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Simultaneous Entrainment Response Assessment at Multiple Sites. JACC Clin Electrophysiol 2022; 8:1381-1390. [PMID: 36424006 DOI: 10.1016/j.jacep.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The entrainment response, defined as the difference between the postpacing interval and the tachycardia cycle length (TCL) recorded from a mapping catheter, allows to track down the components of the tachycardia loop. OBJECTIVES The aim of this study was to evaluate if the postpacing interval measured simultaneously from multiple sites that are remote from the pacing site (PPIR) could be clinically useful in mapping re-entrant circuits. METHODS Ninety-two episodes of entrainment response in 29 patients with different macro-re-entrant tachycardias were evaluated using a standardized entrainment protocol. The spatial distribution of different values of PPIR-TCL in a simulation and a computational model of an entrained re-entrant tachycardia was also analyzed. RESULTS The PPIR exceeded TCL by more than 20 milliseconds only if both pacing and recording sites were outside the tachycardia circuit. The PPIR-TCL at in-circuit sites was always ≤20 milliseconds. Sites with negative PPIR-TCL values were found either outside or inside the tachycardia circuit. CONCLUSIONS Assessment of entrainment response from catheters remote from the pacing site may enhance spatial mapping of the tachycardia circuit. The PPIR-TCL above 20 milliseconds has an excellent positive predictive value in identifying sites outside the tachycardia circuit.
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2
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Tuncez A, Aslan AO, Merovci I, Oksuz F, Dogru CY, Kara M, Ozcan Cetin EH, Korkmaz A, Ozeke O, Cay S, Ozcan F, Aras D, Topaloglu S. Entrainment of ventricular tachycardia with V‐shaped diastolic activation pattern: Is the pacing site in or out? J Cardiovasc Electrophysiol 2022; 33:1609-1613. [DOI: 10.1111/jce.15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ahmet Oguz Aslan
- Health Sciences UniversityAhi Evren Thoracic, and Cardiovascular Surgery Training and Research HospitalTrabzonTurkey
| | - Idriz Merovci
- University Clinical Center of KosovoDepartment of CardiologyPrishtina, Kosovo
| | - Fatih Oksuz
- Health Sciences UniversityAnkara Education and Research Hospital, Department of CardiologyAnkaraTurkey
| | - Ceren Yagmur Dogru
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Meryem Kara
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | | | - Ahmet Korkmaz
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Ozcan Ozeke
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Serkan Cay
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
| | - Firat Ozcan
- Selcuk UniversityDepartment of CardiologyKonyaTurkey
| | - Dursun Aras
- İstanbul Medipol UniversityDepartment of CardiologyİstanbulTurkey
| | - Serkan Topaloglu
- Health Sciences UniversityAnkara City Hospital, Department of CardiologyAnkaraTurkey
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3
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Wiles BM, Li AC, Waight MC, Saba MM. Contemporary Management of Complex Ventricular Arrhythmias. Arrhythm Electrophysiol Rev 2022; 11:e04. [PMID: 35734144 PMCID: PMC9194914 DOI: 10.15420/aer.2021.66] [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: 11/29/2021] [Accepted: 02/06/2022] [Indexed: 12/02/2022] Open
Abstract
Percutaneous catheter ablation is an effective and safe therapy that can eliminate ventricular tachycardia, reducing the risks of both recurrent arrhythmia and shock therapies from a defibrillator. Successful ablation requires accurate identification of arrhythmic substrate and the effective delivery of energy to the targeted tissue. A thorough pre-procedural assessment is needed before considered 3D electroanatomical mapping can be performed. In contemporary practice, this must combine traditional electrophysiological techniques, such as activation and entrainment mapping, with more novel physiological mapping techniques for which there is an ever-increasing evidence base. Novel techniques to maximise energy delivery to the tissue must also be considered and balanced against their associated risks of complication. This review provides a comprehensive appraisal of contemporary practice and the evidence base that supports recent developments in mapping and ablation, while also considering potential future developments in the field.
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Affiliation(s)
- Benedict M Wiles
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Anthony C Li
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Michael C Waight
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Magdi M Saba
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK.,Cardiology Clinical Academic Group, St George's University of London, London, UK
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4
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Dall'Aglio PB, Johner N, Namdar M, Shah DC. Significance of post-pacing intervals shorter than tachycardia cycle length for successful catheter ablation of atypical flutter. Europace 2021; 23:624-633. [PMID: 33197256 DOI: 10.1093/europace/euaa300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS During entrainment mapping of macro-reentrant tachycardias, the time difference (dPPI) between post-pacing interval (PPI) and tachycardia cycle length (TCL) is thought to be a function of the distance of the pacing site to the re-entry circuit and dPPI < 30 ms is considered within the re-entry circuit. This study assessed the importance of PPI < TCL as a successful target for atypical flutter ablation. METHODS AND RESULTS A total of 177 ablation procedures were investigated. Surface electrocardiograms (ECGs) were evaluated and combined activation and entrainment mapping were performed to choose ablation sites. Each entrainment sequence immediately preceding static radiofrequency delivery at the same site was analysed. A total of 545 entrainment sequences were analysed. dPPI < 0 ms was observed in 45.3% (247/545) sequences. Ablation resulted in tachycardia termination more often at sites with dPPI < 0 (27.8% vs. 14.5%, P < 0.001) and with a progressively increasingly inverse correlation between dPPI duration and ablation success [odds ratio (OR): 0.974; 95% confidence interval (CI) 0.960-0.988; P < 0.001]. Tachycardia termination or cycle length prolongation also occurred more often at sites with dPPI < 0 (50.6% vs. 33.2%, P < 0.001) and with a similar inverse correlation with dPPI duration (OR: 0.972; 95% CI 0.960-0.984; P < 0.001). Twelve-lead synchronous isoelectric intervals were observed in 64.4% (163/253) flutter ECGs and were associated with a dPPI < 0 (75.3% vs. 55.8%, P < 0.001). CONCLUSION When combined with activation mapping, a negative dPPI is a more effective parameter for identifying a target for successful ablation compared to a dPPI = 0-30 ms. Its occurrence is associated with a critical small narrow slow-conducting isthmus at the target site.
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Affiliation(s)
- Pietro Bernardo Dall'Aglio
- Cardiology Division, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Nicolas Johner
- Cardiology Division, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Mehdi Namdar
- Cardiology Division, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Dipen C Shah
- Cardiology Division, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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5
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Wakamatsu Y, Nagashima K, Iso K, Sonoda K, Watanabe R, Arai M, Otsuka N, Hayashida S, Yagyu S, Hirata S, Kurokawa S, Kimie O, Nakai T, Okumura Y. Resetting of atrial tachycardia by a scanned extrastimulus at a downstream site on a multielectrode catheter: a simple diagnostic maneuver for locating the macroreentrant atrial tachycardia circuit. J Interv Card Electrophysiol 2021; 63:39-47. [PMID: 33515142 DOI: 10.1007/s10840-020-00934-4] [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: 04/24/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Entrainment is a useful method for locating reentrant atrial tachycardia (AT) circuits, but alterations or termination of the AT can derail this process. We assessed whether resetting an upstream site of a neighboring electrode by a scanned extrastimulus at a downstream site (when the upstream tissue was refractory) could diagnose that site within the AT circuit. METHODS The procedure was applied to 48 ATs with a cycle length (CL) of 238 ± 42 ms (26 common flutters, 8 perimitral flutters, 7 left atrial [LA] roof-dependent AT, 3 LA scar-related macroreentrant ATs, 2 pulmonary vein-gap reentry tachycardias, 1 right atrial scar-related macroreentrant AT, and 1 with an unidentified circuit). Entrainment and scanned extrastimulation were attempted at the cavotricuspid isthmus, LA roof, and mitral isthmus and/or critical AT isthmus. RESULTS Within the circuit, the post-pacing interval minus the ATCL after entrainment was < 30 ms for all ATs and resetting of the AT cycle by ≥ 5 ms occurred in 94% of the ATs. No ATs were reset by extrastimulation outside the circuit. The positive predictive value of both maneuvers for locating the circuit was 100%, and the negative predictive value of the extrastimulation was similar to that of entrainment (96% vs. 100%, P = 0.25). The incidence of an AT alteration was lower with extrastimulation than with entrainment (1% vs. 9%, P = 0.01). For ATs with a CL < 210 ms, extrastimulation yielded a good diagnostic performance without any AT alterations. CONCLUSION AT resetting by a scanned extrastimulus is diagnostic and avoids AT alterations.
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Affiliation(s)
- Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Kazuki Iso
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.,Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku, Kawaguchi-shi, Saitama, 333-0833, Japan
| | - Kazumasa Sonoda
- Tokyo Rinkai Hospital, 1-4-2 Rinkaicho, Edogawa-ku, Tokyo, 134-0086, Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Satoshi Hayashida
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.,Kawaguchi Municipal Medical Center, 180 Nishiaraijyuku, Kawaguchi-shi, Saitama, 333-0833, Japan
| | - Seina Yagyu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Syu Hirata
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ohkubo Kimie
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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6
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Takigawa M, Martin R, Kitamura T, Cochet H, Jais P, Sacher F. Double ventricular tachycardias associated with an anatomical isthmus identified by a computed tomography-derived channel. J Cardiovasc Electrophysiol 2020; 31:3061-3063. [PMID: 32889746 DOI: 10.1111/jce.14735] [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: 06/21/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
We describe a 47-year-old woman with ischemic ventricular tachycardia (VT) with repetitive implantable cardioverter-defibrillator shocks, requiring ablation. Preprocedural computed tomography (CT) demonstrated a single anatomical channel on the inferior-basal infarcted area between less than a 3-mm wall-thinning area and the mitral annulus, which suggested the circuit of two VTs observed. In addition, distribution of less than 2 mm and less than 3 mm wall-thinning area can explain the mechanism of the variation of the QRS morphology and S-QRS interval during entrainment. Ablation in this region resulted in no VT inducibility and the absence of any VTs for 2 years. CT wall thinning data may allow us to understand the mechanism and circuit of VT and aid VT ablation procedures.
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Affiliation(s)
- Masateru Takigawa
- LIRYC Institute, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ruairidh Martin
- LIRYC Institute, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Takeshi Kitamura
- LIRYC Institute, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Hubert Cochet
- LIRYC Institute, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Pierre Jais
- LIRYC Institute, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frederic Sacher
- LIRYC Institute, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
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7
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Mapping and Ablation of Unmappable Ventricular Tachycardia, Ventricular Tachycardia Storm, and Those in Acute Myocardial Infarction. Card Electrophysiol Clin 2019; 11:675-688. [PMID: 31706474 DOI: 10.1016/j.ccep.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In stable ventricular tachycardia (VT), activation mapping and entrainment mapping are the most important strategies to describe the reentrant circuit and its critical components. In many patients, however, VT is noninducible or hemodynamically unstable and unmappable. Several technological advances have broadened ablation options in unmappable VTs. Preprocedural imaging and intraprocedural imaging play an important role in location and extent of the substrate. Electroanatomic mapping with several technological improvements allows more precise electrical assessment of the substrate. A combination of imaging and electroanatomic mapping allows substantial modification of arrhythmogenic substrate in sinus rhythm or during device pacing without hemodynamic compromise.
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8
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Kawamura I, Fukamizu S, Arai M, Inagaki D, Miyabe T, Miyazawa S, Hojo R, Nishizaki M, Sakurada H, Hiraoka M. Characteristics of Marshall bundle-related atrial tachycardias using an ultrahigh-resolution mapping system. J Interv Card Electrophysiol 2019; 55:161-169. [PMID: 31016427 DOI: 10.1007/s10840-019-00544-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Marshall bundle (MB)-related atrial tachycardias (ATs) have already been described; however, their characteristics using an ultrahigh-resolution mapping system are not yet well known. The purpose of this study was to clarify the characteristics of MB-related ATs with ultrahigh-resolution mapping. METHODS In 28 patients who underwent an electrophysiological study for ATs using an ultrahigh-resolution mapping system, precise circuits of 37 ATs were detected. Among those ATs, five were diagnosed as MB-related ATs that had epicardial connections among the reentrant circuits (mean age 76.6 ± 3.7 years, one male patient). We analyzed the characteristics of those MB-related ATs with ultrahigh-resolution mapping. RESULTS The mean cycle length was 260 ± 60 ms, and the total acquired electrograms were 12,962 ± 2616 points. Two ATs were perimitral ATs, two rotated around the left pulmonary vein (PV), and one rotated around the left inferior PV. All ATs had a centrifugal activation pattern: 5 o'clock on the mitral annulus in four ATs and the upper ridge in one. Tiny potentials, which indicated epicardial potentials covering the cycle length, were detected in four of five ATs. The local activation times covered over 95% of the tachycardia cycle length on the endocardial side only in all ATs. All ATs were terminated during a radiofrequency ablation from the endocardial side of the Marshall bundle. CONCLUSIONS The ultrahigh-resolution mapping system demonstrated an activation map of MB-related ATs with a centrifugal pattern. Macroreentrant tachycardias with a centrifugal activation pattern should be considered as possible MB-related ATs.
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Affiliation(s)
- Iwanari Kawamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan.
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Marina Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Dai Inagaki
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Tomonori Miyabe
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Satoshi Miyazawa
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, Japan
| | | | - Harumizu Sakurada
- Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Tokyo, Japan
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Shen MJ, Knight BP, Kim SS. Fusion during entrainment at the cavotricuspid isthmus: What is the mechanism? Heart Rhythm 2018; 15:787-789. [PMID: 29709230 DOI: 10.1016/j.hrthm.2017.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mark J Shen
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Susan S Kim
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
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10
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Yalin K, Golcuk E, Karaayvaz EB, Aksu T, Arslane M, Tiryakioglu SK, Bilge AK, Adalet K. Postpacing Interval During Right Ventricular Overdrive Pacing to Discriminate Supraventricular from Ventricular tachycardia. J Atr Fibrillation 2017; 10:1619. [PMID: 29250234 DOI: 10.4022/jafib.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/19/2017] [Accepted: 08/24/2017] [Indexed: 11/10/2022]
Abstract
Introduction Failure to differentiate supraventricular from ventricular arrhythmias is the most frequent cause of inappropriate implantable cardioverter-defibrillator (ICD) therapies. We hypothesized that the postpacing interval (PPI) after overdrive right ventricular pacing may differentiate ventricular (VT) from supraventricular tachycardia (SVT) such as sinus tachycardia, atrial flutter and atrial tachycardia. This hypothesis is based on the entrainment maneuver. Reentrant tachycardia circuit for VTs would haveshorter distance to RV apex than SVTs have, and the conduction time between a ventricular pacing site and the tachycardia origin is expected to be shorter in VTs than in SVTs. Methods 220episodes from 38 patients with single chamber ICDs that RV overdrive pacing could not terminate or change the tachycardia cycle length (TCL) were retrospectively reviewed. Episodes were classified as VTs (n=115) and SVTs (n=105). TCLs, PPIs and PPI-TCL were compared between groups. Results The cycle length of VTs was shorter than SVTs (320.6±30.3 vs 366.5±40 ms, p=0.001). PPI and PPI-TCL of VTs were shorter than SVTs (504.7±128.3 vs 689.2±121.8 ms, p=0.001, 184±103 vs 322.6±106.6 ms, p=0.001; respectively). ROC curve analysis demonstrated a 525 ms cut-off value for PPI has 89% sensitivity and 57.4% specificity to predict inappropriate ICD therapies due to SVTs (AUC:0.852). Similarly, A PPI-TCL <195 ms favored VT as a diagnosis rather than SVT with a 90% sensitivity, and 51% specificity (AUC:0.838). Conclusion Analyzing of PPI during overdrive pacing from RV apex may discriminate supraventricular from ventricular tachycardia. This criterion may have a potential role in implantable devices that use a single ventricular lead.
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Affiliation(s)
- Kivanc Yalin
- Uşak University, Faculty of Medicine, Department of Cardiology, Uşak-Turkey
| | - Ebru Golcuk
- Balıkesir University, Faculty of Medicine, Department of Cardiology, Baslıkesir-Turkey
| | | | - Tolga Aksu
- Kocaeli Derince Education and Research Hospital, Cardiology Clinic, Kocaeli-Turkey
| | | | | | - Ahmet Kaya Bilge
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul-Turkey
| | - Kamil Adalet
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul-Turkey
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11
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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.
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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
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12
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Takigawa M, Derval N, Frontera A, Martin R, Yamashita S, Cheniti G, Vlachos K, Thompson N, Kitamura T, Wolf M, Massoullie G, Martin CA, Al-Jefairi N, Amraoui S, Duchateau J, Klotz N, Pambrun T, Denis A, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jais P. Revisiting anatomic macroreentrant tachycardia after atrial fibrillation ablation using ultrahigh-resolution mapping: Implications for ablation. Heart Rhythm 2017; 15:326-333. [PMID: 29081399 DOI: 10.1016/j.hrthm.2017.10.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anatomic macroreentrant atrial tachycardias (MATs) are conventionally reported to depend on the cavotricuspid isthmus, the mitral isthmus, or the left atrial roof, and are commonly seen following catheter ablation for atrial fibrillation. OBJECTIVES To define the precise circuits of anatomic MAT with ultrahigh-resolution mapping. METHODS In 57 patients (mean age, 62 years; 10 female) who developed ≥1 anatomic MAT, we analyzed 88 MAT circuits including 16 peritricuspid, 42 perimitral, and 30 roof-dependent circuits, using high-density mapping and entrainment. RESULTS Of 16 peritricuspid atrial tachycardias (ATs), 8 (50.0%) showed a circuit not limited to the tricuspid annulus. However, cavotricuspid isthmus ablation terminated the tachycardia in all patients. Similarly, 26 of 42 perimitral ATs (61.9%) showed a circuit not limited to the mitral annulus, and a low-voltage zone <0.1 mV around the mitral annulus was associated with nontypical perimitral ATs (P < .0001). The practical isthmus was not in the mitral isthmus in 13 of these 26 perimitral ATs (50%). Finally, 22 of 30 roof-dependent ATs (73.3%) had a circuit not rotating around both pairs of pulmonary veins. Brief assessment of the activation direction on the posterior wall in relation to that on the septal, anterior, and lateral wall helped deduce the circuit of roof-dependent AT in 27 of 30 (90.0%). Practical isthmus was not in the roof in 8 of 22 (36.4%). Practical isthmuses mapped with the system were significantly shorter than the usual anatomic isthmuses (16.1 ± 8.2 mm vs 33.7 ± 10.4 mm) (P < .0001). CONCLUSIONS High-density mapping successfully identified the precise circuits and the practical isthmus of anatomic MATs in patients with prior atrial fibrillation ablation.
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Affiliation(s)
- Masateru Takigawa
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Nicolas Derval
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Antonio Frontera
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Ruairidh Martin
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Seigo Yamashita
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Nathaniel Thompson
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Takeshi Kitamura
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Michael Wolf
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Gregoire Massoullie
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Claire A Martin
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Nora Al-Jefairi
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Sana Amraoui
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Klotz
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Frederic Sacher
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Meleze Hocini
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jais
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
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13
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Schaeffer B, Stevenson WG. Entrainment mapping: Theoretical considerations and practical implementation. J Cardiovasc Electrophysiol 2017; 29:204-213. [DOI: 10.1111/jce.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Benjamin Schaeffer
- Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital; Boston MA USA
| | - William G. Stevenson
- Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital; Boston MA USA
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14
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Boyle PM, Zahid S, Trayanova NA. Towards personalized computational modelling of the fibrotic substrate for atrial arrhythmia. Europace 2017; 18:iv136-iv145. [PMID: 28011841 DOI: 10.1093/europace/euw358] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/28/2016] [Indexed: 11/13/2022] Open
Abstract
: Atrial arrhythmias involving a fibrotic substrate are an important cause of morbidity and mortality. In many cases, effective treatment of such rhythm disorders is severely hindered by a lack of mechanistic understanding relating features of fibrotic remodelling to dynamics of re-entrant arrhythmia. With the advent of clinical imaging modalities capable of resolving the unique fibrosis spatial pattern present in the atria of each individual patient, a promising new research trajectory has emerged in which personalized computational models are used to analyse mechanistic underpinnings of arrhythmia dynamics based on the distribution of fibrotic tissue. In this review, we first present findings that have yielded a robust and detailed biophysical representation of fibrotic substrate electrophysiological properties. Then, we summarize the results of several recent investigations seeking to use organ-scale models of the fibrotic human atria to derive new insights on mechanisms of arrhythmia perpetuation and to develop novel strategies for model-assisted individualized planning of catheter ablation procedures for atrial arrhythmias.
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Affiliation(s)
- Patrick M Boyle
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles St, 208 Hackerman Hall, Baltimore, MD 21218, USA
| | - Sohail Zahid
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles St, 208 Hackerman Hall, Baltimore, MD 21218, USA
| | - Natalia A Trayanova
- Department of Biomedical Engineering and Institute for Computational Medicine, Johns Hopkins University, 3400 N Charles St, 208 Hackerman Hall, Baltimore, MD 21218, USA
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15
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Takigawa M, Frontera A, Thompson N, Capellino S, Jais P, Sacher F. The electrical circuit of a hemodynamically unstable and recurrent ventricular tachycardia diagnosed in 35 s with the Rhythmia mapping system. J Arrhythm 2017; 33:505-507. [PMID: 29021859 PMCID: PMC5634715 DOI: 10.1016/j.joa.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
Herein, we report a 47-year-old woman with ischemic cardiomyopathy who underwent ablation therapy due to an electrical storm without any triggers. The voltage mapping in sinus rhythm with the Rhythmia system and Orion catheter displayed several LAVAs in and around the anteroapical scar area. Although the patient did not tolerate the induced clinical ventricular tachycardia, which was reproductively induced, 35-second-mapping in the scar zone with the Orion catheter demonstrated the VT circuit with the critical isthmus. This report shows the possibility of the new ultra-high density mapping system in a specific ischemic VT patient.
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Affiliation(s)
- Masateru Takigawa
- Hôpital Cardiologique Haut Lévêque, Lyric institute, Université de Bordeaux, Av. Magellan, Bordeaux-Pessac 33604, France
- Corresponding author.
| | - Antonio Frontera
- Hôpital Cardiologique Haut Lévêque, Lyric institute, Université de Bordeaux, Av. Magellan, Bordeaux-Pessac 33604, France
| | - Nathaniel Thompson
- Hôpital Cardiologique Haut Lévêque, Lyric institute, Université de Bordeaux, Av. Magellan, Bordeaux-Pessac 33604, France
| | | | - Pierre Jais
- Hôpital Cardiologique Haut Lévêque, Lyric institute, Université de Bordeaux, Av. Magellan, Bordeaux-Pessac 33604, France
| | - Frederic Sacher
- Hôpital Cardiologique Haut Lévêque, Lyric institute, Université de Bordeaux, Av. Magellan, Bordeaux-Pessac 33604, France
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16
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Dual loop reentrant tachycardia with a combination of a localized reentry and a macro-reentry. J Cardiol Cases 2017; 15:197-200. [PMID: 30279779 DOI: 10.1016/j.jccase.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/08/2017] [Accepted: 02/21/2017] [Indexed: 11/20/2022] Open
Abstract
A 78-year-old woman presented 2 years after mitral valve replacement for rheumatic mitral stenosis with cardioversion-resistant atrial tachycardia (AT). Dual-loop AT was identified by activation mapping with the Rhythmia™ system (Boston Scientific, Marlborough, MA, USA) and confirmed by entrainment-mapping; one circuit with localized re-entry turned around the scar on the posterior left atrium and the other circuit, which was macro re-entrant, turned around the left superior pulmonary vein (LSPV) using the PV-carina, the ridge beween the left atrial appendage and the LSPV, and the roof. The two wavefronts fused on the posterior wall close to the LSPV. Radiofrequency ablation of an area of slow conduction on the posterior wall changed the tachycardia to roof-dependent AT which was then terminated by completion of a roof line. <Learning objective: In this case report, we demonstrate the importance of using both conventional entrainment mapping methods and a novel ultra-high density mapping system to precisely understand the mechanism and appropriately terminate the complex atrial tachycardia in patients with prior atrial fibrillation ablation.>.
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17
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RAV-ACHA MOSHE, NG CHEEYUAN, HEIST EKEVIN, ROZEN GUY, CHALHOUB FADI, KOSTIS WILLIAMJ, RUSKIN JEREMY, MANSOUR MOUSSA. A Novel Annotation Technique During Mapping to Facilitate the Termination of Atrial Tachycardia Following Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:1274-1281. [DOI: 10.1111/jce.13063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 12/01/2022]
Affiliation(s)
- MOSHE RAV-ACHA
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
| | - CHEE YUAN NG
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
| | - E. KEVIN HEIST
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
| | - GUY ROZEN
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
| | - FADI CHALHOUB
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
| | - WILLIAM J. KOSTIS
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
| | - JEREMY RUSKIN
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
| | - MOUSSA MANSOUR
- Cardiac Arrhythmia Service, Corrigan Minehan Heart Center; Massachusetts General Hospital; Boston Massachusetts USA
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18
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Kinjo T, Sasaki S, Kimura M, Owada S, Horiuchi D, Sasaki K, Itoh T, Ishida Y, Shoji Y, Nishizaki K, Tsushima Y, Tomita H, Okumura K. Long Postpacing Interval After Entrainment of Tachycardia Including a Slow Conduction Zone Within the Circuit. J Cardiovasc Electrophysiol 2016; 27:923-9. [PMID: 27196507 DOI: 10.1111/jce.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/08/2016] [Accepted: 05/11/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUNDS Postpacing interval (PPI) measured after entrainment pacing describes the distance between pacing site and reentrant circuit. However, the influential features to PPI remain to be elucidated. METHODS AND RESULTS This study included 22 cases with slow/fast atrioventricular (AV) nodal reentrant tachycardia (AVNRT), 14 orthodromic AV reciprocating tachycardia (AVRT) using an accessary pathway, 22 typical atrial flutter (AFL), and 18 other macroreentrant atrial tachycardia (atypical AFL). Rapid pacing at a pacing cycle length (PCL) 5% shorter than tachycardia cycle length (TCL) was done from a site on or close to the reentry circuit. Pacing sites included the coronary sinus ostium in AVNRT, earliest atrial activation site in AVRT, and cavotricuspid isthmus in typical AFL. In atypical AFL, tachycardia circuit was determined on the basis of CARTO mapping, and then the pacing site was. TCL was significantly longer in AVNRT and AVRT than in typical AFL and atypical AFL (both P < 0.05). PCL minus TCL value was similar among the 4 groups. PPI minus TCL value (milliseconds) was significantly longer in AVNRT (median, 40 [IQR, 29-60.8]) and AVRT (34 [20-47]) than in typical AFL (0 [0-4]) and atypical AFL (3.5 [0-8]) (both P < 0.05). Furthermore, PPI minus TCL was prolonged with shortening of PCL in AVNRT and AVRT (both P < 0.05), whereas it was unchanged in typical AFL (P = 0.50). CONCLUSION PPI after concealed entrainment is prolonged compared with TCL when the reentry circuit involves a slow conduction zone with a decremental conduction property such as the AV node.
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Affiliation(s)
- Takahiko Kinjo
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Sasaki
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingen Owada
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Horiuchi
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kenichi Sasaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taihei Itoh
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihiro Shoji
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuichi Tsushima
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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19
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Zahid S, Whyte KN, Schwarz EL, Blake RC, Boyle PM, Chrispin J, Prakosa A, Ipek EG, Pashakhanloo F, Halperin HR, Calkins H, Berger RD, Nazarian S, Trayanova NA. Feasibility of using patient-specific models and the "minimum cut" algorithm to predict optimal ablation targets for left atrial flutter. Heart Rhythm 2016; 13:1687-98. [PMID: 27108938 DOI: 10.1016/j.hrthm.2016.04.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left atrial flutter (LAFL) occurs in patients after atrial fibrillation ablation. Identification of optimal ablation targets to terminate LAFL remains challenging. OBJECTIVE The purpose of this study was to use patient-specific models to simulate LAFL and predict optimal ablation targets using a novel approach based on flow network theory. METHODS Late gadolinium-enhanced cardiac magnetic resonance scans from 10 patients with LAFL were used to construct atrial models incorporating fibrosis by investigators blinded to procedural findings. Rapid pacing was applied in silico to induce LAFL. In each LAFL, we represented reentrant wave propagation as an electric flow network and identified the "minimum cut" (MC), which was the smallest amount of tissue that separated the flow into 2 discontinuous components. In silico ablation was applied at MCs, and targets were compared to those that terminated LAFL during catheter ablation. RESULTS Patient-specific atrial models were successfully generated from patient scans. LAFL was induced in 7 of 10 models. Ablation of MCs terminated LAFL in 4 models and produced new, slower LAFL morphologies in the other 3. For the latter cases, flow analysis was repeated to identify MCs of emergent LAFLs. Ablation of these MCs terminated emergent LAFLs. The MC-based ablation lesions in simulations were similar in length and location to ablation targets that terminated LAFL during catheter ablation for these 7 patients. CONCLUSION Personalized atrial simulations can predict ablation targets for LAFL. These simulations provide a powerful tool for planning ablation procedures and may reduce procedural times and complications.
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Affiliation(s)
- Sohail Zahid
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Kaitlyn N Whyte
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Erica L Schwarz
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Robert C Blake
- CardioSolv Ablation Technologies Inc, Baltimore, Maryland
| | - Patrick M Boyle
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jonathan Chrispin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adityo Prakosa
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Esra G Ipek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Farhad Pashakhanloo
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Henry R Halperin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald D Berger
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saman Nazarian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Natalia A Trayanova
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Miranda AC, Uribe W, Medina LE, Marín JE, Velásquez JE, Aristizábal JM, Díaz JC, Duque M. Capítulo 8. Utilidad del mapeo tridimensional en la ablación de taquicardias atriales por macro y microrreentrada en pacientes con antecedente de cirugía cardiovascular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Choi EK, Kumar S, Nagashima K, Lin KY, Barbhaiya CR, Chinitz JS, Enriquez AD, Helmbold AF, Baldinger SH, Tedrow UB, Koplan BA, Michaud GF, John RM, Epstein LM, Stevenson WG. Better outcome of ablation for sustained outflow-tract ventricular tachycardia when tachycardia is inducible. Europace 2015; 17:1571-9. [DOI: 10.1093/europace/euv064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/23/2015] [Indexed: 11/13/2022] Open
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22
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MAKIMOTO HISAKI, NAKAJIMA IKUTARO, MIYAMOTO KOJI, YAMADA YUKO, OKAMURA HIDEO, NODA TAKASHI, AIBA TAKESHI, KAMAKURA SHIRO, KUSANO KENGO, SHIMIZU WATARU, SATOMI KAZUHIRO. Clinical Impact of Mapping Strategies for Treatment of Ventricular Tachycardias in Patients with Structural Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:630-40. [DOI: 10.1111/pace.12601] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/26/2014] [Accepted: 01/28/2015] [Indexed: 11/27/2022]
Affiliation(s)
- HISAKI MAKIMOTO
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - IKUTARO NAKAJIMA
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - KOJI MIYAMOTO
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - YUKO YAMADA
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - HIDEO OKAMURA
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - TAKASHI NODA
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - TAKESHI AIBA
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - SHIRO KAMAKURA
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - KENGO KUSANO
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - WATARU SHIMIZU
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - KAZUHIRO SATOMI
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
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Michael KA, Enriquez A, Baranchuk A, Haley C, Caldwell J, Simpson CS, Abdollah H, Redfearn DP. Failed anti-tachycardia pacing can be used to differentiate atrial arrhythmias from ventricular tachycardia in implantable cardioverter-defibrillators. Europace 2015; 17:78-83. [DOI: 10.1093/europace/euu169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Asirvatham SJ, Stevenson WG. In the middle. Circ Arrhythm Electrophysiol 2014; 7:982-3. [PMID: 25336369 DOI: 10.1161/circep.114.002202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samuel J Asirvatham
- From the Division of Cardiovascular Diseases, Department of Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.).
| | - William G Stevenson
- From the Division of Cardiovascular Diseases, Department of Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.)
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25
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Nagashima K, Choi EK, Tedrow UB, Koplan BA, Michaud GF, John RM, Epstein LM, Tokuda M, Inada K, Kumar S, Lin KY, Barbhaiya CR, Chinitz JS, Enriquez AD, Helmbold AF, Stevenson WG. Correlates and Prognosis of Early Recurrence After Catheter Ablation for Ventricular Tachycardia due to Structural Heart Disease. Circ Arrhythm Electrophysiol 2014; 7:883-8. [DOI: 10.1161/circep.114.001461] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Catheter ablation for ventricular tachycardia (VT) from structural heart disease has a significant risk of recurrence, but the optimal duration for in-hospital monitoring is not defined. This study assesses the timing, correlates, and prognostic significance of early VT recurrence after ablation.
Methods and Results—
Of 370 patients (313 men; aged 63.0±13.2 years) who underwent a first radiofrequency ablation for sustained monomorphic VT associated with structural heart disease from 2008 to 2012, sustained VT recurred in 81 patients (22%) within 7 days. In multivariable analysis, early recurrence was associated with New York Heart Association classification ≥III (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.03–3.48;
P
=0.04), dilated cardiomyopathy (OR 1.93, 95% CI 1.03–3.57;
P
=0.04), prevalence of VT storm before the procedure (OR 2.62, 95% CI 1.48–4.65;
P
=0.001), a greater number of induced VTs (OR 1.24, 95% CI 1.07–1.45;
P
=0.006), and acute failure or no final induction test (OR 1.88, 95% CI 1.03–3.40;
P
=0.04). During a median of 2.5 (1.2, 4.0) years of follow-up, early VT recurrence was an independent correlates of mortality (hazard ratio 2.59, 95% CI 1.52–4.34;
P
=0.0005).
Conclusions—
Patients who have early recurrences of VT after ablation are a high risk group who may be identifiable from their clinical profile. Further study is warranted to define the optimal treatment strategies for this patient group.
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Affiliation(s)
- Koichi Nagashima
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Eue-Keun Choi
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Usha B. Tedrow
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Bruce A. Koplan
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Gregory F. Michaud
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Roy M. John
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Laurence M. Epstein
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Michifumi Tokuda
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Keiichi Inada
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Saurabh Kumar
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Kaity Y. Lin
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Chirag R. Barbhaiya
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Jason S. Chinitz
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Alan D. Enriquez
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Alan F. Helmbold
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - William G. Stevenson
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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Affiliation(s)
- Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases, Departments of Medicine and Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (W.G.S.)
| | - William G. Stevenson
- From the Division of Cardiovascular Diseases, Departments of Medicine and Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (W.G.S.)
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Nagashima K, Tedrow UB, Koplan BA, Michaud GF, John RM, Epstein LM, Tokuda M, Inada K, Reichlin TR, Ng JP, Barbhaiya CR, Nof E, Tadros TM, Stevenson WG. Reentrant Ventricular Tachycardia Originating From the Periaortic Region in the Absence of Overt Structural Heart Disease. Circ Arrhythm Electrophysiol 2014; 7:99-106. [DOI: 10.1161/circep.113.000870] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In the absence of overt structural heart disease, most left ventricular outflow tract ventricular tachycardias (VTs) have a focal origin and are benign. We hypothesized that multiple morphologies (MMs) of inducible left ventricular outflow tract VT may indicate a scar-related VT that can mimic idiopathic VT.
Methods and Results—
Of 54 consecutive patients referred for ablation of sustained outflow tract VT without overt structural heart disease, 24 had left ventricular outflow tract VT, 10 had MM VT, and 14 had a single VT (SM). The MM group were older (70.3±4.3 versus 53.9±15.9 years;
P
=0.004), had more hypertension (100% versus 29%;
P
=0.0006), and had longer PR intervals and QRS durations compared with the SM group. In contrast to the SM group, the MM group VTs had features consistent with reentry, including induction by programmed stimulation without isoproterenol, entrainment in some, and abnormal electrograms in the periaortic area. Periaortic region voltages suggested scar in the MM group, but not in the SM group. MRI in 2 MM patients was consistent with scar, but not in 10 SM patients. Longer radiofrequency applications were required in the MM group than in the SM group. At a median follow-up of 9.7 (3.0–32.0) months, recurrences tended to be more frequent in the MM group than in the SM group (70% versus 22%;
P
=0.07).
Conclusions—
VTs from small regions of periaortic scar can mimic idiopathic VT but are suggested by multiple VT morphologies and are more difficult to ablate. Whether these patients are at greater risk, as feared for other scar-related VTs, warrants further study.
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Affiliation(s)
- Koichi Nagashima
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Usha B. Tedrow
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Bruce A. Koplan
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Gregory F. Michaud
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Roy M. John
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Laurence M. Epstein
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Michifumi Tokuda
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Keiichi Inada
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Tobias R. Reichlin
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Justin P. Ng
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Chirag R. Barbhaiya
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Eyal Nof
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Thomas M. Tadros
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - William G. Stevenson
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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JAMIL-COPLEY SHAHNAZ, LINTON NICK, KOA-WING MICHAEL, KOJODJOJO PIPIN, LIM PHANGBOON, MALCOLME-LAWES LOUISA, WHINNETT ZACHARY, WRIGHT IAN, DAVIES WYN, PETERS NICHOLAS, FRANCIS DARRELP, KANAGARATNAM PRAPA. Application of Ripple Mapping with an Electroanatomic Mapping System for Diagnosis of Atrial Tachycardias. J Cardiovasc Electrophysiol 2013; 24:1361-9. [DOI: 10.1111/jce.12259] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/17/2013] [Accepted: 07/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - NICK LINTON
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | - MICHAEL KOA-WING
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | - PIPIN KOJODJOJO
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | - PHANG BOON LIM
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | | | - ZACHARY WHINNETT
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | - IAN WRIGHT
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | - WYN DAVIES
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | - NICHOLAS PETERS
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
| | - DARREL P. FRANCIS
- St. Marys Hospital; Imperial College Healthcare NHS Trust; London UK
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Wong KC, Rajappan K, Bashir Y, Betts TR. Entrainment With Long Postpacing Intervals From Within the Flutter Circuit. Circ Arrhythm Electrophysiol 2012; 5:e90-1; discussion e92. [DOI: 10.1161/circep.111.969030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kelvin C.K. Wong
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Kim Rajappan
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Yaver Bashir
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Timothy R. Betts
- From the Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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Vollmann D, Stevenson WG, Lüthje L, Sohns C, John RM, Zabel M, Michaud GF. Misleading long post-pacing interval after entrainment of typical atrial flutter from the cavotricuspid isthmus. J Am Coll Cardiol 2012; 59:819-24. [PMID: 22361402 DOI: 10.1016/j.jacc.2011.11.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/09/2011] [Accepted: 11/17/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the prevalence and mechanism of a misleading long post-pacing interval (PPI) upon entrainment of typical atrial flutter (AFL) from the cavotricuspid isthmus (CTI). BACKGROUND In typical AFL, the PPI from entrainment at the CTI is expected to closely match the tachycardia cycle-length (TCL). METHODS Sixty patients with confirmed CTI-dependent AFL were retrospectively analyzed and grouped into short (≤30 ms) or long (>30 ms) PPI-TCL. Thereafter, we prospectively studied 16 patients to acquire the PPI-TCL at 4 CTI sites with entrainment at pacing cycle-lengths (PCLs) 10 to 40 ms shorter than the TCL. Conduction times during AFL and entrainment were compared in 5 segments of the AFL circuit. RESULTS Eleven patients (18%) in the retrospective analysis had a long PPI-TCL after entrainment from the CTI. Subjects with long PPI-TCL had similar baseline characteristics but greater beat-to-beat TCL variability. In the prospective cohort, PPI-TCL was influenced by the difference between PCL and TCL and site of entrainment. Conduction delays associated with a long PPI-TCL were located predominantly in the segment activated first by the paced orthodromic wave front, and were mainly due to local pacing latency, as confirmed by the use of monophasic action potential catheters. CONCLUSIONS A long PPI upon entrainment of typical AFL from the CTI is common and due to delayed conduction with entrainment. Whether these findings apply to other macro-re-entrant tachycardias warrants further investigation.
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Affiliation(s)
- Dirk Vollmann
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Strasse 40, Göttingen, Germany.
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32
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Mori S, Yagi T, Kaneko U, Takizawa K, Inoue N, Meguro T. Demonstration of entrainment in a case of adenosine-sensitive focal atrial tachycardia near the His-bundle. J Arrhythm 2012. [DOI: 10.1016/j.joa.2012.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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33
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Kim JB, Choi S, Joung B, Lee MH, Kim SS. The effects of a bidirectional cavo-tricuspid isthmus block in persistent atrial fibrillation. Yonsei Med J 2012; 53:76-82. [PMID: 22187235 PMCID: PMC3250333 DOI: 10.3349/ymj.2012.53.1.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Hybrid therapy with catheter ablation of the cavo-tricuspid isthmus (CTI) and continuation of anti-arrhythmic drugs (AAD), or electrical cardioversion with AADs might be alternative treatments for patients with persistent atrial fibrillation (AF). The goal of study was to assess the long term success rate of hybrid therapy for persistent AF compared to antiarrhythmic medication therapy after electrical cardioversion and identify the independent risk factors associated with recurrence after hybrid therapy. MATERIALS AND METHODS A total of 32 patients with persistent AF who developed atrial flutter after the administration of a class Ic or III anti-arrhythmic drug were enrolled. This group was compared with a group (33 patients) who underwent cardioversion and received direct current cardioversion with AADs. Baseline data were collected, and electrocardiogram and symptom driven Holter monitoring were performed every 2-4 months. RESULTS There was no significant difference in the baseline characteristics between the groups. The 12 month atrial arrhythmia free survival was better in the hybrid group, 49.0% vs. 33.1%, p=0.048. However, during a mean 55.7+/- 43.0 months of follow up, the improved survival rate regressed (p=0.25). A larger left atrium size was an independent risk factor for the recurrence of AF after adjusting for confounding factors. CONCLUSION Despite favorable outcome during 12 month, the CTI block with AADs showed outcomes similar to AAD therapy after electrical cardioversion over a 12 month follow up period. Minimal substrate modification with AADs might be an alternative treatment for persistent AF with minimal atrial remodeling.
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Affiliation(s)
- Jin-Bae Kim
- Cardiology Division, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seonghoon Choi
- Cardiology Division, Kang-Nam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Soon Kim
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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34
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Dandamudi G, Mokabberi R, Assal C, Das MK, Oren J, Storm R, Vijayaraman P, Miller JM. A novel approach to differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia. Heart Rhythm 2010; 7:1326-9. [DOI: 10.1016/j.hrthm.2010.05.033] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 05/26/2010] [Indexed: 11/27/2022]
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35
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Santilli R, Perego M, Perini A, Moretti P, Spadacini G. Electrophysiologic Characteristics and Topographic Distribution of Focal Atrial Tachycardias in Dogs. J Vet Intern Med 2010; 24:539-45. [DOI: 10.1111/j.1939-1676.2010.0490.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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36
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ABOUEZZEDDINE OMAR, SULEIMAN MAHMOUD, BUESCHER TRACI, KAPA SURAJ, FRIEDMAN PAULA, JAHANGIR ARSHAD, MEARS JENNIFERA, LADEWIG DOROTHYJ, MUNGER THOMASM, HAMMILL STEPHENC, PACKER DOUGLASL, ASIRVATHAM SAMUELJ. Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia. J Cardiovasc Electrophysiol 2010; 21:245-54. [DOI: 10.1111/j.1540-8167.2009.01621.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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37
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Affiliation(s)
- Frank C. Chen
- From the Department of Medicine (F.C.C., S.J.A.), Division of Cardiovascular Diseases, and Department of Pediatric and Adolescent Medicine (S.J.A.), Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn
| | - Samuel J. Asirvatham
- From the Department of Medicine (F.C.C., S.J.A.), Division of Cardiovascular Diseases, and Department of Pediatric and Adolescent Medicine (S.J.A.), Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn
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38
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COLOMBOWALA ILYASK, MASSUMI ALI, RASEKH ABDI, SAEED MOHAMMAD, CHENG JIE, FAKHRI BITA, SHURAIH MOSSAAB, RAZAVI MEHDI. Variability in Postpacing Intervals Predicts Global Ventricular Activation Pattern during Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:129-34. [DOI: 10.1111/j.1540-8159.2009.02617.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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CHEN FRANKC, ASIRVATHAM SAMUELJ. Determining Arrhythmia Mechanism: Still Critical or Now Obsolete? Pacing Clin Electrophysiol 2010; 33:125-8. [DOI: 10.1111/j.1540-8159.2009.02618.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Raymond JM, Sacher F, Winslow R, Tedrow U, Stevenson WG. Catheter Ablation for Scar-related Ventricular Tachycardias. Curr Probl Cardiol 2009; 34:225-70. [DOI: 10.1016/j.cpcardiol.2009.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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41
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Colorful entrainment: A new approach for mapping and ablation treatment of atrial macroreentrant tachycardia. Heart Rhythm 2009; 6:359-60. [DOI: 10.1016/j.hrthm.2008.12.027] [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: 12/20/2008] [Indexed: 11/20/2022]
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42
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Santilli R, Perego M, Crosara S, Gardini F, Bellino C, Moretti P, Spadacini G. Utility of 12-Lead Electrocardiogram for Differentiating Paroxysmal Supraventricular Tachycardias in Dogs. J Vet Intern Med 2008; 22:915-23. [DOI: 10.1111/j.1939-1676.2008.0127.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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43
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Li YG, Wang QS, Israel CW, Grönefeld G, Lu SB, Ehrlich JR, Hohnloser SH. Quantitative analysis of the duration of slow conduction in the reentrant circuit of ventricular tachycardia after myocardial infarction. J Cardiovasc Electrophysiol 2008; 19:920-7. [PMID: 18399972 DOI: 10.1111/j.1540-8167.2008.01155.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few data are available to define the circuits in ventricular tachycardia (VT) after myocardial infarction and the conduction time (CT) through the zone of slow conduction (SCZ). This study assessed the CT of the SCZ and identified different reentrant circuits. METHODS During VTs, concealed entrainment (CE) was attempted. The SCZ was identified by a difference between postpacing interval (PPI) and VT cycle length (VTcl) < or =30 ms. Since the CT in the normally conducting part of the VT circuit is constant during VT and CE, a CE site within the reentrant circuit with (S-QRS)/PPI > or = 50% was classified as an inner reentry in which the entire circuit was within the scar, and a CE site with (S-QRS)/PPI < 50% as a common reentry in which part of the circuit was within the scar and part out of the scar. RESULTS CE was achieved in 20 VTs (12 patients). Six VTs (30%) with a (S-QRS)/PPI > or =50% were classified as inner reentry and 14 VTs (70%) with a (S-QRS)/PPI <50% during CE mapping as common reentry. The EG-QRS interval (308 +/- 73 ms vs 109 +/- 59 ms, P < 0.0001) was significantly longer and the incidence of systolic potentials higher (4/6 vs 0/12, P < 0.001) in the inner reentry group. For the 14 VTs with a common reetry, the CT of the SCZ was 348 +/- 73 ms, while the CT in the normal area was 135 +/- 50 ms. CONCLUSION According to the proposed classification, 30% of VTs after myocardial infarction had an entire reentrant circuit within the scar. In VTs with a common reentrant circuit, the CT of the SCZ is approximately four times longer than the CT in the normal area, accounting for more than 70% of VTcl.
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Affiliation(s)
- Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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44
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Wolpert C, Pitschner H, Borggrefe M. Evolution of ablation techniques: from WPW to complex arrhythmias. Eur Heart J Suppl 2007. [DOI: 10.1093/eurheartj/sum073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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45
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Hillock RJ, Roberts-Thomson KC, McGavigan AD, Kalman JM. Monomorphic ventricular tachycardia related to Wolff-Parkinson-White surgery. Europace 2007; 9:130-3. [PMID: 17272335 DOI: 10.1093/europace/eul168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Monomorphic ventricular tachycardia (MVT) is well described in patients who have had a ventricular scar due to repair of congenital heart disease. A 54-year-old woman presented with MVT 20 years after WPW surgery for a left-sided accessory pathway. The circuit was mapped to an area at the base of the left ventricle consistent with the incision described in the operation report. Entrainment confirmed the re-entrant circuit. Successful radiofrequency ablation was performed in a zone of slowed conduction consistent with the circuit isthmus. Any iatrogenic ventricular scar may form the substrate for MVT and be treated with standard electrophysiology techniques.
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Affiliation(s)
- R J Hillock
- Department of Cardiology, The Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne 3052, Australia.
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46
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Wright KN, Knilans TK, Irvin HM. When, why, and how to perform cardiac radiofrequency catheter ablation. J Vet Cardiol 2006; 8:95-107. [DOI: 10.1016/j.jvc.2006.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 09/07/2006] [Accepted: 09/13/2006] [Indexed: 10/23/2022]
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Seiler J, Schmid DK, Irtel TA, Tanner H, Rotter M, Schwick N, Delacrétaz E. Dual-loop circuits in postoperative atrial macro re-entrant tachycardias. Heart 2006; 93:325-30. [PMID: 16980513 PMCID: PMC1861432 DOI: 10.1136/hrt.2006.094748] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Patients may develop dual-loop re-entrant atrial arrhythmias late after open-heart surgery, and mapping and catheter ablation remain challenging despite computer-assisted mapping techniques. OBJECTIVES The purpose of the study was to demonstrate the prevalence and characteristics of dual-loop re-entrant arrhythmias, and to define the optimal mapping and ablation strategy. METHODS 40 consecutive patients (mean (SD) age 52 (12) years) with intra-atrial re-entrant tachycardia (IART) after open-heart surgery (with an incision of the right atrial free wall) were studied. Dual-loop IART was defined as the presence of two simultaneous atrial circuits. After an abrupt tachycardia change during radiofrequency ablation, electrical disconnection of the targeted re-entry isthmus from the remaining circuit was demonstrated by entrainment mapping. Furthermore, the second circuit loop was localised using electroanatomical mapping and/or entrainment mapping. RESULTS Dual-loop IART was demonstrated in eight (20%, 5 patients with congenital heart disease, 3 with acquired heart disease) patients. Dual-loop IART included an isthmus-dependant atrial flutter combined with a re-entry related to the atriotomy scar. The diagnosis of dual-loop IART required the comparison of entrainment mapping before and after tachycardia modification. Overall, 35 patients had successful radiofrequency ablation (88%). Success rates were lower in patients with dual-loop IART than in patients without dual-loop IART. Ablation failures in three patients with dual-loop IART were related to the inability to properly transect the second tachycardia isthmus in the right atrial free wall. CONCLUSIONS Dual-loop IART is relatively common after heart surgery involving a right atriotomy. Abrupt tachycardia change and specific entrainment mapping manoeuvres demonstrate these circuits. Electroanatomical mapping appears to be important to assist catheter ablation of periatriotomy circuits.
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Affiliation(s)
- Jens Seiler
- Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
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Deisenhofer I. Simplified algorithm for localization of atrial macroreentrant tachycardias: keep it simple and short. Heart Rhythm 2006; 3:524-5. [PMID: 16648055 DOI: 10.1016/j.hrthm.2006.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Indexed: 10/25/2022]
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Nehgme RA, Carboni MP, Care J, Murphy JD. Transthoracic percutaneous access for electroanatomic mapping and catheter ablation of atrial tachycardia in patients with a lateral tunnel Fontan. Heart Rhythm 2006; 3:37-43. [PMID: 16399050 DOI: 10.1016/j.hrthm.2005.09.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 09/24/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of atrial tachycardia following Fontan surgery is high, but access to the pulmonary venous atrium, a frequent site of arrhythmia origin, is limited. OBJECTIVES The purpose of this study is to report our results with a novel transthoracic percutaneous technique that provides direct access to the pulmonary venous atrium for electrophysiologic procedures. METHODS Six transthoracic ablation procedures were performed in five patients (age 1.2-17 years, weight 9.2-68.4 kg) with a lateral tunnel Fontan. Under biplane fluoroscopy, a percutaneous needle was advanced at the selected intercostal space toward the pulmonary venous atrium. Once access was confirmed, a sheath was placed over a wire and a Navistar CARTO catheter advanced for mapping and ablation. Additional catheters were placed in the baffle and esophagus for pacing and reference. Atrial tachycardia was induced, electroanatomic mapping performed, and candidate areas tested with entrainment techniques. Radiofrequency ablation was performed and success defined as the inability to reinduce tachycardia using the initiating protocol. RESULTS All tachycardias were ablated. Procedure time ranged from 3.7 to 4.9 hours, and fluoroscopy time ranged from 31 to 70 minutes. Hospital stay was 2 days. One patient had a pneumothorax and two had a hemothorax that was drained. Tachycardia recurred in one patient at 3 months. Ablation was repeated successfully. Four patients are free of tachycardia at follow-up ranging from 6 to 29 months. Follow-up is not available for one child. CONCLUSION Transthoracic percutaneous access provided a direct route to the pulmonary venous atrium for successful mapping and radiofrequency ablation in Fontan patients.
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Affiliation(s)
- Rodrigo A Nehgme
- Nemours Cardiac Center A.I. duPont Hospital for Children, Wilmington, Delaware, USA.
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Merino JL, Peinado R, Abello M, Gnoatto M, Vasserot MG, Sobrino JA. Superior Vena Cava Flutter: Electrophysiology and Ablation. J Cardiovasc Electrophysiol 2005; 16:568-75. [PMID: 15946351 DOI: 10.1046/j.1540-8167.2005.40609.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Reentry within a major thoracic vein has been suggested as a cause of atrial arrhythmias. However, little is known about these potential reentrant circuits. METHODS AND RESULTS Atypical atrial flutter was induced and mapped in 67 out of 225 atrial flutter ablation procedures. Reentry around the superior vena cava (SVC) was suspected in three patients. The suspected SVC flutter was induced and terminated by pacing in all patients. Fusion was demonstrated during flutter entrainment by subeustachian isthmus pacing in all of them. The postpacing interval following entrainment by pacing from different sites of the right atrium (RA) or coronary sinus was longer than the flutter cycle length. Macroreentry within the SVC was demonstrated both by sequential activation and a postpacing interval matching the flutter cycle length when pacing from different sites around the SVC in all patients. Atrial-venous-atrial electrogram sequence was demonstrated following flutter entrainment by atrial pacing. Flutter was terminated by an electrical stimulus delivered to the SVC, which was not propagated to the trabeculated RA, in one patient, and linear radiofrequency application from the distal SVC to the posterior wall of the RA, or to the superoseptal portion of the crista terminalis, in the other two. CONCLUSION Macroreentry within the SVC is a distinctive mechanism responsible for rapid atrial activation, which is different from other reported flutter mechanisms, such as upper loop reentry. SVC longitudinal radiofrequency application can eliminate the arrhythmia without the need for complete electrical disconnection of the vein.
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Affiliation(s)
- Jose L Merino
- Laboratory of Cardiac Electrophysiology, Hospital La Paz, Universidad Autónoma, Madrid, Spain.
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