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Eldadah ZA, Al-Ahmad A, Bunch TJ, Delurgio DB, Doshi RN, Hook BG, Hranitzky PM, Joyner CA, Mittal S, Porterfield C, Sanchez JE, Thambidorai SK, Wazni OM, McElderry HT. Same-day discharge following catheter ablation and venous closure with VASCADE MVP: A postmarket registry. J Cardiovasc Electrophysiol 2023; 34:348-355. [PMID: 36448428 DOI: 10.1111/jce.15763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Early and safe ambulation can facilitate same-day discharge (SDD) following catheter ablation, which can reduce resource utilization and healthcare costs and improve patient satisfaction. This study evaluated procedure success and safety of the VASCADE MVP venous vascular closure system in patients with atrial fibrillation (AF). METHODS The AMBULATE SDD Registry is a two-stage series of postmarket studies in patients with paroxysmal or persistent AF undergoing catheter ablation followed by femoral venous access-site closure with VASCADE MVP. Efficacy endpoints included SDD success, defined as the proportion of patients discharged the same day who did not require next-day hospital intervention for procedure/access site-related complications, and access site sustained success within 15 days of the procedure. RESULTS Overall, 354 patients were included in the pooled study population, 151 (42.7%) treated for paroxysmal AF and 203 (57.3%) for persistent AF. SDD was achieved in 323 patients (91.2%) and, of these, 320 (99.1%) did not require subsequent hospital intervention based on all study performance outcomes. Nearly all patients (350 of 354; 98.9%) achieved total study success, with no subsequent hospital intervention required. No major access-site complications were recorded. Patients who had SDD were more likely to report procedure satisfaction than patients who stayed overnight. CONCLUSION In this study, 99.7% of patients achieving SDD required no additional hospital intervention for access site-related complications during follow-up. SDD appears feasible and safe for eligible patients after catheter ablation for paroxysmal or persistent AF in which the VASCADE MVP is used for venous access-site closure.
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Affiliation(s)
- Zayd A Eldadah
- Heart & Vascular Institute, MedStar Health, Columbia, Maryland, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - T Jared Bunch
- Department of Medicine, School of Medicine, University of Utah, Murray, Utah, USA
| | - David B Delurgio
- Department of Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Rahul N Doshi
- Cardiac Arrhythmia Group, HonorHealth Medical Group, Scottsdale, Arizona, USA
| | - Bruce G Hook
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | | | - Charles A Joyner
- Department of Cardiology, Levinson Heart Hospital at Chippenham and Johnston Willis Medical Center, Richmond, Virginia, USA
| | - Suneet Mittal
- Electrophysiology, Valley Health System, Ridgewood, New Jersey, USA
| | | | - Javier E Sanchez
- Texas Cardiac Arrhythmia, Medical City Dallas, Dallas, Texas, USA
| | | | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - H Thomas McElderry
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Kautzner J, Albenque JP, Natale A, Maddox W, Cuoco F, Neuzil P, Poty H, Getman MK, Liu S, Starek Z, Dukkipati SR, Colley BJ, Al-Ahmad A, Sidney DS, McElderry HT. A Novel Temperature-Controlled Radiofrequency Catheter Ablation System Used to Treat Patients With Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:352-363. [PMID: 33516712 DOI: 10.1016/j.jacep.2020.11.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES DIAMOND-AF (DiamondTemp™ Ablation System for the Treatment of Paroxysmal Atrial Fibrillation) was a prospective, multicenter, noninferiority, randomized trial that compared the safety and effectiveness of the DTA system versus those of a force-sensing RF ablation system (control) for the treatment of patients with drug-refractory, recurrent, symptomatic paroxysmal atrial fibrillation (AF). BACKGROUND Irrigated radiofrequency (RF) ablation catheters lose tissue temperature acuity, which is vital in assessing lesion formation. DiamondTemp Ablation (DTA) was designed to re-establish accurate tissue temperature measurements during ablation. METHODS A total of 482 patients with paroxysmal AF were randomized (239 DTA, 243 control) to undergo pulmonary vein isolation and were followed up at 23 sites. Patients were screened for disease progression, cardiac characteristics, and prior interventions. Primary endpoints were effectiveness (freedom from atrial arrhythmia recurrence) and safety (composite of procedure- and device-related serious adverse events). RESULTS The primary safety event rate was 3.3% in the DTA group versus 6.6% in the control group (p < 0.001 vs. 6.5% noninferiority margin). Primary effectiveness was met in 79.1% of DTA subjects and 75.7% of control subjects (p < 0.001 vs. -12.5% noninferiority margin). Secondary endpoint analysis found that off-drug effectiveness favored DTA compared with the control (142 [59.4%] vs. 120 [49.4%], respectively; p = 0.03). Total RF time and individual RF ablation duration were significantly shorter with less saline infused through the DTA catheter (p < 0.001). Both arms saw clinically meaningful improvements in quality of life at 12 months. CONCLUSIONS Safety and efficacy of the DTA system proved noninferior to force-sensing RF ablation in a paroxysmal AF population. Efficiencies were observed using DTA with shorter total RF times, individual RF ablation durations, and less saline infusion. (DiamondTemp™ Ablation System for the Treatment of Paroxysmal Atrial Fibrillation; NCT03334630).
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Affiliation(s)
- Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
| | - William Maddox
- University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Frank Cuoco
- Trident Medical Center, Charleston, South Carolina, USA
| | | | - Herve Poty
- Clinique du Tonkin, Valleurbanne, France
| | | | - Shufeng Liu
- Medtronic, Inc., Minneapolis, Minnesota, USA
| | - Zdenek Starek
- St. Anne's University Hospital, Brno, Czech Republic
| | | | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
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3
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Affiliation(s)
- Thomas E Watts
- From Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - H Thomas McElderry
- From Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - G Neal Kay
- From Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham.
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Yamada T, Yoshida N, Itoh T, Litovsky SH, Doppalapudi H, McElderry HT, Kay GN. Idiopathic Ventricular Arrhythmias Originating From the Parietal Band. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005099. [DOI: 10.1161/circep.117.005099] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
Abstract
Backgrounds—
The parietal band is one of the muscle bands in the right ventricle. This study investigated the electrocardiographic and electrophysiological characteristics and ablation outcome of idiopathic ventricular arrhythmias (VAs) originating from the parietal band.
Methods and Results—
We studied 14 patients with idiopathic VA origins in the parietal band among 294 consecutive patients with VA origins in the right ventricle. The QRS morphologies of the parietal band VAs were characterized by a left bundle branch block and left inferior (n=12) or superior (n=2) axis pattern with the presence of a notch in the middle of the QRS in all cases, precordial transition at ≤lead V3 in 7 patients, and a slow QRS onset in 4 patients. During parietal band VAs, a far-field ventricular electrogram with an early activation was always recorded in the His bundle region, regardless of the location of the VA origins. During the catheter ablation, a mean number of 10.4±7.4 radiofrequency applications with a duration of 1099±1034 seconds were delivered. Catheter ablation was successful in 10 patients, and VAs recurred in 4 during a mean follow-up period of 41±24 months. A change in the QRS morphology was observed spontaneously in 4 patients, immediately after the ablation in 4, and at the time of a VA recurrence in 2.
Conclusions—
Idiopathic VAs rarely originated from the parietal band. The catheter ablation of the parietal band VAs was always challenging, requiring a large amount of the radiofrequency energy delivery for a successful ablation with a relatively high recurrence rate.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Naoki Yoshida
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Taihei Itoh
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., N.Y., T.I., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
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Yamada T, Yoshida N, Doppalapudi H, Litovsky SH, McElderry HT, Kay GN. Efficacy of an Anatomical Approach in Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2017; 10:e004959. [DOI: 10.1161/circep.116.004959] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
Background—
When anatomic obstacles preclude radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT), an alternative approach from the anatomically opposite side (endocardial versus epicardial or above versus below the aortic valve) may be considered (anatomic ablation). The purpose of this study was to investigate the efficacy of an anatomic ablation in idiopathic LVOT VAs.
Methods and Results—
We studied 229 consecutive patients with idiopathic LVOT VAs. Radiofrequency ablation from the first suitable site was successful in 190 patients, and in the remaining 39 patients, it was unsuccessful or had to be abandoned because of anatomic obstacles. In 22 of these 39 patients, an anatomic ablation was successful, and the VA origins were located in the intramural LVOT in 17 patients, basal left ventricular summit in 4, and LVOT septum near the His bundle in 1. The anatomic ablation was highly successful for idiopathic VAs originating from the intramural LVOT (>75%) and lateral LVOT, whereas it was unlikely to be successful for idiopathic VAs originating from the basal left ventricular summit (25%) and sepal LVOT.
Conclusions—
When a standard catheter ablation targeting the best electrophysiological measure of idiopathic LVOT VAs was unsuccessful or had to be abandoned because of anatomic obstacles, an anatomic ablation was moderately successful. These idiopathic LVOT VAs with a successful anatomic ablation commonly arose from the intramural LVOT among the left coronary cusp, aortomitral continuity, and epicardium, occasionally the basal left ventricular summit, and rarely the LVOT septum near the His bundle.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Naoki Yoshida
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., N.Y., H.D., H.T.M.E., G.N.K.), Department of Pathology (S.H.L.), University of Alabama at Birmingham
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Reddy VY, Pollak S, Lindsay BD, McElderry HT, Natale A, Kantipudi C, Mansour M, Melby DP, Lakkireddy D, Levy T, Izraeli D, Sangli C, Wilber D. Relationship Between Catheter Stability and 12-Month Success After Pulmonary Vein Isolation: A Subanalysis of the SMART-AF Trial. JACC Clin Electrophysiol 2016; 2:691-699. [PMID: 29759747 DOI: 10.1016/j.jacep.2016.07.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study sought to assess the correlation between catheter and tissue contact force (CF) stability and 12-month clinical success for atrial fibrillation (AF) ablation. BACKGROUND The SMART-AF (Thermocool Smarttouch Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation) multicenter trial provided a robust dataset of AF ablation procedures, using the CF sensing ablation catheter. METHODS CF and CF stability were correlated with 12-month success for drug-refractory symptomatic AF ablation. CF stability was assessed by stability of ablation parameters (CF, time, location stability) over 3-dimensional electroanatomic maps of pulmonary veins (PVs) using a new proprietary software module and the percentage of time within investigator-selected CF ranges. Available data for potential "PV gaps" were retrospectively identified when stability criteria were not met and were correlated with 12-month success. RESULTS Average CF categories of 0 to 10, 10 to 20, and >20 g were associated with 12-month success rates of 90%, 70%, and 70%, respectively; thus, higher average CF did not correlate with treatment success. An exploratory univariate analysis showed significantly higher success rates with a CF of 6.5 to 10.3 g than with <6.5 g (odds ratio: 2.95; 95% confidence interval: 1.13 to 7.72; p = 0.028) but a CF >10 g did not improve success. When stable CF was applied ≥73% of the time within the preselected CF range, success improved. A receiver operating characteristic curve analysis revealed that PV gaps exceeding 10.6-mm distance significantly correlated with 12-month failure. CONCLUSIONS In the SMART-AF trial, CF stability with sufficient CF was most predictive of optimal 12-month success. (Thermocool Smarttouch Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation [SMART-AF]; NCT01385202).
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Affiliation(s)
- Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Scott Pollak
- Florida Hospital, Cardiovascular Research, Orlando, Florida, USA
| | | | | | - Andrea Natale
- Texas Cardiac Arrhythmia Research Foundation, Austin, Texas, USA
| | | | - Moussa Mansour
- Massachusetts General Hospital, Cardiac Arrhythmia Center, Boston, Massachusetts, USA
| | - Daniel P Melby
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Tzachi Levy
- Biosense Webster (Israel) Ltd., Yokneam, Israel
| | | | | | - David Wilber
- Loyola University Medical Center, Maywood, Illinois, USA
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7
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Yamada T, Doppalapudi H, Litovsky SH, McElderry HT, Kay GN. Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit Near the Left Main Coronary Artery. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004202. [DOI: 10.1161/circep.116.004202] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022]
Abstract
Background—
Radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the basal portion of the left ventricular (LV) summit, which is divided from the apical LV (A-LV) summit by the great cardiac vein (GCV), is challenging. This study investigated the efficacy of RFCA and electrocardiographic and electrophysiological characteristics of these VAs.
Methods and Results—
Forty-five consecutive patients with symptomatic idiopathic LV summit VAs were studied. RFCA was successful within the main trunk of the GCV in 16 patients and within a branch of the GCV traversing the basal LV (B-LV) summit in 7. Transpericardial RFCA was successful on the epicardial surface in the A-LV summit in 6 patients and was abandoned in 14 with the B-LV summit VAs because of the close proximity to the coronary arteries and thick fat pads. RFCA was successful at the aortomitral continuity in 3 patients (2 with a failed transpericardial RFCA), and left coronary cusp in 1. The RFCA success rate of the A-LV summit VAs including the GCV VAs was 100% (22/22), whereas that of the B-LV summit VAs was 48% (11/23). The B-LV summit VAs could be differentiated from the A-LV summit VAs by left bundle branch block pattern, QRS duration ≤175 ms, precordial transition ≥V1, and maximum deflection index of ≥0.55.
Conclusions—
This study revealed that ≈50% of the B-LV summit VAs could be eliminated by a direct approach through a GCV branch running below the proximal left coronary arteries and a remote approach from the adjacent endocardial sites.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
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Yamada T, Doppalapudi H, Maddox WR, McElderry HT, Plumb VJ, Kay GN. Prevalence and Electrocardiographic and Electrophysiological Characteristics of Idiopathic Ventricular Arrhythmias Originating From Intramural Foci in the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004079. [DOI: 10.1161/circep.116.004079] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
Backgrounds—
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from both the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the prevalence and electrocardiographic and electrophysiological characteristics of these idiopathic intramural LVOT VAs when compared with the idiopathic endocardial and epicardial LVOT VAs.
Methods and Results—
We studied 82 consecutive VAs with origins in the aortomitral continuity (n=30), LV summit (n=34), and intramural site (n=18). The maximum deflection index (the time to the maximum deflection in the precordial leads/QRS duration) was the largest in LV summit VAs (0.52±0.07), smallest in aortomitral continuity VAs (0.45±0.06), and midrange in intramural VAs (0.49±0.05). The electrocardiographic and electrophysiological characteristics of the intramural LVOT VAs were similar to those of the aortomitral continuity VAs. The intramural LVOT VAs exhibited a significantly smaller R-wave amplitude ratio in leads III to II, and ratio of the Q-wave amplitude in leads aVL to aVR, and a significantly earlier and later local ventricular activation time relative to the QRS onset at the His bundle and successful ablation sites than the LV summit VAs, respectively.
Conclusions—
Intramural sites account for a significant proportion of LVOT VAs. The electrocardiographic and electrophysiological characteristics of the idiopathic intramural LVOT VAs were midrange between those of the idiopathic endocardial and epicardial LVOT VAs, and more similar to those of the idiopathic endocardial LVOT VAs than those of the idiopathic epicardial LVOT VAs.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - William R. Maddox
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
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Yamada T, Maddox WR, McElderry HT, Doppalapudi H, Plumb VJ, Kay GN. Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From Intramural Foci in the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2015; 8:344-52. [PMID: 25637597 DOI: 10.1161/circep.114.002259] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
Backgrounds—
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the efficacy of sequential and simultaneous unipolar radiofrequency catheter ablation from the endocardial and epicardial sides in treating intramural LVOT VAs.
Methods and Results—
Fourteen consecutive LVOT VAs, which required sequential or simultaneous irrigated unipolar radiofrequency ablation from the endocardial and epicardial sides for their elimination, were studied. The first ablation was performed at the site with the earliest local ventricular activation and best pace map on the endocardial or epicardial side. When the first ablation was unsuccessful, the second ablation was delivered on the other surface. If this sequential unipolar ablation failed, simultaneous unipolar ablation from both sides was performed. The first ablation was performed on the epicardial side in 9 VAs and endocardial side in 5 VAs. The intramural LVOT VAs were successfully eliminated by the sequential (n=9) or simultaneous (n=5) unipolar catheter ablation. Simultaneous ablation was most likely to be required for the elimination of the VAs when the distance between the endocardial and epicardial ablation sites was >8 mm and the earliest local ventricular activation time relative to the QRS onset during the VAs of <–30 ms was recorded at those ablation sites.
Conclusions—
LVOT VAs originating from intramural foci could usually be eliminated by sequential unipolar radiofrequency ablation and sometimes required simultaneous ablation from both the endocardial and epicardial sides.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - William R. Maddox
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
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Natale A, Reddy VY, Monir G, Wilber DJ, Lindsay BD, McElderry HT, Kantipudi C, Mansour MC, Melby DP, Packer DL, Nakagawa H, Zhang B, Stagg RB, Boo LM, Marchlinski FE. Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. J Am Coll Cardiol 2014; 64:647-56. [PMID: 25125294 DOI: 10.1016/j.jacc.2014.04.072] [Citation(s) in RCA: 359] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/01/2014] [Accepted: 04/06/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Catheter ablation is important for treatment of paroxysmal atrial fibrillation (PAF). Limited animal and human studies suggest a correlation between electrode-tissue contact and radiofrequency lesion generation. OBJECTIVES The study sought to assess the safety and effectiveness of an irrigated, contact force (CF)-sensing catheter in the treatment of drug refractory symptomatic PAF. METHODS A prospective, multicenter, nonrandomized study was conducted. Enrollment criteria included: ≥3 symptomatic episodes of PAF within 6 months of enrollment and failure of ≥1 antiarrhythmic drug (Class I to IV). Ablation included pulmonary vein isolation with confirmed entrance block as procedural endpoint. RESULTS A total of 172 patients were enrolled at 21 sites, where 161 patients had a study catheter inserted and 160 patients underwent radiofrequency application. Procedural-related serious adverse events occurring within 7 days of the procedure included tamponade (n = 4), pericarditis (n = 3), heart block (n = 1, prior to radiofrequency application), and vascular access complications (n = 4). By Kaplan-Meier analyses, 12-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 72.5%. The average CF per procedure was 17.9 ± 9.4 g. When the CF employed was between investigator selected working ranges ≥80% of the time during therapy, outcomes were 4.25 times more likely to be successful (p = 0.0054; 95% confidence interval: 1.53 to 11.79). CONCLUSIONS The SMART-AF trial demonstrated that this irrigated CF-sensing catheter is safe and effective for the treatment of drug refractory symptomatic PAF, with no unanticipated device-related adverse events. The increased percent of time within investigator-targeted CF ranges correlates with increased freedom from arrhythmia recurrence. Stable CF during radiofrequency application increases the likelihood of 12-month success. (THERMOCOOL® SMARTTOUCH® Catheter for Treatment of Symptomatic Paroxysmal Atrial Fibrillation; NCT01385202).
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Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Division of Cardiology, Stanford University, Stanford, California; Case Western Reserve University, Cleveland, Ohio; EP Services, California Pacific Medical Center, San Francisco, California; Interventional Electrophysiology, Scripps Clinic, San Diego, California; Department of Biomedical Engineering, University of Texas, Austin, Texas.
| | - Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - George Monir
- Florida Hospital Cardiovascular Institute, Orlando, Florida
| | | | | | | | | | | | - Daniel P Melby
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Hiroshi Nakagawa
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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11
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Yamada T, Lau YR, Litovsky SH, Thomas McElderry H, Doppalapudi H, Osorio J, Plumb VJ, Neal Kay G. Prevalence and clinical, electrocardiographic, and electrophysiologic characteristics of ventricular arrhythmias originating from the noncoronary sinus of Valsalva. Heart Rhythm 2013; 10:1605-12. [DOI: 10.1016/j.hrthm.2013.08.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Indexed: 11/26/2022]
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12
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Affiliation(s)
- Naoki Yoshida
- Division of Cardiovascular Disease, University of Alabama at Birmingham, FOT 930E, 510 20th Street South, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA
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Jennings JM, Robichaux R, McElderry HT, Plumb VJ, Gunter A, Doppalapudi H, Osorio J, Yamada T, Kay GN. Cardiovascular implantable electronic device implantation with uninterrupted dabigatran: comparison to uninterrupted warfarin. J Cardiovasc Electrophysiol 2013; 24:1125-9. [PMID: 23889767 DOI: 10.1111/jce.12214] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/04/2013] [Accepted: 05/17/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND While continuation of oral anticoagulation (OAC) with warfarin may be preferable to interruption and bridging with heparin for patients undergoing cardiovascular implantable electronic device (CIED) implantation, it is uncertain whether the same strategy can be safely used with dabigatran. OBJECTIVE AND METHODS To determine the risk of bleeding and thromboembolic complications associated with uninterrupted OAC during CIED implantation, replacement, or revision, the outcomes of patients receiving uninterrupted dabigatran (D) were compared to those receiving warfarin (W). RESULTS D was administered the day of CIED implant in 48 patients (age 66 ± 12.4 years, 13 F and 35 M, 21 ICDs and 27 PMs), including new implant in 25 patients, replacement in 14 patients, and replacement plus lead revision in 9 patients. D was held the morning of the procedure in 14 patients (age 70 ± 11 years, 4 F and 10 M, 5 ICDs and 9 PMs). W was continued in 195 patients (age 60 ± 14.4 years, 54 F, and 141 M), including new implant in 122 patients, replacement in 33 patients, and replacement plus lead revision or upgrade in 40 patients. Bleeding complications occurred in 1 of 48 patients (2.1%) with uninterrupted dabigatran (a late pericardial effusion), 0 of 14 with interrupted D, and 9 of 195 patients (4.6%) on W (9 pocket hematomas), P = 0.69. Fifty percent of bleeding complications were associated with concomitant antiplatelet medications. CONCLUSIONS The incidence of bleeding complications is similar during CIED implantation with uninterrupted D or W. The risks are higher when OAC is combined with antiplatelet drugs.
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Affiliation(s)
- John M Jennings
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Dukkipati SR, Kuck KH, Neuzil P, Woollett I, Kautzner J, McElderry HT, Schmidt B, Gerstenfeld EP, Doshi SK, Horton R, Metzner A, d’Avila A, Ruskin JN, Natale A, Reddy VY. Pulmonary Vein Isolation Using a Visually Guided Laser Balloon Catheter. Circ Arrhythm Electrophysiol 2013; 6:467-72. [DOI: 10.1161/circep.113.000431] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Srinivas R. Dukkipati
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Karl-Heinz Kuck
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Petr Neuzil
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Ian Woollett
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Josef Kautzner
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - H. Thomas McElderry
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Boris Schmidt
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Edward P. Gerstenfeld
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Shephal K. Doshi
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Rodney Horton
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Andreas Metzner
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Andre d’Avila
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Jeremy N. Ruskin
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Andrea Natale
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
| | - Vivek Y. Reddy
- From the Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY (S.R.D., A.d., V.Y.R.); Asklepios Klinik St. Georg, Hamburg, Germany (K.-H.K., A.M.); Homolka Hospital, Prague, Czech Republic (P.N.); Sentara Cardiovascular Research Institute, Norfolk, VA (I.W.); IKEM, Prague, Czech Republic (J.K.); University of Alabama at Birmingham, Birmingham, AL (H.T.M.); Cardioangiologisches Centrum Bethanien-CCB, Frankfurt, Germany (B.S.); University of California San Francisco School
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Yamada T, Robertson PG, McElderry HT, Doppalapudi H, Plumb VJ, Kay GN. Successful reduction of a high defibrillation threshold by a combined implantation of a subcutaneous array and azygos vein lead. Pacing Clin Electrophysiol 2012; 35:e173-6. [PMID: 22360586 DOI: 10.1111/j.1540-8159.2012.03332.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 72-year-old man with nonischemic cardiomyopathy was referred because his implantable cardioverter defibrillator had failed to terminate spontaneous ventricular fibrillation (VF). Defibrillation threshold (DFT) testing confirmed that 830-V shocks failed to defibrillate VF despite optimization of the biphasic waveform and reversal of shock polarity. The placement of a new right ventricular lead and the addition of a subcutaneous array failed to defibrillate VF at 830 V. The combination of a subcutaneous array and azygos vein coil successfully defibrillated VF. The mechanism for successful DFT reduction was likely greater current supplied to the posterior basal left ventricle by the azygos vein lead.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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16
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Great cardiac venography by contrast injection through an external irrigation catheter. Heart Rhythm 2012; 9:156-7. [DOI: 10.1016/j.hrthm.2010.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Indexed: 11/29/2022]
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Atrial tachycardia originating from the junction of the right atrium and a diverticulum of the inferior vena cava. Circ Arrhythm Electrophysiol 2011; 4:e44-6. [PMID: 21846882 DOI: 10.1161/circep.111.964015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
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Yamada T, Plumb VJ, Allred JD, McElderry HT, Doppalapudi H, Kay GN. Idiopathic ventricular tachycardia originating from the left ventricle near the His bundle. Pacing Clin Electrophysiol 2011; 33:e114-8. [PMID: 20345625 DOI: 10.1111/j.1540-8159.2010.02734.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 62-year-old man with idiopathic ventricular tachycardia (VT) exhibiting left bundle branch block and left inferior axis QRS morphology with a Qr in lead III underwent electrophysiological testing. Successful ablation was achieved in the left ventricle (LV) at a site with an excellent pace map, adjacent to the His bundle electrogram recording site. At that site, the sequence of the ventricular electrogram and late potential recorded during sinus rhythm reversed during spontaneous premature ventricular contractions with the same QRS morphology as the VT. This case shows that VT can arise from the LV ostium adjacent to the membranous septum.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA.
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. A couplet of PVCs with different QRS morphologies arising from a single origin in the left ventricular outflow tract. Pacing Clin Electrophysiol 2011; 33:e88-92. [PMID: 20230472 DOI: 10.1111/j.1540-8159.2010.02716.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 59-year-old man with two different premature ventricular contractions (PVCs) forming a couplet underwent electrophysiological testing. Although pacing from the aorto-mitral continuity (AMC) produced an excellent pace map of one type of PVCs, a radiofrequency application within the right coronary cusp (RCC) eliminated all the PVCs. This case demonstrates that a single origin with two breakout sites in the left ventricular ostium (LVos) may result in a couplet consisting of different PVCs and preferential conduction from the RCC to AMC may also occur. These possibilities should be kept in our mind when predicting sites of origin of LVos ventricular arrhythmias.
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Yamada T, Doppalapudi H, McElderry HT, Plumb VJ, Kay GN. Successful epicardial catheter ablation of a septal ventricular tachycardia after myocardial infarction. Pacing Clin Electrophysiol 2011; 35:e116-9. [PMID: 21208235 DOI: 10.1111/j.1540-8159.2010.02996.x] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 55-year-old man underwent catheter ablation of ventricular tachycardia (VT) after anterior myocardial infarction. Although electrophysiological study suggested that the VT originated from the septum, biventricular endocardial irrigated radiofrequency ablation failed to interrupt the VT. Epicardial ablation at the site located halfway between the lesions in the right and left ventricles via a pericardial approach eliminated the VT, suggesting that the VT likely originated from the top of the septum. When VTs originating from the upper septum are refractory to endocardial ablation, epicardial mapping and ablation may be considered because only that site may be accessible with an epicardial approach.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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Yamada T, McElderry HT, Doppalapudi H, Okada T, Murakami Y, Yoshida Y, Yoshida N, Inden Y, Murohara T, Plumb VJ, Kay GN. Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit. Circ Arrhythm Electrophysiol 2010; 3:616-23. [DOI: 10.1161/circep.110.939744] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Okada
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshimasa Murakami
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiko Yoshida
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshida
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., H.T.M., H.D., V.J.P., G.N.K.), University of Alabama at Birmingham, Birmingham, Ala; the Division of Cardiology (T.O., Y.M.), Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan; the Division of Cardiology (Y.Y.), Nagoya Dai-ni Red Cross Hospital, Cardiovascular Center, Nagoya, Japan; and the Department of Cardiology (N.Y., Y.I., T.M.), Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yamada T, Tabereaux PB, McElderry HT, Doppalapudi H, Kay GN. Idiopathic premature ventricular contractions arising from the intraventricular septum adjacent to the his bundle. Pacing Clin Electrophysiol 2010; 35:e108-11. [PMID: 21091731 DOI: 10.1111/j.1540-8159.2010.02959.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 57-year-old woman with idiopathic premature ventricular contractions (PVCs) exhibiting a left bundle branch block and left inferior axis QRS morphology underwent electrophysiological testing. Mapping revealed that the earliest ventricular activation times during the PVCs recorded on either side of the interventricular septum were the same and no excellent pace maps were reproduced at these sites. Successful radiofrequency catheter ablation was achieved in the right ventricular septum adjacent to the recording site of the His bundle electrogram. These findings suggested that the origin of this PVC was located in the intraventricular septum rather than the endocardial surface.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Idiopathic premature ventricular contractions successfully ablated from the epicardial right ventricular outflow tract. Europace 2010; 13:595-7. [PMID: 20974761 DOI: 10.1093/europace/euq395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A case of idiopathic premature ventricular contractions successfully ablated from the epicardial right ventricular outflow tract (RVOT) via the subxiphoid pericardial approach was described. The sites with earliest endocardial and epicardial ventricular activation were located adjacent to each other in the RVOT and at both sites, double potentials were recorded. Coronary angiography was helpful for identifying the ablation site.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA.
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Yamada T, Doppalapudi H, McElderry HT, Plumb VJ, Kay GN. Demonstration of a right ventricular substrate of ventricular tachycardia after myocardial infarction. Europace 2010; 13:133-5. [PMID: 20858693 DOI: 10.1093/europace/euq345] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 57-year-old man with prior anteroseptal myocardial infarction underwent catheter ablation of ventricular tachycardia (VT) exhibiting a left bundle branch block QRS morphology. After failed left ventricular ablation, catheter ablation from the right ventricle (RV) eliminated the VT. An RV voltage map demonstrated an area of low voltage around the successful ablation site that likely allowed for a VT substrate.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA.
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25
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Yamada T, Lau YR, McElderry HT, Kay GN. Prolongation of local ventriculoatrial conduction during left lateral accessory pathway ablation: what is the mechanism? Heart Rhythm 2010; 8:942-3. [PMID: 20816870 DOI: 10.1016/j.hrthm.2010.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA. -.ne.jp
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26
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Price SL, Norwood CG, Williams JL, McElderry HT, Merryman WD. Radiofrequency Ablation Directionally Alters Geometry and Biomechanical Compliance of Mitral Valve Leaflets: Refinement of a Novel Percutaneous Treatment Strategy. Cardiovasc Eng Technol 2010. [DOI: 10.1007/s13239-010-0018-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Yamada T, Doppalapudi H, McElderry HT, Okada T, Murakami Y, Inden Y, Yoshida Y, Yoshida N, Murohara T, Epstein AE, Plumb VJ, Litovsky SH, Kay GN. Electrocardiographic and electrophysiological characteristics in idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: relevance for catheter ablation. Circ Arrhythm Electrophysiol 2010; 3:324-31. [PMID: 20558848 DOI: 10.1161/circep.109.922310] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Idiopathic ventricular arrhythmias (VAs) can originate from the left ventricular papillary muscles (PAMs). This study investigated the electrophysiological characteristics of these VAs and their relevance for the results of catheter ablation. METHODS AND RESULTS We studied 19 patients who underwent successful catheter ablation of idiopathic VAs originating from the anterior (n=7) and posterior PAMs (n=12). Although an excellent pace map was obtained at the first ablation site in 17 patients, radiofrequency ablation at that site failed to eliminate the VAs, and radiofrequency lesions in a relatively wide area around that site were required to completely eliminate the VAs in all patients. Radiofrequency current with an irrigated or nonirrigated 8-mm-tip ablation catheter was required to achieve a lasting ablation of the PAM VA origins. During 42% of the PAM VAs, a sharp ventricular prepotential was recorded at the successful ablation site. In 9 (47%) patients, PAM VAs exhibited multiple QRS morphologies, with subtle, but distinguishable differences occurring spontaneously and after the ablation. In 7 (78%) of those patients, radiofrequency lesions on both sides of the PAMs where pacing could reproduce an excellent match to the 2 different QRS morphologies of the VAs were required to completely eliminate the VAs. CONCLUSIONS Radiofrequency catheter ablation of idiopathic PAM VAs is challenging probably because the VA origin is located relatively deep beneath the endocardium of the PAMs. PAM VAs often exhibit multiple QRS morphologies, which may be caused by a single origin with preferential conduction resulting from the complex structure of the PAMs.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease and Department of Pathology, University of Alabama at Birmingham, 1670 University Blvd., 1530 3rd Ave. S., Birmingham, AL 35294-0019, USA.
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28
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Yamada T, McElderry HT, Allred JD, Doppalapudi H, Kay GN. Atrial tachycardia originating from the cavo-tricuspid isthmus may exhibit narrow P waves. Indian Pacing Electrophysiol J 2010; 10:152-5. [PMID: 20234813 PMCID: PMC2836011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An 83-year-old man underwent electrophysiological testing for focal atrial tachycardia (AT) exhibiting narrow P waves with negative deflections in the inferior leads. Catheter ablation at the cavo-tricuspid isthmus (CTI) successfully eliminated the AT. The propagation map during AT and pacing study from the successful ablation site demonstrated that the atrial activation throughout the CTI did not produce significant P wave deflections. Consequently, during AT, the left atrial activation time determined the P wave duration. This case demonstrates that AT originating from the CTI may exhibit narrow P waves which can be misinterpreted as AT originating from the inter-atrial septum.
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29
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Yamada T, Tabereaux PB, Thomas McElderry H, Doppalapudi H, Epstein AE, Plumb VJ, Neal Kay G. Successful catheter ablation of epicardial ventricular tachycardia worsened by cardiac resynchronization therapy. Europace 2009; 12:437-40. [DOI: 10.1093/europace/eup395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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30
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Real-time integration of intracardiac echocardiography and electroanatomic mapping in PVCs arising from the LV anterior papillary muscle. Pacing Clin Electrophysiol 2009; 32:1240-3. [PMID: 19719506 DOI: 10.1111/j.1540-8159.2009.02472.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 54-year-old woman with idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Three-dimensional (3D) geometries of the papillary muscles and chamber of the left ventricle (LV) were reconstructed using a CARTO-based 3D ultrasound imaging system (Biosense Webster Inc., Diamond Bar, CA, USA) during the PVCs. Activation mapping in the LV was then performed during the PVCs and the activation map revealed the earliest ventricular activation on the anterior papillary muscle. An irrigated radiofrequency current delivered at that site with guidance from that system eliminated the PVCs. This case may suggest that the guidance system may be feasible and useful for catheter ablation of PVCs arising from uncommon sites.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Yamada T, McElderry HT, Doppalapudi H, Epstein AE, Plumb VJ, Kay GN. Catheter ablation of premature ventricular contractions arising from the mitral annulus after mitral valvoplasty. Pacing Clin Electrophysiol 2009; 32:825-7. [PMID: 19545351 DOI: 10.1111/j.1540-8159.2009.02375.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 57-year-old man undergoing mitral valvoplasty underwent catheter ablation of symptomatic premature ventricular contractions (PVCs) with a right bundle branch block and right inferior axis QRS morphology. Left ventriculography revealed a normal left ventricular function and visualized the anatomical relationships between the left ventricular outflow tract and the mitral annuloplasty ring. Electroanatomic mapping during the PVCs revealed a centrifugal activation pattern arising from the mitral annulus, and the PVCs were likely to be idiopathic. Successful radiofrequency ablation was achieved at the site close to the antero-paraseptal end of the mitral annuloplasty ring, which was located adjacent to the fibrous trigone.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA.
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33
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Yamada T, McElderry HT, Okada T, Murakami Y, Doppalapudi H, Yoshida N, Allred JD, Murohara T, Kay GN. Idiopathic Focal Ventricular Arrhythmias Originating from the Anterior Papillary Muscle in the Left Ventricle. J Cardiovasc Electrophysiol 2009; 20:866-72. [PMID: 19298560 DOI: 10.1111/j.1540-8167.2009.01448.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [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] [Indexed: 11/29/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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34
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Epstein AE, Kay GN, Plumb VJ, McElderry HT, Doppalapudi H, Yamada T, Shafiroff J, Syed ZA, Shkurovich S. Implantable cardioverter-defibrillator prescription in the elderly. Heart Rhythm 2009; 6:1136-43. [DOI: 10.1016/j.hrthm.2009.04.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022]
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Abstract
A 49-year-old woman with dextrocardia and situs inversus underwent catheter ablation of paroxysmal atrial fibrillation (AF). During the electrophysiologic study, AF triggered by frequent premature atrial contractions (PACs) with a short coupling interval exhibiting a "P on T" pattern occurred. Pulmonary vein mapping revealed that those PACs originated from right-sided (anatomic left) or left-sided (anatomic right) pulmonary veins. In this case with mirror-image dextrocardia, the P-wave morphologies in leads I and aVL and the II/III ratio of the P-wave amplitude were helpful for predicting a right- or left-sided pulmonary vein origin.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019 ,USA.
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36
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Yamada T, McElderry HT, Allison JS, Doppalapudi H, Epstein AE, Plumb VJ, Kay GN. Successful transseptal catheter ablation of premature ventricular contractions arising from the mitral annulus: a case with a pure annular origin. Pacing Clin Electrophysiol 2009; 32:680-2. [PMID: 19422595 DOI: 10.1111/j.1540-8159.2009.02351.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 74-year-old man with symptomatic premature ventricular contractions (PVCs) with a right bundle branch block and right inferior axis QRS morphology underwent electrophysiologic testing. During the PVCs, coronary sinus mapping revealed ventricular prepotentials with the earliest activation in the distal great cardiac vein (GCV) where the local ventricular electrograms were smaller in amplitude than the atrial electrograms. The transaortic approach could not reach the earliest activation site within the GCV, but the transseptal catheter ablation successfully eliminated the PVCs on the mitral valve. With catheter ablation of ventricular arrhythmias with pure mitral annular origins, a transseptal approach may be necessary.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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37
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Yamada T, McElderry HT, Allred JD, Doppalapudi H, Kay GN. Ventricular fibrillation induced by a radiofrequency energy delivery for idiopathic premature ventricular contractions arising from the left ventricular anterior papillary muscle. Europace 2009; 11:1115-7. [PMID: 19395416 DOI: 10.1093/europace/eup092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 73-year-old man with idiopathic premature ventricular contractions (PVCs) underwent electrophysiological testing. Left ventricular activation mapping revealed a focal mechanism of the PVCs with the earliest activation on the anterior papillary muscle (APM). Irrigated radiofrequency (RF) current delivered at that site induced a cluster of non-sustained ventricular tachycardia episodes with the same QRS morphology as the PVCs, followed by ventricular fibrillation (VF). The APM might have served as an abnormal automatic trigger and driver for the VF occurrence. Ventricular fibrillation may occur as a complication during RF catheter ablation of papillary muscle ventricular arrhythmias even if the clinical arrhythmia is limited to PVCs.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294-0019, USA.
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38
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Yamada T, Jennings JM, McElderry HT, Doppalapudi H, Epstein AE, Plumb VJ, Kay GN. Catheter ablation of a posteroseptal accessory pathway in a case with congenital long QT syndrome. Int Heart J 2009; 50:259-62. [PMID: 19367035 DOI: 10.1536/ihj.50.259] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 23-year-old woman with pre-excitation who was resuscitated from ventricular fibrillation underwent electrophysiologic testing. Successful catheter ablation of a left posteroseptal accessory pathway was achieved. Though the JT and JTc intervals as well as QT and QTc intervals were prolonged before and one day after the ablation, they normalized within about 5 hours after the ablation. This case demonstrated that in a patient with pre-excitation and long QT syndrome (LQTs), the JTc interval was useful for diagnosing LQTs and a longer follow-up of the JTc interval after the ablation was necessary in order not to miss the diagnosis of LQTs.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama, Birmingham, AL 35294-0019, USA
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39
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Yamada T, McElderry HT, Muto M, Okada T, Murakami Y, Doppalapudi H, Epstein AE, Plumb VJ, Kay GN. Ventricular arrhythmias originating from the epicardial ventricular outflow tract complicated with peripartum cardiomyopathy. J Interv Card Electrophysiol 2008; 25:53-7. [DOI: 10.1007/s10840-008-9325-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 09/18/2008] [Indexed: 12/31/2022]
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40
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Yamada T, Tabereaux PB, Doppalapudi H, McElderry HT, Kay GN. Successful catheter ablation of a ventricular tachycardia storm originating from the left ventricular posterior papillary muscle involved with a remote myocardial infarction. J Interv Card Electrophysiol 2008; 24:143-5. [DOI: 10.1007/s10840-008-9327-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 09/19/2008] [Indexed: 11/30/2022]
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Abstract
An 81-year-old woman was admitted for symptomatic bradycardia. On admission, the ECG exhibited QRS alternans, narrow QRS complex and left bundle branch block with 2:1 AV block. The patient soon had complete AV block and underwent a pacemaker implantation. An appropriate mechanism for explaining those ECG findings might be 4:1 conduction over the left bundle branch and 2:1 conduction over the right bundle branch. An ECG pattern exhibiting QRS alternans with a narrow QRS complex and bundle branch block with 2:1 AV block may suggest the coexistence of both bundle branch blocks and a high risk of complete AV block.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA.
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Yamada T, Doppalapudi H, McElderry HT, Kay GN. Atrial tachycardia with widely-split P waves may mimic a distinct faster atrial tachycardia with half the cycle length of the actual P-P interval. Circ J 2008; 72:1381-4. [PMID: 18654030 DOI: 10.1253/circj.72.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 57-year-old man with atrial tachycardia (AT) after cavo-tricuspid isthmus ablation underwent electrophysiological testing. Mapping revealed atrial activation with a cycle length exactly twice that of the P-P interval on electrocardiogram. Electroanatomic mapping revealed an AT focus near the left superior pulmonary vein, with inter-atrial conduction occurring in the lower septum and cavo-tricuspid isthmus conduction block. A propagation map demonstrated activation going down the left atrial posterior wall and right atrial free wall, generating different positive P waves in the inferior leads. The focal AT with inter- and intra-atrial conduction block exhibited widely-split P waves misinterpreted as a distinct AT.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35294-0019, USA.
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Yamada T, McElderry HT, Doppalapudi H, Murakami Y, Yoshida Y, Yoshida N, Okada T, Tsuboi N, Inden Y, Murohara T, Epstein AE, Plumb VJ, Singh SP, Kay GN. Idiopathic Ventricular Arrhythmias Originating From the Aortic Root. J Am Coll Cardiol 2008; 52:139-47. [DOI: 10.1016/j.jacc.2008.03.040] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 03/03/2008] [Accepted: 03/04/2008] [Indexed: 10/21/2022]
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Yamada T, Tabereaux PB, McElderry HT, Kay GN. Successful catheter ablation of atrial fibrillation in a patient with cor triatriatum sinister. Heart Rhythm 2008; 5:903-4. [DOI: 10.1016/j.hrthm.2008.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2007] [Indexed: 10/22/2022]
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45
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Yamada T, Platonov M, McElderry HT, Kay GN. Left Ventricular Outflow Tract Tachycardia With Preferential Conduction and Multiple Exits. Circ Arrhythm Electrophysiol 2008; 1:140-2. [DOI: 10.1161/circep.108.778563] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - Michael Platonov
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. Successful radiofrequency catheter ablation of ventricular tachycardia originating from underneath the mechanical prosthetic aortic valve. Pacing Clin Electrophysiol 2008; 31:618-20. [PMID: 18439180 DOI: 10.1111/j.1540-8159.2008.01052.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 67-year-old man who developed sustained ventricular tachycardia (VT) 4 years after a prosthetic aortic valve replacement, underwent electrophysiologic testing and catheter ablation. The mechanism of the VT was suggested to be triggered activity because the VT could be induced by programmed ventricular stimulation, and burst ventricular pacing demonstrated overdrive suppression without a transient entrainment. Successful catheter ablation using a transseptal approach was achieved underneath the mechanical prosthetic aortic valve on the blind side for that approach. This case demonstrated that catheter mapping and ablation of the entire LV using a transseptal approach might be possible.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, Cardiac Rhythm Management Laboratory, University of Alabama at Birmingham VH B147, 1670 University Boulevard, 1530 3rd AVE S, Birmingham, AL 35294, USA.
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Doppalapudi H, Yamada T, McElderry HT, Plumb VJ, Epstein AE, Kay GN. Ventricular Tachycardia Originating From the Posterior Papillary Muscle in the Left Ventricle. Circ Arrhythm Electrophysiol 2008; 1:23-9. [DOI: 10.1161/circep.107.742940] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Several distinct forms of focal ventricular tachycardia (VT) from the left ventricle (LV) have been described. We report a new syndrome of VT arising from the base of the posterior papillary muscle in the LV.
Methods and Results—
Among 290 consecutive patients who underwent ablation for VT or symptomatic premature ventricular complexes (PVCs) based on a focal mechanism, 7 patients were found to have an ablation site at the base of the posterior papillary muscle in the LV. All patients had normal LV systolic function and a normal baseline electrocardiogram. The electrocardiogram during VT or PVCs demonstrated a right bundle-branch block and superior-axis QRS morphology in all patients. VT was not inducible by programmed atrial or ventricular stimulation. In 2 patients with sustained VT, overdrive pacing neither terminated VT nor demonstrated any criterion for transient entrainment. Activation mapping localized the earliest site of activation to the base of the posterior papillary muscle in all patients. When Purkinje potentials were recorded at the site of successful ablation, these potentials preceded local ventricular muscle potentials during sinus rhythm. During VT or PVCs, however, the ventricular muscle potential always preceded the Purkinje potentials. After recurrence of VT or PVCs with standard radiofrequency ablation, irrigated ablation was successful in eliminating the arrhythmia in all patients. Over a mean follow-up period of 9 months, all patients have been free of PVCs and VT.
Conclusion—
We present a distinct syndrome of VT arising from the base of the posterior papillary muscle in the LV by a nonreentrant mechanism. Ablation can be challenging, and irrigated ablation may be necessary for long-term success.
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Affiliation(s)
- Harish Doppalapudi
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Takumi Yamada
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - Andrew E. Epstein
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham
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Yamada T, McElderry HT, Doppalapudi H, Kay GN. A case of bifocal premature ventricular contractions exhibiting bigeminy with an alternating QRS morphology. J Cardiovasc Electrophysiol 2008; 19:1114-5. [PMID: 18373662 DOI: 10.1111/j.1540-8167.2008.01150.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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Yamada T, Lau YR, McElderry HT, Doppalapudi H, Kay GN. Adenosine can improve the intra-atrial conduction block along the mitral annulus during accessory pathway ablation. Europace 2008; 10:303-5. [PMID: 18308752 DOI: 10.1093/europace/eun036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A 10-year-old boy with a supraventricular tachycardia was referred for catheter ablation. An electrophysiologic study revealed a left lateral concealed accessory pathway (AP). A few radiofrequency (RF) applications targeting the AP resulted in an inadvertent intra-atrial conduction block at the mitral isthmus without any damage to the AP. Adenosine was then administered during left ventricular pacing. Soon after that, the conduction at the mitral isthmus recovered partially, and that change disappeared soon. Those findings suggested that the administration of adenosine may transiently recover the conduction at the mitral isthmus damaged by RF ablation.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, VH B147, 1670 University Boulevard, 1530 3rd Avenue South, Birmingham, AL 35294-0019, USA.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0019, USA.
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