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Sau A, Ibrahim S, Kramer DB, Waks JW, Qureshi N, Koa-Wing M, Keene D, Malcolme-Lawes L, Lefroy DC, Linton NW, Lim PB, Varnava A, Whinnett ZI, Kanagaratnam P, Mandic D, Peters NS, Ng FS. Artificial intelligence-enabled electrocardiogram to distinguish atrioventricular re-entrant tachycardia from atrioventricular nodal re-entrant tachycardia. Cardiovasc Digit Health J 2023; 4:60-67. [PMID: 37101944 PMCID: PMC10123507 DOI: 10.1016/j.cvdhj.2023.01.004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Accurately determining arrhythmia mechanism from a 12-lead electrocardiogram (ECG) of supraventricular tachycardia can be challenging. We hypothesized a convolutional neural network (CNN) can be trained to classify atrioventricular re-entrant tachycardia (AVRT) vs atrioventricular nodal re-entrant tachycardia (AVNRT) from the 12-lead ECG, when using findings from the invasive electrophysiology (EP) study as the gold standard. Methods We trained a CNN on data from 124 patients undergoing EP studies with a final diagnosis of AVRT or AVNRT. A total of 4962 5-second 12-lead ECG segments were used for training. Each case was labeled AVRT or AVNRT based on the findings of the EP study. The model performance was evaluated against a hold-out test set of 31 patients and compared to an existing manual algorithm. Results The model had an accuracy of 77.4% in distinguishing between AVRT and AVNRT. The area under the receiver operating characteristic curve was 0.80. In comparison, the existing manual algorithm achieved an accuracy of 67.7% on the same test set. Saliency mapping demonstrated the network used the expected sections of the ECGs for diagnoses; these were the QRS complexes that may contain retrograde P waves. Conclusion We describe the first neural network trained to differentiate AVRT from AVNRT. Accurate diagnosis of arrhythmia mechanism from a 12-lead ECG could aid preprocedural counseling, consent, and procedure planning. The current accuracy from our neural network is modest but may be improved with a larger training dataset.
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Affiliation(s)
- Arunashis Sau
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Safi Ibrahim
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Daniel B. Kramer
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jonathan W. Waks
- Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Norman Qureshi
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Koa-Wing
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Louisa Malcolme-Lawes
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - David C. Lefroy
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nicholas W.F. Linton
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Phang Boon Lim
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Amanda Varnava
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Zachary I. Whinnett
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Prapa Kanagaratnam
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Danilo Mandic
- Department of Electrical and Electronic Engineering, Imperial College London, London, United Kingdom
| | - Nicholas S. Peters
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Cardiology, Chelsea & Westminster Hospital NHS Foundation Trust, London, United Kingdom
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Miyazawa H, Morishima I, Kanzaki Y, Kamiya Y. Cryoablation for atrioventricular nodal re-entrant tachycardia associated with persistent left superior vena cava. Indian Pacing Electrophysiol J 2021; 21:421-424. [PMID: 34400322 PMCID: PMC8577138 DOI: 10.1016/j.ipej.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/17/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022] Open
Abstract
Catheter ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) in patients with persistent left superior vena cava (PLSVC) is challenging because of anatomical abnormalities of Koch's triangle associated with the enlarged coronary sinus ostium. We present the Case of successful ablation in a patient with PLSVC using the cryoablation technique. The ablation was successfully performed without damaging the conduction system by virtue of “cryomapping” and “cryoadhesion.” Cryoablation is a safe and efficacious alternative to radiofrequency catheter ablation for the treatment of AVNRT associated with PLSVC. Catheter ablation for AVNRT in patients with PLSVC is challenging We performed successful ablation in a PLSVC patient with the cryoablation technique Ablation was successfully performed without damaging the conduction system
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Affiliation(s)
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yoshihiko Kamiya
- Department of ECG Laboratory, Ogaki Municipal Hospital, Ogaki, Japan
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Kumar SK, Thomas GR, Singh SM. ATP - A friend with benefits. J Electrocardiol 2021; 65:102-104. [PMID: 33588256 DOI: 10.1016/j.jelectrocard.2021.01.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/15/2022]
Abstract
Anti-tachycardia pacing (ATP) has gained widespread acceptance to treat ventricular tachyarrhythmias and prevent implantable defibrillator shocks. A 63-year-old lady with nonischemic cardiomyopathy underwent insertion of a primary prevention biventricular implantable cardioverter defibrillator (BIV-ICD). Post implant she was found to have recurrent episodes of atrioventricular nodal re-entry tachycardia (AVNRT) based on device electrograms. In this report, we describe the use of anti-tachycardia pacing to manage this tachycardia.
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Affiliation(s)
- Sharath K Kumar
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Garry R Thomas
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sheldon M Singh
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Bertini M, Brieda A, Balla C, Pollastrelli A, Smarrazzo V, Francesco V, Malagù M, Ferrari R. Efficacy and safety of catheter ablation of atrioventricular nodal re-entrant tachycardia by means of flexible-tip irrigated catheters. J Interv Card Electrophysiol 2019; 58:61-67. [PMID: 31236760 DOI: 10.1007/s10840-019-00578-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Irrigated-tip ablation catheters increase safety and efficacy of ablation procedures, but their use in atrioventricular nodal re-entrant tachycardia (AVNRT) ablation has not been systematically evaluated. The aim of this study is to evaluate the safety and efficacy of radiofrequency (RF) catheter ablation of AVNRT by means of the novel flexible-tip open-irrigated catheter FlexAbility™ and a 3D electroanatomic mapping (EAM) system. METHODS This is a single-center and single-operator study on 80 patients referred for AVNRT catheter ablation. Outcome included acute and long-term procedural success as well as complications reported over a median follow-up of 19 months (interquartile range 6-24 months). RESULTS Acute success was achieved in all 80 patients. One procedure-related major complication, involving the vascular access, occurred. Mean fluoroscopy time was 106 ± 71 s. One patient (1.2%) suffered long-term AVNRT recurrence. Five patients (6.2%) underwent ablation for AVNRT combined with ablation for other clinical arrhythmias. CONCLUSIONS Irrigated RF ablation of AVNRT by means of the novel flexible-tip open-irrigated catheter associated to 3D EAM system is effective and safe. Success rates are comparable to those of other techniques. Complication rate is very low.
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Affiliation(s)
- Matteo Bertini
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy.
| | - Alessandro Brieda
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Cristina Balla
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Annalisa Pollastrelli
- Abbott Medical Italy, Clinical Department, Viale Thomas Alva Edison, 110, 20099, Sesto San Giovanni, MI, Italy
| | - Vittorio Smarrazzo
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Vitali Francesco
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Michele Malagù
- Cardiovascular Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8 - 44124 Cona, Ferrara, FE, Italy
| | - Roberto Ferrari
- From Maria Cecilia Hospital, GVM Care & Research, Via Madonna di Genova, 1, 48033, Cotignola, RA, Italy
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Katritsis DG. Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia: Facts and Fiction. Arrhythm Electrophysiol Rev 2018; 7:230-231. [PMID: 30588309 PMCID: PMC6304791 DOI: 10.15420/aer.2018.7.4.eo1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 11/04/2022] Open
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Kondo H, Shinohara T, Otsubo T, Miyoshi M, Fukui A, Tsuchiya T, Takahashi N. A case of Wolff-Parkinson-White syndrome presenting spontaneous mutual frequent transition between atrioventricular reciprocating tachycardia and atrioventricular nodal re-entrant tachycardia. J Electrocardiol 2018; 51:467-469. [PMID: 29478804 DOI: 10.1016/j.jelectrocard.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Indexed: 10/18/2022]
Abstract
Atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal re-entrant tachycardia (AVNRT) can coexist and present unidirectional transition (from AVRT to AVNRT, or from AVNRT to AVRT) in a single patient. Actually, such cases have already been reported previously. However, a case with spontaneous bidirectional transition of both tachycardias during supraventricular tachycardia has never been reported. This article describes a case with spontaneous, mutual, and frequent transition between AVRT and AVNRT.
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Affiliation(s)
- Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, Oita, Japan.
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, Oita, Japan
| | - Toyokazu Otsubo
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, Oita, Japan
| | - Miho Miyoshi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, Oita, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, Oita, Japan
| | | | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Oita University Faculty of Medicine, Oita, Japan
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Shah B, Saidullah S, Awan ZA. Cross Over: A Reliable Maneuver In The Confirmation Of Atrioventricular Nodal Reentrant Tachycardia Ablation. J Ayub Med Coll Abbottabad 2017; 29:408-411. [PMID: 29076671] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Atrioventricular nodal re-entrant tachycardia (AVNRT) is still the most common presentation to our electrophysiology laboratory for ablation. The aim of this study is to document the confirmative value of cross over manoeuvre in successful AVNRT ablation. METHODS This study was conducted in Hayat Abad Medical complex Peshawar June 2006 to October 2015. In all patient with AVNRT, Dual-nodal pathway physiology confirmed by programmed atrial pacing of eight Tran with an extra beat by 10 millisecond (ms) decrement and at least Atrial HIS (A-H) interval prolongation of 50 ms. The dual pathway was further confirmed by cross over manoeuvre. Slow pathway potential identified and radiofrequency ablation (RFA) energy applied at 60 temperatures and 30 powers in Left Anterior Oblique (LAO) projection. Post ablation absence of cross over documented with and without isoproterenol and patient followed for any complication or recurrence. RESULTS Total 567 patients studied with mean age 36.56±12.16 and male to female ratio 1:1.4 with presentation of supraventricular tachycardia (SVT). Slow pathway was successfully modified and statistically no significant complication or recurrence documented. CONCLUSIONS Failure to cross over reliably excludes any conduction over the slow pathway and so recurrence of AVNRT.
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Affiliation(s)
- Bakhtawar Shah
- Cardiology Department Hayat Abad Medical Complex Peshawar, Pakistan
| | - Shahab Saidullah
- Cardiology Department Hayat Abad Medical Complex Peshawar, Pakistan
| | - Zahid Aslam Awan
- Cardiology Department Hayat Abad Medical Complex Peshawar, Pakistan
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Katritsis DG, Zografos T, Katritsis GD, Giazitzoglou E, Vachliotis V, Paxinos G, Camm AJ, Josephson ME. Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. Europace 2017; 19:602-606. [PMID: 28431060 DOI: 10.1093/europace/euw064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To conduct a randomized trial in order to guide the optimum therapy of symptomatic atrioventricular nodal re-entrant tachycardia (AVNRT). METHODS AND RESULTS Patients with at least one symptomatic episode of tachycardia per month and an electrophysiologic diagnosis of AVNRT were randomly assigned to catheter ablation or chronic antiarrhythmic drug (AAD) therapy with bisoprolol (5 mg od) and/or diltiazem (120-300 mg od). All patients were properly educated to treat subsequent tachycardia episodes with autonomic manoeuvres or a 'pill in the pocket' approach. The primary endpoint of the study was hospital admission for persistent tachycardia cardioversion, during a follow-up period of 5 years. Sixty-one patients were included in the study. In the ablation group, 1 patient was lost to follow-up, and 29 were free of arrhythmia or conduction disturbances at a 5-year follow-up. In the AAD group, three patients were lost to follow-up. Of the remainder, 10 patients (35.7%) continued with initial therapy, 11 patients (39.2%) remained on diltiazem alone, and 7 patients (25%) interrupted their therapy within the first 3 months following randomization, and subsequently developed an episode requiring cardioversion. During a follow-up of 5 years, 21 patients in the AAD group required hospital admission for cardioversion. Survival free from the study endpoint was significantly higher in the ablation group compared with the AAD group (log-rank test, P < 0.001). CONCLUSIONS Catheter ablation is the therapy of choice for symptomatic AVNRT. Antiarrhythmic drug therapy is ineffective and not well tolerated.
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Affiliation(s)
- Demosthenes G Katritsis
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Baker 4, Boston, MA 02215, USA
- Athens Euroclinic, Athens, Greece
| | | | | | | | | | | | - A John Camm
- St George's University of London, London, UK
| | - Mark E Josephson
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Baker 4, Boston, MA 02215, USA
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Beach C, Beerman L, Mazzocco S, Brooks MM, Arora G. Use of three-dimensional mapping in young patients decreases radiation exposure even without a goal of zero fluoroscopy. Cardiol Young 2016; 26:1297-302. [PMID: 26507259 DOI: 10.1017/S1047951115002449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
At present, three-dimensional mapping is often used during cardiac ablations with an explicit goal of decreasing radiation exposure; three-dimensional mapping was introduced in our institution in 2007, but not specifically to decrease fluoroscopy time. We document fluoroscopy use and catheterisation times in this setting. Data were obtained retrospectively from patients who underwent ablation for atrioventricular nodal re-entrant tachycardia from January, 2004 to December, 2011. A total of 93 patients were included in the study. Among them, 18 patients who underwent radiofrequency ablation without three-dimensional mapping were included in Group 1, 13 patients who underwent cryoablation without three-dimensional mapping were included in Group 2, and 62 patients who underwent cryoablation with three-dimensional mapping were included in Group 3. Mean fluoroscopy times differed significantly (34.3, 23.4, and 20.3 minutes, p<0.001) when all the groups were compared. Group 3 had a shorter average fluoroscopy time that did not reach significance when compared directly with Group 2 (p=0.29). An unadjusted linear regression model showed a progressive decrease in fluoroscopy time (p=0.002). Mean total catheterisation times differed significantly (180, 211, and 210 minutes, p=0.02) and were related to increased ablation times inherent to cryoablation techniques. Acute success was achieved in 89, 100, and 97% of patients (p=0.25), and chronic success was achieved in 80, 92, and 93% of patients (p=0.38). Complication rates were similar (17, 23, and 7%, p=0.14). In conclusion, three-dimensional mapping systems decrease fluoroscopy times even without an explicit goal of zero fluoroscopy. Efficacy and safety of the procedure have not changed.
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Burri H. Atrioventricular 1:1 tachycardia effectively terminated by antitachycardia pacing : What is your diagnosis? Herzschrittmacherther Elektrophysiol 2016; 27:244-248. [PMID: 27459976 DOI: 10.1007/s00399-016-0444-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
This case describes a tachycardia with a 1:1 atrioventricular relationship that was effectively terminated with antitachycardia pacing by the implantable cardioverter defibrillator. The differential diagnosis and clues that allow the reader to establish the correct diagnosis are discussed. The case also serves to analyse technical features of Boston Scientific dual-chamber defibrillators.
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Affiliation(s)
- Haran Burri
- Cardiology Department, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1211, Geneva, Switzerland.
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Lin CH, Lin YJ, Chang SL, Lo LW, Huang HK, Chiang CH, Allamsetty S, Liao JN, Chung FP, Chang YT, Lin CY, Chen SA. Novel electrophysiological characteristics of atrioventricular nodal continuous conduction curves in atrioventricular nodal re-entrant tachycardia with concomitant cavotricuspid isthmus-dependent atrial flutter. Europace 2015; 18:1259-64. [PMID: 26612879 DOI: 10.1093/europace/euv345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/15/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS The detailed electrophysiological characteristics of patients with both atrioventricular nodal re-entrant tachycardia (AVNRT) and atrial flutter (AFL) have not been clarified. This study investigated the related electrophysiological differences in a large series of patients undergoing radiofrequency catheter ablation of AVNRT. METHODS AND RESULTS A total of 1063 clinically documented AVNRT patients underwent catheter ablation were enrolled. Before the slow pathway (SP) ablation, 61 patients (5.7%) had inducible sustained cavotricuspid isthmus (CTI)-dependent AFL (Group 1), and the others (94.3%) without inducible sustained CTI-dependent AFL were defined as Group 2. The electrophysiological characteristics of these two groups and effect of the SP ablation on the inducibility of AFL were assessed. In Group 1, 36 patients (59%) had inducible/sustained AFL after the ablation of AVNRT and required a CTI ablation. The Group 1 patients had more AVNRT with continuous atrioventricular (AV) node function curves (P < 0.001, odds ratio = 7.55 [3.70-16.7], multivariate regression), and a younger age (P = 0.02, odds ratio = 1.02 [1.003-1.03], multivariate regression) than Group 2. The other characteristics were comparable between the two groups. The long-term follow-up (64.9 ± 34.9 months) revealed that the recurrence of AFL/atrial fibrillation was similar between the two groups (P > 0.05). CONCLUSION Atrioventricular nodal re-entrant tachycardia patients with concomitant CTI-dependent AFL had more continuous AV node function curves. Forty-one per cent of these patients had non-inducible AFL after the SP ablation, indicating a slow conduction isthmus in the triangle of Koch area.
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Affiliation(s)
- Chung-Hsing Lin
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan Division of Cardiology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Kai Huang
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Division of Cardiology, Department of Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Cheng-Hung Chiang
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Suresh Allamsetty
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Nizam's Institute of Medical Science, Hyderabad, India
| | - Jo-Nan Liao
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan Faculty of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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Brembilla-Perrot B, Sellal JM, Olivier A, Manenti V, Beurrier D, de Chillou C, Villemin T, Girerd N. Recurrences of symptoms after AV node re-entrant tachycardia ablation: a clinical arrhythmia risk score to assess putative underlying cause. Int J Cardiol 2014; 179:292-6. [PMID: 25464467 DOI: 10.1016/j.ijcard.2014.11.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/22/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE OF THE RESEARCH To identify clinical factors associated with the probability for each arrhythmic mechanism causing recurring symptoms after atrioventricular nodal re-entrant tachycardia (AVNRT) ablation. Slow pathway radiofrequency ablation is used to treat AVNRT. After ablation, recurrence of symptoms due to AVNRT or other arrhythmias can occur. RESULTS We studied 835 patients successfully treated with AVNRT ablation. Variables associated with each specific arrhythmia underlying symptom recurrence were studied by logistic regression. During a mean follow-up of 2.2 ± 2 years, 136 (16%) patients had a recurrence of symptoms. Following invasive and non-invasive studies, symptoms were mostly attributed to sinus tachycardia, recurrence of AVNRT and atrial arrhythmias (respectively 4.7%, 5.2% and 6.1%). Older age and history of atrial fibrillation were associated with a markedly increased risk of symptom recurrence due to atrial arrhythmias (OR=15.58, 7.09-35.22, p<0.001) whereas younger age was associated with a higher risk of sinus tachycardia. A simple 3-item clinical score based on age categories and atrial fibrillation history efficiently predicted atrial arrhythmia (C-Index=0.82, 0.75-0.89) and sinus tachycardia (C-Index=0.83, 0.75-0.90). 8.3% of patients with scores=0 had atrial arrhythmias whereas 100% of patients with scores ≥4 had atrial arrhythmias. CONCLUSIONS While recurrence of symptoms after successful AVNRT ablation is relatively frequent (16%), true AVNRT recurrence accounts for only 1/3 of these recurrences. A simple clinical score based on age and history of atrial fibrillation enables efficient risk stratification for symptom recurrence attributable to atrial arrhythmias and inappropriate sinus tachycardia.
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Affiliation(s)
| | - Jean-Marc Sellal
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Arnaud Olivier
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Vladimir Manenti
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Daniel Beurrier
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | | | - Thibaut Villemin
- Department of Cardiology, University Hospital of Brabois, Vandoeuvre, France
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France
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Yadav R, Chandra S, Naik N, Juneja R. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia associated with anomalous drainage of both superior vena cava into coronary sinus. Indian Pacing Electrophysiol J 2009; 9:278-82. [PMID: 19763197 PMCID: PMC2735161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Total upper body drainage via left superior vena cava into coronary sinus (i.e. absent right superior vena cava) is a rare anomaly and distorts the anatomy of coronary sinus and triangle of Koch. Herewith we are reporting the first report of ablation in a patient with superior vena cava draining into coronary sinus totally. This patient with atrioventricular nodal re-entrant tachycardia, baseline left bundle branch block, transient complete heart block during electrophysiological study and total upper body venous drainage into coronary sinus had successful slow pathway ablation using anatomical approach.
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