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Mizutani A, Okada M, Tanaka K, Tanaka N. Ripple map delineation of the reentrant circuit in a tricuspid annular atrial tachycardia mimicking focal activity. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00072-X. [PMID: 38901653 DOI: 10.1016/j.ipej.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
A 70-year-old man with hypertensive heart disease underwent catheter ablation of persistent atrial fibrillation. After completing the pulmonary vein isolation, atrial burst pacing induced an annular atrial tachycardia (AT). Overdrive pacing exhibited constant fusion, indicating a macroreentrant mechanism of the AT. However, the CARTO3 activation map created using the Octaray catheter (both Biosense Webster, Irvine, CA) exhibited a centrifugal spread with the earliest activation site at the 4 o'clock position of the tricuspid annulus. In contrast, the Ripple map revealed a clear reentrant circuit with its isthmus located at the 4-6 o'clock position of the tricuspid annulus. The local electrograms in these areas recorded systolic and diastolic potentials simultaneously, and the misannotation of the large far-field potentials caused this discrepant result. Handling low-amplitude complex fractionated electrograms remains a challenge in creating a precise activation mapping. The Ripple map, especially when combined with the Octaray catheter, was effective in dynamically visualizing all these electrograms and accurately delineating the reentrant circuit.
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Affiliation(s)
- Akinobu Mizutani
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan.
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Nagamori Y, Kusayama T, Nakagawa Y, Tuda T, Kato T, Takamura M. Target potential for ablation in adenosine-sensitive atrial tachycardia originating from the vicinity of the atrioventricular node identified by the LUMIPOINT software. HeartRhythm Case Rep 2024; 10:203-207. [PMID: 38496741 PMCID: PMC10943559 DOI: 10.1016/j.hrcr.2023.12.009] [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: 03/19/2024] Open
Affiliation(s)
- Yuta Nagamori
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Yoichiro Nakagawa
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Toyonobu Tuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
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Yamabe H, Soejima T, Kajiyama K, Fukami Y, Haraguchi K, Okonogi T, Hirai K, Fukuoka R, Umeji K, Orita Y, Koga H, Kawasaki T. Efficacy of Catheter Ablation From the Non-Coronary Aortic Cusp of Verapamil-Sensitive Atrial Tachycardia Arising Near the Atrioventricular Node. Heart Rhythm 2021; 19:719-727. [PMID: 34968740 DOI: 10.1016/j.hrthm.2021.12.021] [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] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efficacy of catheter ablation from the non-coronary aortic cusp (NCC) of verapamil-sensitive atrial tachycardia arising near the atrioventricular node (AVN-AT) has yet to be fully clarified. OBJECTIVE We elucidated the determinant of an effective AVN-AT ablation from the NCC. METHODS After identifying the earliest atrial activation site (EAAS) during tachycardia, the direction of the slow conduction zone (SCZ) of reentry circuit was identified by demonstrating manifest entrainment in 26 AVN-AT patients. Catheter ablation was initially performed from the NCC irrespective of the local activation time. If the NCC ablation was ineffective, catheter ablation was performed targeting the SCZ entrance. Then the anatomical relationship between the SCZ and successful ablation site was elucidated. RESULTS NCC catheter ablation terminated AVN-AT in 14 patients (NCC Group) but not in 12 (Non-NCC Group). Catheter ablation targeting the SCZ entrance terminated all Non-NCC Group ATs. The local activation time at the NCC relative to the EAAS did not differ between the NCC and Non-NCC Groups (10.1±6.5 vs. 11.2±4.8 msec, p=0.6333). The direction of the SCZ was posterior to the EAAS in all NCC Group patients, however, it was postero-lateral (n=5) and lateral to the EAAS (n=7) in the Non-NCC Group, suggesting that the SCZ existed in the direction of the NCC in NCC Group but was away from the NCC in Non-NCC Group. CONCLUSION A close proximity between the NCC and SCZ of the reentry circuit, but not the local activation time at the NCC, determined the efficacy of NCC catheter ablation in AVN-ATs.
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Affiliation(s)
- Hiroshige Yamabe
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan.
| | - Toshiya Soejima
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kimihiro Kajiyama
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Yurie Fukami
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kazuki Haraguchi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Taichi Okonogi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Keisuke Hirai
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Ryota Fukuoka
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Kyoko Umeji
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Yoshiya Orita
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Hisashi Koga
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, Kurume City, Fukuoka, Japan
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Hayashi T, Mizukami A, Kuroda S, Tateishi R, Kanehama N, Tachibana S, Hayasaka K, Hiroki J, Arai H, Yoshioka K, Iwatsuka R, Ueshima D, Matsumura A, Goya M, Sasano T. Outcomes of deep sedation for catheter ablation of paroxysmal supraventricular tachycardia, with adaptive servo ventilation. J Arrhythm 2021; 37:33-42. [PMID: 33664884 PMCID: PMC7896470 DOI: 10.1002/joa3.12476] [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: 09/07/2020] [Revised: 11/10/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Catheter ablation for paroxysmal supraventricular tachycardia (PSVT) is an established treatment, but the effect of deep sedation on PSVT inducibility remains unclear. AIM We sought to examine PSVT inducibility and outcomes of catheter ablation under deep sedation using adaptive servo ventilation (ASV). METHODS We retrospectively evaluated consecutive patients who underwent catheter ablation for PSVT under deep sedation (Propofol + Dexmedetomidine) with use of ASV. Anesthetic depth was controlled with BIS™ monitoring, and phenylephrine was administered to prevent anesthesia-induced hypotension. PSVT induction was attempted in all patients using extrastimuli at baseline, and after isoproterenol (ISP) infusion when necessary. RESULTS PSVT was successfully induced in 145 of 147 patients, although ISP infusion was required in the majority (89%). The PSVT was atrioventricular nodal reentrant tachycardia (AVNRT) in 77 (53%), atrioventricular reciprocating tachycardia (AVRT) in 51 (35%), and atrial tachycardia (AT) in 17 (12%). A higher ISP dose was required for AT compared to other PSVT (AVNRT: 0.06 (IQR 0.03-0.06) vs AVRT: 0.03 (0.02-0.06) vs AT: 0.06 (0.03-0.12) mg/h, P = .013). More than half (51%) of the patients developed hypotension requiring phenylephrine; these patients were older. Acute success was obtained in 99% (patients with AVNRT had endpoints with single echo on ISP in 46%). Long-term success rate was 136 of 144 (94%) (AVNRT 96%, AVRT 92%, and AT 93%). There were no complications related to deep sedation. CONCLUSIONS Deep sedation with use of ASV is a feasible anesthesia strategy for catheter ablation of PSVT with good long-term outcome. PSVT remains inducible if ISP is used.
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Affiliation(s)
- Tatsuya Hayashi
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
- Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Akira Mizukami
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Shunsuke Kuroda
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Ryo Tateishi
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Nozomu Kanehama
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | | | - Kazuto Hayasaka
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Jiro Hiroki
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Hirofumi Arai
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Kenji Yoshioka
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Ryota Iwatsuka
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | - Daisuke Ueshima
- Department of CardiologyKameda Medical CenterKamogawaChibaJapan
| | | | - Masahiko Goya
- Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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Yamabe H, Kajiyama K, Soejima T, Fukami Y, Haraguchi K, Okonogi T, Hirai K, Fukuoka R, Orita Y, Umeji K, Koga H, Kawasaki T. Comparison of the catheter ablation outcome in patients between targeting the entrance and exit of the reentry circuit in verapamil-sensitive atrial tachycardia originating from the atrioventricular-node vicinity. Heart Vessels 2021; 36:1201-1211. [PMID: 33512600 DOI: 10.1007/s00380-021-01791-5] [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] [Received: 11/08/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Verapamil-sensitive atrial tachycardia originating from the atrioventricular node vicinity (AVN-AT) can be eliminated with radiofrequency energy (RF) deliveries targeting either the entrance or exit of its reentry circuit. However, the outcome of these different approaches has not been clarified well. Thus, we compared the catheter ablation outcome targeting the entrance of reentry circuit, identified by the entrainment method (Ent-Group; 21 patients) with that targeting the earliest atrial activation site (EAAS) during AT (Exit-Group; 16 patients). There was no significant difference in the tachycardia cycle length (441.4 ± 87.4 vs. 392.8 ± 64.8 ms, p = 0.0704) or distance from the His bundle (HB) site to the EAAS (6.5 ± 2.0 vs. 7.6 ± 1.8 mm, p = 0.0822) between the Ent- and Exit-Groups. However, distance from the successful ablation site to the HB site in the Ent-Group was significantly longer than that in the Exit-Group (13.4 ± 3.1 vs. 7.6 ± 1.8 mm, p < 0.0001), resulting in more frequent transient atrioventricular block episodes in the Exit-Group than Ent-Group (31.3 vs. 0%, p < 0.01). Initial ATs (AT1s) were terminated in all patients in both Groups. However, ATs accompanied by shifting in the EAAS (AT2) were induced more frequently in the Exit-Group than Ent-Group (50.0 vs. 14.3%, p < 0.02) after eliminating AT1. RF deliveries to the EAAS eliminated all AT2s. The number of RF deliveries was greater in the Exit-Group than Ent-Group (6.9 ± 3.3 vs. 3.9 ± 1.6, p < 0.001). In conclusion, RF ablation targeting the entrance sites can avoid AVN injury and is superior in reducing the number of RF deliveries and occurrence of different ATs than targeting the exit sites in the AVN-AT.
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Affiliation(s)
- Hiroshige Yamabe
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan.
| | - Kimihiro Kajiyama
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Toshiya Soejima
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Yurie Fukami
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Kazuki Haraguchi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Taichi Okonogi
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Keisuke Hirai
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Ryota Fukuoka
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Yoshiya Orita
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Kyoko Umeji
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Hisashi Koga
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
| | - Tomohiro Kawasaki
- Department of Cardiology, Cardiovascular Center, Shin-Koga Hospital, 120, Tenjin-cho, Kurume City, Fukuoka, 830-8577, Japan
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Yamabe H, Orita Y. Demonstration of the Anatomical Tachycardia Circuit in Sinoatrial Node Reentrant Tachycardia: Analysis Using the Entrainment Method. J Am Heart Assoc 2020; 9:e014472. [PMID: 31928174 PMCID: PMC7033835 DOI: 10.1161/jaha.119.014472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The anatomical tachycardia circuit of sinoatrial node reentrant tachycardia (SANRT) has not been well clarified. This study aimed to elucidate the tachycardia circuit of SANRT. Methods and Results Exit and entrance of the intranodal sinoatrial node conduction (I‐SANC) of the reentry circuit were identified in 15 SANRT patients. After identifying the earliest atrial activation site (EAAS) during the tachycardia (EAAS‐SANRT), rapid atrial pacing was delivered from multiple atrial sites to identify the entrainment pacing site where manifest entrainment and orthodromic capture of the EAAS‐SANRT were demonstrated. Radiofrequency energy was then delivered starting at a site 2 cm proximal to the EAAS‐SANRT in the direction of the entrainment pacing site and gradually advanced toward the EAAS‐SANRT until tachycardia termination to localize the I‐SANC entrance. The EAAS‐SANRT was orthodromically captured by pacing delivered from the distal coronary sinus (n=7), high posteroseptal right atrium (n=2), low posteroseptal right atrium (n=2), low anterolateral right atrium (n=2), or coronary sinus ostium (n=2). Radiofrequency energy delivery to the entrance of the I‐SANC, 10.4±2.8 mm away from the EAAS‐SANRT, terminated tachycardia immediately after onset of energy delivery (3.4±2.3 seconds). The successful ablation site was located further from the EAAS during sinus rhythm (EAAS‐sinus) than the EAAS‐SANRT (12.8±4.5 versus 7.2±3.1 mm; P<0.0001). Conclusions The reentry circuit of SANRT was composed of the entrance and exit of the I‐SANC being located at distinctly different anatomical sites. SANRT was eliminated by radiofrequency energy delivered to the I‐SANC entrance, which was further from the EAAS‐sinus than I‐SANC exit.
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Affiliation(s)
- Hiroshige Yamabe
- Department of Cardiology Cardiovascular Center Shin-Koga Hospital Kurume City Japan
| | - Yoshiya Orita
- Department of Cardiology Cardiovascular Center Shin-Koga Hospital Kurume City Japan
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