1
|
Abdelrahim E, Miller J, Maskoun W. Anteroseptal accessory pathways: Killing one bird with two stones. J Cardiovasc Electrophysiol 2023; 34:2563-2572. [PMID: 37787022 DOI: 10.1111/jce.16091] [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: 06/12/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND AND AIMS Ablation of anteroseptal accessory pathways (AS-AP) is challenging, with lower success and more complications compared to other APs. AS-APs can be successfully ablated from the right atrium (RA) or the aortic valve's noncoronary cusp (NCC). We report two patients who required a hybrid ablation approach to achieve successful abolition of both anterograde and retrograde AS-AP conduction. METHODS AND RESULTS A 21-year-old female with supraventricular tachycardia (SVT) and pre-excitation on electrocardiogram (ECG) underwent electrophysiology study (EPS) confirming an AS-AP with anterograde and retrograde conduction. Ablation in the NCC achieved immediate and persistent anterograde conduction block. Electrophysiological maneuvers showed persistent retrograde AP conduction and orthodromic reciprocating tachycardia (ORT) remained easily inducible. Additional ablation in the NCC did not eliminate retrograde conduction. Further ablation in the RA opposite the NCC at the site of earliest retrograde atrial activation during ORT restored sinus and eliminated retrograde AP conduction. A 52-year-old male with SVT and ECG with pre-excitation underwent EPS that confirmed an AS-AP with anterograde and retrograde conduction. Ablation was performed in the NCC resulting in immediate elimination of pre-excitation. Retrograde conduction was still present and confirmed by repeating electrophysiological maneuvers. Ablation was performed in the RA opposite the successful ablation site in the NCC, eliminating retrograde AP conduction. CONCLUSION Two cases of AS-AP with anterograde and retrograde conduction and successful elimination of pathway conduction required a hybrid ablation approach from the NCC and RA. This approach may be helpful in other cases to improve success rates without using excessive ablation near the normal conduction system.
Collapse
Affiliation(s)
- Elsheikh Abdelrahim
- Department of Cardiovascular Diseases, Division of Electrophysiology, Henry Ford Health System, Detroit, Michigan, USA
| | - John Miller
- Department of Medicine, Division of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Waddah Maskoun
- Department of Cardiovascular Diseases, Division of Electrophysiology, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
2
|
Mohanty V, Sharma S, Deora S. Anomalous Double Right Coronary Artery Presenting as Inferior Wall ST-elevation Myocardial Infarction: A Rare Coronary Anomaly. Heart Views 2023; 24:114-118. [PMID: 37305328 PMCID: PMC10249642 DOI: 10.4103/heartviews.heartviews_94_22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/16/2023] [Indexed: 06/13/2023] Open
Abstract
Congenital anomalous origin of coronary arteries is rare and occurs in 0.2%-2% of patients undergoing coronary angiography (CAG). Most of the cases are benign but may present with life-threatening symptoms such as myocardial ischemia or sudden cardiac death. The prognosis depends on the site of origin of the anomalous artery, intramyocardial course, and relation to other great vessel and cardiac structures. Increased awareness and easy availability of noninvasive methods like computed tomography CAG have led to more reporting of such cases. Here, we report the case a 52-year-old male with a double right coronary artery having anomalous origin from a noncoronary aortic cusp detected during CAG which has not been reported in the literature before.
Collapse
Affiliation(s)
- Vivek Mohanty
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shubham Sharma
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
3
|
Ozcan Cetin EH, Kara M, Korkmaz A, Ozeke O, Cay S, Ozcan F, Aras D, Topaloglu S. Precordial double transition pattern with inferior lead discordance in the accessory pathway and ventricular arrhythmias: Do All Roads Lead to Rome? J Cardiovasc Electrophysiol 2022; 33:2421-2422. [PMID: 36177696 DOI: 10.1111/jce.15695] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
We read the article by Deb et al. entitled "Positive QRS complex in limb lead 2 with negative QRS in lead 3 on the surface electrocardiogram (ECG): A novel predictor for the anterior location of right-sided accessory pathways (AP) This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Elif Hande Ozcan Cetin
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Meryem Kara
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Ahmet Korkmaz
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Ozcan Ozeke
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Serkan Cay
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Firat Ozcan
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Dursun Aras
- İstanbul Medipol University, Department of Cardiology, İstanbul, Turkey
| | - Serkan Topaloglu
- University of Health Sciences, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| |
Collapse
|
4
|
Varma N. Bidirectional Atrial Tachycardia Ablated From an Aortic Sinus. JACC Clin Electrophysiol 2021; 7:1326-1327. [PMID: 34454886 DOI: 10.1016/j.jacep.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
| |
Collapse
|
5
|
Affiliation(s)
- Stephani C. Wang
- Division of Cardiology, Department of Medicine, University of California, Irvine, CA, USA
| | - Jack Guccione
- Department of Pathology, University of California, Irvine, CA, USA
| | - Cy Kim
- Division of Cardiology, Department of Medicine, University of California, Irvine, CA, USA
| | - Pranav M. Patel
- Division of Cardiology, Department of Medicine, University of California, Irvine, CA, USA
| |
Collapse
|
6
|
Nishimura T, Kannan A, Tung R. Reentrant para-Hisian ventricular tachycardia eliminated from the noncoronary cusp: Importance of regional anatomy for vantage-point ablation. J Cardiovasc Electrophysiol 2020; 31:968-971. [PMID: 32077542 DOI: 10.1111/jce.14401] [Citation(s) in RCA: 2] [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: 10/15/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
We present a rare case of reentrant ventricular tachycardia proven by entrainment maneuvers that was successfully ablated from the noncoronary cusp. The case highlights regional anatomy, pacing maneuvers with multi-modality images from fluoroscopy, intracardiac echo, and electroanatomical mapping.
Collapse
Affiliation(s)
- Takuro Nishimura
- Department of Medicine, Section of Cardiology, Pritzker School of Medicine, Center for Arrhythmia Care, The University of Chicago Medicine, Chicago, Illinois
| | - Arun Kannan
- Department of Medicine, Section of Cardiology, Pritzker School of Medicine, Center for Arrhythmia Care, The University of Chicago Medicine, Chicago, Illinois
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, Pritzker School of Medicine, Center for Arrhythmia Care, The University of Chicago Medicine, Chicago, Illinois
| |
Collapse
|
7
|
Abstract
Sinus of Valsalva aneurysm is a rare congenital cardiac abnormality and is usually diagnosed when it ruptures. An asymptomatic 55-year-old male of unruptured sinus of Valsalva aneurysm of noncoronary cusp was on medical follow-up. At 2-year follow-up, there was thrombus formation in the aneurysm, mimicking right atrium tumor on 2D transthoracic echocardiography. Cardiac computed tomography showed filling defect in the aneurysm suggestive of thrombus. Considering the high risk of systemic emboli surgery was performed, and aneurysm was repaired with Dacron patch.
Collapse
Affiliation(s)
- Roopali Khanna
- Department of cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pujan Shah
- Department of cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Mousam Dey
- Department of radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Pravin K Goel
- Department of cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Puneet Goyal
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Shantanu Pandey
- Department of Cardiothoracic surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
8
|
Pap R, Makai A, Szilágyi J, Klausz G, Bencsik G, Forster T, Sághy L. Should the Aortic Root Be the Preferred Route for Ablation of Focal Atrial Tachycardia Around the AV Node?: Support From Intracardiac Echocardiography. JACC Clin Electrophysiol 2015; 2:193-199. [PMID: 29766869 DOI: 10.1016/j.jacep.2015.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the optimal approach to focal atrial tachycardia originating from around the atrioventricular node. BACKGROUND Focal atrial tachycardia (FAT) demonstrating earliest activation around the atrioventricular (AV) node during right atrial (RA) mapping has been eliminated by ablation at the RA para-Hisian region, from the left atrium (LA) or the noncoronary aortic cusp (NCC). However the optimal approach has not been determined. METHODS We conducted a retrospective analysis of a consecutive series of 148 patients undergoing catheter ablation for FAT between 2006 and 2014 in our institution. RESULTS Earliest activation was recorded in the peri-AV nodal region during RA mapping in 34 patients (23%). Of these, 7 patients (20.5%) had successful ablation at the RA septum, using either radiofrequency (n = 4) or cryoenergy (n = 3). Seven FATs (20.5%) were ablated from the LA at the region of the aortomitral continuity, and 20 patients (59%) had successful ablation in the NCC, including 1 patient with a recurrence after a temporarily successful cryoablation from the RA. The proportion of the 3 approaches in this series showed a significant temporal evolution and overall frequency favoring ablation in the NCC (p = 0.011 for time trend and 0.013 for actual vs. expected frequencies). Intracardiac echocardiography proved superior catheter stability with the NCC approach. There were 2 cases of atrioventricular block and 1 recurrence after RA ablation versus no complications or recurrent FAT with NCC and LA approaches. CONCLUSIONS Most peri-AV nodal FATs can be safely and effectively ablated from the NCC. The strategy of preferential NCC approach avoids RA para-Hisian ablation with the accompanying risk of AV block.
Collapse
Affiliation(s)
- Robert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
| | - Attila Makai
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Judit Szilágyi
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gergely Klausz
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Gábor Bencsik
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - László Sághy
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| |
Collapse
|
9
|
Miyazaki S, Uchiyama T, Iesaka Y. An irregular supraventricular tachycardia: what is the mechanism? J Cardiovasc Electrophysiol 2014; 26:231-2. [PMID: 25213766 DOI: 10.1111/jce.12541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 09/04/2014] [Accepted: 09/09/2014] [Indexed: 11/28/2022]
|