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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki YK, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. Circ J 2024; 88:1509-1595. [PMID: 37690816 DOI: 10.1253/circj.cj-22-0827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center
| | - Masaomi Chinushi
- School of Health Sciences, Niigata University School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine
| | - Kaoru Tanno
- Cardiology Division, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of Cardiology, Tokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, International University of Health and Welfare, Mita Hospital
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hirotaka Yada
- Department of Cardiology, International University of Health and Welfare, Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
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2
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Nagashima K, Michaud GF, Ho RT, Okumura Y. SVT quest: The adventure diagnosing narrow QRS tachycardia. J Arrhythm 2024; 40:767-785. [PMID: 39139886 PMCID: PMC11317754 DOI: 10.1002/joa3.13112] [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: 05/11/2024] [Revised: 06/19/2024] [Accepted: 06/30/2024] [Indexed: 08/15/2024] Open
Abstract
In the field of cardiac electrophysiology, there is a universal desire: the discovery of a flawless diagnostic maneuver for supraventricular tachycardias (SVTs). This is not merely a wish but a shared odyssey. To improve diagnostic accuracy and achieve sufficient sensitivity and specificity, numerous diagnostic maneuvers have been proposed. However, each has its limitations and prompts a search for new diagnostic techniques. This continuous cycle of discovery and refinement, which we titled "SVT Quest" is reviewed in chronological sequence. This adventure in diagnosing narrow QRS tachycardia unfolds in 3 steps: Step 1 involves differentiating atrial tachycardia from other SVTs based on the observations such as V-A-V or V-A-A-V response, ΔAA interval, VA linking, the last entrainment sequence, and response to the atrial extrastimulus. Step 2 focuses on differentiating orthodromic reciprocating tachycardia from atrioventricular nodal reentrant tachycardia based on the observations such as tachycardia reset upon the premature ventricular contraction during His refractoriness, uncorrected/corrected postpacing interval, differential ventricular entrainment, orthodromic His capture, transition zone analysis, and total pacing prematurity. Step 3 characterizes the concealed nodoventricular/nodofascicular pathway and His-ventricular pathway-related tachycardia based on observations such as V-V-A response, ΔatrioHis interval, and paradoxical reset phenomenon. There is no single diagnostic maneuver that fits all scenarios. Therefore, the ability to apply multiple maneuvers in a case allows the operator to accumulate evidence to make a likely diagnosis. Let's embark on this adventure!
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Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Gregory F. Michaud
- Division of Cardiovascular MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Reginald T. Ho
- Division of Cardiology, Department of MedicineThomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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3
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Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki Y, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. J Arrhythm 2024; 40:655-752. [PMID: 39139890 PMCID: PMC11317726 DOI: 10.1002/joa3.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and GeneticsNational Cerebral and Cardiovascular Center
| | | | - Shinji Koba
- Division of Cardiology, Department of MedicineShowa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | | | - Kaoru Tanno
- Cardiovascular Center, Cardiology DivisionShowa University Koto‐Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of CardiologyTokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Toshio Kinoshita
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, Mita HospitalInternational University of Health and Welfare
| | - Nobuyuki Masaki
- Department of Intensive Care MedicineNational Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | - Hirotaka Yada
- Department of CardiologyInternational University of Health and Welfare Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular MedicineNippon Medical School
| | - Takeshi Kimura
- Cardiovascular MedicineKyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of MedicineUniversity of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric CardiologySaitama Medical University International Medical Center
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4
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Hirata S, Nagashima K, Kaneko Y, Tamura S, Mori H, Nishiuchi S, Tokuda M, Kawaji T, Hayashi T, Nishimura T, Fukunaga M, Kishihara J, Fukaya H, Teranishi J, Takami M, Okada M, Miyazaki N, Watanabe R, Wakamatsu Y, Okumura Y. Recurrent episodes of atrioventricular nodal reentrant tachycardia: Sites of ablation success, ablation endpoint, and primary culprits for recurrence. J Arrhythm 2024; 40:552-559. [PMID: 38939776 PMCID: PMC11199834 DOI: 10.1002/joa3.13060] [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: 12/07/2023] [Revised: 03/12/2024] [Accepted: 05/02/2024] [Indexed: 06/29/2024] Open
Abstract
Background Atrioventricular nodal reentrant tachycardia (AVNRT) sometimes recurs even after anatomical slow pathway (SP) ablation targeting the rightward inferior extension (RIE). This multicenter study aimed to determine the reasons for AVNRT recurrence. Methods and Results Forty-six patients were treated successfully for recurrent AVNRT. Initial treatment was for 38 slow-fast AVNRTs, 3 fast-slow AVNRTs, 2 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 noninducible AVNRT. All initial treatments were of RF application to the RIE; SP elimination was achieved in 11, dual AVN physiology was seen in 29, and AVNRT remained inducible in 5. The recurrent AVNRTs included 34 slow-fast AVNRTs, 6 fast-slow AVNRTs, 3 slow-slow AVNRTs, 2 slow-fast and fast-slow AVNRTs, and 1 slow-fast and slow-slow AVNRTs. Successful ablation site was within the RIE in 39 and left inferior extension in 7. In 30 of 39, the successful RIE site was in the same area or higher than that of the initial procedure. Conclusion For a high majority (around 85%) of patients in whom AVNRT recurs after initial ablation success, the site of a second successful procedure will be within the RIE even though the RIE was originally targeted. Furthermore, a high majority (around 86%) of sites of successful ablation will be higher than those originally targeted.
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Affiliation(s)
- Shu Hirata
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yoshiaki Kaneko
- Department of Cardiovascular MedicineGunma University Graduate School of MedicineMaebashiJapan
| | - Shuntaro Tamura
- Department of Cardiovascular MedicineGunma University Graduate School of MedicineMaebashiJapan
| | - Hitoshi Mori
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | | | - Michifumi Tokuda
- Department of CardiologyThe Jikei University School of MedicineTokyoJapan
| | - Tetsuma Kawaji
- Department of CardiologyMitsubishi Kyoto HospitalKyotoJapan
| | - Tatsuya Hayashi
- Division of Cardiovascular Medicine, Saitama Medical CenterJichi Medical UniversityShimotsukeJapan
| | - Takuro Nishimura
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Masato Fukunaga
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Jun Kishihara
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Hidehira Fukaya
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Jin Teranishi
- Department of Cardiovascular MedicineJapanese Red Cross Society Himeji HospitalHimejiJapan
| | - Mitsuru Takami
- Division of Cardiovascular MedicineKobe University Graduate School of MedicineKobeJapan
| | - Masato Okada
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Naoko Miyazaki
- Cardiovascular CenterSakurabashi Watanabe HospitalOsakaJapan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of MedicineTokyoJapan
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Nagashima K. One-Shot Diagnosis for Atrial Tachycardia: The Utility of a Single Atrial Extrastimulus. JACC Clin Electrophysiol 2024; 10:1132-1134. [PMID: 38703166 DOI: 10.1016/j.jacep.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/25/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
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Suzuki K, Aoki K, Sato E, Yamashina Y, Ishida A, Yagi T. Narrow QRS tachycardia in a patient with recurrence years after "rightward inferior extension" ablation: What is the mechanism? Pacing Clin Electrophysiol 2024; 47:782-785. [PMID: 38761057 DOI: 10.1111/pace.15002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Keisuke Suzuki
- Department of Cardiovascular Medicine, Sendai City Hospital, Sendai, Japan
| | - Kosuke Aoki
- Department of Cardiovascular Medicine, Sendai City Hospital, Sendai, Japan
| | - Eiji Sato
- Department of Cardiovascular Medicine, Sendai City Hospital, Sendai, Japan
| | | | - Akihiko Ishida
- Department of Cardiovascular Medicine, Sendai City Hospital, Sendai, Japan
| | - Tetsuo Yagi
- Department of Cardiovascular Medicine, Sendai City Hospital, Sendai, Japan
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Preda A, Testoni A, Baroni M, Mazzone P, Gigli L. Atrial tachycardia ablation through the sub-pulmonary ventricle in a patient with multiple malformations associated with congenitally corrected transposition of the great arteries and double-sided slow-pathway. Clin Case Rep 2024; 12:e8745. [PMID: 38659502 PMCID: PMC11039486 DOI: 10.1002/ccr3.8745] [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: 09/04/2023] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
A 46-year-old woman with congenitally corrected transposition of the great arteries (ccTGA) associated with dextrocardia, situs viscerus inversus, and left superior vena cava persistence presented with an incessant supraventricular tachycardia. Electrophysiological study was not conclusive in differential diagnosis of atrial tachycardia versus atypical atrioventricular (AV) nodal reentrant tachycardia, also due to the unconventional anatomy of the coronary sinus. By a comprehensive mapping of cardiac chambers, a double side slow-pathway was localized in both atrial chambers and subsequently ablated by radiofrequency delivery without tachycardia changes. Aortic root and cusps were devoid of electrical activity. The muscular part of the sub-pulmonary ventricle at the level of interatrial septum showed an earliest activation signal of -90 ms and ablation of this site was effective in abolish the tachycardia. This is the first case to report technical concerns of septal atrial tachycardia ablation in ccTGA associated with multiple anatomical malformations. Moreover, some peculiarities have been reported for the first time including the presence of double-side AV nodal slow-pathway and atypical localization of the tachycardia origin into the muscular part of the sub-pulmonary ventricle instead of posterior pulmonary cusp.
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Affiliation(s)
- Alberto Preda
- Cardio‐Thoraco‐Vascular Department, Electrophysiology UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Alessio Testoni
- Cardio‐Thoraco‐Vascular Department, Electrophysiology UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Matteo Baroni
- Cardio‐Thoraco‐Vascular Department, Electrophysiology UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Patrizio Mazzone
- Cardio‐Thoraco‐Vascular Department, Electrophysiology UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Lorenzo Gigli
- Cardio‐Thoraco‐Vascular Department, Electrophysiology UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
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8
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Yamagami S, Nishiuchi S, Kaneko Y, Kondo H, Tamura T. Successful cryoablation of an atypical slow-slow atrioventricular nodal reentrant tachycardia utilizing a superior slow pathway. HeartRhythm Case Rep 2023; 9:624-628. [PMID: 37746566 PMCID: PMC10511899 DOI: 10.1016/j.hrcr.2023.06.007] [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: 09/26/2023] Open
Affiliation(s)
| | | | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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9
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Matsumoto K, Mori H, Nagashima K, Kaneko Y, Kato R. Fast-slow atrioventricular nodal re-entrant tachycardia incorporating superior and inferolateral left atrial slow pathways. J Cardiovasc Electrophysiol 2023; 34:2002-2005. [PMID: 37526239 DOI: 10.1111/jce.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND A 70-year-old man revealed a rare type of atrioventricular nodal re-entrant tachycardia (AVNRT) involving distinct retrograde pathways, superior slow pathway, and inferolateral left atrial slow pathway. RESULT Radiofrequency ablation was successfully performed on the noncoronary cusp and in the left atrium, respectively, to eliminate the tachycardias. DISCUSSION AND CONCLUSION Due to the anomalous electrical conduction patterns, careful diagnosis and ablation strategies were necessary to avoid the risk of atrioventricular block. These findings underscore the diversity and complexity of AVNRT and highlight the importance of tailored therapeutic approaches.
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Affiliation(s)
- Kazuhisa Matsumoto
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka-city, Saitama, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka-city, Saitama, Japan
| | - Koichi Nagashima
- Department of Medicine, Division of Cardiology, Nihon University School of Medicine, Bunkyo City, Tokyo, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medicine, Gunma University, Maebashi, Gunma, Japan
| | - Ritsushi Kato
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka-city, Saitama, Japan
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10
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Aslani A, Shahrzad S, Bazrafshan M, Rahmanian M, Fakhar R, Pirahesh K, Bazrafshan H, Bazrafshan H. Optimal method for ablation of atypical AVNRT. BMC Cardiovasc Disord 2023; 23:264. [PMID: 37208638 DOI: 10.1186/s12872-023-03305-9] [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: 11/18/2022] [Accepted: 05/16/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Considering that ablation of atypical AVNRT may be unsuccessful after ablation at the right posterior septum, in this study, we aimed to present an optimal method for ablation of atypical AVNRT. Also, we evaluated the efficacy of this technique for preventing recurrences. METHODS This is a prospective, double-center study. It was conducted on 62 patients with atypical AVNRT referred for radiofrequency ablation. The patients were randomly divided into two groups before ablation: 1-Group A (n = 30): treated with conventional ablation at the anatomic area of the slow pathway; 2-Group B (n = 32): ablation was done 2 mm higher in the septum during fluoroscopy. RESULTS The mean age of patients in groups A and B were 54 ± 11.7 and 55 ± 12.2, respectively (P = 0.43). In group A, ablation was successful in 24 (80%) patients following right-sided slow pathway ablation, and the remaining patients required further treatment with either a left-side approach (N = 4, 13.3%) or ablation of additional regions (N = 2, 6.7%). In group B, ablation was successful in all patients. After a 48-month follow-up, recurrence of symptomatic atypical AVNRT was detected in 4 (13.3%) patients of group A and none of group B patients (p < 0.001). CONCLUSION In patients with atypical AVNRT, ablation 2 mm above the conventional area is more promising regarding success rate and recurrence of the arrhythmia.
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Affiliation(s)
- Amir Aslani
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mehdi Bazrafshan
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Rahmanian
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fakhar
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hanieh Bazrafshan
- Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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11
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Arai H, Nakamura R, Sagawa Y, Oda A, Murata K, Okishige K, Goya M, Sasano T, Aonuma K, Yamauchi Y. Retrograde fast pathway cryoablation inside the coronary sinus for slow-fast atrioventricular nodal reentrant tachycardia in a patient with persistent left superior vena cava. J Cardiovasc Electrophysiol 2023; 34:478-482. [PMID: 36579408 DOI: 10.1111/jce.15795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Persistent left superior vena cava (PLSVC) is accompanied by enlarged coronary sinus (CS) and deformation of the triangle of Koch. This makes anatomical evaluation of the atrioventricular (AV) nodal pathways difficult. METHODS We attempted cryoablation of retrograde fast pathway located in the enlarged CS roof of PLSVC for slow-fast AV nodal reentrant tachycardia (AVNRT) induced by inadvertent antegrade fast pathway elimination during ablation of left atrial tachycardia. RESULTS Slow-fast AVNRT was successfully eliminated without AV block progression. CONCLUSIONS This is the first case of successful retrograde fast pathway ablation of the CS ostial roof for slow-fast AVNRT with PLSVC.
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Affiliation(s)
- Hirofumi Arai
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Rena Nakamura
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Atsuhito Oda
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Kazuya Murata
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Kaoru Okishige
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Ibaraki, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
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12
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Doi A, Nakano W, Ashida T, Yamada T. A long RP tachycardia with the earliest atrial activation at the His bundle region: What is the mechanism? J Cardiovasc Electrophysiol 2022; 33:2667-2669. [PMID: 36259714 DOI: 10.1111/jce.15711] [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: 10/05/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Atsushi Doi
- Department of Cardiovascular Medicine, Otemae Hospital, Osaka, Japan
| | - Wataru Nakano
- Department of Cardiovascular Medicine, Otemae Hospital, Osaka, Japan
| | - Tasuku Ashida
- Department of Cardiovascular Medicine, Otemae Hospital, Osaka, Japan
| | - Takayuki Yamada
- Department of Cardiovascular Medicine, Otemae Hospital, Osaka, Japan
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13
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Matsunaga-Lee Y, Egami Y, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Yano M, Nishino M, Tanouchi J. A narrow QRS tachycardia with an atrial sequence not identical to that during ventricular pacing: what is the mechanism? J Cardiovasc Electrophysiol 2022; 33:2104-2106. [PMID: 35930624 DOI: 10.1111/jce.15646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 12/01/2022]
Abstract
A 53-year-old man was referred to our hospital because of symptomatic palpitations This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
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Kaneko Y, Nakajima T, Tamura S, Nagashima K, Kobari T, Hasegawa H, Ishii H. Discrimination of atypical atrioventricular nodal reentrant tachycardia from atrial tachycardia by the V-A-A-V response. Pacing Clin Electrophysiol 2022; 45:839-852. [PMID: 35661184 DOI: 10.1111/pace.14540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The electrophysiological discrimination between fast-slow (F/S-) atrioventricular (AV) nodal reentrant tachycardia (NRT) and atrial tachycardia (AT) originating from the interatrial septum remains challenging. While a V-A-A-V response may occur immediately after ventricular induction or entrainment of either tachycardia, the electrophysiological dissimilarities in that response between the two tachycardias remain unclear. The purpose of this study was to identify a diagnostic indicator discriminating F/S-AVNRT from AT by examining the difference in the V-A-A-V response between the two tachycardias. METHODS This retrospective study included 17 patients with F/S-AVNRT [7 with common-form F/S-AVNRT using a typical slow pathway (SP) and 10 with superior type F/S-AVNRT using a superior SP] and 10 patients with reentrant AT. All 27 patients presented with long RP supraventricular tachycardia and an initial V-A-A-V response upon ventricular induction or entrainment. The V-A-A-V response in patients with F/S-AVNRT was due to dual atrial responses. We measured the interval between the first (A1) and second atrial electrogram (A2) of V-A-A-V and calculated ΔAA by subtracting A1-A2 from the tachycardia cycle length. RESULTS V-A-A-V responses were observed most often upon ventricular induction of F/S-AVNRT (6±5 times) as well as AT (6±6 times; P = 0.87). The V-A-A-V response upon ventricular entrainment was observed in a single patient with F/S-AVNRT versus 10 all patients with AT (P<0.001). ΔAA ranged between -80 and 228 ms in F/S-AVNRT and between -184 and 26 ms in AT. A ΔAA >26 ms predicted a diagnosis of F/S-AVNRT with a 76% sensitivity and 100% specificity, while a ΔAA ←80 ms predicted a diagnosis of AT with a 50% sensitivity and 100% specificity. CONCLUSIONS ΔAA is a useful, confirmatory, diagnostic indicator of F/S-AVNRT versus AT associated with the V-A-A-V response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Koichi Nagashima
- Division of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Kawada S, Nishii N, Asada S, Nakagawa K, Morita H, Ito H. Successful ablation of a superior fast-slow atrioventricular reentrant tachycardia in a patient with congenitally corrected transposition of great arteries. HeartRhythm Case Rep 2021; 7:698-701. [PMID: 34712569 PMCID: PMC8530927 DOI: 10.1016/j.hrcr.2021.07.008] [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: 11/20/2022] Open
Affiliation(s)
- Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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16
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Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Ishii H. Pacing site- and rate-dependent shortening of retrograde conduction time over the slow pathway after atrial entrainment of fast-slow atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2021; 32:2979-2986. [PMID: 34535933 PMCID: PMC9293002 DOI: 10.1111/jce.15242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
Introduction We tested our hypothesis that atrial entrainment pacing (EP) of a) the common‐type (com‐) fast‐slow (F/S‐) atypical atrioventricular nodal reentrant tachycardia (AVNRT) using a typical slow pathway (SP), or b) the superior‐type (sup‐) F/S‐AVNRT using a superior SP, both modify the retrograde conduction time across the SP immediately after termination of EP (retro‐SP‐time). Methods We measured the difference in the His‐atrial interval (HA difference) immediately after cessation of EP, performed at 2 ± 2 rates from the high right atrium (HA[1]‐HRA) versus from the proximal coronary sinus (HA[1]‐CS) in 17 patients with com‐F/S‐AVNRT and 11 patients with sup‐F/S‐AVNRT. We also measured the atrial‐His and HA intervals of the first and second cycles immediately after cessation of EP and during stable tachycardia. Results Unequal responses, defined as a ≥ 20‐ms HA difference at ≥1 EP rates, were observed in 16 patients (57%), including 7 with com‐ and 9 with sup‐F/S‐AVNRT. Irrespective of the EP rate, all unequal responses of com‐F/S‐AVNRT were due to a shorter HA[1]‐CS than HA[1]‐HRA, with a mean 34 ± 11 ms HA difference, whereas all unequal responses of sup‐F/S‐AVNRT were due to a longer HA[1]‐CS than HA[1]‐HRA, with a mean 49 ± 25 ms HA difference. The unequal responses resolved within two cycles after the cessation of EP. Conclusions We have identified a little‐known pacing site‐ and pacing rate‐dependent shortening of the retro‐SP‐time.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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17
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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18
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Tobiume T, Kato R, Matsuura T, Matsumoto K, Hara M, Takamori N, Taketani Y, Okawa K, Ise T, Kusunose K, Yamaguchi K, Yagi S, Fukuda D, Yamada H, Wakatsuki T, Soeki T, Sata M, Matsumoto K. Antegrade slow pathway mapping of typical atrioventricular nodal reentrant tachycardia based on direct slow pathway capture. J Arrhythm 2021; 37:128-139. [PMID: 33664895 PMCID: PMC7896471 DOI: 10.1002/joa3.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/14/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiofrequency (RF) ablation of typical atrioventricular nodal reentrant tachycardia (tAVNRT) is performed without revealing out the location of antegrade slow pathway (ASp). In this study, we studied a new electrophysiological method of identifying the site of ASp. METHODS This study included 19 patients. Repeated series of very high-output single extrastimulations (VhoSESts) were delivered at the anatomical slow pathway region during tAVNRT. Tachycardia cycle length (TCL), coupling interval (CI), and return cycle (RC) were measured and the prematurity of VhoSESts [ΔPM (= TCL - CI)] and the prolongation of RCs [ΔPL (= RC - TCL)] were calculated. Pacing sites were classified into two categories: (i) ASp capture sites [DSPC(+) sites], where two different RCs were shown, and ASp non-capture sites [DSPC(-) sites], where only one RC was shown. RF ablation was performed at DSPC(+) sites and/or sites with catheter-induced mechanical trauma (CIMT) to ASp. RESULTS DSPC(+) sites were shown in 13 patients (68%). RF ablation was successful in all patients without any degree of atrioventricular block nor recurrence. Total number of RF applications was 1.8 ± 1.1. Minimal distance between successful ablation sites and DSPC(+)/CIMT sites and His bundle (HB) electrogram recording sites was 1.9 ± 0.8 mm and 19.8 ± 6.1 mm, respectively. ΔPL of more than 92.5 ms, ΔPL/TCL of more than 0.286, and ΔPL/ΔPM of more than 1.565 could identify ASp with sensitivity of 100%, 91.1%, and 88.9% and specificity of 92.9%, 97.0%, and 97.6%, respectively. CONCLUSIONS Sites with ASp capture and CIMT were close to successful ablation sites and could be useful indicators of tAVNRT ablation.
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Affiliation(s)
- Takeshi Tobiume
- Department of CardiologyTokushima University HospitalTokushimaJapan
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
- Department of CardiologyKawashima HospitalTokushimaJapan
- Department of CardiologyShikoku Medical Center for Children and AdultsZentsujiJapan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
| | - Tomomi Matsuura
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | | | - Motoki Hara
- Hara Clinic Higashi‐HiroshimaHigashi‐HiroshimaJapan
| | | | - Yoshio Taketani
- Department of CardiologyShikoku Medical Center for Children and AdultsZentsujiJapan
| | - Keisuke Okawa
- Department of CardiologyKagawa Prefectural Central HospitalTakamatsuJapan
| | - Takayuki Ise
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Kenya Kusunose
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Koji Yamaguchi
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Shusuke Yagi
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Daijyu Fukuda
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Hirotsugu Yamada
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | | | - Takeshi Soeki
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Masataka Sata
- Department of CardiologyTokushima University HospitalTokushimaJapan
| | - Kazuo Matsumoto
- Department of CardiologySaitama Medical University International Medical CenterHidakaJapan
- Department of Internal MedicineHigashi‐Matsuyama Medical Association HospitalHigashimatsuyamaJapan
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20
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Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Kurabayashi M. V-A-A-V activation sequence followed by an induction of long RP tachycardia: What is the mechanism? J Cardiovasc Electrophysiol 2020; 32:540-544. [PMID: 33337572 DOI: 10.1111/jce.14844] [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: 11/27/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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21
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Bogossian H, Bimpong-Buta NY, Müller P. Touching the Membranous Septum: A Thin Line between Treating and Threatening? Cardiology 2020; 146:238-239. [PMID: 33348336 DOI: 10.1159/000510349] [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: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Harilaos Bogossian
- Department of Cardiology and Rhythmology, Evangelisches Krankenhaus Hagen, Hagen, Germany, .,Department of Cardiology, Witten/Herdecke University, Witten, Germany,
| | - Nana-Yaw Bimpong-Buta
- Department of Cardiology and Rhythmology, Evangelisches Krankenhaus Hagen, Hagen, Germany
| | - Patrick Müller
- Department of Cardiology II - Electrophysiology, Universitätsklinikum Münster, Münster, Germany
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22
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Kaneko Y, Nakajima T, Tamura S, Hasegawa H, Kobari T, Iizuka T, Kurabayashi M. Superior-Type Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Phenotype Mimicking the Slow-Fast Type. Circ Arrhythm Electrophysiol 2020; 13:e008732. [PMID: 33000970 DOI: 10.1161/circep.120.008732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Superior-type fast-slow (sup-F/S-) atrioventricular nodal reentrant tachycardia (AVNRT) is a rare AVNRT variant using a superior slow pathway (SP) as the retrograde limb. Its intracardiac appearance, characterized by a short atrio-His (AH) interval and the earliest site of atrial activation in the His-bundle, is an initial indicator for making a diagnosis. METHODS Among 22 consecutive patients with sup-F/S-AVNRT, 3 (age, 68-81 years) patients had an apparent slow-fast (S/F-) AVNRT characterized by a long AH interval and the earliest site of atrial activation in or superior to the His-bundle region (tachy-long-AH). RESULTS The diagnosis of sup-F/S-AVNRT was based on the standard criteria in 2 patients and on the occurrence of Wenckebach-type atrioventricular block during tachycardia, which was attributable to a block at the lower common pathway (LCP) below the circuit of the AVNRT, detected owing to the lower common pathway potentials, in one patient. As with the typical S/F-AVNRT, tachy-long-AH was induced after a jump in the AH interval. In contrast to typical S/F-AVNRT, fluctuation in the ventriculoatrial interval was observed during the tachy-long-AH. Ventricular overdrive pacing was unable to entrain or terminate the tachy-long-AH. Moreover, the tachy-long-AH reciprocally transited to/from sup-F/S-AVNRT spontaneously or was triggered by ventricular contractions while the atrial cycle length and earliest site of atrial activation remained unchanged. Both tachycardias were cured by ablation at a single site in the right-side para-Hisian region of 2 patients and the noncoronary aortic cusp of one patient. Collectively, the essential circuit of both tachycardias was identical, and the tachy-long-AH was diagnosed as another phenotype of sup-F/S-AVNRT accompanied by sustained antegrade conduction via another bystander slow pathway breaking through the His-bundle owing to the repetitive antegrade block at the lower common pathway, thus representing a long AH interval during the ongoing sup-F/S-AVNRT. CONCLUSIONS An unknown sup-F/S-AVNRT phenotype exists that apparently mimics the typical S/F-AVNRT and is also an unknown subtype of apparent S/F-AVNRT.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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23
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A long RP supraventricular tachycardia with the earliest atrial activation at the His-bundle region: What is the ablation target? Heart Rhythm 2020; 18:142-144. [PMID: 32645480 DOI: 10.1016/j.hrthm.2020.06.036] [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: 06/13/2020] [Revised: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022]
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24
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Iizuka T, Nakajima T, Tamura S, Hasegawa H, Kobari T, Nakahara S, Kurabayashi M, Kaneko Y. Simple differential entrainment screens ablation strategy for slow-fast atrioventricular nodal reentrant tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:671-679. [PMID: 32469105 DOI: 10.1111/pace.13946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/13/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation of slow-fast atrioventricular nodal reentrant tachycardia (S/F-AVNRT) is occasionally refractory. We hypothesized that the site of ablation for curing S/F-AVNRT can be screened by simple differential atrial entrainment pacing (EP) from the high right atrium (HRA) and proximal coronary sinus (prox-CS). METHODS We enrolled 43 patients with S/F-AVNRT who underwent successful differential atrial EP followed by successful ablation of slow pathway (SP) using step-wise approach, and compared the atrio-His (A-H) interval at the recording of His bundle immediately after EP from the HRA [A-H(HRA)], with the interval between atrial deflection at the prox-CS and His bundle electrogram after EP at an identical cycle length from the prox-CS [A-H (prox-CS)]. RESULTS A typical A-H(CS) shorter than A-H(HRA), consistent with typical SP conduction, was observed in 39 patients (91%), and an atypical A-H(HRA) shorter than A-H(CS) was observed in 4 patients (9%). Successful ablation was obtained at the posteroseptum/midseptum in 32/7 patients with typical responses but only at the midseptum in all 4 patients with atypical responses (P = .0027). The atypical responses predicted a necessity for ablation at the midseptum, with positive and negative predictive values of 100% and 82%, respectively. The mechanism of an atypical response remains unclear but may involve an anatomical variation of Koch's triangle and/or the participation of a variant of the SP, including the superior SP, over which retrograde conduction was observed more frequently in patients with atypical responses (P = .0013). CONCLUSIONS Differential atrial EP predicts the ablation site for successfully curing S/F-AVNRT.
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Affiliation(s)
- Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Hospital, Koshigaya, Saitama, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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25
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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26
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Weiss M, Ho RT. Pathophysiology, Diagnosis, and Ablation of Atrioventricular Node-dependent Long-R-P Tachycardias. J Innov Card Rhythm Manag 2020; 11:4046-4053. [PMID: 32368379 PMCID: PMC7192137 DOI: 10.19102/icrm.2020.110306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/17/2019] [Indexed: 11/15/2022] Open
Abstract
Atrioventricular (AV) node–dependent long-R–P tachycardias are a unique group of supraventricular tachycardias that include atypical AV nodal reentrant tachycardia (AVNRT), atypical AVNRT with a concealed bystander nodofascicular (NF)/nodoventricular (NV) accessory pathway inserting into the slow pathway of the AV node, the permanent form of junctional reciprocating tachycardia, and orthodromic NF/NV reciprocating tachycardia. Here, we discuss the complex pathophysiology, diagnosis, and ablation of these intriguing arrhythmias.
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Affiliation(s)
- Max Weiss
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Reginald T Ho
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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27
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Tamura S, Nakajima T, Iizuka T, Hasegawa H, Kobari T, Kurabayashi M, Kaneko Y. Unique electrophysiological properties of fast‐slow atrioventricular nodal reentrant tachycardia characterized by a shortening of retrograde conduction time via a slow pathway manifested during atrial induction. J Cardiovasc Electrophysiol 2020; 31:1420-1429. [DOI: 10.1111/jce.14501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shuntaro Tamura
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Tadashi Nakajima
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Takashi Iizuka
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Takashi Kobari
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular MedicineGunma University Graduate School of Medicine Maebashi Gunma Japan
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28
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Watanabe T, Imai Y. A Novel Concept in AVNRT. Int Heart J 2020; 61:199-200. [PMID: 32224601 DOI: 10.1536/ihj.20-066] [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: 11/18/2022]
Affiliation(s)
| | - Yasushi Imai
- Division of Cardiovascular Medicine, Jichi Medical University
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29
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Kaneko Y, Nakajima T, Iizuka T, Tamura S, Hasegawa H, Kurabayashi M. Atypical Slow-Slow Atrioventricular Nodal Reentrant Tachycardia with Use of a Superior Slow Pathway. Int Heart J 2020; 61:380-383. [PMID: 31875615 DOI: 10.1536/ihj.19-082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of atypical slow-slow atrioventricular nodal reentrant tachycardia (AVNRT) utilizing a superior slow pathway as a retrograde limb. The standard electrophysiological criteria confirm the diagnosis of this AVNRT by successfully excluding a diagnosis of atrial tachycardia and atrioventricular reentrant tachycardia. The earliest atrial activation during tachycardia was found at the interatrial septum 17.5 mm superior to the site identified during retrograde conduction with the fast pathway. The tachycardia was not inducible after ablation at the right posterior septum, consistent with successful ablation of the typical slow pathway.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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30
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Chen Q, Liu Q, Jiang C. Supraventricular tachycardia with atrial activation earliest at the His bundle region-What is the mechanism? J Cardiovasc Electrophysiol 2019; 30:2535-2538. [PMID: 31471987 DOI: 10.1111/jce.14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022]
Abstract
A 70-year-old man with recurrent symptomatic supraventricular tachycardia was referred for catheter ablation. Atrial activation was earliest at the His bundle region with HA longer than AH.
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Affiliation(s)
- Qiufan Chen
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qiang Liu
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenyang Jiang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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31
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Kaneko Y, Nakajima T, Tamura S, Kurabayashi M. Superior-type fast-slow atrioventricular nodal reentrant tachycardia with a 2:1 atrioventricular block. J Cardiovasc Electrophysiol 2019; 30:1696-1698. [PMID: 31257626 DOI: 10.1111/jce.14054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/07/2019] [Accepted: 06/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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32
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Kaneko Y, Nakajima T, Iizuka T, Tamura S, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Using a Slow Pathway Extending to the Superoanterior Right Atrium. Int Heart J 2019; 60:756-760. [PMID: 31105156 DOI: 10.1536/ihj.18-528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case of atypical fast-slow atrioventricular nodal reentrant tachycardia (AVNRT) using a slow pathway variant extending to the superoanterior right atrium. The AVNRT diagnosis was confirmed by using standard electrophysiological criteria that exclude a diagnosis of atrial tachycardia and atrioventricular reentrant tachycardia. The earliest atrial activation during tachycardia was found in the superoanterior right atrium adjacent to the tricuspid annulus, where the first delivery of radiofrequency energy terminated and eliminated the inducibility of the tachycardia.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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33
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Okada M, Tanaka K, Matsunaga-Lee Y, Ninomiya Y, Hirao Y, Oka T, Tanaka N, Inoue H, Iwakura K, Fujii K, Inoue K. Multiple Shifts of the Earliest Retrograde Atrial Activation Site Along the Tricuspid Annulus During the Fast-Slow Form of Atrioventricular Nodal Reentrant Tachycardia by Radiofrequency Modification. Int Heart J 2019; 60:761-767. [PMID: 31105149 DOI: 10.1536/ihj.18-406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 70-year-old woman was admitted for treatment of supraventricular tachycardia. Ventriculoatrial conduction was revealed through programmed ventricular stimulation; the coronary sinus ostium (CSos) was the earliest atrial activation site. The fast-slow forms of atrioventricular nodal reentrant tachycardia (AVNRT) were induced by ventricular extra-stimuli. During tachycardia, the earliest atrial activation site was located at the bottom of CSos. Radiofrequency (RF) energy application to this site resulted in the delay of local electrical potential, prolongation of tachycardia cycle length, and a shift of the earliest retrograde activation site to the roof of CSos. Subsequent ablation induced a similar shift to the inferior tricuspid annulus and to the right posterior septum. Finally, RF energy application to the right posterior septum resulted in the termination of tachycardia, which was not induced afterward. Multiple shifts in the earliest retrograde atrial activation site along the tricuspid annulus after each slow pathway ablation suggested that annular tissue plays a substantial role as a substrate for AVNRT.
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Affiliation(s)
- Masato Okada
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Yasuharu Matsunaga-Lee
- Department of Cardiology, Japan Community Healthcare Organization (JCHO) Hoshigaoka Medical Center
| | | | - Yuko Hirao
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Takafumi Oka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | | | | | | | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital
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34
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Kaneko Y, Nakajima T, Nogami A, Inden Y, Asakawa T, Morishima I, Mizukami A, Iizuka T, Tamura S, Ota C, Kanzaki Y, Nakagawa K, Suzuki M, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Utilizing a Slow Pathway Extending to the Inferolateral Right Atrium. Circ Rep 2019; 1:46-54. [PMID: 33693113 PMCID: PMC7890287 DOI: 10.1253/circrep.cr-18-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background:
The existence of atypical fast-slow (F/S) atrioventricular (AV) nodal reentrant tachycardias (NRT) using slow pathway (SP) variants connected to the right atrial (RA) inferolateral (inf) free wall (FW) along the tricuspid annulus (TA), has been neither confirmed nor precisely characterized. Methods and Results:
We studied 7 patients (mean age, 48±16 years; 5 men) with F/S-AVNRT with long RP intervals and an earliest atrial activation at the RA inf-FW along the TA (inf-F/S-AVNRT). AV reentrant tachycardia was excluded on observation of the transition zone criteria in all 7 patients. Atrial tachycardia was excluded on the observation of a V-A-V activation sequence after the induction or entrainment of the tachycardia from the right ventricle in all. During the tachycardia, low-frequency, fractionated potentials (LP) preceding the local atrial electrogram were recorded near the site of the earliest atrial activation in 6 patients. Observations of conduction delay and block of the LP during ventricular entrainment or ablation of the tachycardia indicated that LP reflect retrograde activation via the inf-SP. Retrograde SP conduction was interrupted at the site of earliest atrial activation in 3 patients, and in the right posterior septum in 4 patients. Conclusions:
inf-F/S-AVNRT are distinct supraventricular tachycardia incorporating an SP variant connected to the RA inf-FW along the TA in the retrograde direction, which were eliminated by ablation.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Akihiko Nogami
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | | | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Chihiro Ota
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasunori Kanzaki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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35
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Stavrakis S, Jackman WM, Lockwood D, Nakagawa H, Beckman K, Elkholey K, Wang Z, Po SS. Slow/Fast Atrioventricular Nodal Reentrant Tachycardia Using the Inferolateral Left Atrial Slow Pathway. Circ Arrhythm Electrophysiol 2018; 11:e006631. [DOI: 10.1161/circep.118.006631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Deborah Lockwood
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Karen Beckman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Khaled Elkholey
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
| | - Zulu Wang
- Department of Cardiology, Shengyang Northern Hospital, China (Z.W.)
| | - Sunny S. Po
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center (S.S., W.M.J., D.L., H.N., K.B., K.E., S.S.P.)
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36
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Doi A, Takagi M, Yoshiyama M. Conversion of wide QRS tachycardia with a long RP interval in pre-excitation syndrome: What is the mechanism? J Cardiovasc Electrophysiol 2018; 29:1450-1453. [PMID: 29897153 DOI: 10.1111/jce.13667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/30/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Atsushi Doi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiko Takagi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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37
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Katritsis DG, John RM, Latchamsetty R, Muthalaly RG, Zografos T, Katritsis GD, Stevenson WG, Efimov IR, Morady F. Left Septal Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia. Circ Arrhythm Electrophysiol 2018. [DOI: 10.1161/circep.117.005907] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Demosthenes G. Katritsis
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - Roy M. John
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - Rakesh Latchamsetty
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - Rahul G. Muthalaly
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - Theodoros Zografos
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - George D. Katritsis
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - William G. Stevenson
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - Igor R. Efimov
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
| | - Fred Morady
- From the Hygeia Hospital, Athens, Greece (D.G.K., T.Z.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.M.J., R.G.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., F.M.); Imperial University Hospitals NHS Trust, London, United Kingdom (G.D.K.); and Biomedical Engineering, The George Washington University, Washington, DC (I.R.E.)
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38
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Kaneko Y, Nakajima T, Irie T, Iizuka T, Tamura S, Kurabayashi M. Atrial and ventricular activation sequence after ventricular induction/entrainment pacing during fast–slow atrioventricular nodal reentrant tachycardia: New insight into the use of V-A-A-V for the differential diagnosis of supraventricular tachycardia. Heart Rhythm 2017; 14:1615-1622. [DOI: 10.1016/j.hrthm.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Indexed: 10/19/2022]
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39
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Kaneko Y, Suzuki F. Is it truly atrial tachycardia? J Arrhythm 2016; 32:502. [PMID: 27920839 PMCID: PMC5129126 DOI: 10.1016/j.joa.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/20/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yoshiaki Kaneko
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Fumio Suzuki
- Department of Cardiology, Fukujuji Hospital, Tokyo, Japan
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40
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Katritsis DG, Marine JE, Contreras FM, Fujii A, Latchamsetty R, Siontis KC, Katritsis GD, Zografos T, John RM, Epstein LM, Michaud GF, Anter E, Sepahpour A, Rowland E, Buxton AE, Calkins H, Morady F, Stevenson WG, Josephson ME. Catheter Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia. Circulation 2016; 134:1655-1663. [DOI: 10.1161/circulationaha.116.024471] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
Abstract
Background:
Because of its low prevalence, data on atypical atrioventricular nodal reentrant tachycardia (AVNRT) are scarce, and the optimal ablation method has not been established. Our study aimed at assessing the efficacy and safety of conventional slow pathway ablation, as applied for typical cases, in atypical AVNRT.
Methods:
We studied 2079 patients with AVNRT subjected to slow pathway ablation. In 113 patients, mean age 48.5±18.1 years, 68 female, atypical AVNRT or coexistent atypical and typical AVNRT without other concomitant arrhythmia was diagnosed. Ablation data and outcomes were compared with a group of age- and sex-matched control patients with typical AVNRT.
Results:
Fluoroscopy and radiofrequency current delivery times were not different in the atypical and typical groups, 20.3±12.2 versus 20.8±12.9 minutes (
P
=0.730) and 5.9±5.0 versus 5.5±4.5 minutes (
P
=0.650), respectively. Slow pathway ablation was accomplished from the right septum in 110 patients, and from the left septum in 3 patients, in the atypical group. There was no need for additional ablation lesions at other anatomic sites, and no cases of atrioventricular block were encountered. Recurrence rates of the arrhythmia were 5.6% in the atypical (6/108 patients) and 1.8% in the typical (2/111 patients) groups in the next 3 months following ablation (
P
=0.167).
Conclusions:
Conventional ablation at the anatomic area of the slow pathway is the therapy of choice for symptomatic AVNRT, regardless of whether the typical or atypical form is present.
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Affiliation(s)
- Demosthenes G. Katritsis
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Joseph E. Marine
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Fernando M. Contreras
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Akira Fujii
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Rakesh Latchamsetty
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Konstantinos C. Siontis
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - George D. Katritsis
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Theodoros Zografos
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Roy M. John
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Lawrence M. Epstein
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Gregory F. Michaud
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Elad Anter
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Ali Sepahpour
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Edward Rowland
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Alfred E. Buxton
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Hugh Calkins
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Fred Morady
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - William G. Stevenson
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
| | - Mark E. Josephson
- From Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (D.G.K., F.M.C., E.A., A.E.B., M.E.J.); Athens Euroclinic, Greece (D.G.K., T.Z.); Johns Hopkins Hospital, Baltimore, MD (J.E.M., H.C.); Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (A.F., R.M.J., L.M.E., G.F.M., W.G.S.); University of Michigan Health System, Ann Arbor (R.L., K.C.S., F.M.); The Oxford University Clinical Academic Graduate School, United Kingdom (G.D.K.); and The Heart Hospital, London,
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