1
|
Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1-e156. [PMID: 38033089 PMCID: PMC11095842 DOI: 10.1161/cir.0000000000001193] [Citation(s) in RCA: 286] [Impact Index Per Article: 286.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines liaison
| | | | | | | | | | - Paul L Hess
- ACC/AHA Joint Committee on Performance Measures liaison
| | | | | | | | | | - Kazuhiko Kido
- American College of Clinical Pharmacy representative
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Joglar JA, Chung MK, Armbruster AL, Benjamin EJ, Chyou JY, Cronin EM, Deswal A, Eckhardt LL, Goldberger ZD, Gopinathannair R, Gorenek B, Hess PL, Hlatky M, Hogan G, Ibeh C, Indik JH, Kido K, Kusumoto F, Link MS, Linta KT, Marcus GM, McCarthy PM, Patel N, Patton KK, Perez MV, Piccini JP, Russo AM, Sanders P, Streur MM, Thomas KL, Times S, Tisdale JE, Valente AM, Van Wagoner DR. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:109-279. [PMID: 38043043 PMCID: PMC11104284 DOI: 10.1016/j.jacc.2023.08.017] [Citation(s) in RCA: 95] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
AIM The "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation" provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" and the "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.
Collapse
|
3
|
Kinjo T, Kimura M, Kaname N, Horiuchi D, Itoh T, Ishida Y, Nishizaki K, Toyama Y, Sasaki S, Tomita H. Landiolol, an intravenous β1-selective blocker, is useful for dissociating a fusion of atrial activation via accessory pathway and atrioventricular node. J Arrhythm 2023; 39:937-946. [PMID: 38045455 PMCID: PMC10692861 DOI: 10.1002/joa3.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction During ventricular pacing, a fusion of atrial activation may occur owing to the simultaneous retrograde conduction of the atrioventricular (AV) node and accessory pathway (AP), potentially leading to an inaccurate mapping of the atrial AP insertion site. Objective We tested the hypothesis that landiolol, an ultra-short-acting intravenous β1-blocker, could dissociate a fusion of atrial activation. Methods We conducted a prospective before-and-after study to investigate the effect of landiolol on retrograde conduction via the AV node and AP. We enrolled 21 consecutive patients with orthodromic AV reciprocating tachycardia who underwent electrophysiological studies at our hospital between January 1, 2018, and August 31, 2020. Results Six patients exhibited a fusion of atrial activation. After landiolol administration (10 μg/kg/min), the effective refractory period was unchanged in AP (280 [240-290] ms vs. 280 [245-295] ms, p = .91), whereas that of the AV node was prolonged (275 [215-380] ms vs. 332 [278-445] ms, p = .03). The Wenckebach pacing rate via retrograde AV node decreased after landiolol administration (180 [140-200] beats per minute [bpm] vs. 140 [120-180] bpm, p = .02). Thus, landiolol decreased the minimum ventricular pacing rate required to dissociate a fusion of atrial activation (180 [160-200] bpm vs. 140 [128-155] bpm, p = .007). Radiofrequency catheter ablation under landiolol administration successfully eliminated AP in all patients during ventricular pacing without complications or recurrence. Conclusion Landiolol inhibited the AV node without affecting the AP and helped dissociate a fusion of atrial activation at a lower ventricular pacing rate.
Collapse
Affiliation(s)
- Takahiko Kinjo
- Department of Cardiology and NephrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Masaomi Kimura
- Department of Advanced Management of Cardiac ArrhythmiasHirosaki University Graduate School of MedicineHirosakiJapan
| | - Noriyoshi Kaname
- Department of Cardiology and NephrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Daisuke Horiuchi
- Department of Cardiology and NephrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Taihei Itoh
- Department of Advanced Management of Cardiac ArrhythmiasHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yuji Ishida
- Department of Cardiac Remote Management SystemHirosaki University Graduate School of MedicineHirosakiJapan
| | - Kimitaka Nishizaki
- Department of Cardiology and NephrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yuichi Toyama
- Department of Cardiology and NephrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Shingo Sasaki
- Department of Cardiology and NephrologyHirosaki University Graduate School of MedicineHirosakiJapan
- Department of Advanced Management of Cardiac ArrhythmiasHirosaki University Graduate School of MedicineHirosakiJapan
- Department of Cardiac Remote Management SystemHirosaki University Graduate School of MedicineHirosakiJapan
| | - Hirofumi Tomita
- Department of Cardiology and NephrologyHirosaki University Graduate School of MedicineHirosakiJapan
- Department of Advanced Management of Cardiac ArrhythmiasHirosaki University Graduate School of MedicineHirosakiJapan
- Department of Cardiac Remote Management SystemHirosaki University Graduate School of MedicineHirosakiJapan
- Department of the Advanced Therapeutics for Cardiovascular DiseasesHirosaki University Graduate School of MedicineHirosakiJapan
| |
Collapse
|
4
|
Przybylski R, DeWitt ES, Meziab O, Gauvreau K, Dionne A, O'Leary ET, Alexander ME, Walsh EP, Mah DY. Retroflexed catheter course reduces the risk of right free wall accessory pathway recurrence. J Cardiovasc Electrophysiol 2023; 34:1828-1834. [PMID: 37449445 DOI: 10.1111/jce.16003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/18/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Accessory atrioventricular pathways (APs) may mediate atrioventricular reciprocating tachycardia and, in some cases, have the potential to conduct atrial tachycardia rapidly, which can be life threatening. While catheter ablation can be curative, ablation of right free wall APs is associated with a high rate of recurrence, likely secondary to reduced catheter stability along the right free wall atrioventricular groove. We sought to identify characteristics associated with a lower rate of recurrence and hypothesized ablation lesions placed on the ventricular side of the atrioventricular groove using a retroflexed catheter approach would decrease rates of recurrence. METHODS AND RESULTS Retrospective chart review of patients who underwent catheter ablation of a right free wall AP from January 1, 2008 through June 1, 2021 with >2 months follow up. Cox proportional hazards regression was used to identify relationships between predictor variables and AP recurrence. We identified 95 patients who underwent ablation of 98 right free wall APs. Median age was 13.1 years and median weight at ablation was 52.3 kg. Overall, 23/98 (23%) APs recurred. Use of a retroflexed catheter course approaching the atrioventricular groove from the ventricular aspect was associated with reduced risk of AP recurrence with (univariable hazard ratio of 0.10 [95% confidence interval: 0.01-0.78]), which remained significant in multiple two variable Cox proportional hazards models. CONCLUSION Use of a retroflexed catheter course is associated with a reduced likelihood of AP recurrence. This approach results in improved catheter stability and should be considered for ablation of right free wall APs.
Collapse
Affiliation(s)
- Robert Przybylski
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Omar Meziab
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Corcia MCG, Stuart G, Walsh M, Radulescu C, Spera F, Tijskens M, Heidbuchel H, Sarkozy A. Redo accessory pathway ablation in the pediatric population. J Interv Card Electrophysiol 2022; 63:639-649. [PMID: 34811627 PMCID: PMC9151527 DOI: 10.1007/s10840-021-01064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Literature reports 5% of recurrence/failure in paediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long-term success. METHODS Thirty-nine paediatric patients referred for a repeat procedure were analysed: characteristics of the pathways and the initial and redo procedures were identified. RESULTS Mean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-Hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas. CONCLUSION Acute failure and post-procedure recurrence in paediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing manoeuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.
Collapse
Affiliation(s)
- M Cecilia Gonzalez Corcia
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium.
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Mark Walsh
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Cristina Radulescu
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Francesco Spera
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Maxime Tijskens
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| |
Collapse
|
6
|
Kato Y, Matsuyama TA, Fujishiro M, Hashimoto M, Sone H, Onizuka-Yamochi T. Local Variation and Age-Related Change in Atrial and Ventricular Myocardial Contiguity at the Atrioventricular Junction in Human Hearts. Circ Rep 2022; 4:158-165. [PMID: 35434411 PMCID: PMC8979762 DOI: 10.1253/circrep.cr-22-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
Background: We explored the histologic patterns of and age-related changes in atrial and ventricular myocardial contiguity at the left and right atrioventricular (AV) junction that could be a target site for catheter ablation. Methods and Results: Twenty-three structurally normal adult hearts obtained at autopsy were studied. The 2 AV annuli were divided into 13 clinically recognized portions in which we measured distance between the atrial and ventricular myocardium at the AV junction. Overall, measured distance was less on the right than left side (mean [±SD] 0.74±0.59 vs. 1.15±0.78 mm, respectively), and distance increased gradually with age. The gap was smallest at the anterolateral portion on the right side and posterolateral portion on the left side. Three specific features were noted, namely extension of the ventricular myocardium (coarse trabeculae) towards the atrium on the right side of the AV junction, extension of the atrial myocardium onto the AV valve leaflets, and a collection of small myocardial cells, perhaps including specialized cells, in the right anterolateral portion. No concealed AV muscular connections were found. Conclusions: Contiguity and separation of the myocardium at the AV junction have specific patterns, and myocardial proximity is influenced by age. These histologic features of the AV junction may prove to be informative for catheter ablation of tachyarrhythmias related to the AV junction.
Collapse
Affiliation(s)
- Yuki Kato
- Department of Legal Medicine, Showa University School of Medicine
| | | | - Masaya Fujishiro
- Department of Legal Medicine, Showa University School of Medicine
| | - Mari Hashimoto
- Department of Legal Medicine, Showa University School of Medicine
| | - Hiromoto Sone
- Department of Legal Medicine, Showa University School of Medicine
| | | |
Collapse
|
7
|
Blendea D, Tentea CP, Mansour M, Ruskin JN. Intraatrial conduction block in the right posteroseptal region after failed accessory pathway ablation-Importance of delineation of three-dimensional pathway geometry. HeartRhythm Case Rep 2021; 7:659-663. [PMID: 34712560 PMCID: PMC8530815 DOI: 10.1016/j.hrcr.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dan Blendea
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Emergency Clinical County Hospital, University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania
| | - Calina-Patricia Tentea
- Emergency Clinical County Hospital, University of Medicine and Pharmacy "Iuliu Hatieganu," Cluj-Napoca, Romania
| | - Moussa Mansour
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeremy Neil Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
8
|
Verdichizzo D, Gill J, Krasopoulos G. Left ventricular rupture postradiofrequency catheter ablation: Transaortic, intraventricular patch exclusion repair. J Card Surg 2021; 36:2108-2112. [PMID: 33522643 DOI: 10.1111/jocs.15398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Abstract
Left ventricular (LV) rupture after radiofrequency catheter ablation (RFCA) is a rare but life-threatening complication. We describe a case of LV rupture secondary to RFCA successfully treated with a transaortic, intraventricular patch exclusion surgical repair, assisted by transoesophageal echocardiography and epicardial ultrasound assessment. Patch exclusion technique can offer a physiological repair with better preservation of myocardial mechanical characteristics and possibly less damage to healthy myocardium and surrounding structures.
Collapse
Affiliation(s)
- Danilo Verdichizzo
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jaswinder Gill
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
9
|
Yildiz M, Kahraman S, Kafali HC, Surgit O, Ergul Y. An unusual treatment of coronary injury following radiofrequency ablation in a 5-year-old child: Systemic steroid usage. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1404-1407. [PMID: 32543718 DOI: 10.1111/pace.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022]
Abstract
Radiofrequency catheter ablation (RFCA) procedure is performed for many tachyarrhythmias. We performed successful RFCA in a 5-year-old child for supraventricular tachyarrhythmia and Wolff-Parkinson-White syndrome. Acute circumflex artery (CxA) occlusion occurred due to RFCA. After percutaneous balloon angioplasty was performed into the CxA, the patient was treated with systemic steroid to resolve myocardial edema. To the best of our knowledge, systemic steroid was used first time for acute coronary artery injury related myocardial ischemia.
Collapse
Affiliation(s)
- Mustafa Yildiz
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Serkan Kahraman
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Hasan Candas Kafali
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Pediatric Cardiology/Electrophysiology, University of Health Sciences, Istanbul, Turkey
| | - Ozgur Surgit
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Yakup Ergul
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Pediatric Cardiology/Electrophysiology, University of Health Sciences, Istanbul, Turkey
| |
Collapse
|
10
|
Kovach JR, Mah DY, Abrams DJ, Alexander ME, Cecchin F, Triedman JK, Walsh EP. Outcomes of catheter ablation of anteroseptal and midseptal accessory pathways in pediatric patients. Heart Rhythm 2020; 17:759-767. [DOI: 10.1016/j.hrthm.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Indexed: 10/25/2022]
|
11
|
Koca S, Akdeniz C, Tuzcu V. Transseptal Puncture for Catheter Ablation in Children. Pediatr Cardiol 2019; 40:799-804. [PMID: 30729261 DOI: 10.1007/s00246-019-02069-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/31/2019] [Indexed: 11/25/2022]
Abstract
Transseptal puncture (TP) is used in pediatric patients to access the left atrium in left-sided arrhythmia catheter ablation. Performing this procedure can be difficult and risky, especially in small children. In this study, we aimed to evaluate the safety and feasibility of TPs in children ≤ 30 kg. Between April 2012 and April 2018, a retrospective evaluation was conducted of the clinical features, procedural outcomes, and follow-ups of ≤ 30 kg pediatric patients who required TPs for left-sided ablations at a pediatric electrophysiology center in which a three-dimensional mapping system was routinely used. A total of 45 pediatric patients who were ≤ 30 kg, underwent TPs: 10 patients ≤ 20 kg (Group 1) and 35 patients > 20 kg and ≤ 30 kg (Group 2). The TP success rate was 97.8%. The median procedure and fluoroscopy times were 120 min and 5.43 min, respectively. One patient developed self-limited pericardial effusion during the procedure; however, there were no incidences of cardiac tamponade. There was no significant difference between the two groups in terms of the procedure time and fluoroscopy time, and pericardial effusion was only observed in Group 2. TPs are safe and feasible in small children. These procedures can be performed with low complication rates in children weighing ≤ 30 kg.
Collapse
Affiliation(s)
- Serhat Koca
- Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey.
- Yuksek Ihtisas Hospital, Kizilay St. Nu 4 Sihhiye, Ankara, Turkey.
| | - Celal Akdeniz
- Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Volkan Tuzcu
- Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
| |
Collapse
|
12
|
Transseptal or retrograde approach for transcatheter ablation of left sided accessory pathways: a systematic review and meta-analysis. Int J Cardiol 2018; 272:202-207. [PMID: 29954668 DOI: 10.1016/j.ijcard.2018.06.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/08/2018] [Accepted: 06/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Transcatheter ablation is the most effective treatment for patients with symptomatic or high-risk accessory pathways (AP). At present, no clear recommendations have been issued on the optimal approach for left sided AP ablation. We performed this meta-analysis to compare the safety and efficacy of transaortic retrograde versus transseptal approach for left sided AP ablation. METHODS AND RESULTS MEDLINE/PubMed and Cochrane database were searched for pertinent articles from 1990 until 2016. Following inclusion/exclusion criteria application, 29 studies were selected including 2030 patients (1013 retrograde, 1017 transseptal) from 28 observational single Centre studies and one randomized trial. Patients approached by transseptal puncture presented a significantly higher acute success (98% vs. 94%, p = 0.040). The incidence of late recurrences (p = 0.381) and complications (p = 0.301) did not differ among the two groups, but the pattern of complications differed: vascular complications were more frequent with transaortic retrograde approach, while cardiac tamponade was the main transseptal complication. No difference was noted in terms of procedural duration and fluoroscopy time (p = 0.230 and p = 0.980, respectively). Meta-regression analysis showed no relation between year of publication and acute success (p = 0.325) or incidence of complications (p = 0.795); additionally, no direct relation was found between age and acute success (p = 0.256) or complications (p = 0.863). CONCLUSIONS Left sided AP transcatheter ablation is effective in around 95% of the cases, with a very limited incidence of complications. Transseptal access provides higher acute success in achieving AP ablation; late recurrences are rare but observed similarly following both approaches. Retrograde approach is affected by a relatively high incidence of vascular complications.
Collapse
|
13
|
Wright KN, Connor CE, Irvin HM, Knilans TK, Webber D, Kass PH. Atrioventricular accessory pathways in 89 dogs: Clinical features and outcome after radiofrequency catheter ablation. J Vet Intern Med 2018; 32:1517-1529. [PMID: 30216552 PMCID: PMC6189389 DOI: 10.1111/jvim.15248] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 05/10/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background Atrioventricular accessory pathways (APs) in dogs have been reported rarely. Data regarding clinical presentation and long‐term outcome after radiofrequency catheter ablation (RFCA) are limited. Hypothesis/Objectives To study clinical features, electrophysiologic characteristics, and outcome of RFCA in dogs with APs. Animals Eighty‐nine dogs presented consecutively for RFCA of APs. Methods Case series. Results Labrador retrievers (47.2% of dogs) and male dogs (67.4% of dogs) were most commonly affected. Labrador retrievers were more likely to be male than non‐Labrador breeds (P = .043). Clinical signs were nonspecific and most commonly included lethargy and gastrointestinal signs. Concealed APs were more prevalent in Labrador retrievers than other breeds (P = .001). Right‐sided APs (91.7%) predominated over left‐sided (8.3%). Tachycardia‐induced cardiomyopathy (TICM) occurred in 46.1% of dogs, with complete resolution or substantial improvement noted on one‐month postablation echocardiograms. Radiofrequency catheter ablation successfully eliminated AP conduction long term in 98.8% of dogs in which it was performed. Complications occurred in 5/89 dogs. Recurrence in 3 dogs was eliminated long term with a second procedure. Clinical Importance/Conclusions Accessory pathways are challenging to recognize in dogs because of nonspecific clinical signs, frequency of concealed APs that show no evidence of their presence during sinus rhythm, and intermittent occurrence of tachyarrhythmias resulting from APs. Tachycardia‐induced cardiomyopathy commonly occurs with AP‐mediated tachycardias and should be considered in any dog presenting with a dilated cardiomyopathic phenotype because of its good long‐term prognosis with rhythm control. Radiofrequency catheter ablation is a highly effective method for eliminating AP conduction and providing long‐term resolution.
Collapse
Affiliation(s)
- Kathy N Wright
- Department of Cardiology, MedVet Medical & Cancer Centers for Pets, Cincinnati, Ohio
| | - Chad E Connor
- Wright-Patterson Air Force Base Medical Center, Wright-Patterson AFB, Ohio.,Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Holly M Irvin
- Department of Cardiology, MedVet Medical & Cancer Centers for Pets, Cincinnati, Ohio
| | - Timothy K Knilans
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dawn Webber
- Department of Cardiology, MedVet Medical & Cancer Centers for Pets, Cincinnati, Ohio
| | - Philip H Kass
- Department of Population Health and Reproduction, University of California-Davis, Davis, California
| |
Collapse
|
14
|
Santilli RA, Mateos Pañero M, Porteiro Vázquez DM, Perini A, Perego M. Radiofrequency catheter ablation of accessory pathways in the dog: the Italian experience (2008-2016). J Vet Cardiol 2018; 20:384-397. [PMID: 30131290 DOI: 10.1016/j.jvc.2018.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Accessory pathways (APs) in dogs are mostly right-sided, display nondecremental conduction, and mediate atrioventricular reciprocating tachycardias (AVRTs). Radiofrequency catheter ablation (RFCA) is considered the first-line therapy in human patients to abolish electrical conduction along APs. ANIMALS Seventy-six consecutive client-owned dogs. MATERIAL AND METHODS Retrospective study to describe the precise anatomical distribution and the electrophysiologic characteristics of APs in a large population of dogs and to evaluate long-term success and complication rates of RFCA. RESULTS Eighty-three APs were identified in 76 dogs (92.1% with single APs and 7.9% with multiple APs); 96.4% were right-sided, 3.6% left-sided. Conduction along the APs was unidirectional and retrograde in 68.7% of the cases and bidirectional in 31.3%. Accessory pathways presented retrograde decremental properties in 6.5% of the cases. They mediated orthodromic AVRT in 92.1% of the cases and permanent junctional reciprocating tachycardia in 6.5%. In one case, no AVRT could be induced. In 97.4% of dogs, RFCA was attempted with an acute success rate of 100%. In 7.7% of cases, recurrence of the tachycardia occurred within 18 months, followed by a second definitively successful ablation. A major complication requiring pacemaker implantation was identified in 2.6% of dogs. DISCUSSION Accessory pathway distribution and electrophysiologic properties in these 76 dogs were similar to previous report. Long-term success and complication rates of RFCA in dogs appeared very similar to results of humans. CONCLUSION Radiofrequency catheter ablation of APs can be performed with a high success rate and low incidence of complications.
Collapse
Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy.
| | - M Mateos Pañero
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | | | - A Perini
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | - M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| |
Collapse
|
15
|
Krishnan B, Cross C, Dykoski R, Benditt DG, Mbai M, McFalls E, Li JM, Bertog S, Tholakanahalli VN. Intra-Atrial Right Coronary Artery and its Ablation Implications. JACC Clin Electrophysiol 2017; 3:1037-1045. [DOI: 10.1016/j.jacep.2017.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 01/11/2017] [Accepted: 02/22/2017] [Indexed: 12/15/2022]
|
16
|
Editorial commentary: Wolff-Parkinson-White pattern and syndrome: Where do we stand in 2017? Trends Cardiovasc Med 2017; 27:269-270. [DOI: 10.1016/j.tcm.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/18/2017] [Indexed: 11/23/2022]
|
17
|
Transseptal puncture for radiofrequency catheter ablations of left-sided arrhythmias in a paediatric population. Cardiol Young 2017; 27:267-272. [PMID: 27086493 DOI: 10.1017/s1047951116000457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Puncturing the atrial septum is frequently used in adults. In children, the transseptal puncture is less common, technically more demanding, and the rate of complications is not well described. We studied the feasibility and safety of this procedure in a retrospective analysis of 157 consecutive children undergoing transseptal puncture for radiofrequency catheter ablation of left atrial targets in two tertiary-care centres between 2005 and 2013. The median age of the patients at intervention was 12.5 years (1.1-18 years), with median weight of 42 kg (range 9.0-97.0 kg). Pre-excitation was found in 102 procedures, accessory pathway with exclusively retrograde conduction in 41, focal atrial tachycardia in nine, left-sided permanent junctional/reciprocating tachycardia-like accessory pathways in three, and atypical atrioventricular nodal re-entry tachycardia in two. All the procedures were guided by fluoroscopy. Additional imaging by transoesophageal echocardiography was used in three patients. Successful transseptal puncture was possible in 99.4% of the cases, ablation in 97.4%. The median time, including mapping and radiofrequency ablation, was 120 minutes (range 60-450), the median fluoroscopy time 10.8 minutes (range 1.8-75), and the median radiation dose 3 Gy cm2 (range 0.3-35). In total, five patients (3.2%) had a recurrent arrhythmia during the observation period of a median of 40 months (range 1-103). No complications associated with the transseptal puncture were observed. Transseptal puncture is a feasible and safe procedure in children. This access allows successful and efficient radiofrequency ablation of arrhythmia of the left atrium in the vast majority of the patients and might be considered as the first-line approach in this population.
Collapse
|
18
|
Ayabakan C, Şahin M, Çeliker A. Radiofrequency catheter ablation of left-sided accessory pathways via retrograde aortic approach in children. J Arrhythm 2016; 32:176-80. [PMID: 27354861 PMCID: PMC4913158 DOI: 10.1016/j.joa.2015.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/15/2015] [Accepted: 12/25/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND We aimed to analyze the results of retrograde aortic radiofrequency catheter ablation of left-sided accessory pathways in children. METHODS Between January 2010 and September 2014, 25 children who underwent left-sided accessory pathway ablation with a retrograde aortic approach were evaluated retrospectively. RESULTS The mean age of the patients was 11.09±3.71 years. Seventeen patients were male (68%). The mean procedure and fluoroscopy times were 71.54±21.05 min and 31.42±19.57 min, respectively. Radiofrequency energy was delivered with 41.38±15.32 W at 52.38±5.45 °C. Sixteen patients (64%) presented with manifest preexcitation and, 9 had concealed accessory pathways. The location of accessory pathway was left lateral in 16 patients, posteroseptal in 5, left anterolateral in 2, and left posterolateral and left posterior in the remaining 2. The acute success rate was 96%. The patients were followed for a mean of 16.68±18.01 months. There were 2 recurrences. No major complications were observed in the periprocedural period. One patient had groin hematoma, another one had transient severe headache and vomiting. Trivial mitral regurgitation was noted in a patient, which remained the same throughout follow-up. None of the patients developed new aortic regurgitation, pericardial effusion, or thrombi at the site of ablation. CONCLUSIONS The retrograde aortic approach can be safely employed with a high success rate for ablation of left-sided accessory pathways in children.
Collapse
Affiliation(s)
- Canan Ayabakan
- Department of Pediatric Cardiology, Baskent University, Istanbul Research Hospital, İstanbul, Turkey
| | - Murat Şahin
- Department of Pediatric Cardiology, Acıbadem University, İstanbul, Turkey
| | - Alpay Çeliker
- Department of Pediatric Cardiology, Acıbadem University, İstanbul, Turkey
| |
Collapse
|
19
|
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. J Am Coll Cardiol 2016; 67:1575-1623. [DOI: 10.1016/j.jacc.2015.09.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
20
|
Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes III NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm 2016; 13:e136-221. [DOI: 10.1016/j.hrthm.2015.09.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 01/27/2023]
|
21
|
Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2015; 13:e92-135. [PMID: 26409097 DOI: 10.1016/j.hrthm.2015.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 10/23/2022]
|
22
|
Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2015; 67:e27-e115. [PMID: 26409259 DOI: 10.1016/j.jacc.2015.08.856] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
23
|
Garabelli PJ, Stavrakis S, Po SS. A case series and review of the literature regarding coronary artery complications associated with coronary sinus catheter ablation. HeartRhythm Case Rep 2015; 1:315-319. [PMID: 28491575 PMCID: PMC5419666 DOI: 10.1016/j.hrcr.2015.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Key Words
- AP, accessory pathway
- AV, atrioventricular
- AVN, atrioventricular node
- AVNRT, atrioventricular nodal reentrant tachycardia
- Atrioventricular nodal reentrant tachycardia
- Atrioventricular reentrant tachycardia
- CS, coronary sinus
- Catheter ablation
- Coronary sinus
- ECG, echocardiogram
- LA, left atrium
- MCV, middle cardiac vein
- Myocardial infarction
- RCA, right coronary artery
- RF, radiofrequency
Collapse
Affiliation(s)
- Paul J Garabelli
- University of Oklahoma Health Sciences Center, Heart Rhythm Institute, Oklahoma City, Oklahoma
| | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Heart Rhythm Institute, Oklahoma City, Oklahoma
| | - Sunny S Po
- University of Oklahoma Health Sciences Center, Heart Rhythm Institute, Oklahoma City, Oklahoma
| |
Collapse
|
24
|
Abstract
The presence of a Wolf-Parkinson-White (WPW) pattern is not uncommonly discovered on a life insurance applicant's ECG. How does one determine the appropriate mortality risk in this population? This article will discuss the risk of sudden cardiac death (SCD), the interpretation of electrophysiology testing results, and risk-stratification both for asymptomatic individuals and those who have had ablation treatment.
Collapse
|
25
|
Potentially misleading manifestation of a ventricular pre-excitation. COR ET VASA 2014. [DOI: 10.1016/j.crvasa.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
26
|
Does cryomaze injure the circumflex artery?: a preliminary search for occult postprocedure stenoses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:56-66. [PMID: 23571795 DOI: 10.1097/imi.0b013e31828e5267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ensuring the transmurality of the mitral isthmus lesion, a critical component of the cryomaze, entails mirror-image application of the cryoprobe both on endocardial and epicardial surfaces when carrying out ablation. Concerns of circumflex artery injury have been expressed during the epicardial application of the cryoprobe over the coronary sinus as the artery courses on the posterior surface of the sinus in the atrioventricular (AV) groove. The objective of this study was to analyze the incidence of significant injury to the circumflex artery and its impact on outcomes, if any, in those patients who have undergone cryomaze. METHODS Between August 2004 and December 2009, a total of 223 patients underwent argon-based cryoablation (120-second application at -140°C). After Western Institutional Review Board approval, 20 consecutive patients with normal results of preoperative coronary angiograms (right dominance, 75%; left dominance, 15%; codominant circulation, 10%) and who were at least 6 months postablation were enrolled in this study. The mean ± SD age was 60.74 ± 14.99 years, 35% were men, and 50% belonged to New York Heart Association class III/IV. The mean ± SD atrial fibrillation duration was 23.83 ± 36.28 months (65% were paroxysmal). Ten percent (n = 2) underwent primary cryomaze, 40% (n = 8) underwent cryomaze plus mitral valve repair, and 50% (n = 10) underwent two or more concomitant valvular procedures. Twelve patients underwent biatrial cryomaze, and eight underwent only left-sided cryomaze. All patients underwent a 24-hour Holter monitoring, electrocardiogram stress test, and a coronary computed tomographic angiogram, as per the protocol of this study. RESULTS At discharge, 85% had normal sinus rhythm, whereas 15% of the patients were paced. On a mean ± SD follow-up at 32.57 ± 19.51 months, the Holter and/or pacemaker interrogation revealed AV synchrony in all patients-16 in sinus rhythm and 4 with heart block who converted to AV synchrony after subsequent pacemaker implantation. The stress test was available for 18 patients, and its results were negative in all of them. On the computed tomographic angiogram, 95% of the patients had a completely patent circumflex artery. Stenosis was noticed in only one patient (right dominant circulation), with a 30% to 40% tubular stenosis of the circumflex artery. However, this lesion corresponded to the P1 area of the mitral annulus and was significantly proximal on the circumflex to the P3 area, where the cryoprobe was applied during the cryomaze procedure. CONCLUSIONS Barring one case of partial circumflex stenosis, likely due to the ongoing normal progression of coronary artery disease, these data derived from a limited prospective trial suggest that epicardial application during the cryomaze procedure does not cause anatomic or physiological compromise of the circumflex artery. Nevertheless, laboratory and anecdotal evidence exist that conflict with this conclusion, and caution should be exercised when applying cryothermy in the vicinity of coronary arteries.
Collapse
|
27
|
Risk factors of recurrence and complication in radiofrequency catheter ablation of atrioventricular reentrant tachycardia in children and adolescents. Cardiol Young 2013; 23:682-91. [PMID: 23328409 DOI: 10.1017/s1047951112001655] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To compare potential risk factors for complications and recurrence after radiofrequency catheter ablation in symptomatic atrioventricular reentrant tachycardia in children and adolescents. METHODS We retrospectively reviewed the data of 213 consecutive patients with symptomatic atrioventricular reentrant tachycardia who underwent both electrophysiological study and radiofrequency catheter ablation, divided these patients into two groups, children (age < 12 years) and adolescents (12 < or = rage, 18 years), and compared the location of the accessory pathway, success rate, recurrence rate, complications, presence of congenital heart disease, presence of intermittent ventricular pre-excitation, and presence of Wolff–Parkinson–White syndrome in the two groups. RESULTS The position of the accessory pathway was mostly right sided in children (61.3%) and left sided in adolescents (61.5%). Children had significantly more congenital heart disease than adolescents (6.4% versus 0.8%). Univariate analysis showed children or adolescents with right-sided accessory pathways to be 6.84 times and those with accessory pathways on both sides of the septum 25 times more likely to relapse than those with a single accessory pathway. Multivariate analysis indicated that children or adolescents with two accessory pathways were six times, and those with intermittent ventricular pre-excitation nine times more at risk of relapsing following radiofrequency ablation than those with single accessory pathways. All five complications occurred in children. CONCLUSIONS The findings suggest that the position and number of accessory pathways and presence of intermittent ventricular pre-excitation are related to risks of recurrence of atrioventricular reentrant tachycardia in children and adolescents.
Collapse
|
28
|
Nakamura K, Funabashi N, Naito S, Uehara M, Takaoka H, Kaseno K, Kumagai K, Oshima S, Kobayashi Y. Anatomical relationship of coronary sinus/great cardiac vein and left circumflex coronary artery along mitral annulus in atrial fibrillation before radiofrequency catheter ablation using 320-slice CT. Int J Cardiol 2013; 168:5174-81. [DOI: 10.1016/j.ijcard.2013.07.261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/20/2013] [Indexed: 10/26/2022]
|
29
|
Namgung J. Successful ablation of resistant left lateral accessory pathway and coexisting atypical atrioventricular nodal reentrant tachycardia. Korean Circ J 2013; 43:189-92. [PMID: 23613697 PMCID: PMC3629246 DOI: 10.4070/kcj.2013.43.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/01/2012] [Accepted: 08/23/2012] [Indexed: 11/11/2022] Open
Abstract
A 41-year-old male was presented with drug-resistant supraventricular tachycardia. Electrophysiological study confirmed that the supraventricular tachycardia was caused by dual atrioventricular nodal pathways and a left lateral accessory pathway (AP). The left lateral AP was resistant to traditional endocardial ablation, but was successfully eliminated by radiofrequency ablation via the intracoronary sinus approach.
Collapse
Affiliation(s)
- June Namgung
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| |
Collapse
|
30
|
Cheema FH, Pervez MB, Mehmood M, Younus MJ, Munir MB, Bisleri G, Barili F, Ayala IL, Ad N, Cox JL, Roberts HG. Does Cryomaze Injure the Circumflex Artery?: A Preliminary Search for Occult Postprocedure Stenoses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Faisal H. Cheema
- College of Physicians & Surgeons of Columbia University, New York Presbyterian Hospital, New York, NY USA
- Aegis Cardiovascular Research Foundation, Fort Lauderdale, FL USA
| | | | - Mansoor Mehmood
- Aegis Cardiovascular Research Foundation, Fort Lauderdale, FL USA
| | | | | | | | - Fabio Barili
- Aegis Cardiovascular Research Foundation, Fort Lauderdale, FL USA
| | | | - Niv Ad
- Fairfax Hospital, Falls Church, VA USA
| | - James L. Cox
- Washington University School of Medicine, St Louis, MO USA
| | - Harold G. Roberts
- Aegis Cardiovascular Research Foundation, Fort Lauderdale, FL USA
- Jim Moran Heart and Vascular Research Institute at Holy Cross Hospital, Fort Lauderdale, FL USA
| |
Collapse
|
31
|
Will JC, Liu TL, Panagiotou E, Opgen-Rhein B, Schmitz L, Berger F. Nonsymptomatic myocardial injury after radiofrequency and cryoablation: a study of children and patients with congenital heart disease. Pediatr Cardiol 2012; 33:1348-54. [PMID: 22592443 DOI: 10.1007/s00246-012-0343-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was to investigate the degree of myocardial injury following catheter radiofrequency (RF) ablation (RFA) or cryoablation and its clinical significance in children and patients with congenital heart disease. Cardiac troponin T (cTnT) or cardiac troponin I (cTnI), creatine kinase (CK), and its cardiac isoenzyme MB (CK-MB) were measured in 269 patients who underwent catheter ablation (216 RFA, 53 cryoablation) just before the procedure and again 6 hours after the end of the procedure. Follow-up studies included echocardiography and 12 lead electrocardiographics (ECGs). No clinical, ECG, nor ECG signs of ischemia were detected. Biomarkers were increased in 57.7-75.5 %. A linear regression analysis illustrated the ablation target site and the number of RF applications as a function of higher cTnI and cTnT levels, with the maximum increase due to ventricular ablation and higher numbers of RF applications. No significant difference in cTnT levels after RFA or cryoablation were observed for AV nodal reentrant tachycardia procedures and no significant differences were observed after nonirrigated tip or irrigated tip RFA in atrial wall or ventricular wall ablation. Elevations in both troponin T and troponin I levels were commonly observed after ablation, especially in ventricular wall ablation as well as with increasing numbers of radiofrequency applications. However, unlike in patients with acute coronary syndrome, these elevated levels had no specific significance. Reference values for each ablation target site were proposed in order to potentially detect additional subclinical injuries to the coronary arteries.
Collapse
Affiliation(s)
- Joachim C Will
- Department of Pediatric Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
32
|
Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ, Paul T, Perry JC, Sanatani S, Tanel RE. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: 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 Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 2012; 9:1006-24. [PMID: 22579340 DOI: 10.1016/j.hrthm.2012.03.050] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Indexed: 10/28/2022]
Affiliation(s)
-
- Arizona Pediatric Cardiology Consultants & Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Wong KC, Lim C, Sadarmin PP, Jones M, Qureshi N, De Bono J, Rajappan K, Bashir Y, Betts TR. High incidence of acute sub-clinical circumflex artery ‘injury’ following mitral isthmus ablation. Eur Heart J 2011; 32:1881-90. [DOI: 10.1093/eurheartj/ehr117] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
34
|
Caldwell JC, Fath-Odoubadi F, Garratt CJ. Right coronary artery damage during cavotricuspid isthmus ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 33:e110-3. [PMID: 20345628 DOI: 10.1111/j.1540-8159.2010.02731.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Radiofrequency ablation of the cavotricuspid isthmus is the first-line treatment for typical atrial flutter. Despite the close proximity of the right coronary artery (RCA) to the cavotricuspid isthmus, only four cases of arterial injury have been reported during radiofrequency ablation, all detected postablation by inferior ST elevation. Here, we report atrioventricular (AV) conduction delay during coronary sinus pacing as a possible early sign of RCA involvement and review the previous literature on RCA damage and variations of AV nodal circulation.
Collapse
Affiliation(s)
- Jane C Caldwell
- Manchester Heart Centre, Central Manchester University Hospitals Foundation Trust, Manchester, UK.
| | | | | |
Collapse
|
35
|
Left ventricular perforation and dissecting subepicardial hematoma after catheter ablation for Wolff-Parkinson-White syndrome. Gen Thorac Cardiovasc Surg 2011; 59:280-3. [DOI: 10.1007/s11748-010-0667-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 06/29/2010] [Indexed: 10/18/2022]
|
36
|
Huang SY, Hu YF, Chang SL, Lin YJ, Lo LW, Tuan TC, Lee PC, Li CH, Suenari K, Chao TF, Tai CT, Chiang CE, Chen SA. Gender differences of electrophysiologic characteristics in patients with accessory atrioventricular pathways. Heart Rhythm 2011; 8:571-4. [DOI: 10.1016/j.hrthm.2010.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 12/06/2010] [Indexed: 11/30/2022]
|
37
|
Aanhaanen WTJ, Boukens BJD, Sizarov A, Wakker V, de Gier-de Vries C, van Ginneken AC, Moorman AFM, Coronel R, Christoffels VM. Defective Tbx2-dependent patterning of the atrioventricular canal myocardium causes accessory pathway formation in mice. J Clin Invest 2011; 121:534-44. [PMID: 21266775 DOI: 10.1172/jci44350] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 11/01/2010] [Indexed: 11/17/2022] Open
Abstract
Ventricular preexcitation, a feature of Wolff-Parkinson-White syndrome, is caused by accessory myocardial pathways that bypass the annulus fibrosus. This condition increases the risk of atrioventricular tachycardia and, in the presence of atrial fibrillation, sudden death. The developmental mechanisms underlying accessory pathway formation are poorly understood but are thought to primarily involve malformation of the annulus fibrosus. Before birth, slowly conducting atrioventricular myocardium causes a functional atrioventricular activation delay in the absence of the annulus fibrosus. This myocardium remains present after birth, suggesting that the disturbed development of the atrioventricular canal myocardium may mediate the formation of rapidly conducting accessory pathways. Here we show that myocardium-specific inactivation of T-box 2 (Tbx2), a transcription factor essential for atrioventricular canal patterning, leads to the formation of fast-conducting accessory pathways, malformation of the annulus fibrosus, and ventricular preexcitation in mice. The accessory pathways ectopically express proteins required for fast conduction (connexin-40 [Cx40], Cx43, and sodium channel, voltage-gated, type V, α [Scn5a]). Additional inactivation of Cx30.2, a subunit for gap junctions with low conductance expressed in the atrioventricular canal and unaffected by the loss of Tbx2, did not affect the functionality of the accessory pathways. Our results suggest that malformation of the annulus fibrosus and preexcitation arise from the disturbed development of the atrioventricular myocardium.
Collapse
Affiliation(s)
- Wim T J Aanhaanen
- Heart Failure Research Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Santilli RA, Critelli M, Baron Toaldo M. ECG of the Month. Accessory atrioventricular pathway-mediated tachycardia. J Am Vet Med Assoc 2010; 237:1142-4. [PMID: 21073383 DOI: 10.2460/javma.237.10.1142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Roberto A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy.
| | | | | |
Collapse
|
39
|
Bastani H, Insulander P, Schwieler J, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Jensen-Urstad M. Cryoablation of superoparaseptal and septal accessory pathways: a single centre experience. Europace 2010; 12:972-7. [DOI: 10.1093/europace/euq079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
40
|
Sacher F, Wright M, Tedrow UB, O'Neill MD, Jais P, Hocini M, Macdonald R, Davies DW, Kanagaratnam P, Derval N, Epstein L, Peters NS, Stevenson WG, Haissaguerre M. Wolff-Parkinson-White ablation after a prior failure: a 7-year multicentre experience. Europace 2010; 12:835-41. [DOI: 10.1093/europace/euq050] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
Wong KCK, Sadarmin PP, Prendergast BD, Betts TR. Acute occlusion of left circumflex artery following radiofrequency catheter ablation at the mitral isthmus. Europace 2010; 12:743-5. [DOI: 10.1093/europace/eup447] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Schneider HE, Kriebel T, Gravenhorst VD, Paul T. Incidence of coronary artery injury immediately after catheter ablation for supraventricular tachycardias in infants and children. Heart Rhythm 2009; 6:461-7. [DOI: 10.1016/j.hrthm.2009.01.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 01/23/2009] [Indexed: 10/21/2022]
|
43
|
Jiang H, Zhang M, He B, Lu Z, Yang B, Huang H, Wu G, Wan J, Zhao D, Wu X, Liu H, Wang X, Huang C. New access for radiofrequency catheter ablation of left-sided atrioventricular accessory pathways: safety and efficacy of the transradial approach. Circ J 2009; 73:833-7. [PMID: 19282608 DOI: 10.1253/circj.cj-08-0716] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The safety and efficacy of the transradial approach for radiofrequency catheter ablation (RFCA) of left-sided atrioventricular accessory pathways (APs) was evaluated in the present study. METHODS AND RESULTS Included were 40 consecutive patients with type A Wolff-Parkinson-White (WPW) syndrome who underwent RFCA via the radial artery route, and 30 patients with type A WPW syndrome who underwent RFCA via the transfemoral approach (controls) were retrospectively chosen for control. All 45 APs in the 40 patients were successfully ablated: 35 APs were successfully blocked with 1 ablation attempt, and the other 10 APs were ablated after 2-4 attempts. Compared with the transfemoral approach, the total procedure time for the transradial approach was longer (40 +/- 7.7 vs 32.4 +/- 8.7 min, P<0.05) and the fluoroscopic time was similar (7.2 +/- 2.2 vs 7.9 +/- 3.9 min, P>0.05). There were no vascular complications in the transradial group, but 2 patients in the transfemoral developed local hematoma. There was no recurrence of arrhythmia in either group. CONCLUSIONS The transradial approach is a safe and effective access for RFCA of left-sided APs.
Collapse
Affiliation(s)
- Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, PR China.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
|
45
|
Santilli R, Perego M, Crosara S, Gardini F, Bellino C, Moretti P, Spadacini G. Utility of 12-Lead Electrocardiogram for Differentiating Paroxysmal Supraventricular Tachycardias in Dogs. J Vet Intern Med 2008; 22:915-23. [DOI: 10.1111/j.1939-1676.2008.0127.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
46
|
Gil MC, Ha JM, Yoon SG, Chung JI, Jung SI, Yoon JH. Radiofrequency Ablation of Unilateral Kidney VX2 Tumors in the Rabbit Model. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.3.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Myung Cheol Gil
- Department of Urology, College of Medicine Pocheon CHA University, Seoul, Korea
| | - Jung Min Ha
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Seong Guk Yoon
- Department of Radiology, Dong-A University College of Medicine, Busan, Korea
| | - Jae Il Chung
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Se Il Jung
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| | - Jin Han Yoon
- Department of Urology, Dong-A University College of Medicine, Busan, Korea
| |
Collapse
|
47
|
Lee DW, Kim J, Lee HC, Kim JH, Chun KJ, Hong TJ, Shin YW. Catheter ablation of a left free-wall accessory pathway via the radial artery approach. Yonsei Med J 2007; 48:1048-51. [PMID: 18159601 PMCID: PMC2628190 DOI: 10.3349/ymj.2007.48.6.1048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Catheter ablation of the left free-wall accessory pathways (APs) is normally performed by the retrograde transaortic approach via a femoral artery or the transseptal approach. Here we report a case of an overt left free-wall AP, which was successfully ablated with a retrograde transaortic approach via the radial artery without any vascular complications. The patient has remained free of any symptoms or pre-excitation observed on the ECG during a 10-month post- ablation follow-up.
Collapse
Affiliation(s)
- Dong Won Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Jun Kim
- Division of Cardiology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Han-Cheol Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - June Hong Kim
- Division of Cardiology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Kook Jin Chun
- Division of Cardiology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Yung Woo Shin
- Division of Cardiology, Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| |
Collapse
|
48
|
Calò L, Sciarra L, De Ruvo E, Franceschetti R, Pellegrini R, Lioy E. Successful catheter ablation of a manifest left anterior accessory pathway. J Cardiovasc Med (Hagerstown) 2007; 8:1065-8. [PMID: 18163024 DOI: 10.2459/jcm.0b013e32807fb071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Left anterior accessory pathways are considered to be rare. The junction between the mitral and aortic valves consists of a continuous fibrous tissue. Nevertheless, muscular pathways connecting the left atrial and ventricular myocardium through the fibrous ring between these valves have been observed very rarely. Few reports about successful ablation of left anterior accessory pathways are available. We describe the case of a young patient with episodes of recurrent palpitations due to atrioventricular tachycardia through a manifest left anterior accessory pathway. Complete elimination of the accessory pathway was achieved by means of an ablative procedure via the transaortic retrograde approach.
Collapse
Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
49
|
Santilli RA, Spadacini G, Moretti P, Perego M, Perini A, Crosara S, Tarducci A. Anatomic distribution and electrophysiologic properties of accessory atrioventricular pathways in dogs. J Am Vet Med Assoc 2007; 231:393-8. [PMID: 17669040 DOI: 10.2460/javma.231.3.393] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the anatomic distribution and electrophysiologic properties of accessory pathways (APs) in dogs. DESIGN Case series. ANIMALS 10 dogs with tachyarrhythmias associated with an AP. PROCEDURES Each dog underwent electrophysiologic testing to determine the inducibility of documented and undocumented arrhythmias and to identify location, conduction properties, and antegrade and retrograde effective refractory periods of the APs. Radiofrequency catheter ablation was then performed. RESULTS 15 APs were identified; 7 dogs each had a single AP, and 3 had multiple APs. Fourteen of the 15 APs were right-sided (6 right free wall, 4 posteroseptal, 3 midseptal, and 1 anteroseptal), and 1 was left-sided (left free wall). All APs conducted in an all-or-none fashion. Unidirectional retrograde conduction was observed in 11 APs, and bidirectional conduction was observed in 4. All documented tachyarrhythmias could be induced during electrophysiologic testing; atrial fibrillation was also inducible in 2 dogs. Mean +/- SD cycle duration of orthodromic atrioventricular reciprocating tachycardia was 215.80 +/- 44.87 milliseconds. Mean shortest R-R interval during atrial fibrillation was 247.33 +/- 83.17 milliseconds. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in dogs, most APs are right-sided, had unidirectional retrograde conduction, and are associated with various arrhythmias, including orthodromic atrioventricular reciprocating tachycardia and atrial fibrillation without evidence of pre-excitation.
Collapse
Affiliation(s)
- Roberto A Santilli
- Clinica Veterinaria Malpensa, Via Marconi, 27, 21017 Samarate, Varese, Italy
| | | | | | | | | | | | | |
Collapse
|
50
|
Thornton AS, Rivero-Ayerza M, Knops P, Jordaens LJ. Magnetic Navigation in Left-Sided AV Reentrant Tachycardias: Preliminary Results of a Retrograde Approach. J Cardiovasc Electrophysiol 2007; 18:467-72. [PMID: 17343720 DOI: 10.1111/j.1540-8167.2007.00783.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A novel magnetic navigation system allows remote guidance of floppy radiofrequency (RF) ablation catheters. We evaluated the feasibility of mapping and ablation of left-sided accessory pathways (APs) using the retrograde transaortic approach with this system. This might open the gate to retrograde ablation of left atrial arrhythmias. METHODS AND RESULTS Twenty consecutive patients were included. A Helios II was used in five and in 15 a Celsius RMT RF catheter with higher magnetic mass and different flexibility was used. Mapping and ablation were attempted. The learning curve was analyzed. Ablation was acutely successful in 60% of the patients using the Helios II and in 80% using the Celsius RMT. Median procedure time was 158 minutes, with median patient and physician fluoroscopy times of 26 and 4 minutes. In the last 10 patients, procedure times became significantly shorter (median 122 minutes, only Celsius RMT catheters) and standard catheters had to be used only twice. No complications occurred. CONCLUSIONS Remote retrograde transaortic RF ablation of left-sided APs is feasible, safe, and reduces the physician's fluoroscopy exposure. There is a very steep initial learning curve, with the success rate increasing from 50% in the first 10 cases to 80% in the last 10 cases. Different catheter configurations may influence the outcome.
Collapse
Affiliation(s)
- Andrew S Thornton
- Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands.
| | | | | | | |
Collapse
|