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Dulai R, Bangash F, Sharma A, Cambridge A, Wong G, Lim W, Farwell D, Garcia J, Srinivansan NT. Open Window Mapping of Accessory Pathways: A Literature Review and Practical Guide. Arrhythm Electrophysiol Rev 2023; 12:e28. [PMID: 38213630 PMCID: PMC10782422 DOI: 10.15420/aer.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/17/2023] [Indexed: 01/13/2024] Open
Abstract
Catheter ablation is the treatment of choice for patients with symptomatic accessory pathways (APs) causing recurrent atrioventricular reciprocating tachycardia or in situations where APs conduct rapidly, posing a risk of sudden cardiac death. Conventional AP mapping relies on point-by-point assessment of local electrograms looking closely for pathway electrograms or early atrial or ventricular electrograms, which may be challenging and time consuming. Recently, open window mapping (OWM) using 3D navigational systems has emerged as a novel technique to help localise and ablate APs. OWM has significant advantages over conventional point-by-point mapping techniques. The purpose of this review is to summarise the currently available literature on the OWM technique and to highlight the technical aspects and mapping considerations for OWM, including specific cases demonstrating its utility.
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Affiliation(s)
- Rajdip Dulai
- Cardiology Research Department, Eastbourne District General Hospital, East Sussex Hospitals NHS Trust Eastbourne, UK
| | - Fatima Bangash
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University Chelmsford, Essex, UK
| | - Ajay Sharma
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
| | - Alex Cambridge
- Ashford and St Peter's NHS Foundation Trust Chertsey, Surrey, UK
| | - Geoff Wong
- Cardiac Sciences Clinical Institute, Epworth Richmond Hospital Melbourne, Australia
| | - Wei Lim
- Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich, UK
| | - David Farwell
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
| | - Jason Garcia
- Biosense Webster Melbourne, Australia & New Zealand
| | - Neil T Srinivansan
- Department of Cardiac Electrophysiology, The Essex Cardiothoracic Centre Basildon, Essex, UK
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University Chelmsford, Essex, UK
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Nakano M, Kondo Y, Kajiyama T, Nakano M, Ito R, Kitagawa M, Sugawara M, Chiba T, Ryuzaki S, Yoshino Y, Komai Y, Takanashi Y, Kobayashi Y. Junctional rhythm during cryoablation for typical atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2023; 34:1665-1670. [PMID: 37343063 DOI: 10.1111/jce.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Cryoablation is being used as an alternative to radiofrequency (RF) ablation for atrioventricular nodal reentrant tachycardia (AVNRT) owing to the lower risk of atrioventricular block (AVB) compared to RF ablation. Junctional rhythm often occurs during successful application of RF ablation for AVNRT. In contrast, junctional rhythm has rarely been reported to occur during cryoablation. This retrospective study evaluated the characteristics of junctional rhythm during cryoablation for typical AVNRT. METHODS AND RESULTS This retrospective study included 127 patients in whom successful cryoablation of typical AVNRT was performed. Patients diagnosed with atypical AVNRT were excluded. Junctional rhythm appeared during cryofreezing in 22 patients (17.3%). These junctional rhythms appeared due to cryofreezing at the successful site in the early phase within 15 s of commencement of cooling. Transient complete AVB was observed in 10 of 127 patients (7.9%), and it was noted that atrioventricular conduction improved immediately after cooling was stopped in these 10 patients. No junctional rhythm was observed before the appearance of AVB. No recurrence of tachycardia was confirmed in patients in whom junctional rhythm occurred by cryofreezing at the successful site. CONCLUSION Occurrence of junctional rhythms during cryoablation is not so rare and can be considered a criterion for successful cryofreezing. Furthermore, junctional rhythm may be associated with low risk of recurrent tachycardia.
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Affiliation(s)
- Masahiro Nakano
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takatsugu Kajiyama
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Miyo Nakano
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryo Ito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mari Kitagawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masafumi Sugawara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshinori Chiba
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoko Ryuzaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yutaka Yoshino
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuya Komai
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukiko Takanashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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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: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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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: 77] [Impact Index Per Article: 25.7] [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
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Hoshiyama T, Ashikaga K, Tsujita K, Shibata Y. Efficacy of cryo-ablation during atrioventricular nodal reentrant tachycardia. Heart Vessels 2020; 36:541-548. [PMID: 33113566 DOI: 10.1007/s00380-020-01717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
Because of the low atrioventricular (AV) block risk during cryo-ablation, it has become possible to treat AV nodal reentrant tachycardia (AVNRT) during arrhythmia. This study aimed to investigate the clinical outcomes of performing cryo-ablation for AVNRT during arrhythmia. Twenty-three patients with AVNRT treated by cryo-ablation during arrhythmia were enrolled. Cryo-ablation was performed gradually from the bottom to above the paraseptal tricuspid annulus until AVNRT was terminated. If the slow pathway was not eliminated despite cryo-ablation terminating the AVNRT, additional cryo-ablation was performed at a higher site until the slow pathway elimination was achieved. AVNRT was terminated by cryo-ablation in all 23 patients. However, the slow pathway was only eliminated in 6 patients. Among the remaining 17 patients, the slow pathway could not be ablated because transient AV block occurred during cryo-ablation at a higher site in 8 patients; however, cryo-ablation at a higher site successfully eliminated the slow pathway in the other 9 patients. In these 9 patients, the distance from the bottom of tricuspid annulus to the site of slow pathway elimination was significantly longer than that from bottom of tricuspid annulus to the AVNRT termination site (20.1 ± 5.3 vs 14.7 ± 4.5 mm: p = 0.027). During follow-up, AVNRT recurrence was confirmed in 3 patients. In 1 of these 3 patients, even a slow pathway elimination was achieved by cryo-ablation at the AVNRT termination site. The AVNRT termination site may not be the ideal site for performing cryo-ablation.
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Affiliation(s)
- Tadashi Hoshiyama
- Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan. .,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Keiichi Ashikaga
- Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshisato Shibata
- Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan
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Cryoballoon ablation of focal atrial tachycardia originating from right atrial appendage: Case report and review of the literature. Indian Pacing Electrophysiol J 2019; 19:164-166. [PMID: 30981904 PMCID: PMC6697489 DOI: 10.1016/j.ipej.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/25/2022] Open
Abstract
The right atrial appendage (RAA) is a rare site of focal atrial tachycardia (AT). Sometimes, catheter ablation cannot successfully be accomplished at this location due to the difficulty in reaching the exact ablation site as well as the associated possible life-threatening complications like pericardial tamponade or perforation. Although radiofrequency (RF) ablation is preferred for the treatment of RAA tachycardias, alternative tools may be required in rare instances. This report presents a case of RAA tachycardia that was not terminated by RF ablation, instead, has been successfully ablated using cryoballoon. In addition, an overview of the literature and therapeutic options for the AT originating from RAA have also been included.
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Nakano M, Ueda M, Kondo Y, Hayashi T, Nakano M, Miyazawa K, Ishimura M, Kobayashi Y. Shortening of the atrial-His bundle interval during atrial pacing as a predictor of successful ablation for typical atrioventricular nodal re-entrant tachycardia. Europace 2018; 20:654-658. [PMID: 28520908 DOI: 10.1093/europace/eux100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/25/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Shortening of the atrial-His bundle (AH) interval during the sinus rhythm is occasionally observed after slow pathway ablation for atrioventricular nodal re-entrant tachycardia (AVNRT). In addition, high-rate atrial pacing is useful for avoiding atrioventricular block. We hypothesized that shortening of the AH interval during slow pathway ablation under high-rate atrial pacing would lead to successful ablation of typical AVNRT. Methods and results This retrospective study included 37 patients in whom successful ablation of typical AVNRT was performed under atrial pacing. The AH interval was measured immediately before the first radiofrequency (RF) application and immediately after the last RF application, prior to the first induction. Twenty-five of 37 patients achieved procedural success at the first induction (i.e. successful group). No patients developed a prolonged AH interval or atrioventricular block. The AH interval was shortened by an average of 14.6 ± 7.7 and 1.8 ± 1.2 ms in the successful and other patient groups, respectively (P < 0.01). An AH interval decrease of > 10 ms was observed in 23 of 27 (85%) patients in the successful group, whereas all other patients had an AH interval decrease of < 5 ms. Conclusion Shortening of the AH interval during high-rate atrial pacing is a predictor of the successful ablation for typical AVNRT.
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Affiliation(s)
- Masahiro Nakano
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Marehiko Ueda
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Tomohiko Hayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Miyo Nakano
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Kazuo Miyazawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Masayuki Ishimura
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Tatarskiy R, Garkina S, Lebedev D. Catheter Ablation of Incisional Atrial Tachycardia. J Atr Fibrillation 2017; 9:1476. [PMID: 28496935 DOI: 10.4022/jafib.1476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/19/2016] [Accepted: 10/14/2016] [Indexed: 11/10/2022]
Abstract
Tachycardias after atrial incisions represent frequent and serious problem. The majority of them are based on a re-entry electrical activation around a combination of anatomic and surgically created obstacles. Considering significant progress of cardiovascular surgery during the last decade along with potential large amount of open-heart procedures in the near future the number of incisional tachycardias has a tendency to increase. The aim of this work was to quantify the magnitude of the problem, characterize the tachycardias after different surgical operations and to analyze possible interventional treatment strategies. Nowadays evolution of mapping and ablation technologies may contribute to radically treatment of this type of arrhythmias while there are still a lot of issues that should be solved to improve the results of interventional treatment of incisional tachycardias.
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Affiliation(s)
- Roman Tatarskiy
- Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia
| | - Svetlana Garkina
- Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia
| | - Dmitriy Lebedev
- Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia
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Aksu T, Güler TE, Özcan KS. Intolerable wide and narrow QRS complex tachycardia in the same patient: What is your diagnosis? INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chan NY. Catheter ablation of peri-nodal and pulmonary veno-atrial substrates: should it be cool? Europace 2016; 17 Suppl 2:ii19-30. [DOI: 10.1093/europace/euv230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abo-Haded HM. Radiofrequency ablation changes the quality of life of children with supraventricular tachycardias. Arch Dis Child 2015; 100:754-7. [PMID: 25838334 DOI: 10.1136/archdischild-2014-306466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/10/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) has rapidly become the first-line therapy for children with supraventricular tachycardia (SVT). Recently, more attention has been given to the measurement of health-related quality of life (QoL) in children. The primary aim of this study was to determine if there is a change in the QoL in children with SVT pre and post RFA procedure using the Pediatric Quality of Life Inventory (PedsQL) cardiac inventory. In addition, the study discusses the impact of age, gender and variety of SVT mechanisms on the QoL. DESIGN, SETTING AND PATIENTS All consecutive children with SVT referred for RFA at Mansoura University Children's Hospital were enrolled in this study. The PedsQL cardiac module questionnaire was given to the children/parents to be filled out before and 1 month following RFA procedure. Evaluated areas were physical, emotional, social, school and psychosocial function. The paired t test was used to test the difference between pre-time and post-time points for the study groups. Demographic and clinical data were collected. RESULTS The study sample consisted of 38 patients who underwent a successful ablation. The mean age of the patients at the time of RFA procedure was 12.4±5.3 years. There was a statistically significant improvement in all measured areas 1 month post successful RFA as compared with pre ablation. Post ablation, the greatest score improvement was in physical functioning. Older children (>12 years) showed the greatest benefit, but gender and type of SVT did not influence outcome. CONCLUSIONS RFA therapy is useful in improving QoL and perceptions in children with recurrent SVT.
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Kalbfleisch SJ, Rhodes TE. A rare case of permanent junctional reciprocating tachycardia ablated on the roof of the left atrium. J Cardiovasc Electrophysiol 2012; 24:464-7. [PMID: 22963110 DOI: 10.1111/j.1540-8167.2012.02440.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Left-sided anteroseptal accessory pathways that course through the aortomitral fibrous continuity are some of the rarest types of accessory pathways. At this region the atrium and ventricle are separated by their greatest distance because of the intervening aortic valve. These pathways often have a long circuitous course that may involve the root and cusps of the aortic valve. Prior reports have demonstrated the feasibility of ablating these pathways along the anteroseptal mitral annulus, the left ventricular outflow tract, or in the left or noncoronary cusps of the aortic valve. We describe a case of a concealed decremental anteroseptal accessory pathway that was ablated on the roof of the left atrium remote from the mitral or aortic valve annuli. This report indicates that when an appropriate site for ablation of a left-sided anteroseptal accessory pathway is not found close to a valve annulus, these pathways may be amenable to ablation by targeting their atrial insertion site.
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Affiliation(s)
- Steven J Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA.
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14
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Abstract
Major advances in diagnosis and treatment of arrhythmias have created the subspecialty of cardiac electrophysiology. This article reviews supraventricular and ventricular arrhythmias and outlines the indications and process of electrophysiological testing, arrhythmia mechanism and their treatment by catheter ablation.
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Affiliation(s)
- P Boon Lim
- University College London Hospitals NHS Trust, London, UK
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15
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Ilkhanoff L, Couchonnal LF, Goldberger JJ. Implications of cavotricuspid isthmus block complicating ablation of a posteroseptal accessory pathway. J Interv Card Electrophysiol 2012; 35:81-3. [PMID: 22644801 DOI: 10.1007/s10840-012-9684-3] [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: 02/15/2012] [Accepted: 03/22/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Leonard Ilkhanoff
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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RAZMINIA MANSOUR, MANANKIL MARIANF, ERYAZICI PAULAL, ARRIETA-GARCIA CARLOS, WANG THEODORE, D'SILVA OLIVERJ, LOPEZ CHRISTIANS, CRYSTAL GEORGEJ, KHAN SABA, STANCU MIHAELAM, TURNER MARIANNE, ANTHONY JOSEPH, ZHEUTLIN TERRYA, KEHOE RICHARDF. Nonfluoroscopic Catheter Ablation of Cardiac Arrhythmias in Adults: Feasibility, Safety, and Efficacy. J Cardiovasc Electrophysiol 2012; 23:1078-86. [DOI: 10.1111/j.1540-8167.2012.02344.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Almendral J, Castellanos E, Ortiz M. Taquicardias paroxísticas supraventriculares y síndromes de preexcitación. Rev Esp Cardiol 2012; 65:456-69. [DOI: 10.1016/j.recesp.2011.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 11/27/2011] [Indexed: 10/28/2022]
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Al Fagih A, Al Zahrani G, Al Hebaishi Y, Dagriri K, Al Ghamdi SA. Coronary sinus diverticulum as a cause of resistant posteroseptal pathway ablation. J Saudi Heart Assoc 2011; 23:41-4. [PMID: 23960634 DOI: 10.1016/j.jsha.2010.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 06/30/2010] [Accepted: 07/13/2010] [Indexed: 11/26/2022] Open
Abstract
Coronary sinus (CS) anomalies such as diverticulum, persistent left superior vena cava or CS ostium dilatation are predominantly found in patients with accessory pathway-related tachycardias. Diverticulum of the proximal CS found in 7-11% of patients with postero-septal or left posterior manifests accessory pathways. We reported a 28 year old gentleman with manifested postero-septal accessory pathway, who underwent repeat electrophysiological study (EPS) and radiofrequency ablation for previously failed ablation. Huge CS diverticulum was identified by angiography as a reason for resistant accessory pathway. Successful RF ablation was achieved at the neck of the diverticulum without complications. Other associated anomalies were ruled out by cardiac computerized tomography (CT) and trans-esophageal echocardiography.
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Affiliation(s)
- A Al Fagih
- Department of Adult Cardiology, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
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Wood KA, Stewart AL, Drew BJ, Scheinman MM, Froëlicher ES. Patient perception of symptoms and quality of life following ablation in patients with supraventricular tachycardia. Heart Lung 2009; 39:12-20. [PMID: 20109982 DOI: 10.1016/j.hrtlng.2009.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 02/08/2009] [Accepted: 04/07/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES It remains unclear which symptom experiences and aspects of quality of life (QOL) change after ablation in patients with supraventricular tachycardia (SVT). To determine how patient perceptions of symptoms and QOL change after ablation, we used a single group pretest-posttest design. METHODS Patients with SVT (n=52; mean age 41+/-17 years; 65% female) completed generic and disease-specific measures at baseline and 1 month after ablation. RESULTS Significant improvement after ablation was noted on virtually all measures (P <.05). Patients reported decreases from baseline regarding frequency and duration of episodes, number of symptoms, and impact of SVT on routine activities. All symptoms decreased in prevalence; however, no symptoms were completely eliminated at 1-month follow-up. Women, more so than men, reported larger changes in symptom and QOL scores after ablation. CONCLUSIONS Despite the small sample, statistically significant improvement was found after ablation in a variety of patients with different symptoms and QOL indices.
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Affiliation(s)
- Kathryn A Wood
- Duke University School of Nursing, Durham, NC 27710, USA.
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Rodriguez E, Cook RC, Chu MW, Chitwood WR. Minimally Invasive Bi-Atrial CryoMaze Operation for Atrial Fibrillation. ACTA ACUST UNITED AC 2009. [DOI: 10.1053/j.optechstcvs.2009.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Kolditz DP, Wijffels MCEF, Blom NA, van der Laarse A, Hahurij ND, Lie-Venema H, Markwald RR, Poelmann RE, Schalij MJ, Gittenberger-de Groot AC. Epicardium-derived cells in development of annulus fibrosis and persistence of accessory pathways. Circulation 2008; 117:1508-17. [PMID: 18332266 DOI: 10.1161/circulationaha.107.726315] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The developmental mechanisms underlying the persistence of myocardial accessory atrioventricular pathways (APs) that bypass the annulus fibrosis are mainly unknown. In the present study, we investigated the role of epicardium-derived cells (EPDCs) in annulus fibrosis formation and the occurrence of APs. METHODS AND RESULTS EPDC migration was mechanically inhibited by in ovo microsurgery in quail embryos. In ovo ECGs were recorded in wild-type (n=12) and EPDC-inhibited (n=12) hearts at Hamburger-Hamilton (HH) stages 38 to 42. Subsequently, in these EPDC-inhibited hearts (n=12) and in additional wild-type hearts (n=45; HH 38-42), ex ovo extracellular electrograms were recorded. Electrophysiological data were correlated with differentiation markers for cardiomyocytes (MLC2a) and fibroblasts (periostin). In ovo ECGs showed significantly shorter PR intervals in EPDC-inhibited hearts (45+/-10 ms) than in wild-type hearts (55+/-8 ms, 95% CI 50 to 60 ms, P=0.030), whereas the QRS durations were significantly longer in EPDC-inhibited hearts (29+/-14 versus 19+/-2 ms, 95% CI 18 to 21 ms, P=0.011). Furthermore, ex ovo extracellular electrograms (HH 38-42) displayed base-first ventricular activation in 44% (20/45) of wild-type hearts, whereas in all EPDC-inhibited hearts (100%, 12/12), the ventricular base was activated first (P<0.001). Small periostin- and MLC2a-positive APs were found mainly in the posteroseptal region of both wild-type and EPDC-inhibited hearts. Interestingly, in all (n=10) EPDC-inhibited hearts, additional large periostin-negative and MLC2a-positive APs were found in the right and left lateral free wall coursing through marked isolation defects in the annulus fibrosis until the last stages of embryonic development. CONCLUSIONS EPDCs play an important role in annulus fibrosis formation. EPDC outgrowth inhibition may result in marked defects in the fibrous annulus with persistence of large APs, which results in ventricular preexcitation on ECG. These APs may provide a substrate for postnatally persistent reentrant arrhythmias.
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Affiliation(s)
- Denise P Kolditz
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Schneeberger EW, Osterday RM. Lateral Placement of Bipolar Clamp Facilitates Pulmonary Vein Isolation. Ann Thorac Surg 2007; 84:1412-3. [PMID: 17889022 DOI: 10.1016/j.athoracsur.2007.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 02/14/2007] [Accepted: 03/07/2007] [Indexed: 10/22/2022]
Abstract
The surgical management of atrial fibrillation is becoming more commonplace with the procedure of pulmonary vein isolation forming the cornerstone of the treatment of atrial fibrillation. In this article a technique is described to introduce a dry bipolar radiofrequency clamp into the chest through a lateral port sized incision to safely effect pulmonary vein isolation in patients with low ejection fractions undergoing a concomitant mini-maze procedure. Confirmation of the transmurality and effectiveness of the lines of ablation is shown by the demonstration of bidirectional block to and from the pulmonary veins.
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Affiliation(s)
- Eric W Schneeberger
- Department of Cardiothoracic Surgery, University of Cincinnati, Cincinnati, Ohio 45267, USA.
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25
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Kolditz DP, Wijffels MCEF, Blom NA, van der Laarse A, Markwald RR, Schalij MJ, Gittenberger-de Groot AC. Persistence of functional atrioventricular accessory pathways in postseptated embryonic avian hearts: implications for morphogenesis and functional maturation of the cardiac conduction system. Circulation 2006; 115:17-26. [PMID: 17190860 DOI: 10.1161/circulationaha.106.658807] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During heart development, the ventricular activation sequence changes from a base-to-apex to an apex-to-base pattern. We investigated the possibility of impulse propagation through remnants of atrioventricular (AV) connections in quail hearts. METHODS AND RESULTS In 86 hearts (group A, HH30-34, n=15; group B, HH35-44, n=65; group C, 5 to 6 months, n=6) electrodes were positioned at the left atrium, right ventricular base, left ventricular (LV) base, and LV apex. In group A, LV base activation preceded LV apex activation in the majority of cases (60%; 9 of 15), whereas hearts in group B primarily demonstrated an LV apex-to-base activation pattern (72%; 47 of 65). Interestingly, in group B, the right ventricular base (17%; 11 of 65) or LV base (8%; 5 of 65) exhibited premature activation in 25% (16 of 65) of cases, whereas in 26% (17 of 65), the right ventricular base or LV base was activated simultaneously with the LV apex. Morphological analysis confirmed functional data by showing persistent muscular AV connections in embryonic hearts. Interestingly, all myocardial AV connections stained positive for periostin, a nonmyocardial marker. Longitudinal analysis (HH35-44) demonstrated a decrease in both the number of hearts that exhibited premature base activation (P=0.015) and the number (P=0.004) and width (P=0.179) of accessory AV pathways with developmental stage in a similar time course. In the adult quail hearts, accessory myocardial AV pathways were functionally and morphologically absent. CONCLUSIONS Thus, impulse propagation through persistent accessory AV connections remains possible at near-hatching stages (HH44) of development, which may provide a substrate for AV reentrant arrhythmias in perinatal life. Periostin positivity and absence of AV pathways in the adult heart suggest that these connections eventually lose their myocardial phenotype, which implicates ongoing AV ring isolation perinatally and postnatally.
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Affiliation(s)
- Denise P Kolditz
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Jahangiri M, Weir G, Mandal K, Savelieva I, Camm J. Current Strategies in the Management of Atrial Fibrillation. Ann Thorac Surg 2006; 82:357-64. [PMID: 16798260 DOI: 10.1016/j.athoracsur.2005.11.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 11/10/2005] [Accepted: 11/22/2005] [Indexed: 11/25/2022]
Abstract
Treatment of atrial fibrillation (AF) has been undergoing significant changes recently. This is due partly to different mechanisms proposed for persistent and permanent AF and partly due to the introduction of energy-based techniques, providing less invasive procedures. This article aims to review the mechanisms of AF leading to the changes in clinical practice and to review the results of surgery, energy-based, and percutaneous techniques. It is difficult to compare and contrast the results of reported series in the literature due to different definitions of AF; freedom from and recurrence of it. Furthermore, in most series it is difficult to distinguish results of surgery for lone AF and AF associated with valvular heart disease and coronary artery disease.
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Affiliation(s)
- Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital Medical School, London, United Kingdom.
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Abstract
The specialist management of arrhythmias has changed significantly over the past decade. This article outlines current management strategies for atrial flutter and atrial fibrillation, with particular emphasis on curative strategies with catheter ablation and the recent data on rhythm compared with rate control strategies. The expanding role of catheter ablation in the treatment of a wide variety of supraventricular and ventricular arrhythmias is discussed. The current evidence for implantable cardioverter defibrillators in the prevention of sudden cardiac death is summarised. The article also highlights the increasing recognition of a number of inherited syndromes that predispose to sudden cardiac death (for example, Brugada and long QT syndromes).
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Cox JL. The central controversy surrounding the interventional-surgical treatment of atrial fibrillation. J Thorac Cardiovasc Surg 2005; 129:1-4. [PMID: 15632817 DOI: 10.1016/j.jtcvs.2004.08.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Affiliation(s)
- Douglas P Zipes
- Krannert Institute of Cardiology, Indiana University School of Medicine and the Roudebush Veterans Administration Medical Center, Indianapolis, Indiana 46202, USA.
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