1
|
Devecchi C, Matta M, Magnano M, Dell'Era G, Galiffa VA, Renaudo D, Negro A, Occhetta E, Patti G, Rametta F. Voltage and propagation mapping: New tools to improve successful ablation of atrioventricular nodal reentry tachycardia. J Cardiovasc Electrophysiol 2024; 35:942-949. [PMID: 38462681 DOI: 10.1111/jce.16234] [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: 10/14/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Mapping system is useful in ablation of atrioventricular nodal reentry tachycardia (AVNRT) and localization of anatomic variances. Voltage mapping identifies a low voltage area in the Koch triangle called low-voltage-bridge (LVB); propagation mapping identifies the collision point (CP) of atrial wavefront convergence. We conducted a prospective study to evaluate the relationship between LVB and CP with successful site of ablation and identify standard value for LVB. MATERIALS AND METHODS Three-dimensional (3D) maps of the right atria were constructed from intracardiac recordings using the ablation catheter. Cut-off values on voltage map were adjusted until LVB was observed. On propagation map, atrial wavefronts during sinus rhythm collide in the site representing CP, indicating the area of slow pathway conduction. Ablation site was selected targeting LVB and CP site, confirmed by anatomic position on fluoroscopy and atrioventricular ratio. RESULTS Twenty-seven consecutive patients were included. LVB and CP were present in all patients. Postprocedural evaluation identified standard cut-off of 0.3-1 mV useful for LVB identification. An overlap between LVB and CP was observed in 23 (85%) patients. Procedure success was achieved in all patient with effective site at first application in 22 (81%) patients. There was a significant correlation between LVB, CP, and the site of effective ablation (p = .001). CONCLUSION We found correlation between LVB and CP with the site of effective ablation, identifying a voltage range useful for standardized LVB identification. These techniques could be useful to identify ablation site and minimize radiation exposure.
Collapse
Affiliation(s)
- Chiara Devecchi
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Mario Matta
- Division of Cardiology, AOU Città della Salute e della Scienza, Torino, Italy
| | - Massimo Magnano
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
| | | | | | | | | | - Eraldo Occhetta
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
| | - Giuseppe Patti
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | |
Collapse
|
2
|
Matsunaga-Lee Y, Egami Y, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Yano M, Nishino M. An irregular tachycardia: What is the mechanism? J Cardiovasc Electrophysiol 2024; 35:848-851. [PMID: 38303164 DOI: 10.1111/jce.16197] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
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
| |
Collapse
|
3
|
Arai H, Asakawa T, Sagawa Y, Yasui Y, Oda A, Murata K, Nakagawa K, Sasano T, Aonuma K, Yamauchi Y. Validation of dual atrioventricular nodal physiology in dual atrioventricular nodal non-reentrant tachycardia via adenosine triphosphate injection during atrial pacing: A novel insight into the role of leftward inferior extension. J Cardiovasc Electrophysiol 2024; 35:505-510. [PMID: 38178380 DOI: 10.1111/jce.16172] [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: 10/31/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Dual atrioventricular nodal non-reentrant tachycardia (DAVNNT) is a rare and challenging-to-diagnose arrhythmia, without previous reports associating it with a leftward inferior extension (LIE). METHODS Diagnosis was made using adenosine triphosphate (ATP) injection during atrial pacing in a suspected DAVNNT patient. RESULTS Ablation of the rightward inferior extension was unsuccessful in eliminating DAVNNT; however, subsequent ablation of the LIE successfully eradicated the arrhythmia. CONCLUSION This unique case, marked by the first instance of DAVNNT caused by LIE, diagnosed through ATP injection, underscores the utility of this diagnostic approach and broadens the spectrum of our understanding and management of this condition.
Collapse
Affiliation(s)
- Hirofumi Arai
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Tetsuya Asakawa
- Department of Cardiovascular Medicine, Yamanashi Kosei Hospital, Yamanashi, Yamanashi, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Yumi Yasui
- 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
| | - Kazuya Nakagawa
- Department of Cardiovascular Medicine, Yamanashi Kosei Hospital, Yamanashi, Yamanashi, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Aonuma
- Department of Cardiovascular Medicine, Mito Saiseikai General Hospital, Mito, Ibaraki, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| |
Collapse
|
4
|
González-Casal D, Pérez-Castellanos A, Flores NS, Carta-Bergaz A, González-Torrecilla E, Bruña Fernández V, Ávila P, Atienza F, Arenal Á, González-Panizo J, Fernández-Avilés F, Cabrera JA, Datino T. Cannon A wave validation as a diagnostic tool in paroxysmal supraventricular tachycardias. Pacing Clin Electrophysiol 2024; 47:383-391. [PMID: 38348921 DOI: 10.1111/pace.14946] [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: 10/21/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The presence of cannon A waves, the so called "frog sign", has traditionally been considered diagnostic of atrioventricular nodal re-entrant tachycardia (AVNRT). Nevertheless, it has never been systematically evaluated. The aim of this study is to assess the independent diagnostic utility of cannon A waves in the differential diagnosis of supraventricular tachycardias (SVTs). METHODS We prospectively included 100 patients who underwent an electrophysiology (EP) study for SVT. The right jugular venous pulse was recorded during the study. In 61 patients, invasive central venous pressure (CVP) was registered as well. CVP increase is thought to be related with the timing between atria and ventricle depolarization; two groups were prespecified, the short VA interval tachycardias (including typical AVNRT and atrioventricular reciprocating tachycardia (AVRT) mediated by a septal accessory pathway) and the long VA interval tachycardias (including atypical AVNRT and AVRT mediated by a left free wall accessory pathway). RESULTS The relationship between cannon A waves and AVNRT did not reach the statistical significance (OR: 3.01; p = .058); On the other hand, it was clearly associated with the final diagnosis of a short VA interval tachycardia (OR: 10.21; p < .001). CVP increase showed an inversely proportional relationship with the VA interval during tachycardia (b = -.020; p < .001). CVP increase was larger in cases of AVNRT (4.0 mmHg vs. 1.2 mmHg; p < .001) and short VA interval tachycardias (3.9 mmHg vs. 1.2 mmHg; p < .001). CONCLUSION The presence of cannon A waves is associated with the final diagnosis of short VA interval tachycardias.
Collapse
Affiliation(s)
- David González-Casal
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alberto Pérez-Castellanos
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Nina Soto Flores
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | - Alejandro Carta-Bergaz
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Pablo Ávila
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Felipe Atienza
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Arenal
- Arrhythmia Unit, Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge González-Panizo
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
| | | | - José Angel Cabrera
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
| | - Tomás Datino
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Quirón-Salud Madrid and Hospital Universitario Ruber Juan Bravo, Madrid, Spain
- Medical School, Universidad Europea de Madrid, Madrid, Spain
| |
Collapse
|
5
|
Pandozi C, Botto GL, Loricchio ML, D'Ammando M, Lavalle C, Del Giorno G, Matteucci A, Mariani MV, Nicolis D, Segreti L, Papa AA, Casale MC, Galeazzi M, Russo M, Di Belardino N, Pelargonio G, Centurion Aznaran C, Malacrida M, Maddaluno F, Treglia S, Piccolo F, Colivicchi F. High-density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re-entrant tachycardia, integrated with direct recording of atrio-ventricular node structure potential. J Cardiovasc Electrophysiol 2024; 35:379-388. [PMID: 38185855 DOI: 10.1111/jce.16168] [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: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The mechanism of typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known. OBJECTIVE To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit. METHODS Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh-density mapping and a modified signal-filtering toolset to record the potentials of the AV nodal structures. RESULTS Forty-five consecutive cases of successful ablation of typical slow-fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p < .001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p < .001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time-window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow-fast AVNRT. CONCLUSION Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh-density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right-septal and para-septal arrhythmias.
Collapse
Affiliation(s)
- Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Carlo Lavalle
- Azienda ospedaliero-universitaria Policlinico Umberto I, Rome, Italy
| | | | - Andrea Matteucci
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
- Department of System and Experimental Medicine, University of Rome 'Tor Vergata, Rome, Italy
| | | | | | | | - Andrea Antonio Papa
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | | | - Marco Galeazzi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | - Gemma Pelargonio
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
6
|
Manickavasagam A, Ahmed J, Patloori SCS, Chase D, Roshan J. Reoccurrence isn't coincidence: Repeated tachycardia termination with His refractory VPD. What is the mechanism? J Cardiovasc Electrophysiol 2024; 35:498-500. [PMID: 38178361 DOI: 10.1111/jce.16170] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Affiliation(s)
| | - Javaid Ahmed
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - David Chase
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Roshan
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
7
|
Alken FA, Scherschel K, Zhu E, Kahle AK, Meyer C. [Long-term results of catheter ablation for AV nodal reentry tachycardias and accessory pathways]. Herzschrittmacherther Elektrophysiol 2023; 34:278-285. [PMID: 37861731 DOI: 10.1007/s00399-023-00965-0] [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] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia in patients with accessory pathways (AP) are common supraventricular tachycardias. High long-term efficacy of about 97% (AVNRT) and 92% (AP) has been observed in children and adults. The risk of occurring atrioventricular block is low (0.4-0.8% during AVNRT, 0.1-0.2% for AP). Catheter ablation shows a lower efficacy of 87-93% and elevated atrioventricular block risk up to 10% in patient groups with complex congenital heart disease. Nonsynchronized ventricular activation during preexcitation or permanent reentrant tachycardias can induce heart failure, and remission of left ventricular function can be expected in > 90% after successful catheter ablation. Therefore, catheter ablation is the long-term therapy of choice for AVNRT and AP with high efficacy and safety for most patient populations.
Collapse
Affiliation(s)
- Fares-Alexander Alken
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
| | - Katharina Scherschel
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
- Institut für Neuro- und Sinnesphysiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland
| | - Ernan Zhu
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Christian Meyer
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland.
- Institut für Neuro- und Sinnesphysiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland.
| |
Collapse
|
8
|
Soether C, Boehmer AA, Dobre BC, Kaess BM, Ehrlich JR. Zero-fluoro atrioventricular-nodal reentrant tachycardia ablation. Herzschrittmacherther Elektrophysiol 2023; 34:305-310. [PMID: 37950109 DOI: 10.1007/s00399-023-00977-w] [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] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Atrioventricular-nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia, particularly in younger patients. The treatment of choice is radiofrequency catheter ablation (RFCA), traditionally necessitating ionizing radiation for catheter guidance. OBJECTIVE The authors aimed to demonstrate the feasibility and safety of zero-fluoroscopy RFCA of AVNRT using EnSite™ NavX™ as a three-dimensional (3D) electroanatomical mapping system (EAM). METHODS The authors retrospectively analyzed 68 patients that underwent AVNRT-RFCA. One group was a priori allocated to conventional fluoroscopy mapping (convFluoro, n = 30). In 38 cases, the electrophysiologist chose to use 3D-EAM for ablation. Of these patients, 20 could be ablated without fluoroscopy use (zeroFluoro). In 18 cases that were initially intended as 3D-EAM, additional fluoroscopy use was necessary due to difficult anatomic conditions (convertedFluoro). Procedure duration, fluoroscopy duration and dose, as well as complications were analyzed. RESULTS Procedure duration was similar for the convFluoro and zeroFluoro groups (74 ± 24 min vs. 80 ± 26 min, p = ns). The convertedFluoro group showed longer procedure duration compared to the convFluoro group (94 ± 30 min vs. 74 ± 24 min, p < 0.05). The use of 3D-EAM significantly reduced fluoroscopy duration comparing the convFluoro with the convertedFluoro group (12 ± 9 min vs. 7 ± 6 min, p < 0.05). The difference in fluoroscopy dose between convFluoro and convertedFluoro did not reach significance (169 ± 166 cGycm2 vs. 134 ± 137 cGycm2, p = ns). In zeroFluoro cases, no radiation was used at all. 3D-EAM-guided RFCA was primarily successful in all patients. Overall, there were only few minor complications in the different groups. No major complications occurred. CONCLUSION Zero-fluoro RFCA in patients with AVNRT is feasible and safe. 3D-EAM can reduce radiation exposure in the majority of patients without prolonging procedure duration or increasing complications.
Collapse
Affiliation(s)
- Christina Soether
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Andreas A Boehmer
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bianca C Dobre
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Bernhard M Kaess
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital GmbH, Beethovenstraße 20, 65189, Wiesbaden, Germany.
| |
Collapse
|
9
|
Sakamoto Y, Osanai H. Ultra-high-density mapping for safe and effective typical atrioventricular nodal reentrant tachycardia ablation. Nagoya J Med Sci 2023; 85:844-851. [PMID: 38155630 PMCID: PMC10751505 DOI: 10.18999/nagjms.85.4.844] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/18/2023] [Indexed: 12/30/2023]
Abstract
Ultra-high-density mapping was used for potential-guided radiofrequency ablation for typical atrioventricular nodal reentrant tachycardia. The mapping detailed the spread of activation in the Koch's triangle and identified target potentials and tachycardia circuits. This mapping provides additional information to the slow pathway conventionally used for safe and effective ablation.
Collapse
Affiliation(s)
- Yusuke Sakamoto
- Department of Cardiology, Tosei General Hospital, Nagoya, Japan
| | - Hiroyuki Osanai
- Department of Cardiology, Tosei General Hospital, Nagoya, Japan
| |
Collapse
|
10
|
Ho RT. An atypical short RP tachycardia: What is the mechanism? Heart Rhythm 2023; 20:1583-1585. [PMID: 37625471 DOI: 10.1016/j.hrthm.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Reginald T Ho
- Division of Cardiology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| |
Collapse
|
11
|
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] [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: 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.
Collapse
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
| |
Collapse
|
12
|
Nakano M, Kondo Y, Kajiyama T, Nakano M, Ito R, Kitagawa M, Sugawara M, Chiba T, Ryuzaki S, Yoshino Y, Komai Y, Takanashi Y, Kobayashi Y. Junctional rhythm during cryoablation for typical atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2023; 34:1665-1670. [PMID: 37343063 DOI: 10.1111/jce.15979] [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: 03/05/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Cryoablation is being used as an alternative to radiofrequency (RF) ablation for atrioventricular nodal reentrant tachycardia (AVNRT) owing to the lower risk of atrioventricular block (AVB) compared to RF ablation. Junctional rhythm often occurs during successful application of RF ablation for AVNRT. In contrast, junctional rhythm has rarely been reported to occur during cryoablation. This retrospective study evaluated the characteristics of junctional rhythm during cryoablation for typical AVNRT. METHODS AND RESULTS This retrospective study included 127 patients in whom successful cryoablation of typical AVNRT was performed. Patients diagnosed with atypical AVNRT were excluded. Junctional rhythm appeared during cryofreezing in 22 patients (17.3%). These junctional rhythms appeared due to cryofreezing at the successful site in the early phase within 15 s of commencement of cooling. Transient complete AVB was observed in 10 of 127 patients (7.9%), and it was noted that atrioventricular conduction improved immediately after cooling was stopped in these 10 patients. No junctional rhythm was observed before the appearance of AVB. No recurrence of tachycardia was confirmed in patients in whom junctional rhythm occurred by cryofreezing at the successful site. CONCLUSION Occurrence of junctional rhythms during cryoablation is not so rare and can be considered a criterion for successful cryofreezing. Furthermore, junctional rhythm may be associated with low risk of recurrent tachycardia.
Collapse
Affiliation(s)
- Masahiro Nakano
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takatsugu Kajiyama
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Miyo Nakano
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryo Ito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mari Kitagawa
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masafumi Sugawara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshinori Chiba
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoko Ryuzaki
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yutaka Yoshino
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuya Komai
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukiko Takanashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| |
Collapse
|
13
|
Nasir M, Sturts A, Sturts A. Common Types of Supraventricular Tachycardia: Diagnosis and Management. Am Fam Physician 2023; 107:631-641. [PMID: 37327167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Supraventricular tachycardia (SVT) is an abnormal rapid cardiac rhythm that involves atrial or atrioventricular node tissue from the His bundle or above. Paroxysmal SVT, a subset of supraventricular dysrhythmias, has three common types: atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, and atrial tachycardia. Presenting symptoms may include altered consciousness, chest pressure or discomfort, dyspnea, fatigue, lightheadedness, or palpitations. Diagnostic evaluation may be performed in the outpatient setting and includes a comprehensive history and physical examination, electrocardiography, and laboratory workup. Extended cardiac monitoring with a Holter monitor or event recorder may be needed to confirm the diagnosis. Acute management of paroxysmal SVT is similar across the various types and is best completed in the emergency department or hospital setting. In patients who are hemodynamically unstable, synchronized cardioversion is first-line management. In those who are hemodynamically stable, vagal maneuvers are first-line management, followed by stepwise medication management if ineffective. Beta blockers and/or calcium channel blockers may be used acutely or for long-term suppressive therapy. When evaluating patients for paroxysmal SVTs, clinicians should have a low threshold for referral to a cardiologist for electrophysiologic study and appropriate intervention such as ablation. Clinicians should use a patient-centered approach when formulating a long-term management plan for atrioventricular nodal reentrant tachycardia. Catheter ablation has a high success rate and is recommended as the first-line method for long-term management of recurrent, symptomatic paroxysmal SVT, including Wolff-Parkinson-White syndrome.
Collapse
Affiliation(s)
- Munima Nasir
- Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ashley Sturts
- Pennsylvania State University, Penn State Health, State College, Pennsylvania
| | - Adam Sturts
- Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
14
|
Ibáñez Criado JL, Almendral J. Atrioventricular conduction modulation and ablation: Better at a distance from the node? J Cardiovasc Electrophysiol 2023; 34:487. [PMID: 36598421 DOI: 10.1111/jce.15802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 01/05/2023]
Affiliation(s)
- José Luis Ibáñez Criado
- Department of Cardiology, Arrhythmia Unit, Cardiology Service, University General Hospital Doctor Balmis, Alicante Institute of Health and Biomedical Research (ISABIAL foundation), Alicante, Spain
| | - Jesús Almendral
- Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain
| |
Collapse
|
15
|
Adachi T, Asakawa T, Yamauchi Y, Naito S, Yoshida K, Nakagawa K, Nakamura K, Yamasaki H, Sekiguchi Y, Nogami A, Suzuki F, Ieda M, Aonuma K. Dual atrioventricular nodal non-reentrant tachycardia: Various atrioventricular conduction responses to atrioventricular simultaneous pacing. Heart Rhythm 2022; 19:1841-1855. [PMID: 35817252 DOI: 10.1016/j.hrthm.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/27/2021] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Specific pacing methods to unmask the existence of the dual atrioventricular (AV) nodal pathway in patients with dual AV nodal non-reentrant tachycardia remain to be established. OBJECTIVE This study aimed to determine the electrophysiological characteristics of dual AV nodal non-reentrant tachycardia by its responses to specific pacing methods. METHODS Five patients diagnosed as having dual AV nodal non-reentrant tachycardia were retrospectively investigated. RESULTS Atrial pacing could not induce the clinical tachycardia as continuous double firing in any of the 5 patients, but did induce sudden prolongation of the A-H interval as the linking phenomenon in 1 patient. A single atrial extrastimulation after sinus excitations was performed without interruption of double firing in 1 patient, and it induced the double ventricular response phenomenon within the limited range of the extrastimulus intervals. The pacing method of AV simultaneous basic pacing preceding atrial programmed extrastimulation did not allow interruptions of double firing during the basic drive trains and induced the double ventricular response phenomenon within the limited range of the extrastimulus intervals in all 5 patients, even in 1 patient without inducibility of the clinical tachycardia in the catheterization laboratory. The double ventricular response phenomenon within the limited range of the extrastimulus intervals may be based on the existence of the dual AV nodal pathway with concealed retrograde penetration. CONCLUSION The AV simultaneous basic pacing preceding atrial programmed extrastimulation method consistently and reproducibly unmasked the existence of the dual AV nodal pathway as the double ventricular response phenomenon in patients with dual AV nodal non-reentrant tachycardia.
Collapse
Affiliation(s)
- Toru Adachi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Tetsuya Asakawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Kentaro Yoshida
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuya Nakagawa
- Department of Cardiology, Yamanashi Kosei Hospital, Yamanashi, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumio Suzuki
- Department of Cardiology, Fukujuji Hospital, Tokyo, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
16
|
Liszewski S, Oskarsson V. [Dual ventricular response - a rare and underdiagnosed condition?]. Lakartidningen 2022; 119:22029. [PMID: 36082918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Dual ventricular response, also called dual atrioventricular [AV] nodal non-re-entrant tachycardia, is a rare arrhythmic condition, characterized by 1:2 anterograde conduction via dual AV-nodal pathways, that is, one P wave is followed by two QRS complexes. The main symptom is palpitations, and it can be treated by catheter ablation. To date, less than 100 cases of dual ventricular response have been published in the scientific literature. In this case report, we present two patients with dual ventricular response (based on ECG findings), both of whom were identified during a 10-year period at a small hospital in Sweden. The case report exemplifies the potential for underdiagnosis of dual ventricular response, due to its tendency to mimic more common arrhythmic conditions, like supraventricular tachycardia and atrial fibrillation.
Collapse
Affiliation(s)
| | - Viktor Oskarsson
- med dr, ST-läkare, medicin- och rehabiliteringskliniken, Piteå sjukhus
| |
Collapse
|
17
|
Bergfeldt L. [The AV node - an enigmatic »black box« located in the centre of the heart]. Lakartidningen 2022; 119:22072. [PMID: 36082919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This commentary refers to a case report describing dual ventricular responses following a single P-wave, which is an unusual but possibly underdiagnosed phenomenon. The AV node synchronizes atrial and ventricular mechanical functions, acts as an electrical filter protecting the ventricles from high heart rates during atrial fibrillation and flutter and is also a back-up generator if the sinus node fails. Dual AV-nodal pathways are the substrate for the relatively common AV-nodal re-entrant tachycardia (AVNRT), which is curable by ablation. Ablation is also the therapy of choice when dual ventricular responses cause palpitations with or without AVNRT, or in rare cases of continuously impaired ventricular mechanical function.
Collapse
|
18
|
Yazaki Y, Satomi K, Chikamori T. The Utility of a Lewis Lead for Distinguishing Atrioventricular Reentrant Tachycardia from Typical Atrioventricular Nodal Reentrant Tachycardia. Intern Med 2022; 61:1645-1651. [PMID: 34744113 PMCID: PMC9259309 DOI: 10.2169/internalmedicine.8470-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The Lewis lead configuration is an alternative bipolar chest lead and it can help detect atrial activity. The utility of the Lewis lead to distinguish orthodromic atrioventricular reentrant tachycardia (AVRT) from typical atrioventricular nodal reentrant tachycardia (AVNRT) by visualizing the apparent retrogradely conducted P waves was investigated. Methods Forty-four patients with paroxysmal supraventricular tachycardia (PSVT) were included in this study. All patients had PSVT documented by an electrocardiogram (ECG) and underwent an electrophysiological study (EPS). During tachycardia, an ECG recording was performed using a Lewis lead with the electrode on the right aspect of the sternum at the second intercostal space instead of the right arm and the electrode on the fourth intercostal space instead of the left arm. The ECG parameters during tachycardia were compared between AVRT and AVNRT. Results Fourteen patients were diagnosed with AVRTs and 30 with typical AVNRTs on EPS. The positive P wave could be seen in the Lewis lead configuration in 9 of 14 patients with AVRTs and 21 of 30 patients with AVNRTs. P waves were more often visible in the Lewis lead configuration than in the standard leads (66% vs. 45%). The RP interval was significantly longer for AVRTs than for AVNRTs (88±17 vs. 154±34 ms, p<0.001), which yields 89% sensitivity and 71% specificity for distinguishing these 2 tachyarrhythmias with a cut-off point of 100 ms. Conclusion A Lewis lead configuration may help to make an accurate diagnosis among the reentrant supraventricular tachycardias prior to procedures, owing to its ability to locate P waves.
Collapse
Affiliation(s)
- Yoshinao Yazaki
- Department of Cardiology, Tokyo Medical University Hospital, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University Hospital, Japan
| | | |
Collapse
|
19
|
Jansen H, Nürnberg JH, Veltmann C, Hebe J. Anatomy for ablation of atrioventricular nodal reentry tachycardia and accessory pathways. Herzschrittmacherther Elektrophysiol 2022; 33:133-147. [PMID: 35608665 DOI: 10.1007/s00399-022-00860-0] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/17/2022] [Indexed: 11/26/2022]
Abstract
The atrioventricular (AV) valve plane and the central septum are of particular importance for electrophysiological diagnosis and interventional therapy of supraventricular tachycardias because accessory electrical connections of various types may be present in addition to the specific conduction system. Although modern 3D electroanatomic reconstruction systems including high-density mapping can be of great assistance, detailed knowledge of the anatomic structures involved, their complex three-dimensional arrangement, and their electrical properties in conjunction with electrophysiological features of supraventricular arrhythmias is essential for safe and efficient electrophysiological treatment. The aim of this article is to present current anatomical, topographical, and electrophysiological findings against the background of historical, seminal, and still indispensable literature.
Collapse
|
20
|
Mercik JS, Radziejewska J, Pach K, Zyśko D, Gajek J. ST-segment depression in atrioventricular nodal reentrant tachycardia: Preliminary results. ADV CLIN EXP MED 2021; 30:1323-1328. [PMID: 34898057 DOI: 10.17219/acem/144161] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The ST-segment is part of the electrocardiogram and physiologically, it forms an isoelectric line. The ST-segment depression is often observed in young, healthy people with paroxysmal tachycardia with narrow QRS complexes. In this group of patients, the 'mysterious tachycardia-induced ST-segment depression', 'subendocardial myocardial ischemia' and other not fully understood terms are used to explain this phenomenon. OBJECTIVES To assess the presence and possible mechanisms of ST-segment depression during atrioventricular nodal reentrant tachycardia (AVNRT) in patients undergoing radiofrequency (RF) ablation of the underlying arrhythmia. MATERIAL AND METHODS The study included 50 patients (35 women and 15 men) aged about 49 years with clinically relevant paroxysmal narrow QRS complex tachycardia. During electrophysiological study (EPS), all patients had measured QRS components - QR, RS and RJ during the tachycardia and during the sinus rhythm. All of the measurements were done in lead V5. RESULTS There was a statistically significant difference in cycle length during sinus rhythm and tachycardia (707.0 ±137.8 ms compared to 327.5 ±29.1 ms, p = 0.000), the RJ component (0.819 ±0.381 mV compared to 0.878 ±0.376 mV, p = 0.003) and the difference RJ-QR (0.081 ±0.083 mV compared to 0.163 ±0.108 mV, p = 0.000). The differences in RS and QR components during sinus rhythm and tachycardia did not reach the statistical significance. The difference RJ-QR during tachycardia correlated negatively with tachycardia cycle length (R = -0.39, p = 0.0049). The tachycardia cycle length correlated positively with the age of the studied patients (R = 0.28, p = 0.043). CONCLUSION In patients with AVNRT, there is a ST-segment depression during the episodes of tachycardia and the degree of this change is related to tachycardia cycle length. The most probable explanation of the ST-segment depression is the overlap of the QRS complex on the preceded T wave. Some intrinsic properties of individual electrocardiogram (ECG) also influence this phenomenon. The ischemic origin of the presented ST-segment change can be excluded.
Collapse
Affiliation(s)
| | | | - Katarzyna Pach
- Students' Scientific Association, Department of Emergency Medical Service, Wroclaw Medical University, Poland
| | - Dorota Zyśko
- Department of Emergency Medicine, Wroclaw Medical University, Poland
| | - Jacek Gajek
- Department of Emergency Medical Service, Wroclaw Medical University, Poland
| |
Collapse
|
21
|
Deutsch K, Ciurzyński M, Śledź J, Zienciuk-Krajka A, Mazij M, Ludwik B, Stec P, Wileczek A, Pruszczyk P, Stec S. Association between the geographic region and the risk of familial atrioventricular nodal reentrant tachycardia in the Polish population. Pol Arch Intern Med 2021; 131. [PMID: 34581176 DOI: 10.20452/pamw.16099] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common regular supraventricular arrhythmias referred for catheter ablation (CA). In Poland, several families with familial AVNRT (FAVNRT) were reported in Podkarpacie Province (PP). OBJECTIVES We aimed to determine the frequency of FAVNRT in PP compared with other south‑eastern provinces of Poland. PATIENTS AND METHODS Clinical data of 1544 patients with AVNRT diagnosed by invasive electrophysi-ological study between 2010 and 2019 were screened for FAVNRT. From January 2017 to June 2019, patients were asked to provide details on family history and origin to obtain 3‑generation pedigrees. Families with at least 2 members with previous CA of AVNRT were divided into those from south‑eastern provinces (SEPs; including PP and bordering provinces [BPs]) and the remaining parts of Poland (RPP). RESULTS There were 932 patients from SEPs and 612 from RPP. FAVNRT was reported in 45 patients (2.91%) from 27 families, with a higher frequency in SEPs than RPP (4.02% vs 1.17%; P = 0.002) and the highest frequency in PP (6.33% vs 2.47% in BPs; P = 0.004). The risk of FAVNRT was higher in PP compared with BPs (odds ratio, 2.67; 95% CI, 1.36-5.23; P = 0.004) and similar in BPs compared with RPP (odds ratio, 2.14; 95% CI, 0.86-5.34; P = 0.1). CONCLUSIONS A relationship exists between the geographic region and frequency of FAVNRT. A greater distance from PP was associated with less frequent FAVNRT. International cooperation and genetic test-ing are needed to confirm the genetic impact of FAVNRT in this part of Central Europe.
Collapse
Affiliation(s)
- Karol Deutsch
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warsaw, Poland.
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Mariusz Mazij
- Regional Specialist Hospital in Wrocław, Wrocław, Poland
| | - Bartosz Ludwik
- Regional Specialist Hospital in Wrocław, Wrocław, Poland
| | - Piotr Stec
- Specialist Hospital in Stalowa Wola, Stalowa Wola, Poland
| | - Antoni Wileczek
- Cardiology Departament, Specialist Hospital in Sanok, Sanok, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Warsaw, Poland
| | - Sebastian Stec
- ELMedica EP-Network, Kielce, Poland
- Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland
- MediNice Research and Development Center, Rzeszów / Krosno, Poland
| |
Collapse
|
22
|
Affiliation(s)
- Gregory K Feld
- University of California, San Diego Health System, San Diego, California.
| |
Collapse
|
23
|
Hartmann J, Jungen C, Stec S, Klatt N, Willems S, Makimoto H, Steven D, Pürerfellner H, Martinek M, Meyer C. Outcomes in patients with dual antegrade conduction in the atrioventricular node: insights from a multicentre observational study. Clin Res Cardiol 2020; 109:1025-1034. [PMID: 32002633 PMCID: PMC7375989 DOI: 10.1007/s00392-020-01596-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Supraventricular tachycardias induced by dual antegrade conduction via the atrioventricular (AV) node are rare but often misdiagnosed with severe consequences for the affected patients. As long-term follow-up in these patients was not available so far, this study investigates outcomes in patients with dual antegrade conduction in the AV node. METHODS AND RESULTS In this multicentre observational study, patients from six European centres were studied. Catheter ablation was performed in 17 patients (52 ± 16 years) with dual antegrade conduction via both AV nodal pathways between 2012 and 2018. Patients with the final diagnosis of a manifest dual AV nodal non-re-entrant tachycardia had a mean delay of the correct diagnosis of over 1 year (range 2-31 months). Two patients received prescription of non-indicated oral anticoagulation, two further patients suffered from inappropriate shocks of an implantable cardioverter defibrillator. In 12 patients, a co-existence of dual antegrade and re-entry conduction in the AV node was present. Mean fast pathway conduction time was 138 ± 61 ms and mean slow pathway conduction time was 593 ± 134 ms. Successful radiofrequency catheter ablation was performed in all patients. Post-procedurally oral anticoagulation was discontinued, without detection of cerebrovascular events or atrial fibrillation during a long-term follow-up of median 17 months (range 6-72 months). CONCLUSION This first multicentre study investigating patients with supraventricular tachycardia and dual antegrade conduction in the AV node demonstrates that catheter ablation is safe and effective while long-term patient outcome is good. Autonomic tone dependent changes in ante- vs. retrograde conduction via slow and/or fast pathway can challenge the diagnosis and therapy in some patients.
Collapse
Affiliation(s)
- Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Sebastian Stec
- Subcarpathian Center for Cardiovascular Intervention, G.V.M. Carint, Sanok, Poland
- Medinice Research and Development Centre, Aeropolis-Jasionka, Rzeszow, Poland
- ELMedica EP-Network, Kielce, Poland
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Daniel Steven
- Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Helmut Pürerfellner
- Department of Cardiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Martin Martinek
- Department of Cardiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.
| |
Collapse
|
24
|
Duchateau J, Tixier R, Vlachos K, Nakatani Y, Ramirez FD, André C, Escande W, Chauvel R, Pambrun T, Derval N, Sacher F, Hocini M, Jaïs P, Haissaguerre M. Ventricular-triggered atrial pacing: A new maneuver for slow-fast atrioventricular nodal reentrant tachycardia. Heart Rhythm 2020; 17:955-964. [PMID: 31954857 DOI: 10.1016/j.hrthm.2020.01.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrioventricular (AV) node duality is suggested by several electrophysiological findings, none of which are strong predictors of AV nodal reentrant tachycardia (AVNRT). OBJECTIVE The purpose of this study was to propose a novel maneuver to study conduction over the AV node and attempt to induce slow-fast AVNRT. METHODS Ventricular-triggered atrial pacing (VTAP) with decremental VA delay was carried out in 36 consecutive patients with slow-fast AVNRT and in 21 controls after conventional electrophysiology study. Maneuvers were repeated after ablation in patients with AVNRT. RESULTS VTAP resulted in a hysteretic conduction curve in 21 of 36 patients (58%) in the AVNRT group but only 4 of 21 patients (19%) in the control group (sensitivity 58; specificity 81%). This finding demonstrates sustained conduction in a slow conducting pathway and concealed retrograde conduction over a fast pathway. VTAP resulted in AVNRT induction in 15 of 25 inducible patients at baseline (60%), 4 of which were not inducible with incremental pacing or programmed atrial stimulation. VTAP resulting in a suspended p wave had 51% (39%-64%) sensitivity and 100% (89%-100%) specificity for predicting noninducibility in a given autonomic state. CONCLUSION VTAP is useful in patients with suspected slow-fast AVNRT. A hysteretic conduction curve demonstrates sustained conduction over a slow pathway and concealed retrograde conduction through the fast pathway, a finding in favor of slow-fast AVNRT. VTAP may facilitate AVNRT induction and proves to be an interesting complement to classic maneuvers. A suspended p-wave response specifically predicts noninducibility of slow-fast AVNRT in a given autonomic state, providing an interesting surrogate to noninducibility as a procedural end point.
Collapse
Affiliation(s)
- Josselin Duchateau
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France.
| | - Romain Tixier
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Yosuke Nakatani
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - F Daniel Ramirez
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Clémentine André
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - William Escande
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| |
Collapse
|
25
|
Tamargo Delpón M, González Torrecilla E. Repetitive Ventriculoatrial Block During Nodal Reentrant Tachycardia. Rev Esp Cardiol (Engl Ed) 2019; 72:964. [PMID: 30318185 DOI: 10.1016/j.rec.2018.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Affiliation(s)
- María Tamargo Delpón
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | |
Collapse
|
26
|
Wang Y, Liu Q, Deng X, Xiao Y, Chen Z. Atrioventricular reentrant tachycardia in a child with tricuspid atresia: A case report of catheter ablation. Medicine (Baltimore) 2019; 98:e14320. [PMID: 30732151 PMCID: PMC6380756 DOI: 10.1097/md.0000000000014320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Atrioventricular reentrant tachycardia (AVRT) is the most common supraventricular tachycardia occurring in children. However, in complex congenital heart disease patients with a different heart anatomy and conduction system morphology, accessory pathway modification may be particularly challenging because of distortion of typical anatomic landmarks. PATIENT CONCERNS A 10-year-old boy with tricuspid atresia and history of bidirectional Glenn operation had recurrent chest distress and palpitation for 3 months. He had multiple hospitalizations for narrow-QRS tachycardia with poor hemodynamic tolerance, despite the use of adenosine and amiodarone. DIAGNOSES AVRT. Tricuspid atresia with secundum atrial septal defect, large ventricular septal defect, and right ventricular outflow tract stenosis. INTERVENTIONS Cardiac catheterization, electrophysiological examination, and ablation. OUTCOMES The child has not had a recurrent AVRT during 6 months of follow-up and is waiting for Fontan operation. LESSONS Since there is an increased risk of accessory pathways in patients with tricuspid atresia, all these patients should be checked before the Fontan operation to exclude congenital accessory pathways.
Collapse
Affiliation(s)
- Yefeng Wang
- Department of Cardiology, Hunan Children's Hospital
| | - Qiming Liu
- Department of Cardiology, Second Xiangya Hospital, Central South University
| | - Xicheng Deng
- Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha, Hunan, China
| | - Yunbin Xiao
- Department of Cardiology, Hunan Children's Hospital
| | - Zhi Chen
- Department of Cardiology, Hunan Children's Hospital
| |
Collapse
|
27
|
Bagliani G, Leonelli FM, De Ponti R, Padeletti L. Advanced Concepts of Atrioventricular Nodal Electrophysiology: Observations on the Mechanisms of Atrioventricular Nodal Reciprocating Tachycardias. Card Electrophysiol Clin 2019; 10:277-297. [PMID: 29784484 DOI: 10.1016/j.ccep.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/19/2022]
Abstract
Atrioventricular node reentrant tachycardia (AVNRT) is a supraventricular arrhythmia easily diagnosed by 12-lead electrocardiogram. What is far more challenging, is the understanding of the reentrant circuit in its typical and atypical presentations. The function of the atrioventricular node is still incomplete and this knowledge gap is reflected in the reconstruction of the pathways used by AVNRT in its multiform presentations. This article illustrates the heterogeneous electrocardiographic manifestations of AVNRT. We reconstruct the reentrant circuits involved using more recent understanding of the anatomic and electrophysiologic characteristics of the atrioventricular node.
Collapse
Affiliation(s)
- Giuseppe Bagliani
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Via Massimo Arcamone, Foligno 06034, Italy; Cardiovascular Diseases Department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Cardiology Department, University of Insubria, Via Ravasi, 2, 21100 Varese, Italy
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, Florence 50134, Italy; IRCCS Multimedica, Cardiology Department, Via Milanese, 300, 20099 Sesto San Giovanni, Italy
| |
Collapse
|
28
|
Kaiser DW, Nasir JM, Liem LB, Brodt C, Motonaga KS, Ceresnak SR, Turakhia MP, Dubin AM. A novel pacing maneuver to verify the postpacing interval minus the tachycardia cycle length while adjusting for decremental conduction: Using "dual-chamber entrainment" for improved supraventricular tachycardia discrimination. Heart Rhythm 2018; 16:717-723. [PMID: 30465902 DOI: 10.1016/j.hrthm.2018.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The postpacing interval (PPI) minus the tachycardia cycle length (TCL) is frequently used to investigate tachycardias. However, a variety of issues (eg, failure to entrain, decremental conduction, and oscillating TCLs) can make interpretation of the PPI-TCL challenging. OBJECTIVE The purpose of this study was to investigate a novel maneuver to confirm the PPI-TCL value without using either the ventricular PPI or the TCL interval and to assess the ability of this maneuver to identify decremental conduction and differentiate supraventricular tachycardias. METHODS We analyzed 77 intracardiac recordings from patients (age 25 ± 20 years; 40 female) who underwent catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) or orthodromic reciprocating tachycardia (ORT) with a concealed pathway. We calculated the PPI-TCL, the AH-corrected PPI-TCL, and estimated the PPI-TCL using "dual-chamber entrainment" calculated as [PPIV - TCL = Stim(A→V) + Stim(V→A) - PPIA]. RESULTS The PPI-TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI-TCL (R2 = 0.79 and 0.96, respectively; P <.001]. A dual-chamber entrainment PPI-TCL value of 80 ms correctly differentiated all AVNRT from septal ORT cases, whereas the standard PPI-TCL and AH-corrected PPI-TCL methods were incorrect in 14% and 6% of cases, respectively. Dual-chamber entrainment identified 3 ± 10 ms of additional decremental conduction beyond AH prolongation, including 4 pathways with significant (>10 ms) decrement. CONCLUSION Dual-chamber entrainment estimates the PPI-TCL value without using either the ventricular PPI or the TCL interval. This maneuver adjusts for all decremental conduction, including within concealed pathways, where a dual-chamber entrainment PPI-TCL value >80 ms favors AVNRT over ORT. This maneuver can be used to verify the observed PPI-TCL value in challenging cases.
Collapse
Affiliation(s)
- Daniel W Kaiser
- El Camino Hospital, Mountain View, California; St Helena Hospital, St Helena, California.
| | - Javed M Nasir
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - L Bing Liem
- El Camino Hospital, Mountain View, California; St Helena Hospital, St Helena, California
| | - Chad Brodt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kara S Motonaga
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Scott R Ceresnak
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Mintu P Turakhia
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Anne M Dubin
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
29
|
Bukari A, Wali E, Deshmukh A, Aziz Z, Broman M, Beaser A, Upadhyay G, Nayak H, Tung R, Ozcan C. Prevalence and predictors of atrial arrhythmias in patients with sinus node dysfunction and atrial pacing. J Interv Card Electrophysiol 2018; 53:365-371. [PMID: 30293095 DOI: 10.1007/s10840-018-0463-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/27/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to determine the incidence, prevalence, and predictors of atrial arrhythmias (AAs) in patients with symptomatic sinus node dysfunction (SND) who required permanent pacemaker implantation. Also, we evaluated the impact of atrial pacing (AP) on AAs. METHODS All consecutive patients who underwent pacemaker implantation from 2005 to 2011 were included. Atrial fibrillation (AF), atrial flutter (AFL), atrial tachycardia (AT), and AV nodal reentrant tachycardia (AVNRT) were detected via pacemaker interrogation and clinical documentation. RESULTS The study group included 322 patients (44% male) with mean age 68.8 ± 15 years and followed for an average of 5.6 ± 2.2 years (median 5.7 years). Overall, 61.8% were found to have any AA at follow-up. Individual prevalence of AAs was high as follows: AF 43.5%, AFL 6.5%, AT 25%, and AVNRT 6.8%. AF was documented in 23% of patients (n = 74) prior to pacemaker; among those, 15% (n = 11) had no recurrence of AF with average AP of 74%. The incidence of new-onset AF after pacemaker was 15.8%. In subgroup analysis, prevalence of AF was increased by 16% with high rate of AP (81-100%) and 17% with lower rate of AP (0-20%). Incidence of new-onset AF was not affected by AP. Diabetes, hypertension, and left atrial enlargement were predictors of AAs. White men and women had higher prevalence of AF. CONCLUSIONS AAs are highly prevalent in SND, particularly in white patients. Paroxysmal AF is suppressed with AP in minority, but there is no impact of AP on new-onset AF. Patients with diabetes, hypertension, and dilated atria must be monitored closely for early detection of AAs.
Collapse
Affiliation(s)
- Abdallah Bukari
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Eisha Wali
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Amrish Deshmukh
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Zaid Aziz
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Michael Broman
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Andrew Beaser
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Gaurav Upadhyay
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Hemal Nayak
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA
| | - Cevher Ozcan
- Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago Medicine Pritzker School of Medicine, 5841 S. Maryland Avenue, MC 6092, Chicago, IL, 60637, USA.
| |
Collapse
|
30
|
Sledz J, Labus M, Mazij M, Klank-Szafran M, Karbarz D, Ludwik B, Kusa J, Deutsch K, Szydlowski L, Mscisz A, Spikowski J, Morka A, Kameczura T, Swietoniowska-Mscisz A, Stec S. A simplified approach for evaluating sustained slow pathway conduction for diagnosis and treatment of atrioventricular nodal reentry tachycardia in children and adults. Adv Med Sci 2018; 63:249-256. [PMID: 29433068 DOI: 10.1016/j.advms.2018.01.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE During incremental atrial pacing in patients with atrioventricular nodal reentrant tachycardia, the PR interval often exceeds the RR interval (PR > RR) during stable 1:1 AV conduction. However, the PR/RR ratio has never been evaluated in a large group of patients with pacing from the proximal coronary sinus and after isoproterenol challenge. Our study validates new site of pacing and easier method of identification of PR > RR. MATERIAL AND METHODS A prospective protocol of incremental atrial pacing from the proximal coronary sinus was carried out in 398 patients (AVNRT-228 and control-170). The maximum stimulus to the Q wave interval (S-Q = PR), SS interval (S-S), and Q-Q (RR) interval were measured at baseline and 10 min after successful slow pathway ablation and after isoproterenol challenge (obligatory). RESULTS The mean maximum PR/RR ratios at baseline were 1.17 ± 0.24 and 0.82 ± 0.13 (p < 0.00001) in the AVNRT and controls respectively. There were no PR/RR ratios ≥1 at baseline and after isoproterenol challenge in 12.3% of the AVNRT group and in 95.9% of the control group (p < 0.0001). PR/RR ratios ≥1 were absent in 98% of AVNRT cases after slow pathway ablation/modification in children and 99% of such cases in adults (P = NS). The diagnostic performance of PR/RR ratio evaluation before and after isoproterenol challenge had the highest diagnostic performance for AVNRT with PR/RR > = 1 (sensitivity: 88%, specificity: 96%, PPV-97%, NPV-85%). CONCLUSIONS The PR/RR ratio is a simple tool for slow pathway substrate and AVNRT evaluation. Eliminating PR/RR ratios ≥1 may serve as a surrogate endpoint for slow pathway ablation in children and adults with AVNRT.
Collapse
Affiliation(s)
- Janusz Sledz
- Elmedica, EP-Network, Kielce, Poland; Department of Cardiology, G.V.M. Carint, Ostrowiec Swietokrzyski, Poland; Carint Medica, EP-Network, Cracow, Poland
| | - Michal Labus
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | - Mariusz Mazij
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | | | | | - Bartosz Ludwik
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | - Jacek Kusa
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | | | - Leslaw Szydlowski
- Department of Pediatric Cardiology, Medical University of Silesia, Katowice, Poland
| | - Adrian Mscisz
- Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | - Jerzy Spikowski
- Department of Cardiology, Regional Specialist Hospital, Centre for Research and Development, Wroclaw, Poland
| | - Aleksandra Morka
- Department of Pediatric Cardiosurgery and Cardiosurgical Intensive Care University Children Hospital, Faculty of Health Sciences Jagiellonian University Medical College, Krakow, Poland.
| | - Tomasz Kameczura
- Podkarpackie Center for Cardiovascular Intervention, G.V.M. Carint, Sanok, Poland; Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
| | | | - Sebastian Stec
- Elmedica, EP-Network, Kielce, Poland; Chair of Electroradiology, Faculty of Medicine, University of Rzeszow, Rzeszow, Poland; Podkarpackie Center for Cardiovascular Intervention, G.V.M. Carint, Sanok, Poland
| |
Collapse
|
31
|
Wilson JL, Wilson BH, Edwards JR. 13 weeks' gestation · heart palpitations · chest tightness · Dx? J Fam Pract 2018; 67:E9-E11. [PMID: 30110502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Joseph L Wilson
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA.
| | - Bridgid H Wilson
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Justin R Edwards
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA
| |
Collapse
|
32
|
Elkoundi A, Meskine A, Lahlafi Z, Bensghir M, Lalaoui SJ. Supraventricular tachycardia in a trauma patient masquerading as a Wolff-Parkinson-White syndrome. Anaesth Crit Care Pain Med 2018; 37:277-279. [PMID: 28927735 DOI: 10.1016/j.accpm.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Abdelghafour Elkoundi
- Department of Anaesthesiology and intensive care, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Amine Meskine
- Department of Anaesthesiology and intensive care, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Zakaria Lahlafi
- Department of Cardiology, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Mustapha Bensghir
- Department of Anaesthesiology and intensive care, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| | - Salim Jaafar Lalaoui
- Department of Anaesthesiology and intensive care, Military Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
| |
Collapse
|
33
|
De Ponti R, Marazzato J, Bagliani G, Tondini A, Donzelli S, Padeletti L. Peculiar Electrocardiographic Aspects of Wide QRS Complex Tachycardia: When Differential Diagnosis Is Difficult. Card Electrophysiol Clin 2018; 10:317-332. [PMID: 29784486 DOI: 10.1016/j.ccep.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 11/19/2022]
Abstract
Wide complex tachycardia may represent a challenge for correct interpretation of standard electrocardiogram, which is crucial for proper patient management. For this reason, algorithms based on electrocardiographic criteria have been developed to guide interpretation in a step-by-step approach. Despite their greater accuracy, some cases of wide QRS complex tachycardia are a challenge. Some peculiar forms of ventricular tachycardia, and complex supraventricular substrate or particular clinical condition, may originate a challenging electrocardiographic pattern. In this article, a series of peculiar cases of wide QRS complex tachycardia is presented as paradigm of how important a comprehensive clinical approach is in these patients.
Collapse
Affiliation(s)
- Roberto De Ponti
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese 21100, Italy.
| | - Jacopo Marazzato
- Department of Cardiology, School of Medicine, University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, Perugia 06034, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, Perugia 06129, Italy
| | - Alessandra Tondini
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Stefano Donzelli
- Arrhythmology Unit, Cardiology Department, Terni Hospital, Piazzale Tristano da Joannuccio, 1, Terni 05100, Italy
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, Florence 50134, Italy; Cardiology Department, IRCCS Multimedica, Via Milanese, 300, Sesto San Giovanni, Milan 20099, Italy
| |
Collapse
|
34
|
Wang H, Che X. Case report: an unstable wide QRS complexes tachycardia after ablation of a poster-septal accessory pathway: What is the mechanism? Medicine (Baltimore) 2018. [PMID: 29538207 PMCID: PMC5882396 DOI: 10.1097/md.0000000000010120] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Differentiation of wide QRS complex tachycardia required repeated electrophysiological stimuli and mapping. However, instability of tachycardia would increase the difficulty in differential diagnosis. SYMPTOMS AND CLINICAL FINDINGS In this paper, we reported a wide QRS tachycardia following ablation of an atrioventricular reentrant tachycardia participated by a poster-septal accessory pathway. Limited differentiation strategy was performed because the wide QRS tachycardia was self-limited and with unstable hemodynamics. We analyzed the mechanism of the wide QRS tachycardia by only 4 beats ventricular overpacing. On the basis of the last ventricular pacing, an atypical atrioventricular nodal reentrant tachycardia was confirmed. INTERVENTION AND OUTCOMES After slow-pathway modification, the wide QRS tachycardia was eliminated. CONCLUSION It was an atypical atrial-ventricular node reentrant tachycardia with right bundle branch block. Reasonable analysis based on electrophysiological electrophysiologic knowledge was the basis of successful diagnosis and treatment.
Collapse
Affiliation(s)
- Huan Wang
- Department of Cardiology, Zhejiang Province People's Hospital
- Department of Cardiology People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, China
| | - Xiaoru Che
- Department of Cardiology, Zhejiang Province People's Hospital
- Department of Cardiology People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, China
| |
Collapse
|
35
|
Santangeli P. February 26th Question. Circ Arrhythm Electrophysiol 2018; 11:e006249. [PMID: 29483099 DOI: 10.1161/circep.118.006249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
36
|
Takigawa M, Derval N, Frontera A, Martin R, Yamashita S, Cheniti G, Vlachos K, Thompson N, Kitamura T, Wolf M, Massoullie G, Martin CA, Al-Jefairi N, Amraoui S, Duchateau J, Klotz N, Pambrun T, Denis A, Sacher F, Cochet H, Hocini M, Haïssaguerre M, Jais P. Revisiting anatomic macroreentrant tachycardia after atrial fibrillation ablation using ultrahigh-resolution mapping: Implications for ablation. Heart Rhythm 2017; 15:326-333. [PMID: 29081399 DOI: 10.1016/j.hrthm.2017.10.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anatomic macroreentrant atrial tachycardias (MATs) are conventionally reported to depend on the cavotricuspid isthmus, the mitral isthmus, or the left atrial roof, and are commonly seen following catheter ablation for atrial fibrillation. OBJECTIVES To define the precise circuits of anatomic MAT with ultrahigh-resolution mapping. METHODS In 57 patients (mean age, 62 years; 10 female) who developed ≥1 anatomic MAT, we analyzed 88 MAT circuits including 16 peritricuspid, 42 perimitral, and 30 roof-dependent circuits, using high-density mapping and entrainment. RESULTS Of 16 peritricuspid atrial tachycardias (ATs), 8 (50.0%) showed a circuit not limited to the tricuspid annulus. However, cavotricuspid isthmus ablation terminated the tachycardia in all patients. Similarly, 26 of 42 perimitral ATs (61.9%) showed a circuit not limited to the mitral annulus, and a low-voltage zone <0.1 mV around the mitral annulus was associated with nontypical perimitral ATs (P < .0001). The practical isthmus was not in the mitral isthmus in 13 of these 26 perimitral ATs (50%). Finally, 22 of 30 roof-dependent ATs (73.3%) had a circuit not rotating around both pairs of pulmonary veins. Brief assessment of the activation direction on the posterior wall in relation to that on the septal, anterior, and lateral wall helped deduce the circuit of roof-dependent AT in 27 of 30 (90.0%). Practical isthmus was not in the roof in 8 of 22 (36.4%). Practical isthmuses mapped with the system were significantly shorter than the usual anatomic isthmuses (16.1 ± 8.2 mm vs 33.7 ± 10.4 mm) (P < .0001). CONCLUSIONS High-density mapping successfully identified the precise circuits and the practical isthmus of anatomic MATs in patients with prior atrial fibrillation ablation.
Collapse
Affiliation(s)
- Masateru Takigawa
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Nicolas Derval
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Antonio Frontera
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Ruairidh Martin
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Seigo Yamashita
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Nathaniel Thompson
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Takeshi Kitamura
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Michael Wolf
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Gregoire Massoullie
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Claire A Martin
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Nora Al-Jefairi
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Sana Amraoui
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Klotz
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Frederic Sacher
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Hubert Cochet
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Meleze Hocini
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jais
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| |
Collapse
|
37
|
Roca-Luque I, Rivas Gándara N, Dos Subirà L, Pascual JF, Domenech AP, Pérez-Rodon J, Subirana MT, Santos Ortega A, Miranda B, Rosés-Noguer F, Ferreira-Gonzalez I, Ferrer JC, García-Dorado García D, Mitjans AM. Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage. Europace 2017; 20:353-361. [PMID: 29016802 DOI: 10.1093/europace/eux250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/03/2017] [Indexed: 11/13/2022] Open
MESH Headings
- Action Potentials
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Atrial Function
- Catheter Ablation
- Child
- Child, Preschool
- Electrophysiologic Techniques, Cardiac
- Female
- Heart Atria/physiopathology
- Heart Atria/surgery
- Heart Conduction System/physiopathology
- Heart Conduction System/surgery
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/physiopathology
- Heart Rate
- Humans
- Male
- Middle Aged
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/etiology
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Young Adult
Collapse
Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Nuria Rivas Gándara
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Laura Dos Subirà
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Francisco Pascual
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Antònia Pijuan Domenech
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - M Teresa Subirana
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Alba Santos Ortega
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Berta Miranda
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Ferran Rosés-Noguer
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| | - Ignacio Ferreira-Gonzalez
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Jaume Casaldàliga Ferrer
- Adult Congenital Heart Disease Unit, Cardiology Service, Hospital Universitari Val d'Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - David García-Dorado García
- Ciber CV Research Unit, Hospital Universitari Vall d' Hebron, Passeig Vall d' Hebron 119-129, Barcelona, Spain
| | - Angel Moya Mitjans
- Arrhythmia Unit, Cardiology Service, Hospital Universitari Vall d'Hebron, Passeig Vall d' Hebron 119-129, 08035 Barcelona, Spain
| |
Collapse
|
38
|
Aman R, Qureshi AU, Sadiq M. Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms. J PAK MED ASSOC 2017; 67:975-979. [PMID: 28770871] [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
OBJECTIVE To determine the yield of 48-hour Holter monitoring in children with unexplained palpitations and the significance of associated symptoms. METHODS This descriptive study was conducted at the Children's Hospital and Institute of Child Health, Lahore, Pakistan, from January 1 to December 31, 2015. All children above 5 years of age with history of intermittent palpitations and normal basic cardiovascular workup were enrolled. A 48-hour Holter study was performed using Motara Holter Monitoring System. Frequency of various symptoms and abnormal Holter findings were analysed. SPSS 21 was used for data analysis. RESULTS Of the 107 patients, 69(64.5%) were males and 38(34.5%) females. The median age was 10 years (interquartile range: 5-18 years). Most common concomitant symptoms with palpitation included syncope/pre-syncope in 35(32.7%) patients, chest pain 22(20.5%), shortness of breath 21(19.6%) and colour change/pallor 11(10.3%). Holter recording was positive in 40(37%) patients. Frequent premature ventricular contractions 12(11.2%) and atrial ectopic beats 9(8.4%) were the most common findings. Holter findings were significantly more common in patients with history of shortness of breath and colour change/pallor during palpitations (p=0.002). CONCLUSIONS Extended 24-hour Holter monitoring in children with palpitations was an inexpensive, non-invasive investigation with a reasonably high diagnostic yield in detecting arrhythmias.
Collapse
MESH Headings
- Adolescent
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/epidemiology
- Atrial Premature Complexes/diagnosis
- Atrial Premature Complexes/epidemiology
- Chest Pain/epidemiology
- Child
- Child, Preschool
- Dyspnea/epidemiology
- Electrocardiography, Ambulatory/methods
- Female
- Humans
- Male
- Pakistan/epidemiology
- Pallor/epidemiology
- Syncope/epidemiology
- Tachycardia, Atrioventricular Nodal Reentry/diagnosis
- Tachycardia, Atrioventricular Nodal Reentry/epidemiology
- Tachycardia, Ectopic Atrial/diagnosis
- Tachycardia, Ectopic Atrial/epidemiology
- Tachycardia, Reciprocating/diagnosis
- Tachycardia, Reciprocating/epidemiology
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/epidemiology
- Time Factors
- Ventricular Premature Complexes/diagnosis
- Ventricular Premature Complexes/epidemiology
Collapse
|
39
|
Affiliation(s)
- Hein J Wellens
- Cardiovascular Research Institute, Maastricht, The Netherlands.
| |
Collapse
|
40
|
Insulander P, Bastani H, Braunschweig F, Drca N, Kennebäck G, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation of atrioventricular nodal re-entrant tachycardia: 7-year follow-up in 515 patients-confirmed safety but very late recurrences occur. Europace 2017; 19:1038-1042. [PMID: 27738058 DOI: 10.1093/europace/euw145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/27/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Cryoablation is an alternative method to radiofrequency ablation for treatment of atrioventricular nodal re-entrant tachycardia (AVNRT). This study investigates the long-term safety and efficacy of cryoablation in AVNRT. Methods and results We studied 515 consecutive patients (317 women, mean age 50 years, range 13-89 years) undergoing a first cryoablation for AVNRT between 2003 and 2008. Ablations were performed with a 6-mm Freezor Xtra catheter. Six patients were acute failures; 494 out of 509 (97%) primarily successfully ablated patients were followed up for a mean of 7.1 years (range 2-12 years). About 11% (54/494 patients) of patients had recurrences of the index arrhythmia. Time to recurrence varied from days to 9 years; 14 patients (3%) had recurrences later than 2 years, 8 patients (2%) later than 3 years, and 6 patients (2%) later than 4 years. Recurrence rate was higher in patients with slow-slow or fast-slow AVNRT (n = 24) compared with the common slow-fast variant (25 vs. 10%; P = 0.04). Recurrence rate was not higher in patients with residual slow pathway conduction (jump with or without echo beat, n = 199, 39%). Transient atrioventricular (AV) block of the first-, second-, or third-degree during ablation was observed in 45 patients but had no impact on the risk of AVNRT recurrence. No late AV block occurred. Single vs. multiple applications or total amount of cryoenergy delivered did not differ between patients with and without recurrences. Conclusion Cryoablation in AVNRT is safe with a long-term efficacy of 88%; however, very late recurrences occur.
Collapse
|
41
|
Reithmann C. [Bundle branch reentry VT : Diagnosis, mapping, and ablation]. Herzschrittmacherther Elektrophysiol 2017; 28:193-198. [PMID: 28484841 DOI: 10.1007/s00399-017-0502-6] [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] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 04/10/2017] [Indexed: 11/26/2022]
Abstract
Macroreentry in the His-Purkinje system can result in sustained ventricular tachycardia (VT) termed bundle branch reentry VT. Bundle branch reentry is usually associated with His-Purkinje disease and depressed left ventricular function. In the case of typical bundle branch reentry, the right bundle is activated in the anterograde direction and ventricular depolarization begins at the distal end of the right bundle on the ventricular septum generating a typical left bundle branch block QRS morphology. However, atypical surface ECGs can also be found in patients with severe left ventricular dysfunction and involvement of the right ventricle complicating the diagnosis of bundle branch reentry VT. It is important to diagnose bundle branch reentry VT because patients with bundle branch reentry VT may suffer from a high rate of serial implantable cardioverter defibrillator (ICD) interventions based on VT recurrences due to immediate reinitiation of the arrhythmia. Ablation of the right bundle branch easily cures bundle branch reentry VT and can prevent frequent ICD interventions. After ablation of bundle branch reentry VT, mortality remains high due to the severe left ventricular dysfunction in many patients, and the patients are candidates for cardiac resynchronization therapy (CRT-D).
Collapse
Affiliation(s)
- Christopher Reithmann
- Medizinische Klinik 1, HELIOS Klinikum München West, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität München, Steinerweg 5, 81241, München, Deutschland.
| |
Collapse
|
42
|
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.
Collapse
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
| |
Collapse
|
43
|
Hluchy J, Nguyen DQ, Sobczak H, Brandts B. Nonfluoroscopic Imaging as Guidance for Radiofrequency Ablation of Atrioventricular Nodal Reentrant Tachycardia after Mustard Repair. Tex Heart Inst J 2017; 44:58-61. [PMID: 28265215 DOI: 10.14503/thij-15-5548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most tachycardias in the pulmonary venous atrium are inaccessible by direct means and require either a retrograde approach or a transseptal approach for ablation. We present a case in which successful radiofrequency ablation of common atrioventricular nodal reentrant tachycardia was accomplished via a retrograde transaortic approach guided by nonfluoroscopic mapping with use of the NavX™ mapping system. The patient was a 49-year-old woman who at the age of 4 years had undergone Mustard repair for complete dextrotransposition of the great arteries. Three-dimensional reconstructions of the ascending aorta, right ventricle, systemic venous atrium, left ventricle, and superior vena cava-inferior vena cava baffle complex were created, and the left-sided His bundle was marked. After a failed attempt at ablation from the systemic venous side, we eliminated the atrioventricular nodal reentrant tachycardia by ablation from the pulmonary venous side. This case is, to our knowledge, the first report of successful radiofrequency ablation of common atrioventricular nodal reentrant tachycardia after Mustard repair for this congenital cardiac malformation in which ablation was guided by 3-dimensional nonfluoroscopic imaging. This imaging technique enabled accurate anatomic location of the ablation catheters in relation to the His bundle marked from the systemic venous side.
Collapse
|
44
|
Pellizzón OA, Nannini S. [Induction of atrioventricular nodal reentrant tachycardia by radiofrequency application]. Medicina (B Aires) 2017; 77:433-436. [PMID: 29044024] [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] Open
Abstract
Atrioventricular nodal reentrant tachycardia is the most common form of sustained regular narrow QRS complex tachycardia. It is caused by the presence of a dual atrioventricular nodal anatomy and physiology, with a fast and a slow pathway forming a substrate for re-entry. Electrophysiology study confirms the diagnosis when the tachycardia is induced, although in some cases this is not possible. Casuistry is here presented where the application of radiofrequency induced atrioventricular nodal reentrant tachycardia, when the electrophysiological study could not do it; we explain here its electrophysiological mechanism.
Collapse
Affiliation(s)
- Oscar A Pellizzón
- Centro de Arritmias Cardíacas, Servicio de Cardiología, Hospital Universitario del Centenario, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Santa Fe, Argentina. E-mail:
| | - Sebastián Nannini
- Centro de Arritmias Cardíacas, Servicio de Cardiología, Hospital Universitario del Centenario, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Santa Fe, Argentina
| |
Collapse
|
45
|
Yalcinkaya E, Duru F, Greutmann M, Wolber T. Play the Map: Ablation of a Macro Reentrant Atrial Tachycardia in a Patient After Senning Repair for Transposition of the Great Arteries. J Invasive Cardiol 2017; 29:E13. [PMID: 28045674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 50-year-old male patient who had undergone Senning repair for transposition of the great arteries at the age of 7 years was referred to our electrophysiology lab with recurrent supraventricular tachycardias. Fast anatomical mapping of the systemic venous atrium was performed with the CARTO electroanatomical mapping system. Propagation mapping with animated dynamic maps facilitates the understanding of the underlying mechanism and provides visualization of reentrant circuits of tachycardias in cardiac chambers with native barriers and surgical scars.
Collapse
Affiliation(s)
- Emre Yalcinkaya
- Zurich University Hospital, Arrhythmia and Electrophysiology Division, University Heart Center, 8091, Zurich, Switzerland.
| | | | | | | |
Collapse
|
46
|
Yalcinkaya E, Winnik S, Haegeli L, Brunckhorst C, Duru F. Successful Cryoablation of an Anteroseptal Accessory Pathway Guided by Electroanatomical Activation Mapping. J Invasive Cardiol 2016; 28:E227. [PMID: 27922815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of electroanatomical mapping can facilitate the identification of the ideal cryoablation site by providing a three-dimensional map of the earliest activation site. Combined use of the cryoablation technology with electroanatomical mapping can further increase the precision and safety of the procedure by applying test applications at a lower energy level.
Collapse
Affiliation(s)
- Emre Yalcinkaya
- Arrhythmia and Electrophysiology Division, University Heart Center, 8091, Zurich, Switzerland.
| | | | | | | | | |
Collapse
|
47
|
Voss F, Eckardt L, Busch S, Estner HL, Steven D, Sommer P, von Bary C, Neuberger HR. [AV-reentrant tachycardia and Wolff-Parkinson-White syndrome : Diagnosis and treatment]. Herzschrittmacherther Elektrophysiol 2016; 27:381-389. [PMID: 27878364 DOI: 10.1007/s00399-016-0466-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/01/2022]
Abstract
The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/1000. The pathophysiological basis is an accessory atrioventricular pathway (AP). Patients with AVRT typically present with palpitations, an on-off characteristic, anxiety, dyspnea, and polyuria. This type of tachycardia may often be terminated by vagal maneuvers. Although the clinical presentation of AVRT is quite similar to AV-nodal reentrant tachycardias, the correct diagnosis is often facilitated by analyzing a standard 12-lead ECG at normal heart rate showing ventricular preexcitation. Curative catheter ablation of the AP represents the therapy of choice in symptomatic patients. This article is the fourth part of a series written to improve the professional education of young electrophysiologists. It explains pathophysiology, symptoms, and electrophysiological findings of an invasive EP study. It focusses on mapping and ablation of accessory pathways.
Collapse
Affiliation(s)
- Frederik Voss
- Innere Medizin III, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54290, Trier, Deutschland.
| | - Lars Eckardt
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Sonia Busch
- Medizinische Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Coburg, Coburg, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Universitätsklinikum München-Großhadern, München, Deutschland
| | - Daniel Steven
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Köln, Deutschland
| | - Philipp Sommer
- Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | | | | |
Collapse
|
48
|
He J, Liu Z, Fang PH, Chen XB, Liu J, Tang M, Jia YH, Zhang S. Long-term efficacy of empirical slow pathway ablation in non-inducible and suspected atrioventricular nodal reentry tachycardia. Acta Cardiol 2016; 71:457-62. [PMID: 27594362 DOI: 10.2143/ac.71.4.3159699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
49
|
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.
Collapse
Affiliation(s)
- Haran Burri
- Cardiology Department, University Hospital of Geneva, Rue Gabrielle Perret Gentil 4, 1211, Geneva, Switzerland.
| |
Collapse
|
50
|
Bellmann B, Roser M, Suhail S, Muntean BG. Is it ventricular tachycardia or not? Multiple ICD therapies in a patient with ischemic cardiomyopathy. Minerva Cardioangiol 2016; 64:499-500. [PMID: 27228490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Barbara Bellmann
- Department of Cardiology, Campus Benjamin Franklin, Charité Medical University, Berlin, Germany -
| | | | | | | |
Collapse
|