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Sugumar H, Chieng D, Prabhu S, Voskoboinik A, Anderson RD, Al-Kaisey A, Lee G, McLellan AJ, Morton JB, Taylor AJ, Ling LH, Kalman JM, Kistler PM. A prospective evaluation of the impact of individual RF applications for slow pathway ablation for AVNRT: Markers of acute success. J Cardiovasc Electrophysiol 2021; 32:1886-1893. [PMID: 33855753 DOI: 10.1111/jce.15045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/25/2021] [Accepted: 03/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Catheter ablation is highly effective for atrioventricular nodal re-entrant tachycardia (AVNRT). Generally junctional rhythm (JR) is an accepted requirement for successful ablation however there is a lack of detailed prospective studies to determine the characteristics of JR and the impact on slow pathway conduction. METHODS Multicentre prospective observational study evaluating the impact of individual radiofrequency (RF) applications in typical AVNRT (slow/fast). Characteristics of JR during ablation were documented and detailed testing was performed after every RF application to determine outcome. Procedural success was defined as ≤1 AV nodal echo. RESULTS Sixty-seven patients were included (mean age 53 ± 18years, 57% female and a history of SVT 2.9 ± 4.7 years). RF (50w, 60°) ablation for AVNRT was applied in 301 locations with JR in 178 (59%). Successful slow pathway modification was achieved in 66 (99%) patients with slow pathway block in 30 (46%). Success was associated with JR in all patients. Success was achieved in six patients with RF < 10 s. There was no significant difference in the CL of JR during RF between effective (587 ± 150 ms) versus ineffective (611 ± 193 ms, p = .4) applications. Inadvertent junctional beat-atrial (JA) block with immediate termination of RF was observed in 19 (28%) patients with AVNRT no longer inducible in 14 (74%). Freedom from SVT was achieved in 66 (99%) patients at a mean follow up of 15 ± 6 months. CONCLUSION In this prospective study, JR was required during RF for acute success in AVNRT. Cycle length of JR during RF was not predictive of success. Although unintended JA block during faster JR was associated with slow pathway block, this is a precursor to fast pathway block and should not be intentionally targeted.
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Affiliation(s)
- Hariharan Sugumar
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David Chieng
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Sandeep Prabhu
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Robert D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Alex J McLellan
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Joseph B Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrew J Taylor
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Liang-Han Ling
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Peter M Kistler
- Department of Cardiology, The Baker Heart & Diabetes Institute, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
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Goldstein K, Hansen C, Lüthje L, Vollmann D. [Safety and efficiency of interventional electrophysiology utilizing the German "Belegarztsystem"]. Herzschrittmacherther Elektrophysiol 2020; 31:210-218. [PMID: 32372229 DOI: 10.1007/s00399-020-00687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Electrophysiology study (EPS) and catheter ablation (abl.), in particular for atrial fibrillation, are increasingly performed in Germany. Therefore, measures and steps to ensure quality assurance are indicated. Most of the procedures are performed by physicians employed by hospitals; however, some are also carried out by attending cardiologists on contract in private practice, applying the so-called Belegarztsystem. The aim of this study was to determine the safety and efficiency of an interventional electrophysiology performed in a German Belegarztsystem. METHODS Based on a prospective registry, we analyzed procedure-related data from 1400 consecutive EPS/abl. performed at our center between 2014 and 2018. One-year follow-up data (arrhythmia recurrences, complications, deaths) were collected for all procedures carried out during the first 2 years. RESULTS In the total study cohort, no periprocedural death occurred, and there was a low cumulative incidence of groin complications (0.9%). The most common procedure (n = 772) was complex ablation for atrial fibrillation/flutter (55%). In this group, the success rate was 98% (acute) and 65% (1 year), and the cumulative rate of complications was 5.0% (transient ischemic attack/stroke 0.1%, pericardial tamponade 0.4%, relevant pericarditis/pericardial effusion 1.1%, groin complication 1.5%, other 1.9%). For the other procedures, rates for success and complications were comparable, and procedure times and x‑ray doses tended to be lower in our analysis as compared to prior reports. CONCLUSION Interventional electrophysiology, carried out by experienced operators and qualified staff, can be performed safely and effectively by attending physicians in a Belegarztsystem.
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Affiliation(s)
- Kathi Goldstein
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Claudius Hansen
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Lars Lüthje
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland
| | - Dirk Vollmann
- Herz- & Gefäßzentrum am Krankenhaus Neu Bethlehem, Humboldtallee 6, 37073, Göttingen, Deutschland.
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Multicenter, randomized comparison between magnetically navigated and manually guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia (the MagMa-AVNRT-trial). Clin Res Cardiol 2017; 106:947-952. [PMID: 28849269 DOI: 10.1007/s00392-017-1144-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/31/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Remote magnetic navigation (RMN) is attributed to diminish radiation exposure for both patient and operator performing catheter ablation for different arrhythmia substrates. The purpose of this prospective, randomized study was to compare RMN with manually guided catheter ablation for AV nodal reentrant tachycardia (AVNRT) regarding fluoroscopy time/dosage, acute and long-term efficacy as well as safety. METHODS AND RESULTS A total of 218 patients with AVNRT undergoing catheter ablation at three centers (male 34%, mean age 50 ± 17 years) were randomized to a manual approach (n = 113) or RMN (n = 105) using the Niobe® magnetic navigation system. The primary study endpoint was total fluoroscopy time/dosage for patient and operator at the end of the procedure. Secondary endpoints included acute success, procedure duration, complications and success rate after 6 months. Fluoroscopy time and dosage for the patient were significantly reduced in the RMN group compared to the manual group (6 ± 6 vs. 11 ± 10 min; p < 0.001 and 425 ± 558 vs. 751 ± 900 cGycm2, p = 0.002). A reduction in fluoroscopy time/dose also applied to the operator (3 ± 5 vs. 7 ± 9 min 209 ± 444 vs. 482 ± 689 cGycm2, p < 0.001). Procedure duration was significantly longer in the RMN group (88 ± 29 vs. 79 ± 29 min; p = 0.03) and crossover from the RMN group to manual ablation occurred in 7.6% of patients (7.6 vs. 0.1%; p = 0.02). Acute success was achieved in 100% of patients in both groups. Midterm success after 6 months was 97 vs. 98% (p = 0.67). No complications occurred in both groups. CONCLUSION The use of RMN for catheter ablation of AVNRT compared to a manual approach results in a reduction of fluoroscopy time and dosage of about 50% for both patients and physicians. Acute and midterm success and safety are comparable. RMN is a good alternative to a manual approach for AVNRT ablation.
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Steven D, Bonnemeier H, Deneke T, Estner HL, Kriatselis C, Kuniss M, Luik A, Neuberger HR, Shin DI, Sommer P, Tilz RR, Thomas D, von Bary C, Voss F, Eckardt L. [How to approach the patient with supraventricular tachycardia in the EP lab: A systematic overview]. Herzschrittmacherther Elektrophysiol 2015; 26:167-72. [PMID: 26031513 DOI: 10.1007/s00399-015-0373-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/22/2015] [Indexed: 11/26/2022]
Abstract
The term supraventricular tachycardia (SVT) summarizes those tachycardias involving the atrial myocardium along with the atrioventricular (AV) node. The prevalence is about 2.25 per 1000 (without atrial fibrillation and atrial flutter) and, therefore, SVT represents one of the most common group of arrhythmias besides atrial fibrillation encountered in the emergency department especially since they tend to recur until definite therapy. The clinical symptoms may include palpitations, anxiety, presyncope, angina, and dyspnea. Pharmacological therapy of these arrhythmias often fails. The present article deals with the differential diagnosis of SVT and also introduces a series of manuscripts that provide detailed insight into the differential diagnosis and treatment of these arrhythmias.
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Affiliation(s)
- D Steven
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland,
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Heydari A, Tayyebi M, Jami RD, Amiri A. Role of isoproterenol in predicting the success of catheter ablation in patients with reproducibly inducible atrioventricular nodal reentrant tachycardia. Tex Heart Inst J 2014; 41:280-5. [PMID: 24955042 DOI: 10.14503/thij-13-3332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Noninducibility of the arrhythmia is the widely accepted endpoint of successful ablation of atrioventricular nodal reentrant tachycardia (AVNRT). However, to rely upon that as the only endpoint, the arrhythmia must also be inducible before ablation. Despite the fact that AVNRT is not reproducibly inducible in a significant number of cases, the role of reproducible arrhythmia induction and its relationship with the infusion of isoproterenol after successful ablation of AVNRT has not been well defined. We studied 175 consecutive patients who all underwent successful radiofrequency ablation after showing that they had reproducibly inducible AVNRT without use of isoproterenol. In Group 1 (n=90), isoproterenol was used for arrhythmia reinduction after ablation, whereas in Group 2 (n=85) it was not. The procedural and follow-up data of both groups were recorded, and the results of appropriate statistical tests were analyzed. During a mean follow-up time of 18.7 ± 4.5 months, 4 patients in Group 1 and 3 patients in Group 2 experienced recurrences. Regardless of elimination or modification of slow-pathway conduction, no significant difference was seen in the recurrence rates of AVNRT between the 2 groups (P=0.72). We conclude that, when the original arrhythmia in patients with AVNRT is reproducibly inducible in the basal state, the use of isoproterenol after ablation in order to confirm the noninducibility of AVNRT does not appear to alter the recurrence rates and can be omitted.
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Affiliation(s)
- Alireza Heydari
- Department of Cardiology (Drs. Heydari and Jami), Ghaem Educational, Research and Treatment Center; and Preventive Cardiovascular Care Research Center (Drs. Amiri and Tayyebi), Imam Reza Educational, Research and Treatment Center; Mashhad University of Medical Sciences, Mashhad 9137913316, Iran
| | - Mohammad Tayyebi
- Department of Cardiology (Drs. Heydari and Jami), Ghaem Educational, Research and Treatment Center; and Preventive Cardiovascular Care Research Center (Drs. Amiri and Tayyebi), Imam Reza Educational, Research and Treatment Center; Mashhad University of Medical Sciences, Mashhad 9137913316, Iran
| | - Rahmatolah Damanpak Jami
- Department of Cardiology (Drs. Heydari and Jami), Ghaem Educational, Research and Treatment Center; and Preventive Cardiovascular Care Research Center (Drs. Amiri and Tayyebi), Imam Reza Educational, Research and Treatment Center; Mashhad University of Medical Sciences, Mashhad 9137913316, Iran
| | - Asgar Amiri
- Department of Cardiology (Drs. Heydari and Jami), Ghaem Educational, Research and Treatment Center; and Preventive Cardiovascular Care Research Center (Drs. Amiri and Tayyebi), Imam Reza Educational, Research and Treatment Center; Mashhad University of Medical Sciences, Mashhad 9137913316, Iran
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