±0.056 (CI, 0.74-0.93, P=0.001). After a mean follow-up longer than 3.5 years, 78.3% of the patients were in sinus rhythm (33.1% of the patients required more than 1 radiofrequency catheter ablation procedure). CONCLUSIONS Although ablation in CHD is a challenging procedure, acute success of 75% can be achieved in moderate-highly complex CHD patients in a referral center. Predictors of failed ablation are IART different from cavotricuspid isthmus, previous atrial fibrillation, and markers of complex CHD (transposition of great arteries, systemic ventricle dilation).
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Atrial Fibrillation/complications
- Atrial Fibrillation/diagnosis
- Atrial Fibrillation/physiopathology
- Atrial Flutter/complications
- Atrial Flutter/diagnosis
- Atrial Flutter/physiopathology
- Child
- Child, Preschool
- Echocardiography
- Electrocardiography
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Humans
- Male
- Middle Aged
- Prospective Studies
- Radiofrequency Ablation/adverse effects
- Retrospective Studies
- Risk Factors
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/etiology
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Time Factors
- Treatment Failure
- Young Adult
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Dos-Subirà
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Antònia Pijuan-Domenech
- Grown-Up Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ferran Roses-Noguer
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
12
|
Klehs S, Schneider HE, Backhoff D, Paul T, Krause U. Radiofrequency Catheter Ablation of Atrial Tachycardias in Congenital Heart Disease. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005451. [DOI: 10.1161/circep.117.005451] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
Background
Radiofrequency catheter ablation has become the treatment strategy of choice for atrial tachyarrhythmias in patients with congenital heart disease (CHD). We analyzed results of radiofrequency catheter ablation in a large cohort of patients with CHD with special reference to complexity of underlying anatomy.
Methods and Results
One hundred and forty-four patients with CHD and atrial tachyarrhythmias undergoing radiofrequency catheter ablation were classified according to complexity of underlying CHD: simple CHD, n=18 (12%); moderate CHD, n=53 (37%); and complex CHD, n=73 (51%). Overall acute success was achieved in 81% of the patients. Acute success was lower for tachycardias involving the left atrium compared with right atrial tachycardias. Complexity of CHD was associated with longer procedure duration. Tachycardia recurrence was observed in 54% of the patients after a total follow-up of 7.4 years. 75% of all recurrences occurred within the first year. Recurrence of tachycardia was more likely in patients with complex surgical atrial anatomy (ie, Fontan palliation or atrial switch procedure). Major complications occurred in 4 patients and were related to vascular access.
Conclusions
Acute procedural success of atrial tachycardia ablation in congenital heart patients was not influenced by complexity of CHD. Long-term outcome with regard to tachycardia recurrence was worse in patients with complex surgical atrial anatomy.
Collapse
Affiliation(s)
- Sophia Klehs
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - Heike E. Schneider
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - David Backhoff
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - Thomas Paul
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| | - Ulrich Krause
- From the Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University Medical Center, Georg August University Göttingen, Germany
| |
Collapse
|
13
|
Combes N, Derval N, Hascoët S, Zhao A, Amet D, Le Bloa M, Maltret A, Heitz F, Thambo JB, Marijon E. Ablation of supraventricular arrhythmias in adult congenital heart disease: A contemporary review. Arch Cardiovasc Dis 2017; 110:334-345. [DOI: 10.1016/j.acvd.2017.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
|
14
|
Chubb H, Williams SE, Whitaker J, Harrison JL, Razavi R, O'Neill M. Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology. Arrhythm Electrophysiol Rev 2017; 6:85-93. [PMID: 28845235 DOI: 10.15420/aer.2017.1.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.
Collapse
Affiliation(s)
| | - Steven E Williams
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - James L Harrison
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Mark O'Neill
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
15
|
Atrial tachyarrhythmias after atrial switch operation for transposition of the great arteries: Treating old surgery with new catheters. Heart Rhythm 2016; 13:1731-8. [DOI: 10.1016/j.hrthm.2016.03.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Indexed: 11/18/2022]
|
16
|
Abstract
Arrhythmias are common in adults with congenital heart disease and account for a large proportion of hospitalizations. The complex anatomical heterogeneity, often in the presence of a delicate hemodynamic system, presents a significant electrophysiological challenge. This review outlines current clinical practice and advances in maximizing the effectiveness of ablation for arrhythmias in congenital heart patients.
Collapse
|
17
|
Teuwen CP, Taverne YJHJ, Houck C, Götte M, Brundel BJJM, Evertz R, Witsenburg M, Roos-Hesselink JW, Bogers AJJC, de Groot NMS. Tachyarrhythmia in patients with congenital heart disease: inevitable destiny? Neth Heart J 2016; 24:161-70. [PMID: 26728051 PMCID: PMC4771626 DOI: 10.1007/s12471-015-0797-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The prevalence of patients with congenital heart disease (CHD) has increased over the last century. As a result, the number of CHD patients presenting with late, postoperative tachyarrhythmias has increased as well. The aim of this review is to discuss the present knowledge on the mechanisms underlying both atrial and ventricular tachyarrhythmia in patients with CHD and the advantages and disadvantages of the currently available invasive treatment modalities.
Collapse
Affiliation(s)
- C P Teuwen
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Y J H J Taverne
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Houck
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - M Götte
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - B J J M Brundel
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Physiology, Institute of Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
| | - R Evertz
- Department of Cardiology, University Medical Center St. Radboud, Nijmegen, The Netherlands
| | - M Witsenburg
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - A J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N M S de Groot
- Department of Cardiology, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| |
Collapse
|
18
|
Krause U, Backhoff D, Klehs S, Schneider HE, Paul T. Contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. J Interv Card Electrophysiol 2016; 46:191-8. [DOI: 10.1007/s10840-015-0096-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
|
19
|
Krause U, Backhoff D, Klehs S, Schneider HE, Paul T. Transbaffle catheter ablation of atrial re-entrant tachycardia within the pulmonary venous atrium in adult patients with congenital heart disease. Europace 2015; 18:1055-60. [PMID: 26511396 DOI: 10.1093/europace/euv295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/03/2015] [Indexed: 01/11/2023] Open
Abstract
AIMS Catheter ablation of atrial re-entrant tachycardia in patients after atrial switch procedure for transposition of the great arteries or with a Fontan circulation is technically challenging if the critical part of the re-entry circuit is located within the pulmonary venous atrium (PVA). We report our experience in transbaffle access (TBA) to the PVA for ablation of atrial re-entrant tachycardia focusing on technical details. METHODS AND RESULTS In eight patients, six after Mustard procedure and two with a Fontan circulation, endocardial mapping of atrial re-entrant tachycardia revealed the critical part of the re-entry circuit within the PVA. A total of 10 ablation procedures were performed. Detailed angiographic assessment of the anatomy of the systemic and pulmonary venous atria was performed prior to baffle puncture. Transbaffle access was successfully established with a standard transseptal needle in 9 of 10 procedures. No major complications occurred. At the end of the procedure and the removal of the transseptal sheath, there was no residual shunt in any patient. CONCLUSION Transbaffle access to the PVA for ablation of atrial re-entrant tachycardia is feasible, less invasive than alternative approaches and can be safely applied in patients after Mustard procedure or with a Fontan circulation. However, the rigidity of prosthetic material may preclude baffle puncture at least in a subset of those patients.
Collapse
Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany
| | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany
| | - Sophia Klehs
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University of Göttingen, Robert- Koch-Str 40, Göttingen 37075, Germany
| |
Collapse
|
20
|
Maxwell BG, Steppan J, Cheng A. Complications of Catheter-Based Electrophysiology Procedures in Adults With Congenital Heart Disease: A National Analysis. J Cardiothorac Vasc Anesth 2015; 29:258-64. [DOI: 10.1053/j.jvca.2014.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Indexed: 11/11/2022]
|
21
|
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
|
22
|
PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: Executive Summary. Heart Rhythm 2014. [DOI: 10.1016/j.hrthm.2014.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
23
|
Radiation safety protocol using real-time dose reporting reduces patient exposure in pediatric electrophysiology procedures. Pediatr Cardiol 2014; 35:1116-23. [PMID: 24801673 DOI: 10.1007/s00246-014-0904-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/25/2014] [Indexed: 12/21/2022]
Abstract
Radiation exposure during pediatric catheterization is significant. We sought to describe radiation exposure and the effectiveness of radiation safety protocols in reducing exposure during catheter ablations with electrophysiology studies in children and patients with congenital heart disease. We additionally sought to identify at-risk patients. We retrospectively reviewed all interventional electrophysiology procedures performed from April 2009 to September 2011 (6 months preceding intervention, 12 months following implementation of initial radiation safety protocol, and 8 months following implementation of modified protocol). The protocols consisted of low pulse rate fluoroscopy settings, operator notification of skin entrance dose every 1,000 mGy, adjusting cameras by >5 at every 1,000 mGy, and appropriate collimation. The cohort consisted of 291 patients (70 pre-intervention, 137 after initial protocol implementation, 84 after modified protocol implementation) at a median age of 14.9 years with congenital heart disease present in 11 %. Diagnoses included atrioventricular nodal reentrant tachycardia (25 %), atrioventricular reentrant tachycardia (61 %), atrial tachycardias (12 %), and ventricular tachycardia (2 %). There were no differences between groups based on patient, arrhythmia, and procedural characteristics. Following implementation of the protocols, there were significant reductions in all measures of radiation exposure: fluoroscopy time (17.8 %), dose area product (80.2 %), skin entry dose (81.0 %), and effective dose (76.9 %), p = 0.0001. Independent predictors of increased radiation exposure included larger patient weight, longer fluoroscopy time, and lack of radiation safety protocol. Implementation of a radiation safety protocol for pediatric and congenital catheter ablations can drastically reduce radiation exposure to patients without affecting procedural success.
Collapse
|
24
|
Song K, Ge D, Guan S, Sun C, Ma X, Liu T. Mass transfer analysis of growth and substance metabolism of NSCs cultured in collagen-based scaffold in vitro. Appl Biochem Biotechnol 2014; 174:2114-30. [PMID: 25163884 DOI: 10.1007/s12010-014-1165-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/15/2014] [Indexed: 01/28/2023]
Abstract
The aim of this study is to analyze the growth and substance metabolism of neural stem cells (NSCs) cultured in biological collagen-based scaffolds. Mass transfer and metabolism model of glucose, lactic acid, and dissolved oxygen (DO) were established and solved on MATLAB platform to obtain the concentration distributions of DO, glucose, and lactic acid in culture system, respectively. Calculation results showed that the DO influenced their normal growth and metabolism of NSCs mostly in the in vitro culture within collagen-based scaffolds. This study also confirmed that 2-mm thickness of collagen scaffold was capable of in vitro cultivation and growth of NSCs with an inoculating density of 1 × 10(6) cells/mL.
Collapse
Affiliation(s)
- Kedong Song
- State Key Laboratory of Fine Chemicals, Dalian R&D Center for Stem Cell and Tissue Engineering, Dalian University of Technology, Dalian, 116024, China,
| | | | | | | | | | | |
Collapse
|
25
|
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]
|
26
|
Chubb H, Williams SE, Wright M, Rosenthal E, O'Neill M. Tachyarrhythmias and catheter ablation in adult congenital heart disease. Expert Rev Cardiovasc Ther 2014; 12:751-70. [PMID: 24783943 DOI: 10.1586/14779072.2014.914434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances in surgical technique have had an immense impact on longevity and quality of life in patients with congenital heart disease. However, an inevitable consequence of these surgical successes is the creation of a unique patient population whose anatomy, surgical history and haemodynamics result in the development of a challenging and complex arrhythmia substrate. Furthermore, this patient group remains susceptible to the arrhythmias seen in the general adult population. It is through a thorough appreciation of the cardiac structural defect, the surgical corrective approach, and haemodynamic impact that the most effective arrhythmia care can be delivered. Catheter ablation techniques offer a highly effective management option but require a meticulous attention to the real-time integration of anatomical and electrophysiological information to identify and eliminate the culprit arrhythmia substrate. This review describes the current approach to the interventional management of patients with tachyarrhythmias in the context of congenital heart disease.
Collapse
Affiliation(s)
- Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering and Division of Cardiovascular Medicine, King's College London, 4th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | | | | | | | | |
Collapse
|
27
|
Stec S, Sledz J, Mazij M, Ludwik B, Labus M, Spikowski J, Szydlowski L, Klank-Szafran M, Kraszewska E, Budzikowski AS. Simplified Automated Right Ventricular Overdrive Pacing for Rapid Diagnosis of Supraventricular Tachycardia. Cardiology 2014; 129:93-102. [DOI: 10.1159/000362786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/09/2014] [Indexed: 11/19/2022]
|
28
|
Sherwin ED, Triedman JK, Walsh EP. Update on interventional electrophysiology in congenital heart disease: evolving solutions for complex hearts. Circ Arrhythm Electrophysiol 2013; 6:1032-40. [PMID: 24129205 DOI: 10.1161/circep.113.000313] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Elizabeth D Sherwin
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | |
Collapse
|