130 results on '"Tachycardia, Reciprocating"'
Search Results
2. Anteroseptal accessory pathways: Killing one bird with two stones.
- Author
-
Abdelrahim E, Miller J, and Maskoun W
- Subjects
- Female, Humans, Male, Middle Aged, Young Adult, Bundle of His surgery, Cardiac Conduction System Disease, Electrocardiography methods, Heart Conduction System surgery, Catheter Ablation methods, Tachycardia, Paroxysmal, Tachycardia, Reciprocating, Tachycardia, Supraventricular diagnosis, Tachycardia, Supraventricular surgery, Ventricular Septum
- Abstract
Background and Aims: Ablation of anteroseptal accessory pathways (AS-AP) is challenging, with lower success and more complications compared to other APs. AS-APs can be successfully ablated from the right atrium (RA) or the aortic valve's noncoronary cusp (NCC). We report two patients who required a hybrid ablation approach to achieve successful abolition of both anterograde and retrograde AS-AP conduction., Methods and Results: A 21-year-old female with supraventricular tachycardia (SVT) and pre-excitation on electrocardiogram (ECG) underwent electrophysiology study (EPS) confirming an AS-AP with anterograde and retrograde conduction. Ablation in the NCC achieved immediate and persistent anterograde conduction block. Electrophysiological maneuvers showed persistent retrograde AP conduction and orthodromic reciprocating tachycardia (ORT) remained easily inducible. Additional ablation in the NCC did not eliminate retrograde conduction. Further ablation in the RA opposite the NCC at the site of earliest retrograde atrial activation during ORT restored sinus and eliminated retrograde AP conduction. A 52-year-old male with SVT and ECG with pre-excitation underwent EPS that confirmed an AS-AP with anterograde and retrograde conduction. Ablation was performed in the NCC resulting in immediate elimination of pre-excitation. Retrograde conduction was still present and confirmed by repeating electrophysiological maneuvers. Ablation was performed in the RA opposite the successful ablation site in the NCC, eliminating retrograde AP conduction., Conclusion: Two cases of AS-AP with anterograde and retrograde conduction and successful elimination of pathway conduction required a hybrid ablation approach from the NCC and RA. This approach may be helpful in other cases to improve success rates without using excessive ablation near the normal conduction system., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
3. Iatrogenic cardiomyopathy in patients with manifest right supero-paraseptal accessory pathways.
- Author
-
Abdelrahim E, Birchak J, Khan A, and Maskoun W
- Subjects
- Humans, Male, Female, Middle Aged, Stroke Volume, Electrocardiography, Ventricular Function, Left, Iatrogenic Disease, Accessory Atrioventricular Bundle, Tachycardia, Supraventricular, Tachycardia, Paroxysmal surgery, Tachycardia, Reciprocating, Ventricular Dysfunction, Left, Pre-Excitation Syndromes surgery, Cardiomyopathies complications, Cardiomyopathies surgery, Catheter Ablation adverse effects
- Abstract
Introduction: We describe two patients with right supero-paraseptal accessory pathway (SPAP) who developed left ventricular dysfunction associated with an increased degree of ventricular pre-excitation and frequent orthodromic reciprocating tachycardia (ORT) due to worsening atrioventricular (AV) node conduction., Methods and Results: Case 1: 48-year-old female with a history of normally functioning mechanical mitral valve, CABG, and ventricular pre-excitation that worsened after her open heart surgery. She presented with frequent palpitations with documented supraventricular tachycardia (SVT) and found to have a new left ventricular dysfunction with decrease in left ventricular ejection fraction (LVEF) from 55% to 46% with dyssynchrony. An electrophysiological study confirmed a right SPAP and ORT. The pathway was successfully ablated from the antegrade approach after careful mapping. After ablation and 6-month follow up echocardiogram showed improvement of EF to 54% and the LV dyssynchrony resolved. Case 2: 51-year-old male with a history of frequent SVT with recent unsuccessful ablations that resulted in worsening ventricular pre-excitation, more frequent SVT, and new left ventricular dysfunction (LVEF from 60% to 40%). He was started on amiodarone which resulted in significant sinus bradycardia, intermittent ventricular pre-excitation, and first degree AV block with significant increase in ORT events. His electrophysiology study confirmed SPAP which was successfully ablated from the antegrade approach after careful mapping. After 1 month, follow-up echocardiogram showed an improved ejection fraction to 60%., Conclusion: Left ventricular dysfunction due to dyssynchrony and symptomatic frequent ORT of right SPAP can develop in the setting of new iatrogenic diminished AV node conduction. Successful ablation will result in LV function recovery to baseline., (© 2023 Wiley Periodicals LLC.)
- Published
- 2023
- Full Text
- View/download PDF
4. Multicenter Outcomes of Catheter Ablation for Atrioventricular Reciprocating Tachycardia Mediated by Twin Atrioventricular Nodes
- Author
-
Paul Khairy, Shuenn-Nan Chiu, Maully J. Shah, Philip M. Chang, David S. Spar, Sabine Ernst, Kevin Shannon, Elizabeth S. DeWitt, Ronald J. Kanter, Ian H. Law, Benjamin A. Blais, Frank A. Fish, Jeremy P. Moore, Eric S. Silver, Thomas A. Pilcher, Roberto G. Gallotti, and Mei-Hwan Wu
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Catheter ablation ,Fontan Procedure ,QRS complex ,Interquartile range ,Tachycardia, Reciprocating ,medicine ,Humans ,cardiovascular diseases ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,medicine.disease ,Surgery ,Catheter ,Left atrial isomerism ,Atrioventricular Node ,Catheter Ablation ,cardiovascular system ,Female ,Supraventricular tachycardia ,medicine.symptom ,Cardiomyopathies ,business - Abstract
Objectives This study sought to describe the electrophysiologic properties and catheter ablation outcomes for T-AVRT. Background Although catheter ablation for atrioventricular (AV) reciprocating tachycardia via twin AV nodes (T-AVRT) is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure. Methods An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT. Results Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years [interquartile range, 4.4-17.0 years]; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava–to–azygous vein continuation (P = 0.11). Conclusions T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning.
- Published
- 2022
5. An unusual incessant long RP tachycardia—What is the mechanism?
- Author
-
Arnold J. Greenspon and Reginald T. Ho
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Diagnosis, Differential ,Electrocardiography ,Heart Conduction System ,Tachycardia, Ectopic Junctional ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,Tachycardia, Supraventricular ,medicine ,Humans ,business.industry ,Stroke Volume ,medicine.disease ,Accessory Atrioventricular Bundle ,Treatment Outcome ,Echocardiography ,Catheter Ablation ,Cardiology ,Cardiac Electrophysiology ,Supraventricular tachycardia ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Mechanism (sociology) - Published
- 2021
6. Radiofrequency catheter ablation of patients with permanent junctional reciprocating tachycardia and long-term follow-up results
- Author
-
Basri Amasyali, Serdar Fırtına, Erkan Yildirim, Veysel Kutay Vurgun, Serkan Asil, Hasan Kutsi Kabul, Sedat Kose, Suat Görmel, Yalçın Gökoğlan, and Salim Yaşar
- Subjects
Tachycardia ,medicine.medical_specialty ,Long term follow up ,business.industry ,Middle Cardiac Vein ,Cardiomyopathy ,Accessory pathway ,medicine.disease ,Electrocardiography ,Radiofrequency catheter ablation ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,Catheter Ablation ,Tachycardia, Supraventricular ,cardiovascular system ,medicine ,Cardiology ,Humans ,In patient ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Permanent junctional reciprocating tachycardia ,Follow-Up Studies - Abstract
Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of atrioventricular re-entrant tachycardia. We report the clinical and electrophysiological properties of PJRT and outcomes of radiofrequency catheter ablation (RCA) in a large group of patients. We included 62 patients with the diagnosis of PJRT. Radiofrequency catheter ablation was performed in all. Location of accessory pathway was right posteroseptal in 37 (59,7%) cases, right midseptal in 3 (4,8%), left posterior in 7 (11,3%), left lateral in 5 (8,1%), left posterolateral in 3 (4,8%), left anterolateral in 2 (3,2%), left posteroseptal in 2 (3,2%), middle cardiac vein in 2 (3,2%), and left coronary cusp in 1 (1,6%). Single procedure success rate was 90.3%. None of patients had recurrence during follow-up after repeat ablations. Overall long-term success rate was 98.4%. Left ventricular systolic function recovered in all patients with tachycardia-induced cardiomyopathy (TIC). Retrograde decremental accessory pathways are mainly located in posteroseptal region. Radiofrequency catheter ablation is a safe and effective approach in patients with PJRT.
- Published
- 2021
7. Clinical Course and Electrophysiological Characteristics of Permanent Junctional Reciprocating Tachycardia in Children
- Author
-
Yakup, Ergül, Ayşe, Sulu, Bahar, Çaran, Hasan Candaş, Kafalı, Celal, Akdeniz, and Volkan, Tuzcu
- Subjects
Male ,Electrocardiography ,Tachycardia ,Tachycardia, Reciprocating ,Tachycardia, Supraventricular ,Catheter Ablation ,Humans ,Female ,Child ,Cardiomyopathies ,Retrospective Studies - Abstract
In this study, we aimed to evaluate the clinical aspects, electrophysiological studies, and ablation results of permanent junctional reciprocating tachycardia in children.The study comprised 29 pediatric patients diagnosed with permanent junctional reciprocating tachycardia between 2011 and 2021 in 2 pediatric electrophysiology centers. From the file records, the basic demographic characteristics of the patients, as well as electrocardiographic and echocardiographic findings, were acquired retrospectively. The medical treatment and responses of the patients throughout follow-up, as well as the electrophysiological study and ablation data of the patients who had electrophysiological study, were assessed.The mean age at diagnosis of the patients was 3.13 ± 4.43 (0-18) years and the mean weight was 18.22 ± 19.68 (3.8-94) kg. Eighteen patients (62.1%) were girls. Eleven patients (38%) developed tachycardia-induced cardiomyopathy. Tachycardia was incessant in 15 patients (51.7%). In total, 22 patients required 26 ablation procedures. Tachycardia-induced cardiomyopathy and multidrug-resistant tachycardia were the most prevalent indications for ablation. The right posteroseptal pathway was detected in 18 patients (81.8%). The acute procedure success rate was 100% (22/22). The recurrence rate was 18% (4/22) and 3 of them underwent successful ablation again. The overall success percentage was 95.4% (21/22). None of the patients had any complications. The mean follow-up period was 4.39 ± 3.05 years.Although permanent junctional reciprocating tachycardia is uncommon, it is often persistent, resistant to medical treatment, and associated with a substantial risk of tachycardia-induced cardiomyopathy. Catheter ablation can be performed on these patients at any age, with minimal risk of complications and a high success rate. It is crucial to keep monitor of the patients' recurrence.
- Published
- 2022
8. Novel Diagnostic Observations of Nodoventricular/Nodofascicular Pathway-Related Orthodromic Reciprocating Tachycardia Differentiating From Atrioventricular Nodal Re-Entrant Tachycardia
- Author
-
Takeshi Kitamura, Kazuyoshi Ogura, Seiji Fukamizu, Satoshi Higuchi, Mitsuharu Kawamura, Naokata Sumitomo, Rintaro Hojo, Yumi Munetsugu, Yasuo Okumura, Hiroshi Hasegawa, Kenta Kumagai, Shinsuke Miyazaki, Koichi Nagashima, Kojiro Tanimoto, Morio Shoda, Yuji Wakamatsu, Mitsunori Maruyama, Yoshiaki Kaneko, Akiko Ueda, Shinya Kowase, Akihiko Nogami, Hitoshi Mori, Takayuki Otsuka, Mitsuru Takami, Hisanori Kanazawa, Kyoko Soejima, Shigeki Kusa, Tetsuya Asakawa, Akira Mizukami, and Shuntaro Tamura
- Subjects
Tachycardia ,medicine.medical_specialty ,business.industry ,Cardiac Pacing, Artificial ,030204 cardiovascular system & hematology ,Electrocardiography ,03 medical and health sciences ,Reciprocating motion ,0302 clinical medicine ,Heart Conduction System ,Internal medicine ,Tachycardia, Reciprocating ,Tachycardia, Ventricular ,medicine ,Cardiology ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Re entrant ,030212 general & internal medicine ,medicine.symptom ,NODAL ,business ,Orthodromic - Abstract
This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT).Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging.We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference).More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT.Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT.
- Published
- 2020
9. Last Entrainment Sequence: A Novel Diagnostic Technique for Atrial Tachycardia Mimicking Other Supraventricular Tachycardias
- Author
-
Mitsunori, Maruyama, Hiroshige, Yamabe, Seiji, Takatsuki, Yuta, Seki, Shunsuke, Uetake, Tsuyoshi, Nohara, Ippei, Tsuboi, Shiro, Ishihara, Yasushi, Miyauchi, and Wataru, Shimizu
- Subjects
Electrocardiography ,Adenosine ,Tachycardia, Reciprocating ,Cardiac Pacing, Artificial ,Tachycardia, Supraventricular ,Humans ,Retrospective Studies - Abstract
Adenosine-sensitive re-entrant atrial tachycardia (AT) originating from near the atrioventricular (AV) node or AV annulus resembles other supraventricular tachycardias (SVTs), and the differential diagnosis is sometimes challenging.This study sought to develop a novel technique to distinguish adenosine-sensitive re-entrant AT from AV nodal re-entrant tachycardia (AVNRT) and orthodromic reciprocating tachycardia (ORT).The study retrospectively studied 117 re-entrant SVTs that were successfully entrained by atrial overdrive pacing (AOP) (27 adenosine-sensitive re-entrant ATs, 63 AVNRTs, 27 ORTs). If the second atrial electrogram after AOP (A2) at the earliest atrial activation site (EAAS) accelerated to the pacing cycle length, the EAAS was considered orthodromically activated. Then, we compared the sequence of A2 and the last entrained His bundle (H∗) and QRS complex (V∗). The study hypothesized that the last entrained impulse would activate the EAAS before it enters the AV node, His bundle, and ventricle during AT (A2-H∗-V∗) but would activate the EAAS after the His bundle activation during AVNRT and ORT (H∗-V∗-A2 or H∗-A2-V∗).Orthodromic EAAS activation was documented during AOP in 84 SVTs (72%) when performing AOP from sites proximal to the entrance of SVTs. A2-H∗-V∗ responses were observed in 21 of 25 ATs, but were never for AVNRTs or ORTs. All ORTs and fast-slow AVNRTs had H∗-V∗-A2 responses. Eleven of 21 slow-fast AVNRTs had H∗-A2-V∗ responses. The sensitivity, specificity, and positive and negative predictive values of the A2-H∗-V∗ response for diagnosing AT were 84%, 100%, 100%, and 94%, respectively.The last entrainment sequence was useful for differentiating ATs with diagnostic difficulties.
- Published
- 2022
10. Unusual variants of pre‐excitation: From anatomy to ablation: Part III—Clinical presentation, electrophysiologic characteristics, when and how to ablate nodoventricular, nodofascicular, fasciculoventricular pathways, along with considerations of permanent junctional reciprocating tachycardia
- Author
-
Hein J.J. Wellens, Frederico Soares Correa, Eduardo Back Sternick, Yash Lokhandwala, Shumpei Mori, Robert H. Anderson, Damián Sánchez-Quintana, Cardiologie, and RS: Carim - H01 Clinical atrial fibrillation
- Subjects
Tachycardia ,nodoventricular ,medicine.medical_treatment ,Action Potentials ,030204 cardiovascular system & hematology ,Intracardiac injection ,accessory pathways ,Pre-Excitation, Mahaim-Type ,Part iii ,Electrocardiography ,0302 clinical medicine ,ATRIOVENTRICULAR DISSOCIATION ,Heart Rate ,Tachycardia, Reciprocating ,Sinus rhythm ,030212 general & internal medicine ,PARKINSON-WHITE-SYNDROME ,fasciculoventricular ,CATHETER ABLATION ,Ablation ,Accessory Atrioventricular Bundle ,Treatment Outcome ,nodofascicular ,REENTRY TACHYCARDIA ,cardiovascular system ,Cardiology ,Presentation (obstetrics) ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,Mahaim fibers ,medicine.medical_specialty ,permanent junctional reciprocating tachycardia ,Catheter ablation ,variants of pre-excitation ,QRS COMPLEX TACHYCARDIA ,03 medical and health sciences ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,ACCESSORY PATHWAY ,LONG RP TACHYCARDIA ,TERM-FOLLOW-UP ,business.industry ,SUPRAVENTRICULAR TACHYCARDIA ,CONDUCTION ,business ,Permanent junctional reciprocating tachycardia - Abstract
The recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, but frequently a difficult, challenge for the clinical cardiac arrhythmologist. In this third part of our series of reviews, we discuss the different steps required to come to the correct diagnosis and management decision in patients with nodofascicular, nodoventricular, and fasciculo-ventricular pathways. We also discuss the concealed accessory atrioventricular pathways with the properties of decremental retrograde conduction that are associated with the so-called permanent form of junctional reciprocating tachycardia. Careful analysis of the 12-lead electrocardiogram during sinus rhythm and tachycardias should always precede the investigation in the catheterization room. When using programmed electrical stimulation of the heart from different intracardiac locations, combined with activation mapping, it should be possible to localize both the proximal and distal ends of the accessory connections. This, in turn, should then permit the determination of their electrophysiologic properties, providing the answer to the question "are they incorporated in a tachycardia circuit?". It is this information that is essential for decision-making with regard to the need for catheter ablation, and if necessary, its appropriate site.
- Published
- 2019
11. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
- Author
-
Page, Richard L., Joglar, José A., Caldwell, Mary A., Calkins, Hugh, Conti, Jamie B., Deal, Barbara J., Estes III, Mark, Field, Michael E., Goldberger, Zachary D., Hammill, Stephen C., Indik, Julia H., Lindsay, Bruce D., Olshansky, Brian, Russo, Andrea M., Win-Kuang Shen, Tracy, Cynthia M., Al-Khatib, Sana M., Estes, N A Mark 3rd, Shen, Win-Kuang, and Evidence Review Committee Chair‡
- Subjects
- *
GUIDELINES , *SUPRAVENTRICULAR tachycardia , *HEALTH policy , *MEDICAL care , *THERAPEUTICS - Abstract
The article presents the report of the 2015 American College of Cardiology/American Heart Association (ACC/AHA) and the Heart Rhythm Society (HRS) guideline for supraventricular tachycardia management among adults. The report discusses topics on the guideline's general principles, the management of atrioventricular nodal reentrant tachycardia, and the recommended treatment for junctional tachycardia.
- Published
- 2016
- Full Text
- View/download PDF
12. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
- Author
-
Page, Richard L., Joglar, José A., Caldwell, Mary A., Calkins, Hugh, Conti, Jamie B., Deal, Barbara J., Estes III, Mark, Field, Michael E., Goldberger, Zachary D., Hammill, Stephen C., Indik, Julia H., Lindsay, Bruce D., Olshansky, Brian, Russo, Andrea M., Win-Kuang Shen, Tracy, Cynthia M., Al-Khatib, Sana M., Estes, N A Mark 3rd, Shen, Win-Kuang, and Evidence Review Committee Chair‡
- Subjects
- *
GUIDELINES , *SUPRAVENTRICULAR tachycardia , *HEALTH policy , *MEDICAL care , *THERAPEUTICS - Abstract
The article presents the report of the American College of Cardiology/American Heart Association (ACC/AHA) and the Heart Rhythm Society (HRS) guideline for supraventricular tachycardia management. The report discusses topics on the guideline's general principles, the management of atrioventricular nodal reentrant tachycardia, and the recommended treatment for junctional tachycardia.
- Published
- 2016
- Full Text
- View/download PDF
13. Old yet new form of permanent junctional reciprocating tachycardia: What is the mechanism?
- Author
-
Naoto Otsuka, Toshiko Nakai, Yuji Wakamatsu, Shu Hirata, Sayaka Kurokawa, Yasuo Okumura, Seina Yagyu, Moyuru Hirata, and Koichi Nagashima
- Subjects
medicine.medical_specialty ,business.industry ,Nodal disease ,Electrocardiography ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,Cardiology ,Tachycardia, Supraventricular ,Medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Cardiology and Cardiovascular Medicine ,business ,Permanent junctional reciprocating tachycardia ,Mechanism (sociology) - Published
- 2021
14. Lidocaine for chemical cardioversion of orthodromic atrioventricular reciprocating tachycardia in dogs
- Author
-
Thaibinh Nguyenba, Kathy N. Wright, and Holly M. Irvin
- Subjects
Tachycardia ,Male ,Lidocaine ,040301 veterinary sciences ,medicine.medical_treatment ,Cardiology ,Standard Article ,030204 cardiovascular system & hematology ,Cardioversion ,arrhythmia ,ablation ,0403 veterinary science ,03 medical and health sciences ,0302 clinical medicine ,Dogs ,Interquartile range ,antiarrhythmic drugs ,Tachycardia, Reciprocating ,medicine ,Animals ,Dog Diseases ,Prospective Studies ,Adverse effect ,ventricular preexcitation ,Wolff‐Parkinson‐White syndrome ,accessory atrioventricular pathways ,lcsh:Veterinary medicine ,General Veterinary ,Cumulative dose ,business.industry ,cardiovascular ,04 agricultural and veterinary sciences ,Standard Articles ,Anesthesia ,lcsh:SF600-1100 ,Female ,SMALL ANIMAL ,medicine.symptom ,Electrical conduction system of the heart ,business ,Cardiomyopathies ,Orthodromic ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Background Typical atrioventricular accessory pathways (APs) are composed of myocardial cells. They provide electrical connections between atria and ventricles separate from the normal conduction system. Accessory pathways can participate in a macroreentrant circuit resulting in orthodromic atrioventricular reciprocating tachycardia (OAVRT). Hypothesis Because of ultrastructural similarities of typical AP cells to ventricular myocardial cells, we hypothesized lidocaine would be effective in blocking AP conduction, thus terminating OAVRT. Animals Thirty‐two consecutive client‐owned dogs presenting with narrow complex tachyarrhythmias were confirmed to have OAVRT by electrophysiologic study (EPS). Methods Prospective, nonrandomized, single‐arm study with lidocaine administered IV to dogs during OAVRT in 2 mg/kg boluses to a cumulative dose of 8 mg/kg or development of adverse effects. Electrocardiograms were monitored continuously. Subsequent EPS was performed to confirm OAVRT and the absence of other tachycardia mechanisms. Results Twenty‐seven dogs experienced OAVRT cardioversion with lidocaine, before or at the time of adverse effects. Orthodromic atrioventricular reciprocating tachycardia in 5 dogs did not cardiovert before adverse effects, precluding additional dosing. Median total lidocaine dose for cardioversion was 2 mg/kg (interquartile range, 2‐5.5 mg/kg). Dogs with right free wall APs had a significantly higher rate of cardioversion than did dogs with right posteroseptal APs. Conclusions and Clinical Importance Lidocaine successfully cardioverted OAVRT in 84.4% of dogs in our study before adverse effects precluded additional dosing. In 5 dogs with dose limited by adverse effects, it is unknown whether cardioversion would have occurred at a higher cumulative dose.
- Published
- 2019
15. 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
- Author
-
L. Bing Liem, Scott R. Ceresnak, Javed M. Nasir, Kara S. Motonaga, Daniel W. Kaiser, Chad Brodt, Mintu P. Turakhia, and Anne M. Dubin
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Decremental conduction ,Adolescent ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Article ,Intracardiac injection ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,Tachycardia, Supraventricular ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,030212 general & internal medicine ,Cycle length ,business.industry ,Reproducibility of Results ,medicine.disease ,Dimensional Measurement Accuracy ,Catheter Ablation ,Cardiology ,Female ,Supraventricular tachycardia ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Entrainment (chronobiology) ,Orthodromic - 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 [PPI(V) − TCL = Stim(A→V) + Stim(V→A) − PPI(A)]. RESULTS: The PPI–TCL calculated by dual-chamber entrainment highly correlated with the observed and AH-corrected PPI–TCL (R(2) = 0.79 and 0.96, respectively; P 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.
- Published
- 2019
16. Narrow Complex Tachycardia With Ventriculoatrial Dissociation: Keep Your Eye on the His
- Author
-
Travis D, Richardson and Gregory F, Michaud
- Subjects
Tachycardia, Reciprocating ,Tachycardia, Ventricular ,Humans ,Dissociative Disorders ,Accessory Atrioventricular Bundle - Published
- 2020
17. Electrophysiologic approach to diagnosis and ablation of patients with permanent junctional reciprocating tachycardia associated with complex anatomy and/or physiology
- Author
-
Adam Oesterle, Vasanth Vedantham, Adam Lee, Byron K. Lee, Zian H. Tseng, Joshua D. Moss, Melvin M. Scheinman, Aleksandr Voskoboinik, Tomos E. Walters, and Edward P. Gerstenfeld
- Subjects
Tachycardia ,Premature atrial contraction ,Accessory pathway ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Physiology (medical) ,Tachycardia, Reciprocating ,medicine ,Tachycardia, Supraventricular ,Humans ,Sinus rhythm ,cardiovascular diseases ,030212 general & internal medicine ,Atrium (heart) ,Coronary sinus ,business.industry ,Atrial fibrillation ,Anatomy ,medicine.disease ,medicine.anatomical_structure ,cardiovascular system ,Atrioventricular Node ,Catheter Ablation ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Permanent junctional reciprocating tachycardia (PJRT) is a rare supraventricular tachycardia (SVT), typically involving a single decremental posteroseptal accessory pathway (AP). Methods: Four patients with long RP SVT underwent electrophysiology (EP) study and ablation. The cases were reviewed. Results: Case 1 recurred despite 3 prior ablations at the site of earliest retrograde atrial activation during orthodromic reciprocating tachycardia (ORT). Mapping during a repeat EP study demonstrated a prepotential in the coronary sinus (CS). Ablation over the earliest atrial activation in the CS resulted in dissociation of the potential from the atrium during sinus rhythm. The potential was traced back to the CS os and ablated. Case 2 underwent successful ablation at 6 o'clock on the mitral annulus (MA). ORT recurred and successful ablation was performed at 1 o'clock on the MA. Case 3 had tachycardia with variation in both V-A and A-H intervals which precluded the use of usual maneuvers so we used simultaneous atrial and ventricular pacing and introduced a premature atrial contraction with a closely coupled premature ventricular contraction. Case 4 had had two prior atrial fibrillation ablations with continued SVT over a decremental atrioventricular bypass tract that was successfully ablated at 5 o'clock on the tricuspid annulus. A second SVT consistent with a concealed nodoventricular pathway was successfully ablated at the right inferior extension of the AV nodal slow pathway. Conclusion: We describe challenging cases of PJRT by virtue of complex anatomy, diagnostic features, and multiple arrhythmia mechanisms.
- Published
- 2020
18. Tachycardia cycle length alternans in orthodromic reciprocating tachycardia due to mutually dependent dual AV node physiology and retrograde supernormal conduction
- Author
-
Dhanunjaya Lakkireddy, Sundeep Kumar, Rakesh Gopinathannair, Ahmed Hussein, and Philip L. Mar
- Subjects
Tachycardia ,medicine.medical_specialty ,business.industry ,Supernormal conduction ,Cardiac Pacing, Artificial ,Reciprocating motion ,Electrocardiography ,Heart Rate ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Cardiology ,Atrioventricular Node ,Humans ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cycle length ,Orthodromic - Published
- 2020
19. Catheter ablation of orthodromic reciprocating tachycardia and atrioventricular nodal reentrant tachycardia in children with hypoplastic left heart syndrome
- Author
-
Prince J. Kannankeril, Manish Malkar, Andrew E. Radbill, and Frank A. Fish
- Subjects
Tachycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Single Center ,Intracardiac injection ,Hypoplastic left heart syndrome ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Hypoplastic Left Heart Syndrome ,Tachycardia, Reciprocating ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,cardiovascular diseases ,030212 general & internal medicine ,Child ,Atrial tachycardia ,Retrospective Studies ,business.industry ,medicine.disease ,Ablation ,Child, Preschool ,cardiovascular system ,Cardiology ,Catheter Ablation ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Experience with catheter ablation of orthodromic reciprocating tachycardia (ORT) and atrioventricular nodal reentrant tachycardia (AVNRT) in young children with hypoplastic left heart syndrome (HLHS) is limited. We report the feasibility, safety, and outcomes of catheter ablation of ORT and AVNRT in children with HLHS. Methods and results This was a retrospective review of patients with HLHS who underwent catheter ablation for reentrant supraventricular tachycardias (excluding atrial tachycardias) between 2005 and 2017 at a single center. Descriptive data including demographics, clinical history, procedural data, and outcomes were recorded. Ten children with HLHS underwent eleven catheter ablation procedures. Median age and weight at ablation were 2.7 years (range: 0.1-10.5) and 11.4 kg (range: 3.6-30.4), respectively. Tachycardia mechanism was AVNRT in four, ORT in five (two with preexcitation), and both in one. Acute procedural success was 100% and there was no spontaneous recurrence of tachycardia orpreexcitationin median 92 months (range: 21-175 months) follow-up. Five patients underwent subsequent EP studies at catheterization (intracardiac) or after surgery (via epicardial wires): three were noninducible, one after AVNRT ablation had inducible atrial tachycardia, and one after initial ORT ablation had inducible ORT at fenestration closure and underwent successful repeat ablation. Thus, long-term freedom from clinical tachycardia was 100% and from inducible AVNRT or ORT was 80%. Conclusion Transcatheter ablation for ORT and AVNRT in children with HLHS can be performed with excellent acute and long-term success without major complications.
- Published
- 2020
20. Last Entrainment Sequence: A Novel Diagnostic Technique for Atrial Tachycardia Mimicking Other Supraventricular Tachycardias.
- Author
-
Maruyama M, Yamabe H, Takatsuki S, Seki Y, Uetake S, Nohara T, Tsuboi I, Ishihara S, Miyauchi Y, and Shimizu W
- Subjects
- Humans, Retrospective Studies, Cardiac Pacing, Artificial methods, Electrocardiography methods, Adenosine, Tachycardia, Supraventricular, Tachycardia, Reciprocating
- Abstract
Background: Adenosine-sensitive re-entrant atrial tachycardia (AT) originating from near the atrioventricular (AV) node or AV annulus resembles other supraventricular tachycardias (SVTs), and the differential diagnosis is sometimes challenging., Objectives: This study sought to develop a novel technique to distinguish adenosine-sensitive re-entrant AT from AV nodal re-entrant tachycardia (AVNRT) and orthodromic reciprocating tachycardia (ORT)., Methods: The study retrospectively studied 117 re-entrant SVTs that were successfully entrained by atrial overdrive pacing (AOP) (27 adenosine-sensitive re-entrant ATs, 63 AVNRTs, 27 ORTs). If the second atrial electrogram after AOP (A2) at the earliest atrial activation site (EAAS) accelerated to the pacing cycle length, the EAAS was considered orthodromically activated. Then, we compared the sequence of A2 and the last entrained His bundle (H∗) and QRS complex (V∗). The study hypothesized that the last entrained impulse would activate the EAAS before it enters the AV node, His bundle, and ventricle during AT (A2-H∗-V∗) but would activate the EAAS after the His bundle activation during AVNRT and ORT (H∗-V∗-A2 or H∗-A2-V∗)., Results: Orthodromic EAAS activation was documented during AOP in 84 SVTs (72%) when performing AOP from sites proximal to the entrance of SVTs. A2-H∗-V∗ responses were observed in 21 of 25 ATs, but were never for AVNRTs or ORTs. All ORTs and fast-slow AVNRTs had H∗-V∗-A2 responses. Eleven of 21 slow-fast AVNRTs had H∗-A2-V∗ responses. The sensitivity, specificity, and positive and negative predictive values of the A2-H∗-V∗ response for diagnosing AT were 84%, 100%, 100%, and 94%, respectively., Conclusions: The last entrainment sequence was useful for differentiating ATs with diagnostic difficulties., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
21. Fetal Persistent junctional reciprocating tachycardia : a diagnostic and a therapeutic challenge
- Author
-
Fatma, Ouarda, Meriem, Drissa, Khaouther, Hakim, and Hela, Msaad
- Subjects
Adult ,Male ,Digoxin ,Infant, Newborn ,Amiodarone ,Gestational Age ,Heart Rate, Fetal ,Ultrasonography, Prenatal ,Electrocardiography ,Fetal Diseases ,Echocardiography ,Pregnancy ,Pregnancy Trimester, Second ,Tachycardia, Ectopic Junctional ,Tachycardia, Reciprocating ,Humans ,Drug Therapy, Combination ,Female ,Anti-Arrhythmia Agents - Abstract
A mother presented with a fetus at 22±1 weeks of gestation with a sustained supraventricular tachycardia (SVT) at initially 186 beat per minute (bpm). The fetal M-mode echocardiography showed a 1/1 atrio ventricular ratio (with short atrioventricular (AV) interval and a long ventriculo-atrial (VA) interval, suggesting a Persistent junctional reciprocating tachycardia (PJRT) . Upon initial present no signs of heart failure or hydrops were noted and treament was initiated with amiodarone and digoxin . Fetus heart rate slowed .Postnatal electrocardiogram Confirmed the diagnosis of PJRT New born was put on amiodarone and proparonal). Sinus rhythm was rapidly achieved 9 days later .The patient doing well at 10 months of age with maintain of sinus rhythm. Conclusion: our case report illustrates a particular form of JRT diagnosed prenatal PJRT , characterized by a good clinical tolerance, its absence of evolution towards cardiomyopathy and its rapid and unusual response to antiarrhythmics.
- Published
- 2019
22. Analyses of the Mode of Termination During Diagnostic Ventricular Pacing to Differentiate the Mechanisms of Supraventricular Tachycardias
- Author
-
Yasushi Miyauchi, Yoshihiko Seino, Wataru Shimizu, Shunsuke Uetake, and Mitsunori Maruyama
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Heart Ventricles ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,Diagnosis, Differential ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Predictive Value of Tests ,Internal medicine ,Tachycardia, Reciprocating ,Tachycardia, Supraventricular ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Heart Atria ,cardiovascular diseases ,030212 general & internal medicine ,Cycle length ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,Ventricular pacing ,Accessory Atrioventricular Bundle ,Treatment Outcome ,Anesthesia ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,business ,Orthodromic - Abstract
The goal of this study was to determine the diagnostic yield of analyzing the mode of termination during ventricular overdrive pacing (VOP) to differentiate the mechanisms of supraventricular tachycardias (SVTs).The majority of the diagnostic criteria for VOP rely on successful entrainment, but termination of SVTs is common during VOP.We studied 225 SVTs with a 1:1 atrioventricular relationship, including 34 atrial tachycardias, 67 orthodromic reciprocating tachycardias (ORTs) (including 4 ORTs using accessory pathways [APs] with decremental properties), and 124 atrioventricular nodal re-entrant tachycardias. The total pacing prematurity (TPP) needed to reset or terminate the SVT was calculated by using a simplified method, and the post-pacing interval minus the tachycardia cycle length (PPI - TCL) was predicted from the TPP.VOP terminated 87 SVTs (39%). No atrial tachycardias were terminated by VOP in this study. SVT termination occurred after (n = 71) or before (n = 16) atrial resetting. The predicted PPI - TCL was highly correlated with the measured PPI - TCL (r = 0.96; p 0.001). The TPP had diagnostic accuracy equivalent to the predicted PPI - TCL. The TPP was measurable irrespective of the termination mode and correctly diagnosed ORTs with decremental APs. All ORTs using septal APs and no atrioventricular nodal re-entrant tachycardias had a TPP 125 ms. Considering other criteria evaluable in terminated SVTs, a combined criteria of a TPP125 ms and atrial capture/termination within the fusion period were specific for ORTs using free-wall APs, except for left anterolateral/lateral sites.The termination analyses were useful for differential diagnoses of SVTs terminated during VOP.
- Published
- 2017
23. Utility of Pre-Induction Ventriculoatrial Response to Adenosine in the Diagnosis of Orthodromic Reciprocating Tachycardia
- Author
-
Jim W. Cheung, Steven M. Markowitz, Christopher F. Liu, James E. Ip, George Thomas, and Bruce B. Lerman
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Adenosine ,Accessory pathway ,030204 cardiovascular system & hematology ,Cardiac Resynchronization Therapy ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Heart Rate ,Predictive Value of Tests ,Internal medicine ,Tachycardia, Reciprocating ,Heart Septum ,Tachycardia, Supraventricular ,medicine ,Humans ,Heart Atria ,Prospective Studies ,030212 general & internal medicine ,Atrioventricular Block ,Aged ,business.industry ,VA conduction ,Middle Aged ,medicine.disease ,Accessory Atrioventricular Bundle ,Highly sensitive ,Electrophysiology ,Cardiology ,Female ,Supraventricular tachycardia ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,business ,Anti-Arrhythmia Agents ,Orthodromic ,medicine.drug - Abstract
Objectives This study sought to evaluate the utility of ventriculoatrial (VA) conduction patterns in response to adenosine in predicting inducibility of orthodromic reciprocating tachycardia (ORT). Background Adenosine is known to consistently block atrioventricular (AV) nodal conduction. We hypothesized that persistent VA conduction despite administration of adenosine would have a high predictive value for identifying the presence of a retrograde accessory pathway (AP) and associated ORT. Methods A total of 168 patients undergoing electrophysiological study for supraventricular tachycardia (SVT) had assessment of VA conduction during ventricular pacing and adenosine administration. Standard pacing maneuvers were then used for induction and diagnosis of the SVT mechanism. Results Absence of VA block to adenosine (doses up to 24 mg) had 88% sensitivity and 91% specificity for identifying ORT (positive predictive value 76%, negative predictive value 96%). Four patients with adenosine-induced VA block and inducible ORT had decremental APs. Adenosine caused VA block in 6 patients with eccentric VA activation due to atypical AV nodal conduction, and concentric VA conduction persisted in all 12 patients with a septal AP. Adenosine unmasked free-wall APs in 10 patients by blocking AV nodal conduction, shifting VA activation from concentric to eccentric. Conclusions The response of VA conduction to adenosine is a highly sensitive and specific method for detecting retrograde AP conduction and inducible ORT. Adenosine-induced VA block rules out inducible ORT due to a nondecremental AP. In cases of VA fusion, adenosine-induced block of AV nodal conduction can delineate the location of the AP atrial insertion site.
- Published
- 2017
24. Recurrent hypoglycaemia in a toddler on β-blocker therapy
- Author
-
Véronique Pépin, Diane Rottembourg, and Nancy Gagné
- Subjects
Blood Glucose ,medicine.medical_specialty ,Side effect ,Ketotic hypoglycaemia ,Adrenergic beta-Antagonists ,Propranolol ,030204 cardiovascular system & hematology ,Carbohydrate metabolism ,Hypoglycemia ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,030225 pediatrics ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Humans ,Toddler ,business.industry ,nutritional and metabolic diseases ,Ketosis ,General Medicine ,medicine.disease ,Endocrinology ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Hypoglycaemia is a well-known side effect of Propranolol. We described the case of a child presenting severe and recurrent Propranolol-induced hypoglycaemia. Those episodes were not related to prolonged fasting and were associated with only mild ketosis. Thus, therapy with β blockers may not only aggravate classical ketotic hypoglycaemia but also interfere with glucose metabolism.
- Published
- 2018
25. Electrophysiological features and radiofrequency catheter ablation of accessory pathways associated with atrioventricular discordance
- Author
-
Daiji Takeuchi, Keiko Toyohara, Morio Shoda, and Nobuhisa Hagiwara
- Subjects
Tachycardia ,Adult ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Action Potentials ,Catheter ablation ,Accessory pathway ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Heart Rate ,Predictive Value of Tests ,Risk Factors ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Tachycardia, Supraventricular ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,Tricuspid valve ,business.industry ,Infant ,medicine.disease ,Cardiac surgery ,Accessory Atrioventricular Bundle ,Electrophysiology ,medicine.anatomical_structure ,Treatment Outcome ,Child, Preschool ,cardiovascular system ,Cardiology ,Catheter Ablation ,Female ,Supraventricular tachycardia ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Electrophysiologic Techniques, Cardiac ,Orthodromic - Abstract
Introduction Although a high prevalence of the presence of an accessory pathway (AP) associated with atrioventricular (AV) discordance has been reported, a case series of its characteristics and the results of catheter ablation (CA) have not been sufficiently documented. Methods and results We retrospectively examined 11 consecutive patients with atrioventricular discordance who underwent CA for atrioventricular reciprocating tachycardia (AVRT) via an AP and planned cardiac surgery after CA. Orthodromic AVRTs were induced in 10 patients via AP, but no antidromic/duodromic AVRT was induced in any of the cases. A total of 13 APs were identified, and all of them were located around the anatomical tricuspid valve (TV) annulus, including two Ebsteinoid valves. The APs were predominantly located posteriorly, posterolaterally, and posteroseptally on the TV in nine patients (82%). Two patients (18%) had multiple APs or a single broad AP. Four (36%) and three (27%) patients showed twin AVNs and other supraventricular tachycardias (SVTs) except AVRT via the AP. Ten patients (91%) had acute successful CA in the first session, except for one patient with multiple APs who required the third session to eliminate all APs before the planned Fontan surgery. There were no major complications associated with CA. Seven of eight patients who underwent cardiac surgery after CA did not experience peri-/postoperative SVT. Conclusion APs in patients with AV discordance are usually associated with the anatomical TV annulus. CA of an AP in AV discordance is highly effective and recommended to reduce the risk of SVT. The coexistence of twin AVNs and other SVTs should be considered during CA of an AP in AV discordance.
- Published
- 2019
26. Long-term outcome of neonates and infants with permanent junctional reciprocating tachycardia. When cardiac ablation changes natural history
- Author
-
Josep Brugada, Isabel Iglesias-Platas, Julio Moreno, Adriana Margarit, Sergi Cesar, Johanna Martinez-Osorio, Oscar Campuzano, Ana Herranz Barbero, and Georgia Sarquella-Brugada
- Subjects
Tachycardia ,Pediatrics ,medicine.medical_specialty ,Ischemia ,Prenatal diagnosis ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Refractory ,Tachycardia, Reciprocating ,medicine ,Tachycardia, Supraventricular ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,Pregnancy ,business.industry ,Infant, Newborn ,Infant ,Cardiac Ablation ,medicine.disease ,Natural history ,Catheter Ablation ,Observational study ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Supraventricular tachycardias (SVT) are the most common arrhythmias in the perinatal period. Permanent junctional reciprocating tachycardia (PJRT) is a rare form of SVT, often incessant and refractory to pharmacological treatments. Our goal was to analyze the clinical features and treatment of PJRT in patients younger than 2 months and to describe their long-term outcomes. Methods Retrospective descriptive observational study of patients diagnosed between 2000 and 2015 in the NICU of a referral center for the treatment of pediatric arrhythmias. History of pregnancy, neonatal period, pharmacological treatment, electrophysiological study and long-term follow-up were reviewed. Results 129 of the 10.198 (1.26%) patients admitted to the NICU had SVT, sixteen of them (12.3%) being diagnosed as PJRT. Ten cases had a prenatal diagnosis. For those six patients postnatally diagnosed, the tachycardia was detected either during a routine check-up or because of acute hemodynamic instability. The majority of patients required combinations of drugs, despite that the tachycardia was poorly controlled. Fifteen patients underwent cardiac ablation, nine patients (60%) in the neonatal period and six during childhood. The procedure was completely effective in all cases. One patient had a transient complete AV block that resolved spontaneously 24 hours after the procedure. No other complications were seen. After a mean follow-up of 10.9 years, no patient has presented recurrence, cardiac dysfunction, signs of ischemia or EKG abnormalities, they all have a normal life. Conclusions When PJRT is refractory to multiple drugs, cardiac ablation should be taken into account at early stages even in very young patients.
- Published
- 2019
27. A 43-year-old man with an unusual initiation of a long RP tachycardia
- Author
-
Hein J. Wellens, Cardiologie, RS: Carim - H01 Clinical atrial fibrillation, and RS: CARIM - R2.01 - Clinical atrial fibrillation
- Subjects
Tachycardia ,Adult ,Heart Failure ,Male ,Pediatrics ,medicine.medical_specialty ,Exercise Tolerance ,business.industry ,Severity of Illness Index ,Diagnosis, Differential ,Electrocardiography ,Text mining ,Physiology (medical) ,Tachycardia, Reciprocating ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
28. Current Concepts of Anatomy, Electrophysiology, and Therapeutic Implications of the Interatrial Septum
- Author
-
Ad J.J.C. Bogers, Rohit K. Kharbanda, Yannick J.H.J. Taverne, Natasja M.S. de Groot, Charles Kik, Ezgi H. Özdemir, Cardiology, and Cardiothoracic Surgery
- Subjects
medicine.medical_specialty ,Conduction disorders ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Interatrial conduction ,Internal medicine ,Atrial Fibrillation ,Tachycardia, Reciprocating ,Medicine ,Humans ,In patient ,Interatrial Block ,030212 general & internal medicine ,Atrium (heart) ,Atrial Septum ,business.industry ,Cardiac Pacing, Artificial ,Atrial fibrillation ,medicine.disease ,Electrophysiological Phenomena ,Electrophysiology ,medicine.anatomical_structure ,Atrial Flutter ,Cardiology ,Catheter Ablation ,business ,Interatrial septum - Abstract
The interatrial septum (IAS), a fibromuscular structure separating the right (RA) and left (LA) atrium, plays an important role in both intra- and interatrial conduction. Electropathological changes in the IAS such as discordant activation of the right and left septal layer and conduction disorders may facilitate intraseptal re-entry and promote development of atrial tachyarrhythmias such as atrial fibrillation (AF). Various experimental studies have emphasized the importance of the IAS in AF initiation and perpetuation. Moreover, a thicker IAS has been associated with atrial tachyarrhythmias and a lower success rate of catheter ablation. Therefore, it is assumed that the septal interatrial connections, which may be more pronounced in patients with a thicker IAS, may furnish an anatomic pathway for re-entry and may explain failure of catheter ablation therapy. However, the exact role of the IAS in the treatment of AF still remains an enigma. More profound understanding of the role of the IAS in the pathophysiology of AF and other atrial tachyarrhythmias is necessary to improve success of current therapeutic options and develop new treatment modalities. This review outlines the current knowledge on the relationship between anatomic and electrophysiological properties of the IAS and discusses its involvement in atrial tachyarrhythmias.
- Published
- 2019
29. Multicenter Outcomes of Catheter Ablation for Atrioventricular Reciprocating Tachycardia Mediated by Twin Atrioventricular Nodes.
- Author
-
Moore JP, Gallotti RG, Shannon KM, Blais BA, DeWitt ES, Chiu SN, Spar DS, Fish FA, Shah MJ, Ernst S, Khairy P, Kanter RJ, Chang PM, Pilcher T, Law IH, Silver ES, and Wu MH
- Subjects
- Atrioventricular Node, Female, Humans, Male, Retrospective Studies, Cardiomyopathies, Catheter Ablation adverse effects, Fontan Procedure, Tachycardia, Reciprocating
- Abstract
Objectives: This study sought to describe the electrophysiologic properties and catheter ablation outcomes for atrioventricular reciprocating tacchycardia via twin atrioventricular nodes (T-AVRT)., Background: Although catheter ablation for T-AVRT is an established entity, there are few data on the electrophysiological properties and outcomes of this procedure., Methods: An international, multicenter study was conducted to collect retrospective procedural and outcomes data for catheter ablation of T-AVRT., Results: Fifty-nine patients with T-AVRT were identified (median age at procedure, 8 years [interquartile range: 4.4-17.0 years]; 49% male). Of these, 55 (93%) were diagnosed with heterotaxy syndrome (right atrial isomerism in 39, left atrial isomerism in 8, and indeterminate in 8). Twenty-three (39%) had undergone Fontan operation (12 extracardiac, 11 lateral tunnel). After the Fontan operation, atrial access was conduit or baffle puncture in 15 (65%), fenestration in 5 (22%), and retrograde in 3 (13%). Acute success was achieved in 43 (91%) of 47 attempts (targeting an anterior node in 23 and posterior node in 24). There was no high-grade AV block or change in QRS duration. Over a median of 3.8 years, there were 3 recurrences. Of 7 patients with failed index procedure or recurrent T-AVRT, 6 (86%) were associated with anatomical hurdles such as prior Fontan or catheter course through an interrupted inferior vena cava-to-azygous vein continuation (P = 0.11)., Conclusions: T-AVRT can be targeted successfully with low risk for recurrence. Complications were rare in this population. Anatomical challenges were common among patients with reduced short and long-term efficacy, representing opportunities for improvement in procedural timing and planning., Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Published by Elsevier Inc.)
- Published
- 2022
- Full Text
- View/download PDF
30. Successful re-ablation of a permanent junctional reciprocating tachycardia with cryoenergy
- Author
-
Mattias Roser, Bogdan G. Muntean, and Barbara Bellmann
- Subjects
Adult ,Male ,Tachycardia ,medicine.medical_specialty ,Radiofrequency ablation ,medicine.medical_treatment ,Pharmacology toxicology ,Accessory pathway ,030204 cardiovascular system & hematology ,law.invention ,Electrocardiography ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Tachycardia-induced cardiomyopathy ,law ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,business.industry ,General Medicine ,Ablation ,medicine.disease ,Surgery ,Treatment Outcome ,Male patient ,Catheter Ablation ,Cardiology ,medicine.symptom ,business ,Permanent junctional reciprocating tachycardia - Abstract
We report the case of a 19-year-old male patient who presented with a permanent junctional reciprocating tachycardia (PJRT). After a primarily successful radiofrequency ablation of a para-Hisian, midseptal, accessory pathway, recurrence of tachycardia was documented. Thereafter, successful ablation using cryoenergy was performed. Since this second ablation the patient has been free of tachycardia. Our case study shows that the treatment of PJRT in young adults using cryoenergy can be successfully and safely conducted, especially after tachycardia recurrence following an initial radiofrequency ablation.
- Published
- 2016
31. Atrioventricular reciprocating tachycardia in a girl with atrial fibrillation
- Author
-
Daisuke Hazeki, Manaka Matsunaga, Kentaro Ueno, Yoshifumi Kawano, and Shunji Seki
- Subjects
Tachycardia ,medicine.medical_specialty ,media_common.quotation_subject ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Reciprocating motion ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,Tachycardia, Reciprocating ,medicine ,Humans ,030212 general & internal medicine ,Girl ,Child ,media_common ,Troponin T ,business.industry ,P wave ,Atrial fibrillation ,medicine.disease ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,medicine.symptom ,business - Published
- 2017
32. Long-term results of atrial maze surgery in patients with congenital heart disease
- Author
-
Edward P. Walsh, Sitaram M. Emani, M Cecilia Gonzalez Corcia, UCL - SSS/IREC/SLUC - Pôle St.-Luc, and UCL - (SLuc) Service de cardiologie pédiatrique
- Subjects
Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Heart disease ,Adolescent ,Univentricular Heart ,Lesion ,Young Adult ,Maze Procedure ,Recurrence ,Physiology (medical) ,Atrial Fibrillation ,Tachycardia, Reciprocating ,medicine ,Tachycardia, Supraventricular ,Humans ,cardiovascular diseases ,Atrium (heart) ,Cardiac Surgical Procedures ,Atrial tachycardia ,Congenital heart disease ,Retrospective Studies ,business.industry ,Atrial arrhythmias ,Maze surgery ,Age Factors ,Cardiac arrhythmia ,Atrial fibrillation ,Prophylactic Surgical Procedures ,Cardiac surgery ,Middle Aged ,medicine.disease ,Surgery ,Ebstein Anomaly ,medicine.anatomical_structure ,Ventricle ,cardiovascular system ,Tetralogy of Fallot ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,psychological phenomena and processes - Abstract
Aims Recurrent atrial tachycardia is common after repair of many types of congenital heart disease, and surgical ablation with a maze procedure represents a potential treatment strategy. The objective of this study is to report a single-centre 19 years’ experience with maze surgery in congenital heart patients. Methods and results Patients undergoing maze procedure concomitantly with cardiac surgical procedures were retrospectively analysed. The maze procedure was classified as therapeutic if the patient demonstrated preoperative atrial arrhythmias, or as prophylactic if done because the patient was considered high risk for post-operative arrhythmias. Acute outcomes and longer-term freedom from atrial arrhythmias were analysed. Maze surgery was performed in 166 patients: 137 in the therapeutic group, and 29 in the prophylactic group. The most common congenital heart lesion was single ventricle for the therapeutic group (27%) and Ebstein’s anomaly for the prophylactic group (76%). Surgery consisted of a right atrial maze in 63%, left atrial maze in 4%, and bilateral maze in 33%. There were no direct complications or mortality related to the maze procedure itself. For the therapeutic group, freedom from arrhythmias was 82% and 67% at 1 and 5 years post-maze. Younger age at the time of surgery correlated with a lower long-term recurrence risk. Conclusion Maze procedure at the time of an elective anatomic surgery is reasonably effective to prevent and treat atrial arrhythmias in patients with congenital heart disease at short- and mid-term, with low morbidity and mortality.
- Published
- 2018
33. A new criterion to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia: Combined AVR criterion
- Author
-
Yahya Kemal Icen, Zikret Koseoglu, Abdullah Orhan Demirtaş, Hasan Koca, Onur Kaypakli, İlker Ünal, Durmuş Yıldıray Şahin, Mevlüt Koç, Çukurova Üniversitesi, Tıp Fakültesi, Temel Tıp Bilimleri Bölümü, Ünal, İlker, and Çukurova Üniversitesi
- Subjects
0301 basic medicine ,Tachycardia ,Adult ,Male ,medicine.medical_specialty ,aVR derivation ,030204 cardiovascular system & hematology ,Narrow QRS complex ,Diagnosis, Differential ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Narrow qrs ,Internal medicine ,Daily practice ,Tachycardia, Reciprocating ,Tachycardia, Supraventricular ,Medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,R' wave amplitude increase ,Sinus rhythm ,In patient ,cardiovascular diseases ,Prospective Studies ,R′ wave amplitude increase ,Pseudo r′ wave ,Pseudo r' wave ,business.industry ,Middle Aged ,medicine.disease ,030104 developmental biology ,Supraventricular tachycardia ,ROC Curve ,Multivariate Analysis ,Cardiology ,cardiovascular system ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
PubMedID: 30497728 Aim: A combined aVR criterion is described as the presence of a pseudo r' wave in aVR during tachycardia in patients without r' wave in aVR in sinus rhythm and/or a ?50% increase in r' wave amplitude compared to sinus rhythm in patients with r' wave in the basal aVR lead. We aimed to investigate the use of combined aVR criterion in differential diagnosis of atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT). Methods: In this prospective study, 480 patients with inducible narrow QRS supraventricular tachycardia (SVT) were included. Twelve-lead electrocardiogram (ECG) was conducted during tachycardia and sinus rhythm. The patients were divided into two groups according to the arrhythmia mechanism that determined via EPS, AVNRT, and AVRT. Criteria of narrow QRS complex tachycardia were compared between the two groups. Results: AVNRT was present in 370 (77%) patients and AVRT in 110 (23%) patients. Combined aVR criterion was found to be more frequent in patients with AVNRT (84.1% and 9.1%, p < 0.001). In logistic regression analysis, combined aVR criterion and classical ECG criterion were found to be the most important predictors of AVNRT (p < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of the combined aVR criterion for AVNRT were 84.1%, 90.9%, 96.9%, and 62.9%, respectively. Conclusion: In the differential diagnosis of patients with SVT, the combined aVR criterion identifies the presence of AVNRT with an independent and acceptable diagnostic value. In addition to classical ECG criteria for AVNRT, it is necessary to evaluate the combined aVR criterion in daily practice. © 2018 Elsevier Inc.
- Published
- 2018
34. Dynamics of Pivoting Electrical Waves in a Cardiac Tissue Model
- Author
-
Jacques Beaumont
- Subjects
0301 basic medicine ,State variable ,Quantitative Biology::Tissues and Organs ,General Mathematics ,Immunology ,Plane wave ,Action Potentials ,General Biochemistry, Genetics and Molecular Biology ,Displacement (vector) ,03 medical and health sciences ,0302 clinical medicine ,Drug Discovery ,Tachycardia, Reciprocating ,Animals ,Humans ,Computer Simulation ,General Environmental Science ,Pharmacology ,Physics ,Plane (geometry) ,General Neuroscience ,Electric Conductivity ,Models, Cardiovascular ,Heart ,Mechanics ,Mathematical Concepts ,Finite element method ,Electrophysiological Phenomena ,Ray tracing (physics) ,030104 developmental biology ,Reentrancy ,Computational Theory and Mathematics ,030220 oncology & carcinogenesis ,Orbit (dynamics) ,General Agricultural and Biological Sciences ,Anti-Arrhythmia Agents - Abstract
Through a detailed mathematical analysis we seek to advance our understanding of how cardiac tissue conductances govern pivoting (spiral, scroll, rotor, functional reentry) wave dynamics. This is an important problem in cardiology since pivoting waves likely underlie most reentrant tachycardias. The problem is complex, and to advance our methods of analysis we introduce two new tools: a ray tracing method and a moving-interface model. When used in combination with an ionic model, they permit us to elucidate the role played by tissue conductances on pivoting wave dynamics. Specifically we simulate traveling electrical waves with an ionic model that can reproduce the characteristics of plane and pivoting waves in small patches of cardiac tissue. Then ray tracing is applied to the simulated pivoting waves in a manner to expose their real displacement. In this exercise we find loci with special characteristics, as well as zones where a part of a pivoting wave quickly transitions from a regenerative to a non-regenerative propagation mode. The loci themselves and the monitoring of the ionic model state variables in this zone permit to elucidate several aspects of pivoting wave dynamics. We then formulate the moving-interface model based on the information gathered with the above-mentioned analysis. Equipped with a velocity profile v(s), s: distance along of the pivoting wave contour and the steady- state action potential duration (APD) of a plane wave during entrainment, APDss(T), at period T, this simple model can predict: shape, orbit of revolution, rotation period, whether a pivoting wave will break up or not, and whether the tissue will admit pivoting waves or not. Because v(s) and APDss(T) are linked to the ionic model, dynamical analysis with the moving-interface model conveys information on the role played by tissue conductances on pivoting wave dynamics. The analysis conducted here enables us to better understand previous results on the termination of pivoting waves. We surmise the method put forth here could become a means to discover how to alter tissue conductances in a manner to terminate pivoting waves at the origin of reentrant tachycardias.
- Published
- 2018
35. Usefulness of High-Dose Oral Flecainide for Termination of Recent-Onset Atrial Fibrillation in Children
- Author
-
Eric S. Silver, Thomas J. Starc, and Leonardo Liberman
- Subjects
Tachycardia ,Male ,medicine.medical_specialty ,Adolescent ,Hospital setting ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,Single high dose ,Atrial Fibrillation ,Tachycardia, Reciprocating ,medicine ,Humans ,Young adult ,Recent onset ,Child ,Flecainide ,business.industry ,Atrial fibrillation ,medicine.disease ,Treatment Outcome ,Atrial Flutter ,Child, Preschool ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,Atrial flutter ,medicine.drug - Abstract
A high dose of oral flecainide has been used for acute termination of atrial fibrillation (AF) and atrial flutter or intra-atrial re-entry tachycardia (AFL-IART) in adults. The use of flecainide for these conditions in children has not been well described. We describe our institutional experience on acute termination of AF or AFL-IART in children with a single high dose of oral flecainide in a hospital setting. All patients who received a single high dose of oral flecainide from 2009 to 2016 who were21 years of age were included. Patients were treated only if AF or AFL-IART was less than 24 hours of duration. The dose was 300 mg for patients70 kg, 200 mg for patients 40 to 70 kg, and 5 mg/kg for patients40 kg. Charts were reviewed to determine demographic information, flecainide dose, termination of arrhythmia, and time to termination. There were 22 patients identified. The median age was 16 years (range 4.6 to 20.3) with a median weight of 75 kg (range 19 to 112). There were 13 patients with AF (11 with a normal heart, 85%) and 9 patients with AFL-IART (1 with a normal heart, 11%) (p 0.05). The median dose of flecainide given was 3.6 mg/kg (range 2.7 to 6.1) or 136 mg/m
- Published
- 2017
36. Yield of 48-hour Holter monitoring in children with unexplained palpitations and significance of associated symptoms
- Author
-
Rabbia, Aman, Ahmad Usaid, Qureshi, and Masood, Sadiq
- Subjects
Male ,Tachycardia, Ectopic Atrial ,Chest Pain ,Time Factors ,Adolescent ,Arrhythmias, Cardiac ,Ventricular Premature Complexes ,Syncope ,Dyspnea ,Child, Preschool ,Tachycardia, Reciprocating ,Electrocardiography, Ambulatory ,Tachycardia, Supraventricular ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female ,Pakistan ,Pallor ,Atrial Premature Complexes ,Child - Abstract
To determine the yield of 48-hour Holter monitoring in children with unexplained palpitations and the significance of associated symptoms.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.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).Extended 24-hour Holter monitoring in children with palpitations was an inexpensive, non-invasive investigation with a reasonably high diagnostic yield in detecting arrhythmias.
- Published
- 2017
37. Noninvasive predictors of perioperative atrial arrhythmias in patients with tetralogy of Fallot undergoing pulmonary valve replacement
- Author
-
Cortez, Daniel, Barham, Waseem, Ruckdeschel, Emily, Sharma, Nandita, McCanta, Anthony C., von Alvensleben, Johannes, Sauer, William H., Collins, Kathryn K., Kay, Joseph, Patel, Sonali, and Nguyen, Duy T.
- Subjects
Adult ,Male ,Time Factors ,Adolescent ,Clinical Investigations ,Young Adult ,Risk Factors ,Tachycardia, Reciprocating ,Odds Ratio ,Humans ,cardiovascular diseases ,Child ,Perioperative Period ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Pulmonary Valve ,Logistic Models ,Treatment Outcome ,Atrial Flutter ,Multivariate Analysis ,cardiovascular system ,Electrocardiography, Ambulatory ,Exercise Test ,Tetralogy of Fallot ,Female ,Electrophysiologic Techniques, Cardiac - Abstract
BACKGROUND: Patients with tetralogy of Fallot (TOF) have increased risk of atrial arrhythmias. HYPOTHESIS: A measure of atrial dispersion, the P‐wave vector magnitude (Pvm), can identify patients at risk for perioperative atrial flutter (AFL) or intra‐atrial re‐entrant tachycardia (IART) in a large TOF cohort. METHODS: We performed a blinded, retrospective analysis of 158 TOF patients undergoing pulmonary valve replacement between 1997 and 2015. History of AFL/IART was documented using electrocardiogram, Holter monitor, exercise stress test, implanted cardiac device, and electrophysiology study. P‐R intervals, Pvm, QRS duration, and QRS vector magnitude were assessed from resting sinus‐rhythm 12‐lead electrocardiograms and identification of those with AFL/IART was determined. RESULTS: Fourteen patients (8.9%) were found to have AFL/IART. Pvm, QRS duration, and QRS vector magnitude significantly differentiated those with AFL/IART from those without on univariate analysis: 0.09 ± 0.04 vs 0.18 ± 0.07 mV, 161.3 ± 21.9 vs 137.7 ± 31.4 ms, and 1.2 (interquartile range, 1.0–1.2) vs 1.6 mV (1.0–2.3), respectively (P < 0.05 for each). The Pvm had the highest area under the ROC curve (0.88) and was the only significant predictor on multivariate analysis, with odds ratio of 0.02 (95% confidence interval: 0.01‐0.53). P‐R duration, MRI volumes, and right‐heart hemodynamics did not significantly differentiate those with vs those without AFL/IART. CONCLUSIONS: In TOF patients undergoing pulmonary valve replacement, Pvm has significant value in predicting those with perioperative AFL/IART. These clinical features may help further evaluate TOF patients at risk for perioperative atrial arrhythmias. Prospective studies are warranted.
- Published
- 2017
38. [The Phenomenon of Short PQ Interval in Children]
- Author
-
T Kruchina, G A Novik, E D Oleichuk, and D F Egorov
- Subjects
Tachycardia ,Male ,medicine.medical_specialty ,Adolescent ,Electrocardiography ,Heart Conduction System ,Heart Rate ,Internal medicine ,Heart rate ,Tachycardia, Reciprocating ,Medicine ,Humans ,PR interval ,Child ,medicine.diagnostic_test ,business.industry ,Clinical course ,Child, Preschool ,Cardiology ,Natural phenomenon ,Female ,Electrical conduction system of the heart ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Data of analysis of the clinical course of a natural phenomenon of short PQ interval in 300 children are presented. During the period.
- Published
- 2017
39. Wolff-Parkinson-White syndrome: lessons learnt and lessons remaining
- Author
-
Mitchell I. Cohen and D. Woodrow Benson
- Subjects
Tachycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Accessory pathway ,030204 cardiovascular system & hematology ,Asymptomatic ,Sudden death ,Risk Assessment ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,Tachycardia, Reciprocating ,medicine ,Humans ,Sinus rhythm ,cardiovascular diseases ,030212 general & internal medicine ,business.industry ,Isoproterenol ,Atrial fibrillation ,General Medicine ,History, 20th Century ,medicine.disease ,Accessory Atrioventricular Bundle ,Death, Sudden, Cardiac ,Pediatrics, Perinatology and Child Health ,Ventricular fibrillation ,Practice Guidelines as Topic ,Cardiology ,Catheter Ablation ,Exercise Test ,Wolff-Parkinson-White Syndrome ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The Wolff–Parkinson–White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope – the “delta wave”. It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation
- Published
- 2017
40. His overdrive pacing during supraventricular tachycardia: A novel maneuver for distinguishing atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia
- Author
-
David Singh, Vasanth Vedantham, Nitish Badhwar, Frederick T. Han, Byron K. Lee, Zian H. Tseng, Mohan N. Viswanathan, Cara N. Pellegrini, Melvin M. Scheinman, Edward P. Gerstenfeld, Randall J. Lee, Gregory M. Marcus, Mitsuharu Kawamura, Jeffrey E. Olgin, and Ronn E. Tanel
- Subjects
Adult ,Male ,Tachycardia ,Novel technique ,Bundle of His ,medicine.medical_specialty ,Adolescent ,Accessory pathway ,Diagnosis, Differential ,Electrocardiography ,Young Adult ,Reciprocating motion ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,cardiovascular diseases ,Cycle length ,Retrospective Studies ,business.industry ,Cardiac Pacing, Artificial ,medicine.disease ,Predictive value ,Anesthesia ,cardiovascular system ,Cardiology ,Female ,Supraventricular tachycardia ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Orthodromic ,Follow-Up Studies - Abstract
Background Because the His bundle is intrinsic to the circuit in orthodromic reciprocating tachycardia and remote from that of atrioventricular nodal reentrant tachycardia (AVNRT), pacing the His bundle during supraventricular tachycardia (SVT) may be useful to distinguish these arrhythmias. Objective The purpose of this study was to test the hypothesis that His overdrive pacing (HOP) would affect SVT immediately for orthodromic reciprocating tachycardia and in a delayed manner for AVNRT. Methods Once SVT was induced, HOP was performed by pacing the His bundle 10–30 ms faster than the SVT cycle length. The maneuver was determined to have entered the tachycardia circuit when a nonfused His-capture beat advanced or delayed the subsequent atrial electrogram by ≥10 ms or when the tachycardia was terminated. The number of beats required to enter each tachycardia with HOP was recorded. Results HOP was performed during 66 SVTs (26 atrioventricular reciprocating tachycardia [AVRT] and 40 AVNRT). Entry into the tachycardia within 1 beat had sensitivity of 92%, specificity of 92%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 95% to confirm the diagnosis of AVRT. A cutoff ≥3 beats to enter the circuit had sensitivity of 90%, specificity of 92%, PPV of 95% and NPV of 86% to confirm the diagnosis of AVNRT. HOP had sensitivity, specificity, PPV, and NPV of 100% for distinguishing septal AVRT from atypical AVNRT. Conclusion HOP during SVT is a novel technique for distinguishing orthodromic reciprocating tachycardia from AVNRT. It can reliably distinguish between these arrhythmias with high sensitivity and specificity.
- Published
- 2014
41. Reentrant Ventricular Tachycardia Originating From the Periaortic Region in the Absence of Overt Structural Heart Disease
- Author
-
Koichi Nagashima, Roy M. John, Bruce A. Koplan, Laurence M. Epstein, William G. Stevenson, Thomas M. Tadros, Tobias Reichlin, Chirag R. Barbhaiya, Keiichi Inada, Justin Ng, Gregory F. Michaud, Eyal Nof, Michifumi Tokuda, and Usha B. Tedrow
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Action Potentials ,Catheter ablation ,Ventricular tachycardia ,Cicatrix ,QRS complex ,Heart Conduction System ,Predictive Value of Tests ,Risk Factors ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,Humans ,Medicine ,Ventricular outflow tract ,PR interval ,Aged ,Retrospective Studies ,business.industry ,Cardiac Pacing, Artificial ,Reentry ,Middle Aged ,Ablation ,medicine.disease ,Voltage-Sensitive Dye Imaging ,Kinetics ,Treatment Outcome ,Anesthesia ,Catheter Ablation ,Tachycardia, Ventricular ,Cardiology ,Female ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background— In the absence of overt structural heart disease, most left ventricular outflow tract ventricular tachycardias (VTs) have a focal origin and are benign. We hypothesized that multiple morphologies (MMs) of inducible left ventricular outflow tract VT may indicate a scar-related VT that can mimic idiopathic VT. Methods and Results— Of 54 consecutive patients referred for ablation of sustained outflow tract VT without overt structural heart disease, 24 had left ventricular outflow tract VT, 10 had MM VT, and 14 had a single VT (SM). The MM group were older (70.3±4.3 versus 53.9±15.9 years; P =0.004), had more hypertension (100% versus 29%; P =0.0006), and had longer PR intervals and QRS durations compared with the SM group. In contrast to the SM group, the MM group VTs had features consistent with reentry, including induction by programmed stimulation without isoproterenol, entrainment in some, and abnormal electrograms in the periaortic area. Periaortic region voltages suggested scar in the MM group, but not in the SM group. MRI in 2 MM patients was consistent with scar, but not in 10 SM patients. Longer radiofrequency applications were required in the MM group than in the SM group. At a median follow-up of 9.7 (3.0–32.0) months, recurrences tended to be more frequent in the MM group than in the SM group (70% versus 22%; P =0.07). Conclusions— VTs from small regions of periaortic scar can mimic idiopathic VT but are suggested by multiple VT morphologies and are more difficult to ablate. Whether these patients are at greater risk, as feared for other scar-related VTs, warrants further study.
- Published
- 2014
42. Characteristics of Decremental Accessory Pathways in Children
- Author
-
Allison C. Hill, Yaniv Bar-Cohen, Choo Phei Wee, and Michael J. Silka
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,Adolescent ,Beats per minute ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,Electrophysiology study ,0302 clinical medicine ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Infant, Newborn ,Infant ,Mean age ,medicine.disease ,Accessory Atrioventricular Bundle ,Surgery ,Treatment Outcome ,Child, Preschool ,Catheter Ablation ,Cardiology ,Female ,Supraventricular tachycardia ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Permanent junctional reciprocating tachycardia ,Orthodromic - Abstract
Background— Although retrograde decremental accessory pathways (DAPs) are thought to typically present as permanent junctional reciprocating tachycardia (permanent junctional reciprocating tachycardia), they may also be diagnosed unexpectedly during electrophysiology study. We aimed to compare the clinical and electrophysiological characteristics of patients with DAPs to an age-matched cohort with nondecremental accessory pathways. Methods and Results— We retrospectively studied pediatric patients (30 ms. Twenty-six patients with DAPs were compared with 73 controls (mean age at electrophysiology study 9.8±5.7 and 10.3±5.2 years, respectively [ P =nonsignificant]). Compared with controls, patients with DAPs had more frequent syncope (5/26 [19%] versus 3/73 [4%]; P =0.02) and ventricular dysfunction (6/26 [23%] versus 4/73 [6%]; P =0.04). Only 11 (42%) DAP patients manifested clinical permanent junctional reciprocating tachycardia, and these patients had more syncope (5/11 [45%] versus 0/15 [0%]; P P =0.001), and longer ventriculo-atrial times (mean maximum ventriculo-atrial times of 283±116 ms versus 208±42 ms; P =0.02) compared with those with DAPs without clinical permanent junctional reciprocating tachycardia. DAPs and controls had similar rates of acute ablation success (23/26 [89%] versus 67/73 [92%]; P =nonsignificant) and recurrences (1/23 [4%] versus 2/67 [3%]; P =nonsignificant). Conclusions— The majority of pediatric patients with DAPs do not present with clinical permanent junctional reciprocating tachycardia. DAPs are associated with more severe symptoms, but ablation outcomes are similar to those of age-matched controls.
- Published
- 2016
43. Intra-atrial re-entrant tachycardia around atretic tricuspid annulus
- Author
-
Gilles Soulat, Magalie Ladouceur, Laurence Iserin, Victor Waldmann, Denis Amet, and Eloi Marijon
- Subjects
Tachycardia ,medicine.medical_specialty ,Vena Cava, Inferior ,Tricuspid valve anulus ,Fontan Procedure ,Tricuspid Atresia ,Cicatrix ,Physiology (medical) ,Internal medicine ,Tachycardia, Reciprocating ,medicine ,Tricuspid annulus ,Humans ,Atrium (heart) ,business.industry ,Middle Aged ,medicine.anatomical_structure ,Catheter Ablation ,Cardiology ,Female ,Re entrant ,Tricuspid Valve ,medicine.symptom ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
44. Tachycardia cycle length alternans in orthodromic reciprocating tachycardia due to mutually dependent dual AV node physiology and retrograde supernormal conduction.
- Author
-
Mar PL, Kumar S, Hussein A, Lakkireddy D, and Gopinathannair R
- Subjects
- Cardiac Pacing, Artificial, Electrocardiography, Heart Rate, Humans, Atrioventricular Node diagnostic imaging, Tachycardia, Reciprocating
- Published
- 2021
- Full Text
- View/download PDF
45. Principles of Cardiac Electric Propagation and Their Implications for Re-entrant Arrhythmias
- Author
-
Peter S. Spector
- Subjects
Male ,Treatment outcome ,Risk Assessment ,Heart Conduction System ,Physiology (medical) ,Atrial Fibrillation ,Tachycardia, Reciprocating ,medicine ,Humans ,Simulation ,business.industry ,Body Surface Potential Mapping ,Human heart ,Reentry ,Prognosis ,medicine.disease ,Cellular automaton ,Treatment Outcome ,Classical mechanics ,Action (philosophy) ,Catheter Ablation ,Action potential duration ,Female ,Re entrant ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter - Abstract
The study of clinical electrophysiology essentially comprises examining how electric excitation develops and spreads through the millions of cells that constitute the heart. Given the enormous number of cells in a human heart, there is an extremely large number of possible ways that the heart can behave. We encounter rhythms across the spectrum from the organized and orderly behavior of sinus rhythm through repetitive continuous excitation (via reentry) in structurally defined circuits like atrial flutter and, finally, the complex, dynamic, and disorganized behavior of fibrillation. Despite these myriad possibilities, one can apply a basic understanding of the principles of propagation to predict how cardiac tissue will behave under varied circumstances and in response to various manipulations. In this article, we review the principles of propagation and how these can be used to understand reentry of all degrees of complexity. We use these principles to explain the mechanisms by which antiarrhythmic medications and ablation can terminate and prevent reentry. This article is not intended to be an exhaustive description of the physiology of cardiac propagation, rather, it is meant to capture the essence of propagation with sufficient detail to provide an intuitive feel for the interplay of the physiological features relevant to propagation. The figures and videos used in this article were created using a computational model of cardiac propagation (VisibleEP LLC, Colchester, VT). It is a hybrid between a physics-based and cellular automaton model. The model incorporates the fundamental features of propagation without modeling individual ion channels.1 The model manifests several relevant emergent properties, for example, electrotonic interactions, restitution of action potential duration, and conduction velocity as well as source–sink balance–dependent propagation. ### Cell Excitation A cell becomes excited when the balance of inward and outward currents passes a critical point after which inward currents exceed outward and an action potential ensues. …
- Published
- 2013
46. Narrow Complex Tachycardia With Ventriculoatrial Dissociation: Keep Your Eye on the His.
- Author
-
Richardson TD and Michaud GF
- Subjects
- Dissociative Disorders, Humans, Accessory Atrioventricular Bundle, Tachycardia, Reciprocating, Tachycardia, Ventricular
- Abstract
Competing Interests: Author Disclosures Dr. Michaud has received honoraria from Boston Scientific Medtronic, Biosense-Webster, and Biotronik; and has performed consulting for St. Jude Medical/Abbott. Dr. Richardson has reported that he has no relationships relevant to the contents of this paper to disclose.
- Published
- 2020
- Full Text
- View/download PDF
47. Novel Diagnostic Observations of Nodoventricular/Nodofascicular Pathway-Related Orthodromic Reciprocating Tachycardia Differentiating From Atrioventricular Nodal Re-Entrant Tachycardia.
- Author
-
Nagashima K, Kaneko Y, Maruyama M, Nogami A, Kowase S, Mori H, Sumitomo N, Fukamizu S, Hojo R, Kitamura T, Soejima K, Ueda A, Otsuka T, Takami M, Tanimoto K, Asakawa T, Kumagai K, Tamura S, Hasegawa H, Ogura K, Kawamura M, Munetsugu Y, Shoda M, Higuchi S, Kanazawa H, Kusa S, Mizukami A, Miyazaki S, Wakamatsu Y, and Okumura Y
- Subjects
- Cardiac Pacing, Artificial, Electrocardiography, Heart Conduction System, Humans, Tachycardia, Atrioventricular Nodal Reentry diagnosis, Tachycardia, Reciprocating, Tachycardia, Ventricular
- Abstract
Objectives: This study sought to assess the performance of current diagnostic criteria and identify additional electrophysiological features differentiating orthodromic reciprocating tachycardia (ORT) with a concealed nodoventricular/nodofascicular (NV/NF) pathway from atrioventricular nodal re-entrant tachycardia (AVNRT)., Background: Diagnosing sustained supraventricular tachycardia (SVT) despite the occurrence of ventriculoatrial block (VAB) is challenging., Methods: We analyzed electrograms of 25 sustained SVTs (9 NV/NF-ORTs [n = 7/2] and 16 AVNRTs) with VAB and 91 AVNRTs without VAB (for reference)., Results: More than 1 SVT, each with a different ventriculoatrial interval, was commonly induced in AVNRT cases (75%) but not in NV/NF-ORT cases (0%; p = 0.0005). Wenckebach VAB was common in NV/NF-ORTs (78%), but VAB patterns varied in AVNRTs. The His-His interval transiently prolonged in the following beat after the VAB in most AVNRTs but rarely did in NV/NF-ORTs (79% vs. 22%; p = 0.01). NV/NF-ORT was diagnosed by His-refractory premature ventricular contractions (n = 5) and the findings during right ventricular overdrive pacing showing an uncorrected/corrected post-pacing interval (PPI)-tachycardia cycle length (TCL) ≤115/110 ms (n = 5/5), orthodromic His capture (n = 6), and V-V-A (ventricle-ventricle-atrial response) response (n = 3). A single form of induced SVT (positive predictive value [PPV]: 69%; negative predictive value [NPV]: 100%), Wenckebach VAB (PPV: 70%; NPV: 87%), stable His-His interval despite VAB (PPV: 70%; NPV: 85%), orthodromic His capture (PPV: 100%; NPV: 97%), and V-V-A response (PPV: 100%; NPV: 95%) characterized NV/NF-ORT, and a PPI-TCL of ≤125 ms (PPV: 100%; NPV: 100%) characterized NV-ORT., Conclusions: Induction of a single SVT form, Wenckebach VAB, stable His-His interval despite VAB, orthodromic His capture, and V-V-A response appeared to discriminate NV/NF-ORT from AVNRT, with a PPI-TCL of ≤125 ms discriminating NV-ORT from NF-ORT and AVNRT., Competing Interests: Author Disclosures This study was supported by departmental resources only. Dr. Ueda has received an endowment from Abbott Japan. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
48. Coexistence of a permanent form of a junctional reciprocating tachycardia and coronary sinus aneurysm: A case report
- Author
-
Yuki, Shimizu, Osamu, Inaba, Masahiko, Goya, and Kenzo, Hirao
- Subjects
Male ,Electrocardiography ,Tachycardia, Reciprocating ,Catheter Ablation ,Coronary Aneurysm ,Humans ,Middle Aged ,Coronary Angiography ,Electrophysiologic Techniques, Cardiac - Abstract
A 58-year-old man with a long R-P' narrow QRS tachycardia underwent an electrophysiological study. The tachycardia was diagnosed as a permanent form of junctional reciprocating tachycardia (PJRT), and the earliest atrial activation site during tachycardia was coronary sinus (CS) ostium. Radiofrequency ablation at the site was initially not successful because the tip impedance and temperature were unstable. After changing of the ablation catheter to that with contact force sensor, the accessory pathway was immediately ablated and the PJRT was no longer induced. A retrograde CS angiogram revealed a fusiform aneurysm, which was located at the earliest activation site during the tachycardia.
- Published
- 2016
49. Ventriculoatrial Intervals ≤70 ms in Orthodromic Atrioventricular Reciprocating Tachycardia
- Author
-
Koichi, Nagashima, Ichiro, Watanabe, Yasuo, Okumura, Yoshiaki, Kaneko, Kazumasa, Sonoda, Rikitake, Kogawa, Naoko, Sasaki, Kazuki, Iso, Keiko, Takahashi, Sayaka, Kurokawa, Toshiko, Nakai, Kimie, Ohkubo, and Atsushi, Hirayama
- Subjects
Diagnosis, Differential ,Electrophysiology ,Male ,Heart Conduction System ,Tachycardia, Reciprocating ,Atrioventricular Node ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female ,Middle Aged ,Accessory Atrioventricular Bundle - Abstract
Although a ventriculoatrial interval (VAI) of ≤70 ms is used to distinguish atrioventricular nodal reentrant tachycardia from orthodromic atrioventricular reciprocating tachycardia (AVRT), a VAI of ≤70 ms is sometimes observed in cases of AVRT. The study aimed to evaluate the short VAI that is seen in AVRT and to understand its underlying mechanism.Electrophysiologic studies of 46 consecutive patients with AVRT involving an accessory pathway (AP) were examined retrospectively.AP was right sided in seven patients and left sided in 39. A VAI (interval from QRS onset to the earliest intracardiac atrial electrogram recorded by any mapping catheter during AVRT) ≤70 ms during AVRT (short VAI) was observed in eight patients: six with a left lateral AP and two with a left posteroseptal AP. During AVRT involving a left-sided AP, the QRS-V interval (from the earliest QRS onset to the local ventricular electrogram at a site which showed earliest atrial electrogram recorded from the coronary sinus catheter) was significantly shorter (37 ± 7 ms vs 54 ± 13 ms, P = 0.001) and supernormal conduction (QRS duration or the QRS-V interval shortening by ≥10 ms during AVRT) was more frequently seen (63% vs 6%, P = 0.02) in the short VAI group than in the normal VAI group. Furthermore, these parameters were shown to be determinants for short VAI.A short VAI is sometimes observed during AVRT involving a left-sided AP. The short VAI may be caused by rapid propagation or supernormal conduction between the proximal Purkinje-muscle junction and basal left ventricular myocardium.
- Published
- 2016
50. Long Postpacing Interval After Entrainment of Tachycardia Including a Slow Conduction Zone Within the Circuit
- Author
-
Takahiko, Kinjo, Shingo, Sasaki, Masaomi, Kimura, Shingen, Owada, Daisuke, Horiuchi, Kenichi, Sasaki, Taihei, Itoh, Yuji, Ishida, Yoshihiro, Shoji, Kimitaka, Nishizaki, Yuichi, Tsushima, Hirofumi, Tomita, and Ken, Okumura
- Subjects
Adult ,Aged, 80 and over ,Male ,Time Factors ,Cardiac Pacing, Artificial ,Action Potentials ,Middle Aged ,Accessory Atrioventricular Bundle ,Atrial Flutter ,Heart Conduction System ,Heart Rate ,Predictive Value of Tests ,Tachycardia, Reciprocating ,Tachycardia, Supraventricular ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Female ,Electrophysiologic Techniques, Cardiac ,Aged - Abstract
Postpacing interval (PPI) measured after entrainment pacing describes the distance between pacing site and reentrant circuit. However, the influential features to PPI remain to be elucidated.This study included 22 cases with slow/fast atrioventricular (AV) nodal reentrant tachycardia (AVNRT), 14 orthodromic AV reciprocating tachycardia (AVRT) using an accessary pathway, 22 typical atrial flutter (AFL), and 18 other macroreentrant atrial tachycardia (atypical AFL). Rapid pacing at a pacing cycle length (PCL) 5% shorter than tachycardia cycle length (TCL) was done from a site on or close to the reentry circuit. Pacing sites included the coronary sinus ostium in AVNRT, earliest atrial activation site in AVRT, and cavotricuspid isthmus in typical AFL. In atypical AFL, tachycardia circuit was determined on the basis of CARTO mapping, and then the pacing site was. TCL was significantly longer in AVNRT and AVRT than in typical AFL and atypical AFL (both P0.05). PCL minus TCL value was similar among the 4 groups. PPI minus TCL value (milliseconds) was significantly longer in AVNRT (median, 40 [IQR, 29-60.8]) and AVRT (34 [20-47]) than in typical AFL (0 [0-4]) and atypical AFL (3.5 [0-8]) (both P0.05). Furthermore, PPI minus TCL was prolonged with shortening of PCL in AVNRT and AVRT (both P0.05), whereas it was unchanged in typical AFL (P = 0.50).PPI after concealed entrainment is prolonged compared with TCL when the reentry circuit involves a slow conduction zone with a decremental conduction property such as the AV node.
- Published
- 2016
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.