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Longmore L, Reddy YM, Sheldon SH. Masquerade: An unusual accessory pathway with ventricular insertion at the right-left sinus of Valsalva mimicking outflow tract ventricular tachycardia. HeartRhythm Case Rep 2022; 8:752-755. [PMID: 36618587 PMCID: PMC9811021 DOI: 10.1016/j.hrcr.2022.08.005] [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: 01/11/2023] Open
Affiliation(s)
| | | | - Seth H. Sheldon
- Address reprint requests and correspondence: Dr Seth Sheldon, Department of Cardiovascular Medicine, The University of Kansas Health System, 4000 Cambridge St, Kansas City, KS 66160.
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Hayashi T, Sekiguchi Y, Yamamoto S, Fujita H. ‘Vanishing’ fragmented potential at the epicardium in a patient with Brugada syndrome. BMJ Case Rep 2022; 15:15/7/e249054. [PMID: 35906039 PMCID: PMC9344993 DOI: 10.1136/bcr-2022-249054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A man in his 40s with Brugada syndrome underwent catheter ablation for ventricular fibrillation. When we performed epicardial mapping again to check for residual ablation sites after ablation, a remarkable reproducible fragmented potential was observed at the anterior aspect of the right ventricle using an Advisor HD Grid (Abbott), which had not been detected during the initial mapping before ablation, and which was invisible to the ablation catheter. Fluoroscopic imaging demonstrated a shiny area anterior to the heart, suggesting trapped air, presumed to have arisen when the sheath was inserted into the pericardial space. The air trapped between the heart and pericardium prevented the HD grid from contacting the epicardium, resulting in the recording of a fragmented potential. The trapped air was removed manually via the sheath, and the potential vanished. When fragmented potentials are observed at the anterior right ventricle (RV) in the epicardium, air trapping should be ruled out by fluoroscopy.
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Affiliation(s)
- Tatsuya Hayashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Kasumigaura Medical Center, Tsuchiura, Japan
| | - Shingo Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Itoh T, Tomita H. A response to the letter regarding the article, "Isolated prepotential preceding a presumed idiopathic premature ventricular contraction originating from the aortomitral continuity". J Cardiovasc Electrophysiol 2020; 31:1237. [PMID: 32128901 DOI: 10.1111/jce.14410] [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: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Taihei Itoh
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Kara M, Korkmaz A, Ozeke O, Cay S, Ozcan F, Topaloglu S, Aras D. Isolated prepotential during premature ventricular contraction at aortic cusps as a reflection of preferential conduction and successful ablation site or valvular closure artifact? J Cardiovasc Electrophysiol 2020; 31:1235-1236. [PMID: 32125021 DOI: 10.1111/jce.14409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Meryem Kara
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, Ankara City Hospital, Health Sciences University, Ankara, Turkey
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Abstract
Arrhythmias arising from the ventricular outflow tracts are commonly encountered. Although largely benign, they can also present with heart failure and sudden cardiac death. Mapping and ablation of these arrhythmias is commonly performed in the electrophysiology laboratory with a high success rate, but occasionally can prove challenging to abolish. This article discusses the mapping and ablation of outflow tract arrhythmias and the challenges that can be overcome by a systematic approach.
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Affiliation(s)
- Magdi M Saba
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK.
| | - Anthony Li
- Cardiology Clinical Academic Group, St. George's University of London, Cranmer Terrace, London SW17 OQT, UK
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Martinez-Alday JD, Arcocha-Torres MF, Gaztañaga-Arantzamendi L, Zamarreño-Golvano E, Ormaetxe-Merodio JM. Pulmonic Valve Closure Artifact During Right Ventricular Outflow Tract Mapping. JACC Clin Electrophysiol 2019; 5:1098-1099. [PMID: 31537344 DOI: 10.1016/j.jacep.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/06/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Mari Fe Arcocha-Torres
- Cardiovascular Area, Electrophisology Section, Hospital Universitario de Basurto, Bilbao, Bizkaia, Spain
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Di Biase L, Romero J, Zado ES, Diaz JC, Gianni C, Hranitzki PM, Sanchez JE, Mohanty S, Al-Ahmad A, Mohanty P, Trivedi C, Della Rocca D, Santangeli P, Burkhardt JD, Garcia FC, Marchlinski FE, Natale A. Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin. Heart Rhythm 2019; 16:724-732. [DOI: 10.1016/j.hrthm.2018.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Indexed: 10/27/2022]
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Kancharla K, Munger TM, Nishimura RA, Deshmukh A, Packer DL, Asirvatham SJ, Kapa S. Identification of valve-related artifact during cardiac mapping. J Interv Card Electrophysiol 2017; 50:159-167. [PMID: 29047005 DOI: 10.1007/s10840-017-0293-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/11/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE During cardiac mapping, it is critical to discriminate signals related to cardiac conduction versus those due to mechanical interaction with other cardiac structures such as valves. We sought to define characteristics that could facilitate discrimination of valve artifact from cardiac conduction signals. METHODS Patients with structurally normal heart undergoing mapping for ventricular arrhythmias arising from the vicinity of the aortic valve between January 2013 and May 2015 were included. Potentials felt to reflect aortic valve opening (occurring at the end of the QRS after the local ventricular signal) were termed A1, and those felt to reflect valve closure were termed A2. RESULTS A total of 24 patients had mapping in the sinuses of Valsalva, and 10 (average age 40 + 15, 60% male) were found to have additional signals (A1 and/or A2) notable during mapping. In all patients, intervals between A1 and A2 shortened after ectopic beats and lengthened after compensatory pauses. These variations in the interval matched the change in systolic duration on Doppler echocardiography. Overdrive atrial pacing was performed in four patients, which demonstrated progressive shortening of intervals between A1 and A2. Pacing always revealed local capture without affecting A1 or A2. In the one patient in whom ablation was performed in these areas, there was no effect on A1 or A2, suggesting these signals represented artifact. CONCLUSIONS Valve-related signals in the aortic sinuses are commonly seen and can be distinguished. The interval between A1 and A2 correlated with mechanical systole and varied in a physiologically predictable manner with heart rate changes.
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Affiliation(s)
- Krishna Kancharla
- Department of Cardiology and Cardiac Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Cardiovascular Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas M Munger
- Department of Cardiology and Cardiac Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rick A Nishimura
- Department of Cardiology and Cardiac Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Abhishek Deshmukh
- Department of Cardiology and Cardiac Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Douglas L Packer
- Department of Cardiology and Cardiac Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiology and Cardiac Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Suraj Kapa
- Department of Cardiology and Cardiac Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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