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Wei HQ, Guo XG, Zhou GB, Sun Q, Yang JD, Xie HY, Liang J, Zhang S, Wu S, Ma J. Predictors and Long-Term Outcome of Ablation of Discrete Pre-potentials in Patients With Idiopathic Ventricular Arrhythmias Originating From the Aortic Sinuses of Valsalva. Front Cardiovasc Med 2021; 8:767514. [PMID: 34950714 PMCID: PMC8688708 DOI: 10.3389/fcvm.2021.767514] [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: 08/30/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The predictability and long-term outcome of the discrete pre-potential (DPP) of idiopathic ventricular arrhythmias (VAs) arising from the aortic sinuses of Valsalva (ASV) have not been fully identified. Methods: Of 687 consecutive patients undergoing ablation of outflow tract VAs, there were 105 (15.3%) patients with VAs originating from the ASV region who were included. Detailed mapping was performed within the ASV in all patients. Electrocardiographic, electrophysiological parameters, and long-term success rate were compared between patients with and without the DPPs. Results: A DPP was recorded in 67 of 105 (63.8%) patients, including 38 left sinus of Valsalva (LSV)-VAs (38/105, 36.2%) and 29 right sinus of Valsalva (RSV)-VAs (29/105, 27.6%). The patients with DPPs had wider QRS duration (152 ± 17 vs. 145 ± 14 ms, p < 0.001). The average of earliest activation time was significantly earlier in patients with DPPs (−38.6 ± 8.5 vs. −27.7 ± 5.7 ms, p < 0.001). Mean time from the first lesion to elimination of VAs was shorter in patients with DPPs (2.3 ± 2.1 s vs. 4.9 ± 1.0 s, p < 0.001). A stepwise logistic multivariable analysis identified only younger age as a significant predictor of DPP (age ≤ 35.5 years predicted DPP with 92.9% positive predictive value). During a follow-up duration of 42.5 ± 22.3 months, 63 (94.0%) patients with DPPs and 30 (78.9%) patients without DPPs remained free of recurrent VAs (p = 0.027). Conclusion: Discrete pre-potentials were observed in 63.8% of patients with VAs arising from the ASV. Ablation in patients with DPPs was associated with higher long-term success. DPPs were seen more commonly in younger (age ≤ 35.5 years) patients.
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Affiliation(s)
- Hui-Qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai-Yang Xie
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jackson Liang
- Division of Cardiovascular Medicine, Electrophysiology Service, University of Michigan Health System, Ann Arbor, MI, United States
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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2
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Limitation of standard ECG criteria to localize an outflow tract PVC. J Electrocardiol 2021; 68:124-129. [PMID: 34419647 DOI: 10.1016/j.jelectrocard.2021.08.012] [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: 11/01/2020] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/29/2022]
Abstract
Multiple ECG algorithms exist to localize outflow tract PVCs. They can be invaluable in pre-procedure planning and patient counseling. We describe a case where the published algorithm for PVC localization did not predict the site of origin and successful ablation site. This case highlights the strengths and limitations of established ECG PVC localization algorithms.
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3
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Turner D, Kang C, Mesirca P, Hong J, Mangoni ME, Glukhov AV, Sah R. Electrophysiological and Molecular Mechanisms of Sinoatrial Node Mechanosensitivity. Front Cardiovasc Med 2021; 8:662410. [PMID: 34434970 PMCID: PMC8382116 DOI: 10.3389/fcvm.2021.662410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023] Open
Abstract
The understanding of the electrophysiological mechanisms that underlie mechanosensitivity of the sinoatrial node (SAN), the primary pacemaker of the heart, has been evolving over the past century. The heart is constantly exposed to a dynamic mechanical environment; as such, the SAN has numerous canonical and emerging mechanosensitive ion channels and signaling pathways that govern its ability to respond to both fast (within second or on beat-to-beat manner) and slow (minutes) timescales. This review summarizes the effects of mechanical loading on the SAN activity and reviews putative candidates, including fast mechanoactivated channels (Piezo, TREK, and BK) and slow mechanoresponsive ion channels [including volume-regulated chloride channels and transient receptor potential (TRP)], as well as the components of mechanochemical signal transduction, which may contribute to SAN mechanosensitivity. Furthermore, we examine the structural foundation for both mechano-electrical and mechanochemical signal transduction and discuss the role of specialized membrane nanodomains, namely, caveolae, in mechanical regulation of both membrane and calcium clock components of the so-called coupled-clock pacemaker system responsible for SAN automaticity. Finally, we emphasize how these mechanically activated changes contribute to the pathophysiology of SAN dysfunction and discuss controversial areas necessitating future investigations. Though the exact mechanisms of SAN mechanosensitivity are currently unknown, identification of such components, their impact into SAN pacemaking, and pathological remodeling may provide new therapeutic targets for the treatment of SAN dysfunction and associated rhythm abnormalities.
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Affiliation(s)
- Daniel Turner
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Chen Kang
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Pietro Mesirca
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Juan Hong
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Matteo E Mangoni
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Alexey V Glukhov
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Rajan Sah
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
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4
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Hanson M, Enriquez A. Intracardiac Echocardiography to Guide Catheter Ablation of Idiopathic Ventricular Arrythmias. Card Electrophysiol Clin 2021; 13:325-335. [PMID: 33990271 DOI: 10.1016/j.ccep.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Catheter ablation is the most effective treatment option for idiopathic ventricular arrhythmias. Intracardiac echocardiography (ICE) has been increasingly used during ablation procedures, allowing real-time visualization of cardiac anatomy, and improving our understanding of the relationships between different cardiac structures. In this article we review the adjuvant role of ICE to guide mapping and ablation of ventricular arrhythmias in the structurally normal heart.
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Affiliation(s)
- Matthew Hanson
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
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5
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Fries B, Johnson V, Rutsatz W, Schmitt J, Bogossian H. [Localization of ventricular premature contractions by 12-lead ECG]. Herzschrittmacherther Elektrophysiol 2021; 32:21-26. [PMID: 33533995 DOI: 10.1007/s00399-021-00746-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/11/2021] [Indexed: 12/01/2022]
Abstract
The advances in imaging and 3D mapping systems in the last decade allowed a better correlation of ventricular premature contractions (PVCs) with anatomical structures. With regard to PVCs, interpretation of the 12-lead ECG is still crucial for the management of patients and the planning of therapies. Although there is an armamentarium of indices and algorithms to exactly pinpoint the origin of a PVC in advance, a thorough understanding of cardiac anatomy and impulse propagation, together with an awareness of the surface ECGs limitations, provides a sufficiently close approximation. PVCs from the diaphragmatic part of the ventricular cavae exhibit a superiorly directed axis, whereas PVCs from superior parts of the heart show an inferior axis. A right bundle branch block morphology or positive concordance of the precordial leads yields a high probability of left ventricular origin of a PVC. A left bundle branch block morphology is indicative of a right ventricular or septal origin of a PVC. Using the transition zone, one can estimate the origin of a PVC with regard to anterior or posterior regions of the heart: A late precordial transition is indicative of a right ventricular origin, an early precordial transition suggests a left ventricular focus. An absent transition in the sense of negative concordance is indicative for an apical origin. The intertwined course of the ventricular outflow tracts makes PVC localization more difficult. Here, shape and height of the R‑wave in V1-V3 help to narrow the origin down. PVCs from structures like the papillary muscles, the moderator band or infundibular bands are challenging to interpret and evidence of the limitations of the surface ECG. Based on the information gained by the aforementioned approach, a prediction of prognosis and possible treatment success is possible.
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Affiliation(s)
- Bastian Fries
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Victoria Johnson
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Wiebke Rutsatz
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Jörn Schmitt
- Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Harilaos Bogossian
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland. .,Universität Witten-Herdecke, Witten, Deutschland.
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6
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Choe WS, Lee SR, Cha MJ, Choi EK, Oh S. Differentiation of the right versus left outflow tract ventricular arrhythmias using local activation time at the His bundle electrogram. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although multiple algorithms based on surface electrocardiographic criteria have been introduced to localize idiopathic ventricular arrhythmia (VA) origins from the outflow tract (OT), their diagnostic accuracy and clinical usefulness remain limited. We evaluated whether local activation time of the His bundle region could differentiate left and right ventricular OT VA origins in the early stage of electrophysiology study.
Methods
We studied 30 patients who underwent catheter ablation for OT VAs with a left bundle branch block pattern and inferior axis QRS morphology. The interval between the local V signal on the mapping catheter placed in the RVOT and His bundle region (V(RVOT)-V(HB) interval) and the interval from QRS complex onset to the local V signal on the His bundle region (QRS-V(HB) interval) were measured during VAs.
Results
The V(RVOT)-V(HB) and QRS-V(HB) intervals were significantly shorter in patients with LVOT VAs. The area under the curve (AUC) for the V(RVOT)-V(HB) interval by receiver operating characteristic analysis was 0.865. A cutoff value of ≤ 50 ms predicted an LVOT origin of VA with sensitivity, specificity, and positive and negative predictive values of 100%, 62.5%, 40%, and 100%, respectively. The QRS-V(HB) interval showed similar diagnostic accuracy (AUC, 0.840), and a cutoff value of ≤ 15 ms predicted an LVOT origin of VA with a sensitivity, specificity, and positive and negative predictive values of 100%, 70.8%, 45.2%, and 100%, respectively.
Conclusion
The V(RVOT)-V(HB) and QRS-V(HB) intervals could differentiate left from right OT origins of VA with high sensitivity and negative predictive values.
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7
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Romero J, Shivkumar K, Valderrabano M, Diaz JC, Alviz I, Briceno D, Natale A, Di Biase L. Modern mapping and ablation techniques to treat ventricular arrhythmias from the left ventricular summit and interventricular septum. Heart Rhythm 2020; 17:1609-1620. [PMID: 32333973 DOI: 10.1016/j.hrthm.2020.04.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/04/2020] [Accepted: 04/10/2020] [Indexed: 11/18/2022]
Abstract
Managing arrhythmias from the left ventricular summit and interventricular septum is a major challenge for the clinical electrophysiologist requiring intimate knowledge of cardiac anatomy, advanced training and expertise. Novel mapping and ablation strategies are needed to treat arrhythmias originating from these regions given the current suboptimal long-term success rates with standard techniques. Herein, we describe innovative approaches to improve acute and long-term clinical outcomes such as mapping and ablation using the septal coronary venous system and the septal coronary arteries, alcohol ablation, coil embolization, and ablation of all early sites among others.
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Affiliation(s)
- Jorge Romero
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Kalayanam Shivkumar
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, California
| | - Miguel Valderrabano
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Houston Methodist, Houston, Texas
| | - Juan Carlos Diaz
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Isabella Alviz
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York
| | - David Briceno
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York
| | - Andrea Natale
- Cardiac Arrhythmia Center, St David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Cardiac Arrhythmia Center, Montefiore Einstein Center for Heart and Vascular Care, Bronx, New York.
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8
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Kapa S, Mehra N, Deshmukh AJ, Friedman PA, Asirvatham SJ. Left sinus of Valsalva—Electroanatomic basis and outcomes with ablation for outflow tract arrhythmias. J Cardiovasc Electrophysiol 2020; 31:952-959. [DOI: 10.1111/jce.14388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Suraj Kapa
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
| | - Nandini Mehra
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
| | | | - Paul A. Friedman
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
| | - Samuel J. Asirvatham
- Department of CardiologyMayo Clinic College of Medicine Rochester Minnesota
- Division of Pediatric Cardiology, Department of Pediatric and Adolescent MedicineMayo Clinic College of Medicine Rochester Minnesota
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9
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Demir S, Akgun T, Gulsen K, Kup A, Uslu A, Kayan F, Kepez A. Catheter-induced premature ventricular complexes (PVCs) may aid in the determination of optimal timing for clinical PVC ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1573-1578. [PMID: 31696518 DOI: 10.1111/pace.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/16/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate whether catheter-induced premature ventricular complexes (PVCs) produced at the presumptive ablation site may aid in the identification of the optimal timing of the earliest local activation for the successful ablation of clinical PVCs. METHODS Sixty-three consecutive patients (35 males, age: 53.5 ± 14.4 years) without any exclusion criteria who had undergone PVC ablation between 1 July 2018 and 1 July 2019 constituted our study population. The time interval between the beginning of the EGM and the beginning of the QRS of each catheter-induced PVC (Cath EGM-ECG) and the time interval between the beginning of the EGM of clinical PVCs at the earliest site and the beginning of the QRS of clinical PVCs (PVC earliest EGM-ECG) were noted for each patient. The value of Cath EGM-ECG as a reference for procedural success of ablation was evaluated by examining the relationship between Cath EGM-ECG and PVC earliest EGM-ECG. RESULTS Fifty-two patients had successful ablation, and 43 of them (82.7%) had PVC earliest EGM-ECG values greater than or equal to Cath EGM-ECG. Eleven patients had procedural failure, and all of them had PVC earliest EGM-ECG values lower than Cath EGM-ECG. A PVC earliest EGM-ECG value -1.5 ms greater than Cath EGM-ECG predicted successful ablation with a sensitivity of 90.4% and a specificity of 100.0% in the general patient population. CONCLUSION Cath EGM-ECG seems to serve as a reliable guide for finding the optimal timing of the earliest site for successful PVC ablation.
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Affiliation(s)
- Serdar Demir
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Kamil Gulsen
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Kup
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | - Abdulkadir Uslu
- Department of Cardiology, University of Health Sciences, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey
| | | | - Alper Kepez
- Department of Cardiology, Marmara University School of Medicine, Istanbul, Turkey
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10
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Mehra N, Asirvatham SJ. Expecting failure yet obtaining success. J Cardiovasc Electrophysiol 2019; 30:2995-2997. [PMID: 31642149 DOI: 10.1111/jce.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nandini Mehra
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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11
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Egorov YV, Lang D, Tyan L, Turner D, Lim E, Piro ZD, Hernandez JJ, Lodin R, Wang R, Schmuck EG, Raval AN, Ralphe CJ, Kamp TJ, Rosenshtraukh LV, Glukhov AV. Caveolae-Mediated Activation of Mechanosensitive Chloride Channels in Pulmonary Veins Triggers Atrial Arrhythmogenesis. J Am Heart Assoc 2019; 8:e012748. [PMID: 31597508 PMCID: PMC6818041 DOI: 10.1161/jaha.119.012748] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Atrial fibrillation often occurs in the setting of hypertension and associated atrial dilation with pathologically increased cardiomyocyte stretch. In the setting of atrial dilation, mechanoelectric feedback has been linked to the development of ectopic beats that trigger paroxysmal atrial fibrillation mainly originating from pulmonary veins (PVs). However, the precise mechanisms remain poorly understood. Methods and Results We identify mechanosensitive, swelling‐activated chloride ion channels (ICl,swell) as a crucial component of the caveolar mechanosensitive complex in rat and human cardiomyocytes. In vitro optical mapping of rat PV, single rat PV, and human cardiomyocyte patch clamp studies showed that stretch‐induced activation of ICl,swell leads to membrane depolarization and decreased action potential amplitude, which trigger conduction discontinuities and both ectopic and reentrant activities within the PV. Reverse transcription quantitative polymerase chain reaction, immunofluorescence, and coimmunoprecipitation studies showed that ICl,swell likely consists of at least 2 components produced by mechanosensitive ClC‐3 (chloride channel‐3) and SWELL1 (also known as LRRC8A [leucine rich repeat containing protein 8A]) chloride channels, which form a macromolecular complex with caveolar scaffolding protein Cav3 (caveolin 3). Downregulation of Cav3 protein expression and disruption of caveolae structures during chronic hypertension in spontaneously hypertensive rats facilitates activation of ICl,swell and increases PV sensitivity to stretch 10‐ to 50‐fold, promoting the development of atrial fibrillation. Conclusions Our findings identify caveolae‐mediated activation of mechanosensitive ICl,swell as a critical cause of PV ectopic beats that can initiate atrial arrhythmias including atrial fibrillation. This mechanism is exacerbated in the setting of chronically elevated blood pressures.
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Affiliation(s)
- Yuriy V. Egorov
- Laboratory of Heart ElectrophysiologyCardiology Research CentreMoscowRussian Federation
| | - Di Lang
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Leonid Tyan
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Daniel Turner
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Evi Lim
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Zachary D. Piro
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Jonathan J. Hernandez
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
- Department of PediatricsPediatric CardiologyUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Rylie Lodin
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Rose Wang
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Eric G. Schmuck
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Amish N. Raval
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Carter J. Ralphe
- Department of PediatricsPediatric CardiologyUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | - Timothy J. Kamp
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
| | | | - Alexey V. Glukhov
- Department of MedicineCardiovascular MedicineUniversity of Wisconsin‐Madison School of Medicine and Public HealthMadisonWI
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12
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Verbeet T, Castro J, Almorad A. A recurrent concealed parahisian accessory pathway. Clin Case Rep 2018; 6:1101-1105. [PMID: 29881574 PMCID: PMC5985981 DOI: 10.1002/ccr3.1538] [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: 12/19/2017] [Revised: 03/03/2018] [Accepted: 03/24/2018] [Indexed: 11/17/2022] Open
Abstract
This case demonstrates the interest of ablating in the aortic root in case of resistant parahisian accessory pathways with failure of the right side approach. Failure on the right side may be due to fear of creating an AV block of failure to ablate critical fibers in the parahisian position.
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Affiliation(s)
- Thierry Verbeet
- Department of CardiologyCHU BrugmannFree University of Brussels4 Place Van Gehuchten1020BrusselsBelgium
| | - Jose Castro
- Department of CardiologyCHU BrugmannFree University of Brussels4 Place Van Gehuchten1020BrusselsBelgium
| | - Alexandre Almorad
- Department of CardiologyCHU BrugmannFree University of Brussels4 Place Van Gehuchten1020BrusselsBelgium
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13
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Liu Q, Shehata M, Lan DZ, Ehdaie A, Cingolani E, Chugh SS, Fu G, Jiang C, Wang X. Accurate localization and catheter ablation of superoparaseptal accessory pathways. Heart Rhythm 2018; 15:688-695. [DOI: 10.1016/j.hrthm.2017.12.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 11/25/2022]
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14
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Kumar S, Stevenson WG, Tedrow UB. Bicuspid aortic valve supporting supravalvular "substrate" for multiple ventricular tachycardias. HeartRhythm Case Rep 2017; 3:155-158. [PMID: 28491793 PMCID: PMC5420069 DOI: 10.1016/j.hrcr.2016.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Saurabh Kumar
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - William G Stevenson
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
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15
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Ahn J, Kim DH, Roh SY, Lee KN, Lee DI, Shim J, Choi JI, Kim YH. The Role of Intravenous Dopamine on Hemodynamic Support during Radiofrequency Catheter Ablation of Poorly Tolerated Idiopathic Ventricular Tachycardia. Korean Circ J 2017; 47:65-71. [PMID: 28154593 PMCID: PMC5287189 DOI: 10.4070/kcj.2016.0039] [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: 01/29/2016] [Revised: 03/25/2016] [Accepted: 06/21/2016] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives Hemodynamically unstable idiopathic ventricular tachycardias (VTs) are a challenge for activation or entrainment mapping technique. Mechanical circulatory support is an option, but is not always readily available. In this study, we investigated the safety and efficacy of hemodynamic support using intravenous (IV) dopamine solely during radiofrequency catheter ablation (RFCA) of hemodynamically unstable VT. Subjects and Methods Seven out of 86 patients with hemodynamically unstable idiopathic VT underwent de novo RFCA using dopamine in our single center. They were included in the study and reviewed retrospectively to investigate the procedural characteristics and outcomes. Results All patients were male, and the mean age was 50.7±5.3 years. One patient had implantable cardioverter-defibrillator for the secondary prevention. No evidence of myocardial ischemia was found in all patients. During the procedure, the mean blood pressure during VT without dopamine was 52.3±4.1 mmHg and increased to 82.6±3.8 mmHg after administering dopamine (Δ28.8±3.2 mmHg; total average dopamine dosage was 1266.1±389.6 mcg/kg). In all patients, activation mapping was safely applied, and VTs were terminated during energy delivery. Non-inducibility of clinical VT was achieved in all cases. There was no evidence of deterioration due to hypoperfusion during the peri-procedural period. No recurrence of ventricular tachyarrhythmias was observed in any of the patients, during a median follow-up of 23.0±6.1 months. Conclusion Hemodynamic support using IV dopamine during RFCA of hemodynamically unstable idiopathic VT facilitated detailed mapping to guide successful ablation.
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Affiliation(s)
- Jinhee Ahn
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Kwang No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Dae-In Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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16
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Iliodromitis KE, Pastromas S, Tzeis S, Andrikopoulos G. Radiofrequency Ablation of a Nonsustained Ventricular Tachycardia Arising from the Left Coronary Cusp of a Bicuspid Aortic Valve: A Case Report. Cardiology 2016; 135:236-239. [PMID: 27529552 DOI: 10.1159/000447962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/19/2022]
Abstract
Radiofrequency ablation is the therapy of choice for the suppression of medically intractable symptomatic ventricular arrhythmias. Here we present the case report of a 50-year-old woman with bicuspid aortic valve (BAV) and symptomatic nonsustained ventricular tachycardia arising from the left ventricular outflow tract (LVOT). The origin of the ventricular arrhythmia was confirmed in the left coronary cusp (LCC) of the BAV. The patient underwent a successful radiofrequency ablation. LCC of a tricuspid aortic valve is a common origin of idiopathic LVOT tachycardia; however, little is known for these types of arrhythmias when located in the cusps of a BAV.
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17
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Noheria A, Deshmukh A, Asirvatham SJ. Ablating Premature Ventricular Complexes: Justification, Techniques, and Outcomes. Methodist Debakey Cardiovasc J 2016; 11:109-20. [PMID: 26306129 DOI: 10.14797/mdcj-11-2-109] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We reviewed the underlying principles that allow for safe and effective ablation for premature ventricular complexes. Clinical scenarios that necessitate consideration for ablation, the underlying anatomy, and the unique consideration to maximize energy delivery without compromising safety are sequentially examined.
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18
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Letsas KP, Efremidis M, Vlachos K, Georgopoulos S, Karamichalakis N, Saplaouras A, Xydonas S, Valkanas K, Sideris A. Catheter ablation of anteroseptal accessory pathways from the aortic cusps: A case series and a review of the literature. J Arrhythm 2016; 32:443-448. [PMID: 27920827 PMCID: PMC5129122 DOI: 10.1016/j.joa.2016.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/05/2016] [Accepted: 02/29/2016] [Indexed: 10/26/2022] Open
Abstract
Data regarding catheter ablation of anteroseptal accessory pathways through the aortic cusps are limited. We describe two cases of true para-Hisian accessory pathways successfully ablated from the aortic cusps (right coronary cusp and non-coronary cusp, respectively) along with a review of the current literature. Due to the close proximity to the atrioventricular node and the high risk of complication, mapping of the aortic cusps should always be considered in the case of anteroseptal accessory pathways. Anteroseptal accessory pathways can be safely and effectively ablated from the aortic cusps with good long-term outcomes.
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Affiliation(s)
- Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Konstantinos Vlachos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Stamatis Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Nikolaos Karamichalakis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Athanasios Saplaouras
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Sotirios Xydonas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Kosmas Valkanas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
| | - Antonios Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676 Athens, Greece
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19
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Turan OE, Ozturk M, Kocaoglu I, Turan SG. Blood pressure response is impaired in patients with exercise-induced ventricular ectopy. ACTA ACUST UNITED AC 2016; 10:447-56. [PMID: 27085207 DOI: 10.1016/j.jash.2016.03.179] [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: 01/13/2016] [Revised: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
Exercise-induced ventricular ectopy (EIVE) has clinical and prognostic significance. But the mechanism underlying EIVE-related mortality still remains unclear. This study aims to assess blood pressure alteration in patients with EIVE and to identify the potential causes of increased mortality in this patient group. A total number of 3611 patients were screened within a 1-year period, and patients with a structural heart disease, coronary artery disease, hypertension, diabetes mellitus, thyroid dysfunction, and chronic renal disease were excluded from the study. A total number of 98 patients with no chronic disease, who were retrospectively diagnosed with EIVE, were included in the study as patient group and 116 patients without EIVE were included as control group. The median age, gender distribution, laboratory test results, and echocardiographic findings were similar between the two groups. Systolic blood pressure (SBP) alterations during exercise stress testing were found to be significantly different (P < .001). Moreover, EIVE group had significantly higher peak SBP (P < .001). A significant positive relation was found between peak SBP level and ventricular ectopy count (r:0.27, P = .006). Our study showed that EIVE patients without a structural heart disease or a chronic disease had higher peak SBP levels. Higher SBP alteration can be related to ventricular ectopy occurrence during exercise stress testing, which can be a possible reason underlying the increased rate of mortality among EIVE patients.
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Affiliation(s)
| | - Mustafa Ozturk
- Department of Cardiology, Erzurum Medical Training School, Erzurum, Turkey
| | | | - Selen Gursoy Turan
- Department of Public Health, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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20
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Kumar S, Tedrow UB, Stevenson WG. Ventricular Arrhythmias from the Left Ventricular Summit: Critical Importance of Anatomy, Imaging, and Detailed Mapping to Allow Safe and Effective Ablation. Card Electrophysiol Clin 2016; 8:89-98. [PMID: 26920176 DOI: 10.1016/j.ccep.2015.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ventricular arrhythmias arising from the region of the left ventricular summit can be challenging for catheter-based percutaneous ablation. A detailed knowledge of the anatomy of this region and the need of high-density mapping of surrounding structures are critical in ensuring safe and effective ablation. This case-based review focuses on the particular challenges with ablation in this region.
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Affiliation(s)
- Saurabh Kumar
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Usha B Tedrow
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - William G Stevenson
- Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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21
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Xu W, Li M, Chen M, Yang B, Wang D, Kong X, Chen H, Ju W, Gu K, Cao K, Liu H, Jiang Q, Shi J, Cui Y, Wang H. Effect of burden and origin sites of premature ventricular contractions on left ventricular function by 7-day Holter monitor. J Biomed Res 2015; 29:465-74. [PMID: 26668581 PMCID: PMC4662208 DOI: 10.7555/jbr.29.20150032] [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: 03/02/2015] [Revised: 04/10/2015] [Accepted: 06/10/2015] [Indexed: 11/10/2022] Open
Abstract
Recent studies have shown that premature ventricular contractions (PVCs) could enlarge the heart, but its risk factors are incompletely understood as a single 24-hour recording cannot reflect the true PVC burden due to day-to-day variability. Our purpose was to investigate the effect of burden and origin sites on left ventricular (LV) function in patients with PVCs by 7-day Holter electrocardiography (ECG). From May 2012 to August 2013, 112 consecutive patients with PVCs were recruited from the authors' affiliated hospital. All patients received 2-dimensional transthoracic echocardiography, 12-lead routing ECG and 7-days Holter ECG. Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured. A total of 102 participants with PVCs were included in the final analysis. Origin of PVCs from the tricuspid annulus had the highest burden and NT-proBNP level. LV papillary muscle had a higher LV ejection fraction (EF) level and a lower LV end-systolic dimension (ESD) than other PVC foci (P<0.05). The high burden group had a higher LV end-diastolic dimension (EDD) and LVESD but lower LVEF than the other two groups (P<0.05). Female, older age, physical work, and history of PVCs had a significantly positive correlation with symptoms. Male, older age, physical work, and high burden were positive predictors of enlarged LVEDD, LVESD and higher serum NT-proBNP level, but lower LVEF. Seven-day dynamic ECG Holter monitor showed the true PVC burden on patients with PVCs. PVCs with a lower burden or origin from the LV papillary muscle and the fascicle were relatively benign, while PVCs with a higher burden or origin from the tricuspid annulus may lead to cardiac dysfunction.
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Affiliation(s)
- Wenhua Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Mingfang Li
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Minglong Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Bing Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Daowu Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Xiangqing Kong
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Hongwu Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Weizhu Ju
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Kai Gu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Kejiang Cao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Hailei Liu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Qi Jiang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Jiaojiao Shi
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Yan Cui
- Nursing College of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
| | - Hong Wang
- Department of Respiratory, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China
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22
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Yamasaki H, Tada H, Sekiguchi Y, Aonuma K. Right coronary cusp as a new window of ablation for pilsicainide-induced ventricular premature contractions in a patient with Brugada syndrome. Heart Vessels 2015; 31:1397-401. [DOI: 10.1007/s00380-015-0760-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
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23
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Hai JJ, Chahal AA, Friedman PA, Vaidya VR, Syed FF, DeSimone CV, Nanda S, Brady PA, Madhavan M, Cha YM, McLeod CJ, Mulpuru S, Munger TM, Packer DL, Asirvatham SJ. Electrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity-potential role of the conduction system. J Cardiovasc Electrophysiol 2015; 26:158-63. [PMID: 25425429 DOI: 10.1111/jce.12587] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 10/02/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Catheter ablation of ventricular arrhythmia (VA) at the fibrous aortic mitral continuity (AMC) has been described, yet the nature of the arrhythmogenic substrate remains unknown. METHODS Procedural records of 528 consecutive patients undergoing ablation of VA at Mayo Clinic, Rochester, MN, were reviewed. The electrocardiographic and electrophysiologic characteristics of patients with successful ablation at the AMC were analyzed to characterize the underlying arrhythmogenic substrate. RESULTS Of the 21 patients (mean age 53.2 ± 13.4 years, 47.6% male) who underwent ablation of VA at the AMC with acute success, prepotentials (PPs) were found at the ablation sites preceding the ventricular electrogram (VEGM) during arrhythmias in 13 (61.9%) patients and during sinus rhythm in 7 (53.8%) patients. VAs with PPs were associated with a significantly higher burden of premature ventricular complexes (PVCs; 26.1 ± 10.9% vs. 14.9 ± 10.1%, P = 0.03), shorter VEGM to QRS intervals (9.0 ± 28.5 milliseconds vs. 33.1 ± 8.8 milliseconds, P = 0.03), lower pace map scores (8.7 ± 1.6 vs. 11.4 ± 0.8, P = 0.001), and a trend toward shorter V-H intervals during VA (32.1 ± 38.6 milliseconds vs. 76.3 ± 11.1 milliseconds, P = 0.06) as compared to those without PP. A strong and positive correlation was found between V-H interval and QRS duration during arrhythmia in those with PPs (B = 2.11, R(2) = 0.97, t = 13.7, P < 0.001) but not in those without PPs. CONCLUSION Local EGM characteristics and relative activation time of the His bundle suggest the possibility of conduction tissue as the origin for VA arising from the fibrous AMC. Specific identification and targeting of PPs when ablating VAs at this location may improve procedural success.
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Affiliation(s)
- Jo Jo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong
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24
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TEH ANDREWW, REDDY VIVEKY, KORUTH JACOBS, MILLER MARCA, CHOUDRY SUBBARAO, D'AVILA ANDRE, DUKKIPATI SRINIVASR. Bipolar Radiofrequency Catheter Ablation for Refractory Ventricular Outflow Tract Arrhythmias. J Cardiovasc Electrophysiol 2014; 25:1093-9. [DOI: 10.1111/jce.12460] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- ANDREW W. TEH
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
- Cardiology Department; Monash University Eastern Health; Victoria Australia
- Department of Cardiology; Austin Hospital; Victoria Australia
| | - VIVEK Y. REDDY
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - JACOB S. KORUTH
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - MARC A. MILLER
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - SUBBARAO CHOUDRY
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - ANDRE D'AVILA
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - SRINIVAS R. DUKKIPATI
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
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25
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Onishi N, Kaitani K, Amano M, Hayama Y, Nakajima S, Hanazawa K, Tamaki Y, Miyake M, Tamura T, Kondo H, Motooka M, Izumi C, Nakagawa Y. Successful radiofrequency catheter ablation assisted by the CartoSound® system for outflow tract origin nonsustained ventricular tachycardia in a patient with a severely deformed thorax. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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26
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Hai JJ, Lachman N, Syed FF, Desimone CV, Asirvatham SJ. The anatomic basis for ventricular arrhythmia in the normal heart: what the student of anatomy needs to know. Clin Anat 2014; 27:885-93. [PMID: 24446306 DOI: 10.1002/ca.22362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/25/2013] [Indexed: 11/11/2022]
Abstract
The traditional route for teaching cardiac anatomy involves didactic instruction, cadaver dissections, and familiarization with the main structure and relationships of the cardiac chambers, valves, and vasculature. In contemporary cardiac electrophysiology, however, a very different view of anatomy is required including details rarely appreciated with a general overview. In this review, we discuss the critical advances in cardiac electrophysiology that were possible only because of understanding detailed anatomic relationships. While we briefly discuss the clinical relevance, we explain in depth the necessary structural information for the student of clinical anatomy. Interspersed through the text are boxes that highlight and summarize the critical pieces of knowledge to be borne in mind while studying the fascinating structural anatomy of the human heart.
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Affiliation(s)
- Jo Jo Hai
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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27
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EBRILLE ELISA, CHANDRA VISHNUM, SYED FAISAL, DEL CARPIO MUNOZ FREDDY, NANDA SUDIP, HAI JOJO, CHA YONGMEI, FRIEDMAN PAULA, HAMMILL STEPHENC, MUNGER THOMASM, VENKATACHALAM K, PACKER DOUGLASL, ASIRVATHAM SAMUELJ. Distinguishing Ventricular Arrhythmia Originating from the Right Coronary Cusp, Peripulmonic Valve Area, and the Right Ventricular Outflow Tract: Utility of Lead I. J Cardiovasc Electrophysiol 2014; 25:404-410. [DOI: 10.1111/jce.12330] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/18/2013] [Accepted: 11/01/2013] [Indexed: 12/01/2022]
Affiliation(s)
- ELISA EBRILLE
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | | | - FAISAL SYED
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - FREDDY DEL CARPIO MUNOZ
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - SUDIP NANDA
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - JO JO HAI
- Division of Cardiology; Department of Medicine; Queen Mary Hospital; Hong Kong
| | - YONG-MEI CHA
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - PAUL A. FRIEDMAN
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - STEPHEN C. HAMMILL
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - THOMAS M. MUNGER
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - K.L. VENKATACHALAM
- Mayo Clinic Jacksonville Florida; Division of Cardiology; Jacksonville Florida USA
| | - DOUGLAS L. PACKER
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
| | - SAMUEL J. ASIRVATHAM
- Division of Cardiovascular Diseases; Department of Medicine, Mayo Clinic; Rochester Minnesota USA
- Department of Pediatrics and Adolescent Medicine Mayo Clinic; Rochester Minnesota USA
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28
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Stevenson WG, Asirvatham S. Fundamental concepts in electrophysiology in cases and reviews. Circ Arrhythm Electrophysiol 2013; 6:e95-100. [PMID: 24347607 DOI: 10.1161/circep.113.001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William G Stevenson
- The Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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29
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Affiliation(s)
- Samuel J Asirvatham
- Cardiovascular Diseases Division, Department of Medicine, and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN
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30
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VAIDYA VAIBHAVR, ASIRVATHAM SAMUELJ. Safe Ablation Near the Coronary Ostium. J Cardiovasc Electrophysiol 2013; 24:E23. [DOI: 10.1111/jce.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Affiliation(s)
- Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine and Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN
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32
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Wilsmore BR, Tchou PJ, Kanj M, Varma N, Chung MK. Catheter ablation of an unusual decremental accessory pathway in the left coronary cusp of the aortic valve mimicking outflow tract ventricular tachycardia. Circ Arrhythm Electrophysiol 2013; 5:e104-8. [PMID: 23250553 DOI: 10.1161/circep.112.972281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bradley R Wilsmore
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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33
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Advances in management of premature ventricular contractions. J Interv Card Electrophysiol 2012; 35:137-49. [PMID: 22875587 DOI: 10.1007/s10840-012-9698-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 05/24/2012] [Indexed: 11/27/2022]
Abstract
Premature ventricular complexes (PVCs) are a common occurrence in clinical practice. The clinical presentation may range from asymptomatic to left ventricular (LV) dysfunction with congestive heart failure. The decision to suppress PVCs is largely based on the presence of symptoms, interference with other therapy (e.g., cardiac resynchronization therapy), or suspicion of PVC-mediated cardiomyopathy. Catheter ablation has emerged as a safe and effective option for the treatment of frequent PVCs. Careful attention to PVC characteristics on surface electrocardiogram has proven useful for the initial localization of the ectopic focus, which may then serve as a guide to procedural planning. The point of interest is often identified with activation mapping, and the ablation site can be further defined with pace mapping techniques. Clinical experience with PVC ablation has been successful in ≥80 % of cases, and the literature reports multiple cases of marked improvement in LV function after eradicating the culprit ectopic focus in patients with PVC-mediated cardiomyopathy.
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34
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Liu E, Shehata M, Swerdlow C, Amorn A, Cingolani E, Kannarkat V, Chugh SS, Wang X. Approach to the difficult septal atrioventricular accessory pathway: the importance of regional anatomy. Circ Arrhythm Electrophysiol 2012; 5:e63-6. [PMID: 22715241 DOI: 10.1161/circep.112.971135] [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: 11/16/2022]
Abstract
Ablation of accessory tracts in the posteroseptal region can be challenging, as illustrated by these 2 cases. Familiarity of the anatomy of this region and recognition of the ECG patterns can help identify the AP origin and potentially improve success rates of ablation. The isoelectric initial preexcited QRS complex with rSR’ pattern in lead V1 of the surface ECG but not the relatively earlier local ventricular activation at PSMA region may indicate a left-sided ablation approach for these APs.
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Affiliation(s)
- Enzhao Liu
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Park J, Wi J, Joung B, Lee MH, Kim YH, Hwang C, Pak HN. Prevalence, risk, and benefits of radiofrequency catheter ablation at the aortic cusp for the treatment of mid- to anteroseptal supra-ventricular tachyarrhythmias. Int J Cardiol 2012; 167:981-6. [PMID: 22459399 DOI: 10.1016/j.ijcard.2012.03.082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 01/06/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Some outflow tract ventricular tachycardias (VTs) are known to be successfully ablated from the aortic cusp (AC). However, radiofrequency catheter ablation (RFCA) at the AC for the treatment of supraventricular tachyarrhythmia (SVT) has limited experience. METHODS We performed RFCA at the AC in 19 patients (male 64.7%, 46.9 ± 21.9 years old) with mid- to anteroseptal SVTs (12 atrial tachycardias [AT], 7 atrioventricular reciprocating tachycardia [AVRT]), and analyzed the prevalence, electrophysiologic findings, clinical outcome, and compilation risk. RESULTS 1. Among 113 patients with AT, 13 patients had mid- to anteroseptal AT and 12 patients (8.8%, 53.4 ± 19.8 years old, 58.3% female) underwent successful ablation from the non-coronary cusp (NCC; n=10), right CC (RCC; n=1) or left CC (LCC; n=1) without complication (3.1 ± 2.3 times RF delivery, 6.15 ± 3.08 s for termination). During 19.7 ± 9.8 months of follow-up, AT recurred in a patient with multiple foci. 2. Among 580 patients with AVRT, 27 patients had a mid- to anteroseptal bypass tract (4.7%), and 7 of them (1.1%, 2 pre-excitation syndrome, 5 concealed bypass tract) were successfully ablated at the NCC (n=2) or RCC (n=5) (7.0 ± 7.1 times RF delivery, 9.1 ± 4.4s for termination). Among 5 patients with AVRT successfully ablated at the RCC, one patient developed complete heart block 48 h after procedure, and 2 patients recurred AVRT or delta-wave in ECG during 13.9 ± 11.7 month follow-up. CONCLUSION Catheter ablation within the AC is an effective procedure to eliminate mid- to anteroseptal SVTs. However, RFCA on RCC requires a caution for heart block in our limited experience.
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Affiliation(s)
- Junbeom Park
- Yonsei University Health System, Seoul, Republic of Korea
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Wang Z, Liu T, Shehata M, Liang Y, Jin Z, Liang M, Han Y, Amorn A, Liu X, Liu E, Chugh SS, Wang X. Electrophysiological characteristics of focal atrial tachycardia surrounding the aortic coronary cusps. Circ Arrhythm Electrophysiol 2011; 4:902-8. [PMID: 21985795 DOI: 10.1161/circep.111.965640] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catheter ablation of atrial tachycardia (AT) arising near the coronary cusps has been reported in limited numbers of patients. We investigated the electrophysiological characteristics of these ATs in 22 consecutive patients. METHODS AND RESULTS This study included 22 patients (mean age ± SD, 53 ± 11 years; 86% female) with ATs arising near the aortic coronary cusps who underwent successful ablation. Activation mapping was performed during tachycardia to identify the earliest activation site. All patients achieved successful ablation through either a retrograde aortic (n=19) or a transseptal (n=3) approach. The successful ablation sites were located in the noncoronary cusp (NCC) (n=16), including 3 near the junction between the NCC and right coronary cusp. The remaining 6 cases were ablated from the left coronary cusp (LCC) (n=3) or the left atrium posterior to the LCC (n=3). For most tachycardias, there were distinctive P-wave morphological features recorded for each cusp location. Furthermore, analysis of the electrogram morphological features recorded during tachycardia at successful ablation sites revealed an atrial/ventricular (A/V) ratio >1 in 14 of 16 NCC ATs; the remaining 2, from the NCC near the junction with the right coronary cusp, showed an A/V ratio ≤ 1. At ablation sites in the LCC, the A/V ratio was <1 (4 of 6 patients) or 1 (remaining 2 patients). During a follow-up duration of 30 ± 13 months, all patients were free of arrhythmias without antiarrhythmic drugs. CONCLUSIONS ATs surrounding the aortic coronary cusps can be safely and effectively ablated, with good long-term outcomes. In addition to the P-wave morphological features, the A/V ratio of the local electrogram recording during tachycardia facilitated the localization of successful sites.
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Affiliation(s)
- Zulu Wang
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, People's Republic of China
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DEL CARPIO MUNOZ FREDDY, SYED FAISALF, NOHERIA AMIT, CHA YONGMEI, FRIEDMAN PAULA, HAMMILL STEPHENC, MUNGER THOMASM, VENKATACHALAM K, SHEN WINKUANG, PACKER DOUGLASL, ASIRVATHAM SAMUELJ. Characteristics of Premature Ventricular Complexes as Correlates of Reduced Left Ventricular Systolic Function: Study of the Burden, Duration, Coupling Interval, Morphology and Site of Origin of PVCs. J Cardiovasc Electrophysiol 2011; 22:791-8. [DOI: 10.1111/j.1540-8167.2011.02021.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Atrial tachycardia originating from the left coronary cusp near the aorto-mitral junction: anatomic considerations. Heart Rhythm 2010; 7:987-91. [PMID: 20230911 DOI: 10.1016/j.hrthm.2010.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 03/09/2010] [Indexed: 11/22/2022]
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Bala R, Garcia FC, Hutchinson MD, Gerstenfeld EP, Dhruvakumar S, Dixit S, Cooper JM, Lin D, Harding J, Riley MP, Zado E, Callans DJ, Marchlinski FE. Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure. Heart Rhythm 2010; 7:312-22. [DOI: 10.1016/j.hrthm.2009.11.017] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 11/13/2009] [Indexed: 10/20/2022]
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Macedo PG, Kapa S, Mears JA, Fratianni A, Asirvatham SJ. Correlative anatomy for the electrophysiologist: ablation for atrial fibrillation. Part II: regional anatomy of the atria and relevance to damage of adjacent structures during AF ablation. J Cardiovasc Electrophysiol 2010; 21:829-36. [PMID: 20158560 DOI: 10.1111/j.1540-8167.2010.01730.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ablation procedures for atrial fibrillation have become an established and increasingly used option for managing patients with symptomatic arrhythmia. The anatomic structures relevant to the pathogenesis of atrial fibrillation and ablation procedures are varied and include the pulmonary veins, other thoracic veins, the left atrial myocardium, and autonomic ganglia. Exact regional anatomic knowledge of these structures is essential to allow correlation with fluoroscopy and electrograms and, importantly, to avoid complications from damage of adjacent structures within the chest. We present this information as a series of 2 articles. In a prior issue, we have discussed the thoracic vein anatomy relevant to paroxysmal atrial fibrillation. In the present article, we focus on the atria themselves, the autonomic ganglia, and anatomic issues relevant for minimizing complications during atrial fibrillation ablation.
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Affiliation(s)
- Paula G Macedo
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Affiliation(s)
- Frank C. Chen
- From the Department of Medicine (F.C.C., S.J.A.), Division of Cardiovascular Diseases, and Department of Pediatric and Adolescent Medicine (S.J.A.), Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn
| | - Samuel J. Asirvatham
- From the Department of Medicine (F.C.C., S.J.A.), Division of Cardiovascular Diseases, and Department of Pediatric and Adolescent Medicine (S.J.A.), Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minn
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CHEN FRANKC, ASIRVATHAM SAMUELJ. Determining Arrhythmia Mechanism: Still Critical or Now Obsolete? Pacing Clin Electrophysiol 2010; 33:125-8. [DOI: 10.1111/j.1540-8159.2009.02618.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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