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Ali H, Lupo P, Foresti S, De Ambroggi G, Anderson RH, De Lucia C, Turturiello D, Paganini EM, Bessi R, Contrafatto I, Farghaly AAA, Cristiano E, Cappato R. Catheter-induced right bundle branch block: Practical implications for the cardiac electrophysiologist. J Cardiovasc Electrophysiol 2023; 34:2316-2329. [PMID: 37655997 DOI: 10.1111/jce.16050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/23/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
The right bundle branch (RBB), due to its endocardial course, is susceptible to traumatic block caused by "bumping" during right-heart catheterization. In the era of cardiac electrophysiology, catheter-induced RBB block (CI-RBBB) has become a common phenomenon observed during electrophysiological studies and catheter ablation procedures. While typically transient, it may persist for the entire procedure time. Compared to pre-existing RBBB, the transient nature of CI-RBBB allows for comparative analysis relative to the baseline rhythm. Furthermore, unlike functional RBBB, it occurs at similar heart rates, making the comparison of conduction intervals more reliable. While CI-RBBB can provide valuable diagnostic information in various conditions, it is often overlooked by cardiac electrophysiologists. Though it is usually a benign and self-limiting conduction defect, it may occasionally lead to diagnostic difficulties, pitfalls, or undesired consequences. Avoidance of CI-RBBB is advised in the presence of baseline complete left bundle branch block and when approaching arrhythmic substrates linked to the right His-Purkinje-System, such as fasciculo-ventricular pathways, bundle branch reentry, and right-Purkinje focal ventricular arrhythmias. This article aims to provide a comprehensive practical review of the electrophysiological phenomena related to CI-RBBB and its impact on the intrinsic conduction system and various arrhythmic substrates.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Sara Foresti
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Carmine De Lucia
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Dario Turturiello
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Edoardo Maria Paganini
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Riccardo Bessi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Igino Contrafatto
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Cardiac Electrophysiology, Salus Hospital, Reggio Emilia, Italy
| | - Ahmad Abdelrady Abdelsalam Farghaly
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Cardiovascular Department, Assiut University, Assiut, Egypt
| | - Ernesto Cristiano
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Ali H, Ambroggi GD, Contrafatto I, Bessi R, Lupo P, Foresti S, Cristiano E, Cappato R. Catheter ablation of left atrial tachycardia adjacent to a septal closure device: A multifaceted challenge? Pacing Clin Electrophysiol 2023; 46:1230-1234. [PMID: 36788778 DOI: 10.1111/pace.14674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023]
Abstract
Catheter ablation (CA) of left atrial tachycardia adjacent to implanted septal closure devices represents a multifaceted challenge. We describe the case of a 57-year-old patient with remote percutaneous closure of atrial septal defect who underwent successful CA of left atrial tachycardia adjacent to the septal device using a transaortic approach and RF energy. Besides the technical difficulties and associated risks, interference between the device and applied RF parameters may limit ablation efficiency. Further research is required to evaluate the safety, efficacy, and optimal energy type/parameters when ablating arrhythmias adjacent to these devices.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Igino Contrafatto
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Electrophysiology Department, Salus Hospital, Reggio Emilia, Italy
| | - Riccardo Bessi
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Sara Foresti
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Ernesto Cristiano
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Lodi E, Donati F, Lodi G, Contrafatto I, Modena MG. [A sub-merged arrhythmia... and an up-emerged female swimmer. A case of atrioventricular nodal reentry tachycardia in a young female swimmer surfacing from dynamic apnea]. G Ital Cardiol (Rome) 2023; 24:62-65. [PMID: 36573512 DOI: 10.1714/3934.39182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The irrefutable benefits of physical activity as a tool for the prevention and treatment of several clinical conditions, including cardiovascular diseases, are nowadays widely recognized. However, physical exercise may trigger adverse events in subjects with underlying heart disease, often undiagnosed and asymptomatic. It is fundamental to consider that various sports disciplines have peculiar and specific physiological and metabolic adaptations, and it is essential to consider the individual profile of the subject, including gender. We report the case of an agonistic female swimmer with a history of tachycardia heartbeat when resurfacing from dynamic apnea, in whom a diagnosis of atrioventricular nodal reentrant tachycardia was made. This case report provides practical evidence of the importance of a personalized approach, in both individual sex- and sport-specific terms, to optimize the diagnostic and therapeutic pathways.
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Affiliation(s)
- Elisa Lodi
- Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso cardiaco, Cardiopatie dell'Infanzia e A rischio), AOU Policlinico di Modena, Modena - Università degli Studi di Modena e Reggio Emilia, Modena
| | - Federica Donati
- Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso cardiaco, Cardiopatie dell'Infanzia e A rischio), AOU Policlinico di Modena, Modena - Università degli Studi di Modena e Reggio Emilia, Modena
| | - Giovanni Lodi
- Università degli Studi di Modena e Reggio Emilia, Modena
| | | | - Maria Grazia Modena
- Centro P.A.S.C.I.A. (Programma Assistenziale Scompenso cardiaco, Cardiopatie dell'Infanzia e A rischio), AOU Policlinico di Modena, Modena - Università degli Studi di Modena e Reggio Emilia, Modena
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Melandri G, Maresta A, Contrafatto I, Tartagni F, Magnani B. Effects of coronary artery revascularization and perioperative myocardial infarction on left ventricular wall motion. Int J Cardiol 1987; 15:47-54. [PMID: 3494690 DOI: 10.1016/0167-5273(87)90291-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effects of coronary artery revascularization and perioperative myocardial infarction on left ventricular wall motion are still controversial. In this study perioperative myocardial infarction was quantitatively estimated with the cumulative activity of the CK-MB isoenzyme in the perioperative period in a group of 77 consecutive patients undergoing coronary artery bypass surgery. After the operation (on average 9 +/- 1.8 months) all the patients were submitted to left ventricular and coronary angiography. Overall the global left ventricular ejection fraction was unchanged after the operation. The subgroup of patients with all patent grafts showed an improvement of both regional wall motion (P less than 0.05) and ejection fraction (from 58 +/- 13 to 64 +/- 13%, P less than 0.005); the number of angiographically abnormal left ventricular segments decreased from 28.5 to 16.6% (P less than 0.001). The cumulative activity of CK-MB enzyme was significantly correlated with the pre- and postoperative changes of ejection fraction (r = -0.51, P less than 0.01). Thus coronary artery bypass surgery can improve regional wall motion, but the likely benefit is observed in the absence of a perioperative myocardial ischemic damage.
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Melandri G, Maresta A, Tartagni F, Cavallini C, Contrafatto I, Corbelli C, Turinetto B, Magnani B. [Combined use of myocardial scintigraphy with thallium 201 and radioisotopic ventriculography for the non-invasive diagnosis of the patency of aortocoronary bypass]. Cardiologia 1985; 30:357-61. [PMID: 3879589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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