1
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Ye Z, van Schie MS, Pool L, Heida A, Knops P, Taverne YJHJ, Brundel BJJM, de Groot NMS. Characterization of unipolar electrogram morphology: a novel tool for quantifying conduction inhomogeneity. Europace 2023; 25:euad324. [PMID: 37931071 PMCID: PMC10657215 DOI: 10.1093/europace/euad324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/15/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023] Open
Abstract
AIMS Areas of conduction inhomogeneity (CI) during sinus rhythm may facilitate the initiation and perpetuation of atrial fibrillation (AF). Currently, no tool is available to quantify the severity of CI. Our aim is to develop and validate a novel tool using unipolar electrograms (EGMs) only to quantify the severity of CI in the atria. METHODS AND RESULTS Epicardial mapping of the right atrium (RA) and left atrium, including Bachmann's bundle, was performed in 235 patients undergoing coronary artery bypass grafting surgery. Conduction inhomogeneity was defined as the amount of conduction block. Electrograms were classified as single, short, long double (LDP), and fractionated potentials (FPs), and the fractionation duration of non-single potentials was measured. The proportion of low-voltage areas (LVAs, <1 mV) was calculated. Increased CI was associated with decreased potential voltages and increased LVAs, LDPs, and FPs. The Electrical Fingerprint Score consisting of RA EGM features, including LVAs and LDPs, was most accurate in predicting CI severity. The RA Electrical Fingerprint Score demonstrated the highest correlation with the amount of CI in both atria (r = 0.70, P < 0.001). CONCLUSION The Electrical Fingerprint Score is a novel tool to quantify the severity of CI using only unipolar EGM characteristics recorded. This tool can be used to stage the degree of conduction abnormalities without constructing spatial activation patterns, potentially enabling early identification of patients at high risk of post-operative AF or selection of the appropriate ablation approach in addition to pulmonary vein isolation at the electrophysiology laboratory.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Mathijs S van Schie
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Lisa Pool
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Annejet Heida
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Paul Knops
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Dr Molewaterplein 40, Rotterdam 3015GD, The Netherlands
- Department of Microelectronics, Delft University of Technology, Mekelweg 5, 2628CD Delft, The Netherlands
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2
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Woo G, Markert C, Montgomery R. A Direction-independent, High-density Mapping Catheter Provides Electrophysiological Advantage in Complex Atrial Tachycardia Ablation Following Pulmonary Vein Isolation. J Innov Card Rhythm Manag 2022; 12:4785-4788. [PMID: 34970467 PMCID: PMC8712022 DOI: 10.19102/icrm.2021.121203] [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: 02/10/2021] [Accepted: 03/06/2021] [Indexed: 11/21/2022] Open
Abstract
Catheter ablation of recurrent atrial arrhythmias following pulmonary vein isolation can be challenging given the complex nature of previously ablated tissue, and managing these already complex cases may be rendered more difficult by the impact of wavefront directionality on mapping catheter orientation, which can make the accurate identification of arrhythmogenic substrate more difficult to achieve. In this report, a 72-year-old man with a history of symptomatic paroxysmal atrial fibrillation and prior pulmonary vein isolation (PVI) underwent repeat ablation. Importantly, this case study demonstrates how a direction-independent high-density mapping catheter (Advisor™ HD Grid; Abbott, Chicago, IL, USA) can identify fractionated low-voltage zones that may be missed when using a standard linear ablation catheter.
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Affiliation(s)
- Gregory Woo
- Cardiovascular Services, Department of Medicine, CaroMont Regional Medical Center, Gastonia, NC, USA
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3
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van Schie MS, Starreveld R, Roos-Serote MC, Taverne YJHJ, van Schaagen FRN, Bogers AJJC, de Groot NMS. Classification of sinus rhythm single potential morphology in patients with mitral valve disease. Europace 2021; 22:1509-1519. [PMID: 33033830 PMCID: PMC7544534 DOI: 10.1093/europace/euaa130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/24/2020] [Accepted: 04/28/2020] [Indexed: 12/31/2022] Open
Abstract
Aims The morphology of unipolar single potentials (SPs) contains information on intra-atrial conduction disorders and possibly the substrate underlying atrial fibrillation (AF). This study examined the impact of AF episodes on features of SP morphology during sinus rhythm (SR) in patients with mitral valve disease. Methods and results Intraoperative epicardial mapping (interelectrode distance 2 mm) of the right and left atrium (RA, LA), Bachmann’s bundle (BB), and pulmonary vein area (PVA) was performed in 67 patients (27 male, 67 ± 11 years) with or without a history of paroxysmal AF (PAF). Unipolar SPs were classified according to their differences in relative R- and S-wave amplitude ratios. A clear predominance of S-waves was observed at BB and the RA in both the no AF and PAF groups (BB 88.8% vs. 85.9%, RA 92.1% vs. 85.1%, respectively). Potential voltages at the RA, BB, and PVA were significantly lower in the PAF group (P < 0.001 for each) and were mainly determined by the size of the S-waves amplitudes. The largest difference in S-wave amplitudes was found at BB; the S-wave amplitude was lower in the PAF group [4.08 (2.45–6.13) mV vs. 2.94 (1.40–4.75) mV; P < 0.001]. In addition, conduction velocity (CV) at BB was lower as well [0.97 (0.70–1.21) m/s vs. 0.89 (0.62–1.16) m/s, P < 0.001]. Conclusion Though excitation of the atria during SR is heterogeneously disrupted, a history of AF is characterized by decreased SP amplitudes at BB due to loss of S-wave amplitudes and decreased CV. This suggests that SP morphology could provide additional information on wavefront propagation.
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Roeliene Starreveld
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Maarten C Roos-Serote
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Frank R N van Schaagen
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Unit Translational Electrophysiology, Erasmus Medical Centre, Dr Molewaterplein 40, 3015GD Rotterdam, the Netherlands
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4
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van Schie MS, Kharbanda RK, Houck CA, Lanters EAH, Taverne YJHJ, Bogers AJJC, de Groot NMS. Identification of Low-Voltage Areas: A Unipolar, Bipolar, and Omnipolar Perspective. Circ Arrhythm Electrophysiol 2021; 14:e009912. [PMID: 34143644 PMCID: PMC8294660 DOI: 10.1161/circep.121.009912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-voltage areas (LVAs) are commonly considered surrogate markers for an arrhythmogenic substrate underlying tachyarrhythmias. It remains challenging to define a proper threshold to classify LVA, and it is unknown whether unipolar, bipolar, and the recently introduced omnipolar voltage mapping techniques are complementary or contradictory in classifying LVAs. Therefore, this study examined similarities and dissimilarities in unipolar, bipolar, and omnipolar voltage mapping and explored the relation between various types of voltages and conduction velocity (CV).
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Affiliation(s)
- Mathijs S van Schie
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Rohit K Kharbanda
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Charlotte A Houck
- Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eva A H Lanters
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery (R.K.K., C.A.H., Y.J.H.J.T., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology (M.S.v.S., R.K.K., C.A.H., E.A.H.L., N.M.S.d.G.), Erasmus Medical Center, Rotterdam, the Netherlands
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5
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Ye Z, van Schie MS, de Groot NMS. Signal Fingerprinting as a Novel Diagnostic Tool to Identify Conduction Inhomogeneity. Front Physiol 2021; 12:652128. [PMID: 33841188 PMCID: PMC8033016 DOI: 10.3389/fphys.2021.652128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Inhomogeneous intra-atrial conduction facilitates both initiation and perpetuation of atrial fibrillation (AF) and is reflected in electrogram (EGM) morphology. Objective The primary objective of this study is to investigate regional differences in features of different EGM types during sinus rhythm (SR) and to design a patient-specific signal fingerprint, which quantifies the severity and extensiveness of inhomogeneity in conduction. Methods Patients (N = 189, 86% male; mean age 65 ± 9 years) undergoing coronary artery bypass grafting (CABG) underwent high-resolution mapping of the right atrium (RA), left atrium (LA), and pulmonary vein area (PVA) including Bachmann’s bundle (BB). EGMs during 5 s of SR were classified as single potentials (SPs), short double potentials (SDPs, interval between deflections < 15 ms), long double potentials (LDPs, deflection interval > 15 ms), or fractionated potentials (FPs, ≥3 deflections). Of all SPs, differences in relative R- and S-wave amplitude were calculated (R/S ratios). Time difference between first and last deflection was determined (fractionation duration, FD) and potentials with amplitudes < 1.0 mV were labeled as low-voltage. Conduction block (CB) was defined as a difference in local activation time (LAT) between adjacent electrodes of ≥12 ms. Results A total of 1,763,593 EGMs (9,331 ± 3,336 per patient) were classified (Table 1). Conclusion The signal fingerprint, consisting of quantified EGM features, including the R/S ratio of SPs, the relative frequency distribution of unipolar voltages, the proportion of low-voltage areas, the proportion of the different types of EGMs, and durations of LDP and FDP, may serve as a diagnostic tool to determine the severity and extensiveness of conduction inhomogeneity. Further studies are required to determine whether the signal fingerprint can be used to identify patients at risk for AF onset or progression.
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Affiliation(s)
- Ziliang Ye
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
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6
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Le Bloa M, Abadir S, Nair K, Mondésert B, Khairy P. New developments in catheter ablation for patients with congenital heart disease. Expert Rev Cardiovasc Ther 2020; 19:15-26. [PMID: 33153326 DOI: 10.1080/14779072.2021.1847082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.
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Affiliation(s)
- Mathieu Le Bloa
- Montreal Heart Institute, Université De Montréal , Montreal, Canada.,Electrophysiology Service, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Sylvia Abadir
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital , Toronto, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
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7
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Left Atrial Electroanatomical Voltage Mapping to Characterize Substrate and Guide Ablation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00833-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: 10/23/2022]
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8
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Extensive scar modification for the treatment of intra-atrial re-entrant tachycardia in patients after congenital heart surgery. Cardiol Young 2020; 30:1231-1237. [PMID: 32698928 DOI: 10.1017/s1047951120001900] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Catheter ablation is an important therapeutic option for atrial tachycardias in patients with CHD. As a result of extensive scarring and surgical repair, multiple intra-atrial re-entrant tachycardia circuits develop and serve as a substrate for arrhythmias. The best ablation approach for patients with multiple intra-atrial re-entrant tachycardias has not been investigated. Here, we compared substrate-based ablation using extensive scar modification to conventional ablation. METHODS The present study included patients with surgically corrected CHD that underwent intra-atrial re-entrant tachycardia ablation. Extensive scar modification was defined as substrate ablation based on a dense voltage map, aimed to eliminate all potentials in the scar region. The control group had activation mapping-based ablation. A clinical composite endpoint was assessed. Points were given for type, number, and treatment of intra-atrial re-entrant tachycardia recurrence. RESULTS In 40 patients, 63 (extensive scar modification 13) procedures were performed. Acute procedural success was achieved in 78%. Procedural duration was similar in both groups. Forty-nine percent had a recurrence within 1 year. During a 5-year follow-up (2.5-7.5 years), 46% required repeat catheter ablation. Compared to baseline, clinical composite endpoint significantly decreased by 46% after 12 months (p = 0.001). Acute procedural success, procedural parameters, recurrence and repeat ablation were similar between extensive scar modification and activation mapping-based ablation. CONCLUSION Catheter ablation using extensive scar modification for intra-atrial re-entrant tachycardias occurring after surgically corrected CHD illustrated similar short- and long-term outcomes and procedural efficiency compared to catheter ablation using activation mapping-based ablation. The choice of ablation approach for multiple intra-atrial re-entrant tachycardia should remain at the discretion of the operator.
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9
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Laredo M, Waldmann V, Soulat G, Amet D, Marijon E, Iserin L, Ladouceur M, Zhao A. Transbaffle/transconduit puncture using a simple CARTO‐guided approach without echocardiography in patients with congenital heart disease. J Cardiovasc Electrophysiol 2020; 31:2049-2060. [DOI: 10.1111/jce.14590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mikael Laredo
- Unité de Rythmologie, Institut de Cardiologie, Groupe Hospitalier Pitié‐SalpêtrièreSorbonne Université, AP‐HP Paris France
| | - Victor Waldmann
- Département de Cardiologie, Unité de Rythmologie, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
- Unité Médico‐Chirurgicale de Cardiologie Congénitale Adulte, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
| | - Gilles Soulat
- Service de Radiologie, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
| | - Denis Amet
- Département de Cardiologie, Unité de Rythmologie, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
| | - Eloi Marijon
- Département de Cardiologie, Unité de Rythmologie, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
| | - Laurence Iserin
- Unité Médico‐Chirurgicale de Cardiologie Congénitale Adulte, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
| | - Magalie Ladouceur
- Unité Médico‐Chirurgicale de Cardiologie Congénitale Adulte, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
| | - Alexandre Zhao
- Département de Cardiologie, Unité de Rythmologie, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
- Unité Médico‐Chirurgicale de Cardiologie Congénitale Adulte, Hôpital Européen Georges PompidouUniversité de Paris, AP‐HP Paris France
- Laboratoire d'ElectrophysiologieClinique Ambroise Paré Neuilly‐sur‐Seine France
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10
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
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12
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Coveney S, Corrado C, Roney CH, Wilkinson RD, Oakley JE, Lindgren F, Williams SE, O'Neill MD, Niederer SA, Clayton RH. Probabilistic Interpolation of Uncertain Local Activation Times on Human Atrial Manifolds. IEEE Trans Biomed Eng 2020; 67:99-109. [PMID: 30969911 DOI: 10.1109/tbme.2019.2908486] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Local activation time (LAT) mapping of the atria is important for targeted treatment of atrial arrhythmias, but current methods do not interpolate on the atrial manifold and neglect uncertainties associated with LAT observations. In this paper, we describe novel methods to, first, quantify uncertainties in LAT arising from bipolar electrogram analysis and assignment of electrode recordings to the anatomical mesh, second, interpolate uncertain LAT measurements directly on left atrial manifolds to obtain complete probabilistic activation maps, and finally, interpolate LAT jointly across both the manifold and different S1-S2 pacing protocols. METHODS A modified center of mass approach was used to process bipolar electrograms, yielding a LAT estimate and error distribution from the electrogram morphology. An error distribution for assigning measurements to the anatomical mesh was estimated. Probabilistic LAT maps were produced by interpolating on a left atrial manifold using Gaussian Markov random fields, taking into account observation errors and characterizing LAT predictions by their mean and standard deviation. This approach was extended to interpolate across S1-S2 pacing protocols. RESULTS We evaluated our approach using recordings from three patients undergoing atrial ablation. Cross-validation showed consistent and accurate prediction of LAT observations both at different locations on the left atrium and for different S1-S2 intervals. SIGNIFICANCE Interpolation of scalar and vector fields across anatomical structures from point measurements is a challenging problem in biomedical engineering, compounded by uncertainties in measurements and meshes. New methods and approaches are required, and in this paper, we have demonstrated an effective method for probabilistic interpolation of uncertain LAT.
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13
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Bourier F, Martin R, Martin CA, Takigawa M, Kitamura T, Frontera A, Cheniti G, Lam A, Vlachos K, Duchateau J, Pambrun T, Derval N, Denis A, Klotz N, Hocini M, Haïssaguerre M, Jaïs P, Cochet H, Sacher F. Is it feasible to offer 'targeted ablation' of ventricular tachycardia circuits with better understanding of isthmus anatomy and conduction characteristics? Europace 2019; 21:i27-i33. [PMID: 30801128 DOI: 10.1093/europace/euy173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Successful mapping and ablation of ventricular tachycardias remains a challenging clinical task. Whereas conventional entrainment and activation mapping was for many years the gold standard to identify reentrant circuits in ischaemic ventricular tachycardia ablation procedures, substrate mapping has become the cornerstone of ventricular tachycardia ablation. In the last decade, technology has dramatically improved. In parallel to high-density automated mapping, cardiac imaging and image integration tools are increasingly used to assess the structural ventricular tachycardia substrate. The aim of this review is to describe the technologies underlying these new mapping systems and to discuss their possible role in providing new insights into identification and visualization of reentrant tachycardia mechanisms.
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Affiliation(s)
- Felix Bourier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Claire A Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Antonio Frontera
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Anna Lam
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Konstantinos Vlachos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Nicolas Klotz
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, F Pessac- Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F Pessac, France.,University Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F Bordeaux, France
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14
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Determinants of atrial bipolar voltage: Inter electrode distance and wavefront angle. Comput Biol Med 2018; 102:449-457. [DOI: 10.1016/j.compbiomed.2018.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022]
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15
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Handa BS, Roney CH, Houston C, Qureshi NA, Li X, Pitcher DS, Chowdhury RA, Lim PB, Dupont E, Niederer SA, Cantwell CD, Peters NS, Ng FS. Analytical approaches for myocardial fibrillation signals. Comput Biol Med 2018; 102:315-326. [PMID: 30025847 PMCID: PMC6215772 DOI: 10.1016/j.compbiomed.2018.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/11/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022]
Abstract
Atrial and ventricular fibrillation are complex arrhythmias, and their underlying mechanisms remain widely debated and incompletely understood. This is partly because the electrical signals recorded during myocardial fibrillation are themselves complex and difficult to interpret with simple analytical tools. There are currently a number of analytical approaches to handle fibrillation data. Some of these techniques focus on mapping putative drivers of myocardial fibrillation, such as dominant frequency, organizational index, Shannon entropy and phase mapping. Other techniques focus on mapping the underlying myocardial substrate sustaining fibrillation, such as voltage mapping and complex fractionated electrogram mapping. In this review, we discuss these techniques, their application and their limitations, with reference to our experimental and clinical data. We also describe novel tools including a new algorithm to map microreentrant circuits sustaining fibrillation.
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Affiliation(s)
- Balvinder S Handa
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Caroline H Roney
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Charles Houston
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Norman A Qureshi
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Xinyang Li
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - David S Pitcher
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Rasheda A Chowdhury
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Phang Boon Lim
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Emmanuel Dupont
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Steven A Niederer
- Division of Imaging Sciences and Bioengineering, King's College London, United Kingdom
| | - Chris D Cantwell
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom; Department of Aeronautics, Imperial College London, United Kingdom
| | - Nicholas S Peters
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Fu Siong Ng
- ElectroCardioMaths, Imperial Centre for Cardiac Engineering, National Heart & Lung Institute, Imperial College London, United Kingdom.
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16
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 491] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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17
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[Modern mapping technologies : Technical background and clinical use]. Herzschrittmacherther Elektrophysiol 2018; 29:271-277. [PMID: 29946889 DOI: 10.1007/s00399-018-0576-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
Successful mapping and ablation of arrhythmias can be a challenging clinical task. For many years, conventional pacing maneuvers and activation mapping were the gold standard to identify underlying arrhythmia mechanisms in ablation procedures. In the last decade, technology has dramatically improved. In parallel to high-density automated mapping, cardiac imaging and image integration tools are increasingly used to assess the arrhythmia substrate and identify reentrant circuits. The aim of this review is to describe the technologies underlying these new mapping systems and to discuss their possible role in providing new insights into identification and visualization of arrhythmia mechanisms.
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18
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Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Luo B, Wei HQ, Santangeli P, Liang JJ, Ma J. Right atrial dual-loop reentrant tachycardia after cardiac surgery: Prevalence, electrophysiological characteristics, and ablation outcomes. Heart Rhythm 2018; 15:1148-1157. [PMID: 29625278 DOI: 10.1016/j.hrthm.2018.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Right atrial (RA) dual-loop reentrant tachycardia has been described in patients who have undergone open heart surgery. However, the prevalence, electrophysiological (EP) substrate, and ablation outcomes have been poorly characterized. OBJECTIVE The purpose of this study was to investigate the prevalence, EP substrate, and ablation outcomes for RA dual-loop reentrant tachycardia after cardiac surgery. METHODS We identified all patients with atrial tachycardia (AT) after cardiac surgery. We compared EP findings and outcomes of those with RA dual-loop reentrant tachycardia to a control group of patients with RA macroreentrant arrhythmias in the setting of linear RA free-wall (FW) scar. RESULTS Of the 127 patients with 152 postsurgical ATs, 28 of the ATs (18.4%) had RA dual-loop reentry and 24 of 28 (85.7%) had tricuspid annular reentry combined with FW incisional reentry. An incision length >51.5 mm along the FW predicted the substrate for a second loop. In 22 of 23 patients (95.7%) with initial ablation in the cavotricuspid isthmus, a change in the interval between Halod to CSp could be recorded, and 15 of 23 patients (65.2%) had coronary sinus activation pattern change. Complete success was achieved in 25 of 28 patients (89.3%) in the dual-loop reentry group and in 64 of 69 patients (92.8%) in the control group. After mean follow-up of 33.9 ± 24.2 months, 24 of 28 patients (85.7%) and 60 of 69 patients (86.95%) were free of arrhythmias after the initial procedure in the 2 groups, respectively. CONCLUSION The prevalence of RA dual-loop reentry is 18.4% of ATs with prior atriotomy scar. A long incision should alert physicians to the possibility of a second loop at the FW. Halo and coronary sinus activation patterns provide important clues to circuit transformation.
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Affiliation(s)
- Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xu Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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19
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Magtibay K, Massé S, Asta J, Kusha M, Lai PFH, Azam MA, Porta-Sanchez A, Haldar S, Malebranche D, Labos C, Deno DC, Nanthakumar K. Physiological Assessment of Ventricular Myocardial Voltage Using Omnipolar Electrograms. J Am Heart Assoc 2017; 6:e006447. [PMID: 28862942 PMCID: PMC5586472 DOI: 10.1161/jaha.117.006447] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/21/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Characterization of myocardial health by bipolar electrograms are critical for ventricular tachycardia therapy. Dependence of bipolar electrograms on electrode orientation may reduce reliability of voltage assessment along the plane of arrhythmic myocardial substrate. Hence, we sought to evaluate voltage assessment from orientation-independent omnipolar electrograms. METHODS AND RESULTS We mapped the ventricular epicardium of 5 isolated hearts from each species-healthy rabbits, healthy pigs, and diseased humans-under paced conditions. We derived bipolar electrograms and voltage peak-to-peak (Vpps) along 2 bipolar electrode orientations (horizontal and vertical). We derived omnipolar electrograms and Vpps using omnipolar electrogram methodology. Voltage maps were created for both bipoles and omnipole. Electrode orientation affects the bipolar voltage map with an average absolute difference between horizontal and vertical of 0.25±0.18 mV in humans. Vpps provide larger absolute values than horizontal and vertical bipolar Vpps by 1.6 and 1.4 mV, respectively, in humans. Bipolar electrograms with the largest Vpps from either along horizontal or vertical orientation are highly correlated with omnipolar electrograms and with Vpps values (0.97±0.08 and 0.94±0.08, respectively). Vpps values are more consistent than bipoles, in both beat-by-beat (CoV, 0.28±0.19 versus 0.08±0.13 in human hearts) and rhythm changes (0.55±0.21 versus 0.40±0.20 in porcine hearts). CONCLUSIONS Omnipoles provide physiologically relevant and consistent voltages that are along the maximal bipolar direction on the plane of the myocardium.
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Affiliation(s)
- Karl Magtibay
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Stéphane Massé
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - John Asta
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Marjan Kusha
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Patrick F H Lai
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mohammed Ali Azam
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Andreu Porta-Sanchez
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Shouvik Haldar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Daniel Malebranche
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | | | | | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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20
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de Groot NMS, Bogers AJJC. Development of Tachyarrhythmias Late After the Fontan Procedure: The Role of Ablative Therapy. Card Electrophysiol Clin 2017; 9:273-284. [PMID: 28457241 DOI: 10.1016/j.ccep.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with a Fontan circulation are at a high risk of developing a variety of cardiac dysrhythmias after cardiac surgery. These dysrhythmias are most often supraventricular tachyarrhythmias (SVT), but ventricular tachyarrhythmias (VT) may also occur. Mechanisms underlying SVT are variable, including both ectopic activity and reentry. Over time, successive SVT may be caused by different mechanisms. The acute success rate of ablative therapy of atrial tachyarrhythmias is considerably high yet during long-term follow-up 'recurrences' frequently occur. It is most likely that these 'recurrences' are caused by a progressive atrial cardiomyopathy instead of arrhythmogeneity of prior ablative lesions.
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Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, s'Gravendijkwal 230, Rotterdam 3015CE, Netherlands.
| | - Ad J J C Bogers
- Department of Cardiology, Erasmus Medical Center, s'Gravendijkwal 230, Rotterdam 3015CE, Netherlands
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21
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Namgung J, Kwak JJ. Where We Can Find Bypass Tract in Ebstein’s Anomaly?; a Case of Successful Ablation of Bypass Tract in Ebstein’s Anomaly. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2017. [DOI: 10.18501/arrhythmia.2017.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Abstract
Arrhythmias are common in adults with congenital heart disease and account for a large proportion of hospitalizations. The complex anatomical heterogeneity, often in the presence of a delicate hemodynamic system, presents a significant electrophysiological challenge. This review outlines current clinical practice and advances in maximizing the effectiveness of ablation for arrhythmias in congenital heart patients.
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23
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Zhou GB, Hu JQ, Guo XG, Liu X, Yang JD, Sun Q, Ma J, Ouyang FF, Zhang S. Very long-term outcome of catheter ablation of post-incisional atrial tachycardia: Role of incisional and non-incisional scar. Int J Cardiol 2015; 205:72-80. [PMID: 26720044 DOI: 10.1016/j.ijcard.2015.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/08/2015] [Accepted: 12/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The arrhythmogenicity of right atrial (RA) incisional scar after cardiac surgery could result in atrial tachycardia (AT). Radiofrequency catheter ablation is effective in the treatment of such tachycardia. However, data regarding long-term outcomes are limited. METHODS AND RESULTS A total of 105 patients with prior RA incision who underwent radiofrequency catheter ablation of AT were included. In the first procedure, electroanatomic mapping (EAM) revealed a total of 139 ATs in 105 patients, including 88 cavotricuspid isthmus dependent atrial flutters (IDAFs), 5 mitral annulus reentrant tachycardias (MARTs), 44 intra-atrial reentrant tachycardias (IARTs) and 2 focal ATs (FATs). AT was successfully eliminated in 101 (96.1%) patients. During a mean follow-up period of 90 ± 36 months, recurrent AT was observed in 23 patients and 21 underwent a second ablation. A total of 23 ATs were identified in redo procedures including 4 IDAFs, 2 MARTs, 12 IARTs and 5 FATs. The time to recurrence was significantly different among various AT types. Acute success was achieved in 20 of 23 redo procedures. Taking a total of 21 patients presenting atrial fibrillation during follow-up into account, 85 patients (81.9%) were in sinus rhythm. No complications except for a case of RA compartmentation occurred. CONCLUSION RA incisional scar played an essential role in promoting both IDAF and IART, while non-incisional scar contributed to a substantial rate of late recurrent AT in forms of both macroreentry and small reentry. Catheter ablation using EAM system resulted in a high success rate during long-term follow-up.
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Affiliation(s)
- Gong-Bu Zhou
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ji-Qiang Hu
- Department of Cardiology, Oriental Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Gang Guo
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Liu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-du Yang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Fei-Fan Ouyang
- Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Shu Zhang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Anguera I, Dallaglio P, Macías R, Jiménez-Candil J, Peinado R, García-Seara J, Arcocha MF, Herreros B, Quesada A, Hernández-Madrid A, Alvarez M, Filgueiras D, Matía R, Cequier A, Sabaté X. Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease. Am J Cardiol 2015; 115:1705-13. [PMID: 25896151 DOI: 10.1016/j.amjcard.2015.03.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 11/27/2022]
Abstract
Atrial myopathy, atriotomies, and fibrotic scars are the pathophysiological substrate of lines of conduction block, promoting atrial macroreentry. The aim of this study was to determine the acute and long-term outcome of radiofrequency catheter ablation (RFCA) for right atrial tachyarrhythmia (AT) in adults after cardiac surgery for congenital heart disease (CHD) and acquired heart disease (AHD) and predictors of these outcomes. Clinical records of adults after surgery for heart disease undergoing RFCA of right-sided AT were analyzed retrospectively. Multivariate analyses identified clinical and procedural factors predicting acute and long-term outcomes. A total of 372 patients (69% men; age 61 ± 15 years) after surgical repair of CHD (n = 111) or AHD (n = 261) were studied. Cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) was observed in 300 patients and non-CTI-AFL in 72 patients. Ablation was successful in 349 cases (94%). During a mean follow-up of 51 ± 30 months, recurrences were observed in 24.5% of patients. Multivariate analysis showed that non-CTI-AFL (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.1 to 2.9) and CHD (HR 1.75, 95% CI 1.07 to 2.9) were independent predictors of long-term recurrences. Multivariate analysis showed that female gender (HR 2.29, 95% CI 1.6 to 3.3), surgery for AHD (HR 95% 2.31, 95% CI 1.5 to 3.7), and left atrial dilatation (HR 2.1, 95% CI 1.3 to 3.2) were independent predictors of long-term atrial fibrillation. In conclusion, RFCA of right-sided AT after cardiac surgery is associated with high acute success rates and significant long-term recurrences. Non-CTI-dependent AFL and surgery for CHD are at higher risk of recurrence. Atrial fibrillation is common during follow-up, particularly in patients with AHD and enlarged left atrium.
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11:e102-65. [PMID: 24814377 DOI: 10.1016/j.hrthm.2014.05.009] [Citation(s) in RCA: 380] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/07/2023]
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WO HUNGTA, WEN MINGSHIEN, CHANG POCHENG, CHOU CHUNGCHUAN, WANG CHUNCHIEH, YEH SANJOU, WU DELON. Successful Treatment of Macroreentrant Atrial Tachycardia by Radiofrequency Ablation Targeting Channels with Continuous Activation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:927-37. [DOI: 10.1111/pace.12408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 02/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- HUNG-TA WO
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - MING-SHIEN WEN
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - PO-CHENG CHANG
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - CHUNG-CHUAN CHOU
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - CHUN-CHIEH WANG
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - SAN-JOU YEH
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
| | - DELON WU
- Second Section of Cardiology, Chang Gung Memorial Hospital; Linko, and Chang Gung University College of Medicine; Taoyuan Taiwan
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Sherwin ED, Triedman JK, Walsh EP. Update on interventional electrophysiology in congenital heart disease: evolving solutions for complex hearts. Circ Arrhythm Electrophysiol 2013; 6:1032-40. [PMID: 24129205 DOI: 10.1161/circep.113.000313] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Elizabeth D Sherwin
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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Akca F, Bauernfeind T, De Groot NMS, Shalganov T, Schwagten B, Szili-Torok T. The presence of extensive atrial scars hinders the differential diagnosis of focal or macroreentrant atrial tachycardias in patients with complex congenital heart disease. Europace 2013; 16:893-8. [DOI: 10.1093/europace/eut338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Faustino MM, Capuzzi D, Agricola T, Ciammetti D, Pecce P, Santarella L, Pizzi C. A new approach for catheter ablation of atrial tachycardia following atrial fibrillation ablation. J Cardiovasc Med (Hagerstown) 2012; 13:795-804. [DOI: 10.2459/jcm.0b013e3283569774] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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SCHNEIDER HEIKEE, SCHILL MANFRED, KRIEBEL THOMAS, PAUL THOMAS. Value of Dynamic Substrate Mapping to Identify the Critical Diastolic Pathway in Postoperative Ventricular Reentrant Tachycardias After Surgical Repair of Tetralogy of Fallot. J Cardiovasc Electrophysiol 2012; 23:930-7. [DOI: 10.1111/j.1540-8167.2012.02333.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sy RW, Thiagalingam A, Stiles MK. Modern Electrophysiology Mapping Techniques. Heart Lung Circ 2012; 21:364-75. [DOI: 10.1016/j.hlc.2012.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/05/2012] [Accepted: 04/14/2012] [Indexed: 11/26/2022]
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Del Carpio Munoz F, Buescher TL, Asirvatham SJ. Teaching Points With 3-Dimensional Mapping of Cardiac Arrhythmia. Circ Arrhythm Electrophysiol 2011; 4:e72-5. [DOI: 10.1161/circep.110.960369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Freddy Del Carpio Munoz
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| | - Traci L. Buescher
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases (F.D.C.M., T.L.B., S.J.A.) and the Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, MN
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INADA KEIICHI, TOKUDA MICHIFUMI, ROBERTS-THOMSON KURTC, STEVEN DANIEL, SEILER JENS, TEDROW USHAB, STEVENSON WILLIAMG. Relation of High-Pass Filtered Unipolar Electrograms to Bipolar Electrograms during Ventricular Mapping. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:157-63. [DOI: 10.1111/j.1540-8159.2011.03261.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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YAP SINGCHIEN, HARRIS LOUISE, DOWNAR EUGENE, NANTHAKUMAR KUMARASWAMY, SILVERSIDES CANDICEK, CHAUHAN VIJAYS. Evolving Electroanatomic Substrate and Intra-Atrial Reentrant Tachycardia Late After Fontan Surgery. J Cardiovasc Electrophysiol 2011; 23:339-45. [DOI: 10.1111/j.1540-8167.2011.02202.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Berenfeld O, Ennis S, Hwang E, Hooven B, Grzeda K, Mironov S, Yamazaki M, Kalifa J, Jalife J. Time- and frequency-domain analyses of atrial fibrillation activation rate: the optical mapping reference. Heart Rhythm 2011; 8:1758-65. [PMID: 21699849 DOI: 10.1016/j.hrthm.2011.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 05/09/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Time- and frequency-domain estimates of activation rate have been proposed to guide atrial fibrillation (AF) ablation in patients, but their electrophysiological correlates are unclear. OBJECTIVE This study sought to examine the relative correlation of average electrical cycle length (CL) and dominant frequency (DF) during AF with reference optical mapping measures. METHODS Eight sheep hearts were Langendorff-perfused and superfused with oxygenated Tyrode solution inside a tank representing the human thorax. Optical mapping (DI-4-ANEPPS) of 4 × 4 cm2 in the left atrium was performed at 0.5 mm/pixel and 600 fps. A 20-pole catheter was placed in the optical field of view to acquire 1.2-kHz unipolar recordings by the EnSite NavX System (ENS; St. Jude Medical, St. Paul, MN) optimized for CL and DF calculation. During AF, 5-second-long simultaneous optical and electrical signals were analyzed for CL and DF. RESULTS During pacing, DF measurements had fewer false results than CL (6.6% to 2.5% vs. 21.5% to 4.4% depending on filtering, P <.001). During AF in regions showing periodic waves on both sides of the catheter optical 1,000/CL versus DF correlation showed 95% confidence identity and was better than unipolar measurements in the ENS (adjusted R(2): 0.58879 vs. 0.12902; P < 10(-6)). DFs of unipolar signals correlated better than CLs with DFs of optical signals. Similarly, bipolar DF correlation with optical DF was not different from identity (P >.157), but the bipolar CL showed smaller identity with the optical CL (P <.0004). CONCLUSION DF values of unipolar and bipolar signals correlate with those of optical signals better than CL values for the respective signals.
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Affiliation(s)
- Omer Berenfeld
- Center for Arrhythmia Research, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48108, USA.
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A multi-purpose spiral high-density mapping catheter: initial clinical experience in complex atrial arrhythmias. J Interv Card Electrophysiol 2011; 31:225-35. [DOI: 10.1007/s10840-011-9574-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 03/30/2011] [Indexed: 11/27/2022]
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Del Carpio Munoz F, Buescher TL, Asirvatham SJ. Three-Dimensional Mapping of Cardiac Arrhythmias. Circ Arrhythm Electrophysiol 2010; 3:e6-11. [DOI: 10.1161/circep.110.960161] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Freddy Del Carpio Munoz
- From the Division of Cardiovascular Diseases (F.D.C.M.), Mayo Clinic-Franciscan Skemp, LaCrosse, Wisc; Division of Cardiovascular Diseases (T.L.B.), Mayo Clinic; Division of Cardiovascular Diseases (S.J.A.), Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, Minn
| | - Traci L. Buescher
- From the Division of Cardiovascular Diseases (F.D.C.M.), Mayo Clinic-Franciscan Skemp, LaCrosse, Wisc; Division of Cardiovascular Diseases (T.L.B.), Mayo Clinic; Division of Cardiovascular Diseases (S.J.A.), Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, Minn
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases (F.D.C.M.), Mayo Clinic-Franciscan Skemp, LaCrosse, Wisc; Division of Cardiovascular Diseases (T.L.B.), Mayo Clinic; Division of Cardiovascular Diseases (S.J.A.), Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, Minn
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CHANG CHIENJUNG, LIN YENNJIANG, HIGA SATOSHI, CHANG SHIHLIN, LO LIWEI, TUAN TACHUAN, HU YUFENG, UDYAVAR AMEYAR, TANG WEIHUA, TSAI WENCHIN, HUANG SHINYU, TUNG NGUYENHUU, SUENARI KAZUYOSHI, TSAO HSUANMING, CHEN SHIHANN. The Disparities in the Electrogram Voltage Measurement During Atrial Fibrillation and Sinus Rhythm. J Cardiovasc Electrophysiol 2010; 21:393-8. [DOI: 10.1111/j.1540-8167.2009.01637.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de Groot NMS, Atary JZ, Blom NA, Schalij MJ. Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences. Circ Arrhythm Electrophysiol 2010; 3:148-54. [PMID: 20194797 DOI: 10.1161/circep.109.909838] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Catheter ablation has evolved as a possible curative treatment modality for atrial tachyarrhythmia (AT) in patients with congenital heart defects (CHD). However, data on long-term outcome are scarce. We examined characteristics of recurrent AT after ablation of postoperative AT during long-term follow-up in CHD patients. METHODS AND RESULTS CHD patients (n=53; 27 men; age, 38+/-15 years) referred for catheter ablation of AT were studied during a follow-up period of 5+/-3 years. After ablative therapy of the first AT (n=53, 27 atrial flutter, cycle length=288+/-81 ms; 22 intra-atrial reentrant tachycardia, cycle length=309+/-81 ms; 5 focal atrial tachycardia, cycle length=380+/-147 ms; success rate, 65%), AT recurred (59% within the first year) in 29 patients; 15 underwent repetitive ablative therapy. Mechanisms underlying recurrent AT were similar in 7 patients (intra-atrial reentrant tachycardia, 2; atrial flutter, 5). The location of arrhythmogenic substrates of recurrent AT (intra-atrial reentrant tachycardia, focal atrial tachycardia) was different for all but 1 patient. After 5+/-3 years, 5 patients died of heart failure, 3 were lost to follow-up, and the remaining patients had sinus rhythm (n=31), AT (n=5), or atrial flutter (n=14). Antiarrhythmic drugs were used by 18 (57%) sinus rhythm patients. CONCLUSIONS Successive postoperative AT in CHD patients developing over time may be caused by different mechanisms, including focal and reentrant mechanisms. Recurrent AT originated from different locations, suggesting that these new AT were not caused by arrhythmogenicity of previous ablative lesions. Long-term outcome is often complicated by development of atrial fibrillation. Despite frequent need for repeat ablative therapy, most patients are in sinus rhythm.
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Affiliation(s)
- Natasja M S de Groot
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Tung R, Shivkumar K. Ripple mapping: making electroanatomic mapping user-friendly. Heart Rhythm 2009; 6:1763-4. [PMID: 19959126 DOI: 10.1016/j.hrthm.2009.10.015] [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: 10/12/2009] [Indexed: 10/20/2022]
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DE GROOT NATASJAM, BLOM NICO, VD WALL ERNSTE, SCHALIJ MARTINJ. Different Mechanisms Underlying Consecutive, Postoperative Atrial TachyArrhythmias in a Fontan Patient. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:e18-20. [DOI: 10.1111/j.1540-8159.2009.02523.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Linton NWF, Koa-Wing M, Francis DP, Kojodjojo P, Lim PB, Salukhe TV, Whinnett Z, Davies DW, Peters NS, O'Neill MD, Kanagaratnam P. Cardiac ripple mapping: a novel three-dimensional visualization method for use with electroanatomic mapping of cardiac arrhythmias. Heart Rhythm 2009; 6:1754-62. [PMID: 19959125 DOI: 10.1016/j.hrthm.2009.08.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/31/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Mapping of regular cardiac arrhythmias is frequently performed using sequential point-by-point annotation of local activation relative to a fixed timing reference. Assigning a single activation for each electrogram is unreliable for fragmented, continuous, or double potentials. Furthermore, these informative electrogram characteristics are lost when only a single timing point is assigned to generate activation maps. OBJECTIVE The purpose of this study was to develop a novel method of electrogram visualization conveying both timing and morphology as well as location of each point within the chamber being studied. METHODS Data were used from six patients who had undergone electrophysiological study with the Carto electroanatomic mapping system. Software was written to construct a three-dimensional surface from the imported electrogram locations. Electrograms were time gated and displayed as dynamic bars that extend out from this surface, changing in length and color according to the local electrogram voltage-time relationship to create a ripple map of cardiac activation. RESULTS Ripple maps were successfully constructed for sinus rhythm (n = 1), atrial tachycardia (n = 3), and ventricular tachycardia (n = 2), simultaneously demonstrating voltage and timing information for all six patients. They showed low-amplitude continuous activity in four of five tachycardias at the site of successful ablation, consistent with a reentrant mechanism. CONCLUSION Ripple mapping allows activation of the myocardium to be tracked visually without prior assignment of local activation times and without interpolation into unmapped regions. It assists the identification of tachycardia mechanism and optimal ablation site, without the need for an experienced computer-operating assistant.
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Takahashi K, Cecchin F, Fortescue E, Berul CI, Alexander ME, Walsh EP, Fynn-Thompson F, Triedman JK. Permanent atrial pacing lead implant route after Fontan operation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:779-85. [PMID: 19545341 DOI: 10.1111/j.1540-8159.2009.02365.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial pacing is indicated for sinus node dysfunction (SND) after Fontan surgery; preferred lead implantation technique is debated. We compare outcomes of transvenous (TV) and epicardial (Epi) atrial lead implants in this population. METHODS Retrospective review of Fontan patients undergoing atrial lead implant between 1992 and 2007. Demographics, lead performance data, and outcomes were analyzed. RESULTS 78 patients had 90 leads implanted: 25 via TV route and 65 via Epi route. Median follow-up was 1.6 years (TV) and 3.6 years (Epi). TV leads were implanted in older patients (23.1 vs 9.3 years, P < 0.001) and at longer intervals after Fontan (15.2 vs 4.9 years, P < 0.001). Pacing indication for most TV leads was SND, while Epi leads were also indicated for atrioventricular block. Acute complication rates were similar (8% TV vs 19% Epi, P = 0.23), but median hospital stay was shorter for TV (2 vs 5 days, P = 0.03). Thrombus was observed in five patients (two in TV; three in Epi), but no thromboembolic events were observed. Mean lead survival was similar (TV 9.9 vs Epi 7.8 years, P = NS). Energy threshold was lower at implant for TV leads (0.9 vs 2.2 microJ, P = 0.049), but similar at follow-up (1.2 vs 2.6 microJ, P = 0.35). Atrial sensing was unchanged over time for TV (2.2 to 2.1 mV, P = NS), but decreased for Epi (3.3 to 2.5 mV, P = 0.02). CONCLUSIONS Compared to epicardial leads, transvenous atrial pacing leads may be placed in Fontan patients with lower procedural morbidity and equivalent expectation of lead performance and longevity.
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Affiliation(s)
- Kazuhiro Takahashi
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA
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de Groot NM, Lukac P, Blom NA, van Kuijk JP, Pedersen AK, Hansen PS, Delacretaz E, Schalij MJ. Long-Term Outcome of Ablative Therapy of Postoperative Supraventricular Tachycardias in Patients With Univentricular Heart. Circ Arrhythm Electrophysiol 2009; 2:242-8. [DOI: 10.1161/circep.108.828137] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background—
Catheter ablation has evolved as a possible curative treatment modality for supraventricular tachycardias (SVT) in patients with univentricular heart. However, the long-term outcome of ablation procedures is unknown. We evaluated the procedural and long-term outcome of ablative therapy of late postoperative SVT in patients with univentricular heart.
Methods and Results—
Patients with univentricular heart (n=19, 11 male; age, 29�9 years) referred for ablation of SVT were studied. Ablation was guided by 3D electroanatomic mapping in all but 2 procedures. A total of 41 SVT were diagnosed as intra-atrial reentrant tachycardia (n=30; cycle length, 310�68 ms), typical atrial flutter (n=4; cycle length, 288�42 ms), focal atrial tachycardia (n=6; cycle length, 400�60 ms), and atrial fibrillation (n=1). Ablation was successful in 73% of intra-atrial reentrant tachycardia, 75% of atrial flutter, and all focal atrial tachycardia and focal atrial fibrillation. During the follow-up period of 53�34 months, 2 patients were lost to follow-up, 3 died of heart failure, 2 underwent heart transplantation, and 1 underwent conduit replacement. Of the remaining group, 8 had sinus rhythm and 3 had SVT.
Conclusions—
Focal and reentrant mechanisms underlie postoperative SVT in patients with univentricular heart. Successive SVT developing over time may be caused by different mechanisms. Ablative therapy is potentially curative, with a procedural success rate of 78%. In patients who had multiple ablation procedures, the SVT originated from different atrial sites, suggesting that these new SVT were caused by progressive atrial disease. Despite recurrent SVT, sinus rhythm at the end of the follow-up period was achieved in 72%.
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Affiliation(s)
- Natasja M.S. de Groot
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Peter Lukac
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Nico A. Blom
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Jan Peter van Kuijk
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Anders K. Pedersen
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Peter S. Hansen
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Etienne Delacretaz
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Martin J. Schalij
- From the Department of Cardiology (N.M.S.d.G., N.A.B., J.P.v.K., M.J.S.), Leiden University Medical Center, Leiden, The Netherlands; the Department of Cardiology (P.L.), Aarhus University Hospital at Skejby, Aarhus, Denmark; the Department of Cardiology (A.K.P., P.S.H.), Varde Heart Center Varde, Denmark; and the Department of Cardiology (E.D.), Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
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Ernst S, Chun JKR, Koektuerk B, Kuck KH. Magnetic Navigation and Catheter Ablation of Right Atrial Ectopic Tachycardia in the Presence of a Hemi-Azygos Continuation: A Magnetic Navigation Case Using 3D Electroanatomical Mapping. J Cardiovasc Electrophysiol 2009; 20:99-102. [PMID: 18662184 DOI: 10.1111/j.1540-8167.2008.01254.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sabine Ernst
- National Heart and Lung Institute, Imperial College, Royal Brompton and Harefield Hospital, London, UK.
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Sciarra L, Allocca G, Calò L. Use of electroanatomic mapping in the assessment of atrial tachycardia aetiology. J Cardiovasc Med (Hagerstown) 2008; 9:1280-1. [PMID: 19001940 DOI: 10.2459/jcm.0b013e328311eebf] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present case report is of a 36-year-old man who had been symptomatic for frequent palpitations for 4 years after a prolonged febrile episode. The electrocardiogram on admission revealed an iterative supraventricular tachycardia at rate of 110 bpm, with ventriculoatrial interval of 180 ms and superior P-wave axis. Electroanatomic mapping showed substantially normal values in the right atrium other than an area along the posteroseptal region of the tricuspid annulus, with a low-voltage region that correlated with the area of earliest activation.
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Affiliation(s)
- Luigi Sciarra
- Department of Cardiology, Polyclinic Casilino, Rome, Italy.
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50
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Use of non-contact mapping in the treatment of right atrial tachycardias in patients with and without congenital heart disease. Europace 2008; 10:972-81. [DOI: 10.1093/europace/eun183] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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