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Mondal S, Dharan BS, Namboodiri N. A wide complex tachycardia in bigeminy. Pacing Clin Electrophysiol 2024; 47:1032-1034. [PMID: 38953492 DOI: 10.1111/pace.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Sudipta Mondal
- Department of Cardiology, Electrophysiology Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Pediatric Surgery Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Narayanan Namboodiri
- Department of Cardiology, Electrophysiology Division, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Tobiume T, Kato R, Matsuura T, Matsumoto K, Hara M, Takamori N, Taketani Y, Okawa K, Ise T, Kusunose K, Yamaguchi K, Yagi S, Fukuda D, Yamada H, Wakatsuki T, Soeki T, Sata M, Matsumoto K. Antegrade slow pathway mapping of typical atrioventricular nodal reentrant tachycardia based on direct slow pathway capture. J Arrhythm 2021; 37:128-139. [PMID: 33664895 PMCID: PMC7896471 DOI: 10.1002/joa3.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiofrequency (RF) ablation of typical atrioventricular nodal reentrant tachycardia (tAVNRT) is performed without revealing out the location of antegrade slow pathway (ASp). In this study, we studied a new electrophysiological method of identifying the site of ASp. METHODS This study included 19 patients. Repeated series of very high-output single extrastimulations (VhoSESts) were delivered at the anatomical slow pathway region during tAVNRT. Tachycardia cycle length (TCL), coupling interval (CI), and return cycle (RC) were measured and the prematurity of VhoSESts [ΔPM (= TCL - CI)] and the prolongation of RCs [ΔPL (= RC - TCL)] were calculated. Pacing sites were classified into two categories: (i) ASp capture sites [DSPC(+) sites], where two different RCs were shown, and ASp non-capture sites [DSPC(-) sites], where only one RC was shown. RF ablation was performed at DSPC(+) sites and/or sites with catheter-induced mechanical trauma (CIMT) to ASp. RESULTS DSPC(+) sites were shown in 13 patients (68%). RF ablation was successful in all patients without any degree of atrioventricular block nor recurrence. Total number of RF applications was 1.8 ± 1.1. Minimal distance between successful ablation sites and DSPC(+)/CIMT sites and His bundle (HB) electrogram recording sites was 1.9 ± 0.8 mm and 19.8 ± 6.1 mm, respectively. ΔPL of more than 92.5 ms, ΔPL/TCL of more than 0.286, and ΔPL/ΔPM of more than 1.565 could identify ASp with sensitivity of 100%, 91.1%, and 88.9% and specificity of 92.9%, 97.0%, and 97.6%, respectively. CONCLUSIONS Sites with ASp capture and CIMT were close to successful ablation sites and could be useful indicators of tAVNRT ablation.
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Affiliation(s)
- Takeshi Tobiume
- Department of CardiologyTokushima University HospitalTokushimaJapan
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
- Department of CardiologyKawashima HospitalTokushimaJapan
- Department of CardiologyShikoku Medical Center for Children and AdultsZentsujiJapan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Tomomi Matsuura
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | | | - Motoki Hara
- Hara Clinic Higashi‐HiroshimaHigashi‐HiroshimaJapan
| | | | - Yoshio Taketani
- Department of CardiologyShikoku Medical Center for Children and AdultsZentsujiJapan
| | - Keisuke Okawa
- Department of CardiologyKagawa Prefectural Central HospitalTakamatsuJapan
| | - Takayuki Ise
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Kenya Kusunose
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Koji Yamaguchi
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Shusuke Yagi
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Daijyu Fukuda
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Hirotsugu Yamada
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | | | - Takeshi Soeki
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Masataka Sata
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Kazuo Matsumoto
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
- Department of Internal MedicineHigashi‐Matsuyama Medical Association HospitalHigashimatsuyamaJapan
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Kaneko Y, Nakajima T, Iizuka T, Tamura S, Kurabayashi M. What is the mechanism of wide QRS tachycardia? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:725-727. [PMID: 30945302 DOI: 10.1111/pace.13687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Nikoo MH, Attar A, Pourmontaseri M, Jorat MV, Kafi M. Atrioventricular nodal echoes over a wide echo window as a therapeutic end point for the catheter-guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia: a prospective study. Europace 2017; 20:659-664. [DOI: 10.1093/europace/euw434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 12/26/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Armin Attar
- Cardiovascular Research Center, TAHA Clinical Trial Group, Zand Street, Shiraz University of Medical Sciences, 71344-1864, Shiraz, Iran
| | | | - Mohammad Vahid Jorat
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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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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Khachab H, Brembilla-Perrot B. Prevalence of atrial fibrillation in patients with history of paroxysmal supraventricular tachycardia. Int J Cardiol 2013; 166:221-4. [DOI: 10.1016/j.ijcard.2011.10.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/06/2011] [Accepted: 10/18/2011] [Indexed: 11/25/2022]
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FELDMAN ALEXANDER, VOSKOBOINIK ALEKSANDR, KUMAR SAURABH, SPENCE STEVEN, MORTON JOSEPHB, KISTLER PETERM, SPARKS PAULB, VOHRA JITENDRAK, KALMAN JONATHANM. Predictors of Acute and Long-Term Success of Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia: A Single Center Series of 1,419 Consecutive Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:927-33. [DOI: 10.1111/j.1540-8159.2011.03092.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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STERN JOSHUAD, ROLNITZKY LINDA, GOLDBERG JUDITHD, CHINITZ LARRYA, HOLMES DOUGLASS, BERNSTEIN NEILE, BERNSTEIN SCOTTA, KHAIRY PAUL, AIZER ANTHONY. Meta-Analysis to Assess the Appropriate Endpoint for Slow Pathway Ablation of Atrioventricular Nodal Reentrant Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:269-77. [DOI: 10.1111/j.1540-8159.2010.02948.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Atrioventricular node anatomy and physiology: implications for ablation of atrioventricular nodal reentrant tachycardia. Curr Opin Cardiol 2009; 24:105-12. [DOI: 10.1097/hco.0b013e328323d83f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kantharia BK, Padder FA, Kutalek SP. Decremental Ramp Atrial Extrastimuli Pacing Protocol for the Induction of Atrioventricular Nodal Re-entrant Tachycardia and Other Supraventricular Tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1096-104. [PMID: 17038142 DOI: 10.1111/j.1540-8159.2006.00503.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The primary aim of this study was to evaluate the utility of decremental ramp atrial extrastimuli pacing protocol (PRTCL) for induction of atrioventricular nodal re-entrant tachycardia (AVNRT), and other supraventricular tachycardias (SVTs), compared to standard (STD) methods. METHODS The study cohort of 121 patients (age 57.51 +/- 14.02 years) who presented with documented SVTs and/or symptoms of palpitations and dizziness, and underwent invasive electrophysiological evaluation was divided into Group I (AVNRT, n = 42) and Group II (Control, n = 79). The PRTCL involved a train of six atrial extrastimuli, delivered in a decremental ramp fashion. The STD methods included continuous burst and rapid incremental pacing up to atrioventricular (AV) block cycle length, and single and occasionally double atrial extrastimuli. Prolongation in the Atrio-Hisian (Delta-AH) intervals achieved by both methods were compared, as were induction frequencies. RESULTS In Group I, three categories of responses--(1) induction of AVNRT, (2) induction of echo beats only, and (3) none--were observed in 29 (69%), 11 (26%), and 2 (5%) patients with the PRTCL, when compared with 14 (33%), 16 (38%), and 12 (29%) patients with STD methods in the baseline state without the use of pharmacological agents. The Delta-AH intervals for each of these three categories were larger using PRTCL versus STD methods; 293.3 +/- 95.2 ms versus 192.9 +/- 61.4 ms (P < 0.005), 308.6 +/- 68.5 ms versus 189. 9 +/- 64.9 ms (P < 0.0005), and 203.0 +/- 86.3 ms versus 145.8 +/- 58.9 ms (P = NS), respectively. In Group II, in one patient with dual AV nodal physiology but no clinical tachycardia, the PRTCL induced nonsustained (12 beats) AVNRT. Additionally, in this group, both PRTCL and STD methods induced atrial tachycardia in two patients and orthodromic AV re-entrant tachycardia in one patient. CONCLUSION Decremental ramp atrial extrastimuli pacing PRTCL demonstrates a superior response for induction of typical AVNRT as compared to STD techniques. Because of easy and reliable induction of AVNRT and echo beats by the PRTCL, we recommend it as a method to increase the likelihood of induction of AVNRT. For induction of other SVTs, the PRTCL and the STD methods are comparable.
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Affiliation(s)
- Bharat K Kantharia
- Department of Internal Medicine, Division of Cardiac Electrophysiology, Cardiac Electrophysiology Fellowship Training Program, Cardiac Electrophysiology Laboratories, Ohio State University Medical Center, Columbus, Ohio 43210, USA.
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Brembilla-Perrot B, Muhanna I, Marçon O, Popovic B, Terrier de la Chaise A, Louis P, Andronache M, Nippert M, Claudon O, Beurrier D, Houriez P, Belhakem H. Increased sensitivity of electrophysiological study by isoproterenol infusion in unexplained syncope. Int J Cardiol 2006; 106:82-7. [PMID: 16321671 DOI: 10.1016/j.ijcard.2004.12.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 12/31/2004] [Indexed: 11/23/2022]
Abstract
UNLABELLED The purpose of the study was to evaluate the interests of electrophysiologic study (EPS) after infusion of isoproterenol in patients with syncope and negative EPS in control state. METHODS 1350 patients were consecutively admitted for syncope and EPS. Patients were included if they had no history of tachycardia, a normal Holter monitoring, a negative EPS in control state. EPS was repeated after infusion of 2-4 mug/kg of isoproterenol. RESULTS 256 patients, 35 with exercise-related syncope and 105 with heart disease (HD), were recruited. After isoproterenol, an arrhythmia was identified as the sign associated with syncope in 102 patients (40%): SVT in 32 patients, VT in 36 patients, infrahisian 2nd or 3rd degree AV block in three patients and vasovagal reaction in 31 patients. Arrhythmias were more frequent in patients with HD (50/105) than in those without HD (52/151) (p<0.05); SVT tended to be more frequent in patients without HD (n=23) than in those with HD (n=9) (p<0.1); VT was more frequent in patients with HD (n=26) than in those without HD (n=10) (p<0.001). There was no relationship between a positive isoproterenol testing and occurrence of syncope at exercise (19/35 vs 81/221) (p<0.1). CONCLUSION isoproterenol infusion increased the sensitivity of EPS in patients with syncope, related or not to exercise, and with negative study in control state, but principally in those with HD. However, SVT was diagnosed in patients without HD and EPS associated with isoproterenol infusion remained an important and rapid tool to establish this diagnosis.
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Estner HL, Ndrepepa G, Dong J, Deisenhofer I, Schreieck J, Schneider M, Plewan A, Karch M, Weyerbrock S, Wade D, Zrenner B, Schmitt C. Acute and Long-Term Results of Slow Pathway Ablation in Patients with Atrioventricular Nodal Reentrant Tachycardia-An Analysis of the Predictive Factors for Arrhythmia Recurrence. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:102-10. [PMID: 15679639 DOI: 10.1111/j.1540-8159.2005.09364.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Predictors of atrioventricular nodal reentrant tachycardia (AVNRT) recurrence after radiofrequency ablation including the importance of residual slow pathway conduction are not known. The aim of this study was to report the acute and long-term results of slow pathway ablation in a large series of consecutive patients with AVNRT and to analyze the potential predictors of arrhythmia recurrence with a particular emphasis on the residual slow pathway conduction after ablation. METHODS The study included 506 consecutive patients with AVNRT (mean age 52.6 +/- 16 years, 315 women) who underwent slow pathway ablation using a combined electrophysiological and anatomical approach. The end point of ablation procedure was noninducibility of the arrhythmia. The primary end point of the study was the recurrence of AVNRT. RESULTS Acute success was achieved in 500 patients (98.8%). After ablation, 471 patients (93%) were followed up for a mean of 903 +/- 692 days. Of the 465 patients with successful ablation, 24 patients (5.2%) developed AVNRT recurrences during the follow-up. No significant differences in the cumulative rates of AVNRT recurrence were observed in groups with or without electrophysiological evidence of residual slow pathway conduction (P = 0.25, log-rank test). Multivariate analysis identified only age as an independent predictor of AVNRT recurrence (hazard ratio 0.96, 95% confidence interval 0.94-0.99, P = 0.004) with younger patients being at an increased risk for arrhythmia recurrence. CONCLUSIONS Our study demonstrated that only younger age, but not other clinical or electrophysiological parameters including residual slow pathway conduction predicted an increased risk for AVNRT recurrence after slow pathway radiofrequency ablation.
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Affiliation(s)
- Heidi Luise Estner
- Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Delle Karth G, Reinelt P, Buberl A, Geppert A, Huelsmann M, Berger R, Heinz G. Circadian variation in ventricular tachycardia and atrial fibrillation in a medical-cardiological ICU. Intensive Care Med 2003; 29:963-968. [PMID: 12698245 DOI: 10.1007/s00134-003-1735-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2002] [Accepted: 02/28/2003] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the diurnal distribution of ventricular tachycardia (VT) and atrial fibrillation (AF) in critically ill patients. DESIGN AND SETTING Prospective observational study (episode-based design) in an eight-bed medical/cardiological ICU at a university hospital that also admits postoperative patients. PATIENTS 98 consecutive patients with AF ( n=55) or ventricular tachycardia ( n=43). MEASUREMENTS AND RESULTS There were a total of 218 arrhythmia episodes (83 AF, 136 VT). The time of arrhythmia onset was not evenly distributed. Circadian variation in VT but not AF onset was well represented by a sine wave function. Both VT and AF fibrillation showed a trough during the night. The distribution of VT and AF episodes did not differ significantly with or without analgosedation. CONCLUSIONS In critically ill patients the onset of VT and AF over 24-h is nonuniformly distributed. In VT this circadian pattern of occurrence is well modeled by a sine wave function peaking between noon and 2 p.m. The circadian pattern is less clear for AF. The circadian variation is seen irrespective of the presence of absence of analgosedation for both arrhythmias.
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Affiliation(s)
- Georg Delle Karth
- Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Peter Reinelt
- Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Anton Buberl
- Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Alexander Geppert
- Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Huelsmann
- Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rudolf Berger
- Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gottfried Heinz
- Department of Cardiology, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Liberman L, Hordof AJ, Fishberger SB, Pass RH. The role of isoproterenol testing following radiofrequency catheter ablation of accessory pathways in children. Pacing Clin Electrophysiol 2003; 26:559-61. [PMID: 12710314 DOI: 10.1046/j.1460-9592.2003.00094.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Isoproterenol (ISO) testing following radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in children is often performed to assess efficacy. However, its role in postablative testing for this indication has not been previously studied. In view of a recent national shortage of ISO, this study reviewed the results of ISO testing in pediatric patients after acutely successful RFCA to evaluate its role in postablative testing. Seventy patients (median age 13.0 years, range 2.8-24 years) underwent acutely successful RFCA for APs. If AP conduction was not present and tachycardia was not inducible with programmed stimulation 30 minutes following RFCA, repeat testing was performed during continuous infusion ISO. ISO infusion resulted in the induction of arrhythmias in 3 (4%) of 70 patients that required further ablative therapy. None of these patients had inducible arrhythmias or AP conduction during postablative testing without ISO infusion. One patient, with the permanent form of junctional reciprocating tachycardia (PJRT), had persistence of AP conduction requiring further RFCA applications. Two patients had inducible AV nodal reentrant tachycardia (AVNRT) that was treated with slow pathway modification. At a median follow-up of 7.3 months, two (3%) patients had recurrence of tachycardia. These patients did not have inducible tachycardia, AP conduction, or dual AVN physiology with ISO testing. Although ISO may improve AP conduction in patients with PJRT and uncover AVNRT, these results suggest that ISO testing after an apparently successful AP ablation may not be necessary to confirm acute success. In addition, lack of AP conduction on ISO did not rule out the possibility of medium-term recurrence.
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Affiliation(s)
- Leonardo Liberman
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, NY Presbyterian Hospital, Columbia University, New York, USA.
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Weismüller P, Kuly S, Brandts B, Kattenbeck K, Ranke C, Trappe HJ. Is electrical stimulation during administration of catecholamines required for the evaluation of success after ablation of atrioventricular node re-entrant tachycardias? J Am Coll Cardiol 2002; 39:689-94. [PMID: 11849870 DOI: 10.1016/s0735-1097(01)01798-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to answer the question of whether stimulation after administration of catecholamines is mandatory for identifying unsuccessful ablations of atrioventricular node re-entrant tachycardia (AVNRT). BACKGROUND The success of radiofrequency (RF) catheter ablation in AVNRT is confirmed in many centers by noninducibility of tachycardias during stimulation after the administration of catecholamines. METHODS A total of 131 patients (81 women and 50 men; mean age 53.6 +/- 13.7 years [range 20 to 77]) were studied. Electrical stimulation was performed without and with the beta-adrenergic amine Orciprenaline (metaproterenol) before and after RF catheter ablation. RESULTS In 100 patients (76.3%; confidence interval [CI] 68.1% to 83.3%) an AVNRT was inducible without administration of Orciprenaline. Thirty minutes after the initially successful ablation in 95 patients, tachycardia was inducible in none of these patients, not even after Orciprenaline administration. In the 31 patients (23.7%; CI 16.7% to 31.9%) in whom there was no tachycardia inducible before ablation, Orciprenaline was given, and the stimulation protocol was repeated. In only five patients (3.8%; CI 1.3% to 8.7%) was there still no tachycardia inducible. After an initially successful ablation in the 26 patients who had inducible tachycardias with Orciprenaline before ablation, no tachycardia could be re-induced. After Orciprenaline, the tachycardia was inducible again in only one patient. CONCLUSIONS Only patients who require catecholamines for tachycardia induction before ablation need catecholamines for control of the success of the ablation of AVNRT.
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Affiliation(s)
- Peter Weismüller
- Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Herne, Germany.
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Stellbrink C, Diem B, Schauerte P, Brehmer K, Schuett H, Hanrath P. Differential effects of atropine and isoproterenol on inducibility of atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2001; 5:463-9. [PMID: 11752915 DOI: 10.1023/a:1013258331023] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Radiofrequency ablation of the "slow pathway" in atrioventricular nodal reentrant tachycardia (AVNRT) relies on tachycardia non-inducibility after ablation as success criterion. However, AVNRT is frequently non-inducible at baseline. Thus, autonomic enhancement using either atropine or isoproterenol is frequently used for arrhythmia induction before ablation. METHODS 80 patients (57 women, 23 men, age 50+/-14 years) undergoing slow pathway ablation for recurrent AVNRT were randomized to receive either 0.01 mg/kg atropine or 0.5-1.0 microg/kg/min isoproterenol before ablation after baseline assessment of AV conduction. The effects of either drug on ante- and retrograde conduction was assessed by measuring sinus cycle length, PR and AH interval, antegrade and retrograde Wenckebach cycle length (WBCL), antegrade effective refractory period (ERP) of slow and fast pathway and maximal stimulus-to-H interval during slow and fast pathway conduction. RESULTS Inducibility of AVNRT at baseline was not different between patients randomized to atropine (73%) and isoproterenol (58%) but was reduced after atropine (45%) compared to isoproterenol (93%, P<0.001). Of the 28 patients non-inducible at baseline isoproterenol rendered AVNRT inducible in 21, atropine in 4 patients. Dual AV nodal pathway physiology was present in 88% before and 50% after atropine compared to 83% before and 73% after isoproterenol. Whereas both drugs exerted similar effects on ante- and retrograde fast pathway conduction maximal SH interval during slow pathway conduction was significantly shorter after isoproterenol (300+/-48 ms vs. 374+/-113 ms, P=0.012). CONCLUSION Isoproterenol yields higher AVNRT inducibility than atropine in patients non-inducible at baseline. This may be caused by a more pronounced effect on antegrade slow pathway conduction.
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Affiliation(s)
- C Stellbrink
- Department of Cardiology and Internal Medicine, University of Technology, Aachen, Germany.
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Belhassen B, Fish R, Eldar M, Glick A, Glikson M, Viskin S. Simplified "ATP test" for noninvasive diagnosis of dual AV nodal physiology and assessment of results of slow pathway ablation in patients with AV nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2000; 11:255-61. [PMID: 10749348 DOI: 10.1111/j.1540-8167.2000.tb01794.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We recently reported that administration of adenosine triphosphate (ATP) during sinus rhythm identifies dual AV nodal physiology (DAVNP) in 76% of patients with inducible sustained AV nodal reentrant tachycardia (AVNRT) at electrophysiologic (EP) study. In that report, however, the ATP test was considered positive for DAVNP only when the results were reproducible at a given dose of ATP. The aim of the present study was to assess the value of a simplified ATP test for noninvasive diagnosis of DAVNP and abolition or modification of the slow pathway (SP) after radiofrequency ablation (RFA) in patients with inducible sustained AVNRT. METHODS AND RESULTS The value of a single dose of ATP was studied in 105 patients with inducible sustained AVNRT and in 31 control patients before placement of EP catheters in the cardiac chambers. ATP (10 to 60 mg, in 10-mg increments) was injected during sinus rhythm until ECG signs of DAVNP (> or = 50 msec increase or decrease in PR interval in two consecutive beats, or occurrence of > or = 1 AV nodal echo beat) or > or = second-degree AV block was observed. DAVNP was observed in only 1 (3.2%) control patient. The test could be completed in 96 study patients. DAVNP was found by ATP test in 72 (75%) patients, whereas it was diagnosed by EP criteria in 82 (85%) patients. DAVNP by ATP test disappeared in 27 (96%) of 28 patients who underwent SP abolition and in 18 (60%) of 30 patients who underwent SP modification. In the 12 patients with persistent DAVNP determined by ATP test after SP modification, the number of beats conducted over the SP was significantly reduced (from 6.3+/-3.3 to 2.5+/-2.2 beats; P = 0.002). CONCLUSION A single administration of ATP during sinus rhythm (at a given dose) enables noninvasive diagnosis of DAVNP in a high percentage of patients with inducible AVNRT and reliably confirms the results of RFA of the SP.
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Affiliation(s)
- B Belhassen
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Israel.
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