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Lebloa M, Pascale P. Preprocedural Discrimination of Posteroseptal Accessory Pathways Ablated from the Right Endocardium from Those Requiring a Left-sided or Epicardial Coronary Venous Approach. Arrhythm Electrophysiol Rev 2022; 11:e07. [PMID: 35734142 PMCID: PMC9194913 DOI: 10.15420/aer.2021.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/09/2022] [Indexed: 11/04/2022] Open
Abstract
The success of radiofrequency catheter ablation of the accessory pathway (AP) depends on the accurate localisation of the bypass tract. In that respect, posteroseptal or inferior paraseptal APs often pose a diagnostic challenge because of the complex anatomy at the crux of the four cardiac chambers. Considering the differences in procedure risks and success rate depending on the need for a left-sided approach or a coronary sinus ablation, an accurate anticipation of the precise location of inferior paraseptal APs is critical to inform the consent process and guide the initial mapping strategy. Here, the preprocedural clues to discriminate APs that can be ablated from the right atrium, from those requiring a left-sided or epicardial coronary venous approach, are reviewed. Both manifest and concealed APs will be considered and, following the diagnostic process made by the operator before interpretation of the intra-cardiac signals, each of the following aspects will be addressed: clinical context and initial probability; and 12-lead ECG analysis during baseline ECG with manifest AP, maximal preexcitation, and orthodromic reciprocating tachycardia.
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Affiliation(s)
- Mathieu Lebloa
- Arrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Patrizio Pascale
- Arrhythmia Unit, Cardiovascular Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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2
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Radiofrequency catheter ablation of patients with permanent junctional reciprocating tachycardia and long-term follow-up results. J Interv Card Electrophysiol 2021; 63:461-469. [PMID: 34476675 DOI: 10.1007/s10840-021-01057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND 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. METHODS We included 62 patients with the diagnosis of PJRT. Radiofrequency catheter ablation was performed in all. RESULTS 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). CONCLUSION Retrograde decremental accessory pathways are mainly located in posteroseptal region. Radiofrequency catheter ablation is a safe and effective approach in patients with PJRT.
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Matta M, Marazzato J, De Ponti R, Gaita F, Anselmino M. Ablation of Accessory Pathways with Uncommon Electrophysiologic Properties. Card Electrophysiol Clin 2020; 12:567-581. [PMID: 33162004 DOI: 10.1016/j.ccep.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In rare cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic features that may be related to their specific anatomy. Most of these bundles show decremental nodelike conduction properties and sustain peculiar forms of arrhythmias that require careful differential diagnosis. On the other hand, some pathways do not actively sustain any reentrant circuit and should nevertheless be promptly recognized to avoid unnecessary ablation attempts. Although rare, these variants of accessory pathway should be known to warrant a safe and effective catheter ablation procedure.
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Affiliation(s)
- Mario Matta
- Cardiology Division, Sant'Andrea Hospital, corso Mario Abbiate, 21, Vercelli 13100, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fiorenzo Gaita
- Cardiology Unit, J Medical Via Druento, 153/56, Turin 10151, Italy
| | - Matteo Anselmino
- Cardiology Division, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Turin, Corso Bramante, 88, Turin 10126, Italy.
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Abstract
In some cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic properties related to their specific anatomy. Most of these fibers, which may be responsible for variants of ventricular preexcitation, show decremental conduction properties due to a nodelike aspect or a peculiar tortuous anatomic route across the atrioventricular groove. Moreover, some fibers do not actively sustain any reentrant circuit and can be only involved as bystander in other arrhythmias. Although rare, these accessory pathway variants should be properly diagnosed using noninvasive and invasive methods to guide catheter ablation procedures when needed.
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Kaneko Y, Nakajima T, Nogami A, Inden Y, Asakawa T, Morishima I, Mizukami A, Iizuka T, Tamura S, Ota C, Kanzaki Y, Nakagawa K, Suzuki M, Kurabayashi M. Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia Utilizing a Slow Pathway Extending to the Inferolateral Right Atrium. Circ Rep 2019; 1:46-54. [PMID: 33693113 PMCID: PMC7890287 DOI: 10.1253/circrep.cr-18-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background:
The existence of atypical fast-slow (F/S) atrioventricular (AV) nodal reentrant tachycardias (NRT) using slow pathway (SP) variants connected to the right atrial (RA) inferolateral (inf) free wall (FW) along the tricuspid annulus (TA), has been neither confirmed nor precisely characterized. Methods and Results:
We studied 7 patients (mean age, 48±16 years; 5 men) with F/S-AVNRT with long RP intervals and an earliest atrial activation at the RA inf-FW along the TA (inf-F/S-AVNRT). AV reentrant tachycardia was excluded on observation of the transition zone criteria in all 7 patients. Atrial tachycardia was excluded on the observation of a V-A-V activation sequence after the induction or entrainment of the tachycardia from the right ventricle in all. During the tachycardia, low-frequency, fractionated potentials (LP) preceding the local atrial electrogram were recorded near the site of the earliest atrial activation in 6 patients. Observations of conduction delay and block of the LP during ventricular entrainment or ablation of the tachycardia indicated that LP reflect retrograde activation via the inf-SP. Retrograde SP conduction was interrupted at the site of earliest atrial activation in 3 patients, and in the right posterior septum in 4 patients. Conclusions:
inf-F/S-AVNRT are distinct supraventricular tachycardia incorporating an SP variant connected to the RA inf-FW along the TA in the retrograde direction, which were eliminated by ablation.
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Affiliation(s)
- Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Akihiko Nogami
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | | | | | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Chihiro Ota
- Cardiovascular Division, School of Medicine, University of Tsukuba
| | - Yasunori Kanzaki
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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Hluchy J, Van Bracht M, Brandts B. Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty040. [PMID: 31020120 PMCID: PMC6177018 DOI: 10.1093/ehjcr/yty040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/09/2018] [Indexed: 11/14/2022]
Abstract
Introduction Decremental conduction in short anterograde atrioventricular accessory pathways (AV-APs) is rare. Case presentation We report on two cases with radiofrequency (RF) ablation of anterograde fast non-decremental AV-AP conduction. In Case 1, electrophysiological testing revealed fast non-decremental conduction over an anterograde short right posteroseptal AV-AP. During ablation, latent pre-excitation due to anterograde adenosine-sensitive slow decremental conduction over the same AV-AP manifested after eliminating its non-decremental conduction. Complete abolition of AP conduction was achieved by additional ablation. In Case 2, overt pre-excitation disappeared after the first ablation session for an anterograde short non-decremental right mid-septal AV-AP. However, latent pre-excitation due to markedly decremental conduction over the same AV-AP unmasked by intravenous adenosine and atrial pacing manoeuvers could be eliminated in a second session. Discussion This report describes unusual anterograde short non-decremental AV-APs, developing markedly slow adenosine-sensitive decremental conduction during ablation. Such AV-AP conduction properties due to RF injury may be overlooked and mask incomplete ablation and point-out careful testing including stimulation techniques and low and higher dose adenosine administration post-ablation.
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Affiliation(s)
- Jan Hluchy
- Division of Clinical Electrophysiology, Department of Cardiology and Angiology, Augusta-Kranken-Anstalt, Bergstr. 26, Bochum, Germany
| | - Marc Van Bracht
- Division of Clinical Electrophysiology, Department of Cardiology and Angiology, Augusta-Kranken-Anstalt, Bergstr. 26, Bochum, Germany
| | - Bodo Brandts
- Division of Clinical Electrophysiology, Department of Cardiology and Angiology, Augusta-Kranken-Anstalt, Bergstr. 26, Bochum, Germany.,Witten-Herdecke University, Alfred-Herrhausen-Straße 50, Witten, Germany
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Clinical Features and Sites of Ablation for Patients With Incessant Supraventricular Tachycardia From Concealed Nodofascicular and Nodoventricular Tachycardias. JACC Clin Electrophysiol 2017; 3:1547-1556. [PMID: 29759837 DOI: 10.1016/j.jacep.2017.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/22/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to describe the clinical features and sites of successful ablation for incessant nodofascicular (NF) and nodoventricular (NV) tachycardias. BACKGROUND Incessant supraventricular tachycardias have been associated with tachycardia-induced cardiomyopathies and have been previously attributed to permanent junctional reciprocating tachycardias, atrial tachycardias, and atrioventricular nodal re-entrant tachycardias. Incessant concealed NF and NV tachycardias have not been described previously. METHODS Three cases of incessant concealed NF and NV re-entrant tachycardias were identified from 2 centers. RESULTS The authors describe 3 cases with incessant supraventricular tachycardia resulting from NV (2 cases) and NF (1 case) pathways. Atrioventricular nodal re-entrant tachycardia was excluded by His synchronous premature ventricular complexes that either delayed or terminated the tachycardia. Ventricular pacing showed constant and progressive fusion in cases 1 and 3. In 2 cases, there was spontaneous initiation with a 1:2 response (cases 1 and 3); the presence of retrograde longitudinal dissociation or marked decremental pathway conduction in cases 1 and 3 sustains these tachycardias. The NV pathway was successfully ablated in the slow pathway region in case 3 and at the right bundle branch in case 1. The NF pathway was successfully ablated within the proximal coronary sinus in case 2. CONCLUSIONS This is the first report of incessant supraventricular tachycardia using concealed NF or NV pathways. These tachycardias demonstrated spontaneous initiation from sinus rhythm with a 1:2 response and retrograde longitudinal dissociation or marked decremental pathway conduction. Successful ablation was achieved at either right-sided sites or within the coronary sinus.
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8
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Shimizu Y, Inaba O, Goya M, Hirao K. Coexistence of a permanent form of a junctional reciprocating tachycardia and coronary sinus aneurysm: A case report. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1318-1321. [PMID: 28543389 DOI: 10.1111/pace.13108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 04/18/2017] [Accepted: 05/02/2017] [Indexed: 12/01/2022]
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.
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Affiliation(s)
- Yuki Shimizu
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Osamu Inaba
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Masahiko Goya
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University
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Rillig A, Lin T, Ouyang F, Kuck KH, Tilz RR. Which Is The Appropriate Arrhythmia Burden To Offer RF Ablation For RVOT Tachycardias? J Atr Fibrillation 2014; 7:1157. [PMID: 27957135 DOI: 10.4022/jafib.1157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 12/14/2022]
Abstract
Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) in patients with structurally normal hearts originate from the right ventricular outflow tract (RVOT) in the majority of cases. In the last few decades catheter ablation of these arrhythmias has been proven to be effective. RVOT VT/PVCs may cause disabling symptoms or arrhythmia induced cardiomyopathy. However, the PVC burden at which catheter ablation should be recommended is still controversial. What adds to the controversy is why some patients with only a low number of PVCs can be highly symptomatic and may even develop arrhythmia induced cardiomyopathy, whilst others may have a higher PVC/VT burden and remain asymptomatic and do not develop cardiomyopathy for a long period of time. Therefore, although catheter ablation of RVOT PVCs has high success and low complication rates, the time point of when ablation should be recommended is currently still under debate. This review discusses the treatment strategies and prognosis for RVOT tachycardias and focuses on the question of which arrhythmia burden is appropriate to offer RF ablation.
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Affiliation(s)
- Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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10
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Lahrouchi N, Wever EFD, Balt JC. Three is a crowd. Neth Heart J 2014; 22:474-6. [PMID: 25169575 PMCID: PMC4188853 DOI: 10.1007/s12471-014-0586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- N Lahrouchi
- Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, Room L2-109, 1105 AZ, Amsterdam, the Netherlands,
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11
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Yagishita A, Hachiya H, Higuchi K, Nakamura T, Sugiyama K, Tanaka Y, Sasano T, Kawabata M, Isobe M, Hirao K. Differentiation of atrial tachycardia from other long RP tachycardias by electrocardiographic characteristics. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Reply to the Editor–XXXXX. Heart Rhythm 2014; 11:E5. [DOI: 10.1016/j.hrthm.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Indexed: 11/19/2022]
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13
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Gupta S, Figueredo VM. Tachycardia mediated cardiomyopathy: Pathophysiology, mechanisms, clinical features and management. Int J Cardiol 2014; 172:40-6. [DOI: 10.1016/j.ijcard.2013.12.180] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 11/25/2022]
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Abstract
Since 1989, when radiofrequency ablation was introduced into clinical practice for pediatric patients with supraventricular tachycardias, radiofrequency catheter ablation techniques have evolved as the treatment of choice for many forms of tachycardia in young patients. This review discusses the current status of ablation therapy for the four most common forms of supraventricular tachycardias in children, including tachycardias based on accessory atrioventricular pathways, atrioventricular nodal reentrant tachycardia, atrial ectopic tachycardia and the permanent form of junctional reciprocating tachycardia. In addition, the report will focus on the current status and limitations of ablation therapy of ventricular tachycardias and atrial reentry tachycardias in patients after surgical correction of congenital heart defects.
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Affiliation(s)
- Thomas Kriebel
- Department of Pediatric Cardiology, Neonatology and Pediatric Intensive Care Medicine, University Hospital, Georg-August-University Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, FR Germany.
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15
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Amara W, Monsel F. [Permanent junctional reciprocating tachycardia (Coumel type): a rare but curable form of tachycardia]. Ann Cardiol Angeiol (Paris) 2013; 62:361-3. [PMID: 24054446 DOI: 10.1016/j.ancard.2013.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/12/2013] [Indexed: 11/26/2022]
Abstract
We report the case of a 52 year-old man experiencing recurrent and incessant tachycardias despite antiarrhythmic drugs. Electrophysiological exploration confirmed the diagnosis of permanent junctional reentrant tachycardias (Coumel tachycardia). This tachycardia has been treated successfully by catheter ablation. The mechanisms of this tachycardias are explained.
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Affiliation(s)
- W Amara
- Unité de rythmologie, GHI Le Raincy-Montfermeil, 10, rue du G.L.-Leclerc, 93370 Montfermeil, France.
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Santilli RA, Santos LFN, Perego M. Permanent junctional reciprocating tachycardia in a dog. J Vet Cardiol 2013; 15:225-30. [PMID: 23962684 DOI: 10.1016/j.jvc.2013.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 05/07/2013] [Accepted: 06/07/2013] [Indexed: 11/19/2022]
Abstract
A 5-year-old male English Bulldog was presented with a 1-year history of paroxysmal supraventricular tachycardia (SVT) partially responsive to amiodarone. At admission the surface ECG showed sustained runs of a narrow QRS complex tachycardia, with a ventricular cycle length (R-R interval) of 260 ms, alternating with periods of sinus rhythm. Endocardial mapping identified the electrogenic mechanism of the SVT as a circus movement tachycardia with retrograde and decremental conduction along a concealed postero-septal atrioventricular pathway (AP) and anterograde conduction along the atrioventricular node. These characteristics were indicative of a permanent junctional reciprocating tachycardia (PJRT). Radiofrequency catheter ablation of the AP successfully terminated the PJRT, with no recurrence of tachycardia on Holter monitoring at 12 months follow-up.
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Affiliation(s)
- Roberto A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy.
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Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. ACTA ACUST UNITED AC 2013; 15:1337-82. [DOI: 10.1093/europace/eut082] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Bonney WJ, Shah MJ. Incessant SVT in children: Ectopic atrial tachycardia and permanent junctional reciprocating tachycardia. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Single-catheter radiofrequency ablation of a permanent junctional reciprocating tachycardia in a premature neonate. Cardiol Young 2012; 22:606-9. [PMID: 22398140 DOI: 10.1017/s1047951112000182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 34-week premature neonate presented with drug-refractory permanent junctional incessant tachycardia and haemodynamic compromise. The patient underwent successful radiofrequency catheter ablation using a single-catheter approach. The child remains in sinus rhythm, without pharmacological treatment, 2 years after the procedure.
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20
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Rordorf R, Raineri C, De Ferrari GM, Via G, Tavazzi G, Mojoli F, Nicolino A, Landolina M. Post-partum cardiogenic shock in a patient with permanent junctional re-entry tachycardia. Int J Cardiol 2011; 151:e68-70. [PMID: 20557959 DOI: 10.1016/j.ijcard.2010.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/18/2010] [Indexed: 12/01/2022]
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21
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Tseng ZH, Scheinman M. Persistent Long R-P Tachycardia. Card Electrophysiol Clin 2010; 2:225-229. [PMID: 28770755 DOI: 10.1016/j.ccep.2010.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A case of persistent, recalcitrant long R-P tachycardia with decremental retrograde conduction consistent with permanent junctional reciprocating tachycardia (PJRT) is presented, refractory to multiple prior attempts at catheter ablation and antiarrhythmic drug therapy trials. During repeat study at their center, the authors demonstrated the conduction properties and oblique course of the accessory pathway (AP) within the coronary sinus (CS) during PJRT. The authors describe their successful approach to catheter ablation, targeting first the AP-atrium interface at a site distal to the AP recording within the CS, then the AP potential itself at the os. The current case highlights the complexity of the AV connection and the importance of careful mapping of the CS in patients with PJRT.
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Affiliation(s)
- Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, 500 Parnassus Avenue, Room MU E-434, Box 1354, San Francisco, CA 94143-1354, USA
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DIVAKARA MENON SYAMKUMARM, HEALEY JEFFS, NAIR GIRISHM, RIBAS CARLOSS, BARANCHUK ADRIAN, NERY PABLOB, SUMNER GLENL, CONNOLLY STUARTJ, MORILLO CARLOSA. A Case of Long-RP Tachycardia: What is the Mechanism? J Cardiovasc Electrophysiol 2009; 20:702-4. [DOI: 10.1111/j.1540-8167.2008.01423.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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EL-CHAMI MIKHAELF, BLATT JACOB, LLOYD MICHAELS. A Diagnostic Response of a Supraventricular Tachycardia to a Ventricular Premature Beat. Pacing Clin Electrophysiol 2009; 32:660-2. [DOI: 10.1111/j.1540-8159.2009.02341.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee KW, Badhwar N, Scheinman MM. Supraventricular Tachycardia—Part II: History, Presentation, Mechanism, and Treatment. Curr Probl Cardiol 2008; 33:557-622. [DOI: 10.1016/j.cpcardiol.2008.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Pap R, Traykov VB, Makai A, Bencsik G, Forster T, Sághy L. Ablation of posteroseptal and left posterior accessory pathways guided by left atrium-coronary sinus musculature activation sequence. J Cardiovasc Electrophysiol 2008; 19:653-8. [PMID: 18284500 DOI: 10.1111/j.1540-8167.2008.01103.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While some posteroseptal and left posterior accessory pathways (APs) can be ablated on the tricuspid annulus or within the coronary venous system, others require a left-sided approach. "Fragmented" or double potentials are frequently recorded in the coronary sinus (CS), with a smaller, blunt component from left atrial (LA) myocardium, and a larger, sharp signal from the CS musculature. METHODS AND RESULTS Forty patients with posteroseptal or left posterior AP were included. The LA-CS activation sequence was determined at the earliest site during retrograde AP conduction. Eleven APs (27.5%) were ablated on the tricuspid annulus (right endocardial), 9 (22.5%) inside the coronary venous system (epicardial), and 20 (50%) on the mitral annulus (left endocardial). A "fragmented" or double "atrial" potential was recorded in all patients inside the CS at the earliest site during retrograde AP conduction. Sharp potential from the CS preceded the LA blunt component (sharp/blunt sequence) in all patients with an epicardial AP, and in 10 of 11 (91%) patients with a right endocardial AP. Therefore, 18 of 19 (95%) APs ablated by a right-sided approach produced this pattern. The reverse sequence (blunt/sharp) was recorded in 19 of 20 (95%) patients with a left endocardial AP. CONCLUSION During retrograde AP conduction, the sequence of LA-CS musculature activation-as deduced from analysis of electrograms recorded at the earliest site inside the CS-can differentiate posteroseptal and left posterior APs that require left heart catheterization from those that can be eliminated by a totally venous approach.
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Affiliation(s)
- Róbert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
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Hasdemir C, Yavuzgil O, Payzin S, Aydin M, Ulucan C, Kayikcioglu M, Can LH, Turkoglu C, Kultursay H. Angiographic analysis of the anatomic relation of coronary arteries to mitral and tricuspid annulus and implications for radiofrequency ablation. Am J Cardiol 2007; 100:666-71. [PMID: 17697826 DOI: 10.1016/j.amjcard.2007.03.082] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 03/13/2007] [Accepted: 03/13/2007] [Indexed: 11/24/2022]
Abstract
Coronary artery (CA) narrowings and/or occlusions after radiofrequency ablation (RFA) have been reported. The aim of this study was to describe the in vivo topographic anatomy of CAs and their anatomic relation to the mitral and tricuspid annulus using selective coronary angiography. Fifty consecutive patients undergoing RFA for narrow QRS complex tachycardia were included in the study. Multipolar electrode catheters were inserted into the right atrial appendage, His bundle region, distal coronary sinus (CS), and right ventricle. A mapping catheter was placed across the subeustachian isthmus (SEI). Selective coronary angiography was performed. The maximum and minimum distances between the distal CAs and the mapping catheter located along the mitral and tricuspid annulus were measured during systole and diastole and in right and left anterior oblique projections. The large (> or =1.5 mm) distal right CA was < or =5 mm from the mapping catheter in the SEI in 4 patients (8%). The large posterolateral branch of the right CA was < or =2 mm from the CS Os-middle cardiac vein in 10 patients (20%). The large left circumflex CA was < or =2 mm from the floor or ceiling of the CS in 7 patients (14%) and < or =2 mm from the CS catheter at the lateral and anterolateral mitral annulus in 12 patients (24%). RFA was canceled in 2 patients because of the close proximity (< or =2 mm) of the distal CA to the ablation site. In conclusion, large CAs are frequently located in close proximity to the common ablation sites. Coronary angiography should be considered in children and adults who may develop any signs or symptoms suggestive of acute CA occlusion until larger controlled series are available.
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Affiliation(s)
- Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey.
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Abstract
The 12-lead electrocardiogram (ECG) is an invaluable tool for the diagnosis of supraventricular tachycardia (SVT). Most forms of SVT can be distinguished with a high degree of certainty based on specific ECG characteristics by using a systematic, stepwise approach. This article provides a general framework with which to approach an ECG during SVT by describing the salient characteristics, ECG findings, and underlying electroanatomical relationships of each specific type of SVT encountered in adults. It concludes by providing a systematic algorithm for diagnosing SVT based on the findings of the 12-lead ECG.
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Affiliation(s)
- Uday N Kumar
- Division of Cardiology, Department of Medicine, 500 Parnassus Avenue, Box 1354, University of California, San Francisco, San Francisco, California 94143, USA
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Calabrò MP, DE Luca FL, Gitto E, Oreto G. Salbutamol-Induced Narrow QRS Tachycardia: What Is the Mechanism? J Cardiovasc Electrophysiol 2006; 17:792-3. [PMID: 16836682 DOI: 10.1111/j.1540-8167.2006.00481.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Amasyali B, Kose S, Aytemir K, Kilic A, Kursaklioglu H, Isik E. A permanent junctional reciprocating tachycardia with an atypically located accessory pathway successfully ablated from within the middle cardiac vein. Heart Vessels 2006; 21:188-91. [PMID: 16715194 DOI: 10.1007/s00380-005-0848-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 06/25/2005] [Indexed: 10/24/2022]
Abstract
Permanent form of junctional reciprocating tachycardia (PJRT) is an uncommon form of atrioventricular re-entrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction. The majority of accessory pathways in PJRT are localized in the posteroseptal zone. Despite the high success rate, failure may occur during endocardial radiofrequency catheter ablation due to epicardial insertion of the accessory pathway. We report a case of PJRT in a 25-year-old man in whom the accessory pathway was located epicardially in the posteroinferior region and ablated from within the middle cardiac vein by radiofrequency catheter ablation.
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Affiliation(s)
- Basri Amasyali
- Department of Cardiology, Gulhane GATA Military Medical School, 06018, Etlik, Ankara, Turkey.
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30
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Meiltz A, Weber R, Halimi F, Defaye P, Boveda S, Tavernier R, Kalusche D, Zimmermann M. Permanent form of junctional reciprocating tachycardia in adults: peculiar features and results of radiofrequency catheter ablation. ACTA ACUST UNITED AC 2006; 8:21-8. [PMID: 16627404 DOI: 10.1093/europace/euj007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM PJRT occurs predominantly in infants and children and is limited to small series in adults. The aim of this study was to describe the clinical presentation, electrophysiological characteristics, feasibility and safety of radiofrequency ablation, and the long-term prognosis in a large group of adult patients with the permanent form of junctional reciprocating tachycardia (PJRT). METHODS AND RESULTS Forty-nine adult patients (22 male and 27 female; mean age 43+/-16) with a diagnosis of PJRT confirmed at electrophysiological study were included. Eight patients (16%) presented with tachycardia-induced cardiomyopathy (TIC). Ventricular rate was 146+/-30 bpm. The arrhythmia was permanent or incessant in 23/49 cases (47%) and paroxysmal in 26/49 (53%). A significant correlation was found between symptom duration and tachycardia rate (r(2)=0.12, P=0.01). The accessory pathway (AP) was located in the right posteroseptal region in 37 cases (76%) and in atypical sites in 12 cases (24%). Patients with the incessant or permanent form of PJRT had longer duration of symptoms, more frequently TIC and a slower tachycardia rate. Radiofrequency catheter ablation was initially successful in 46 cases (94%) without any serious complication. Long-term success rate was 100% (49/49 patients) in the absence of any antiarrhythmic drug treatment (mean follow-up 49+/-38 months). Regression of TIC was observed in all cases (8/8). CONCLUSION PJRT in adults is often paroxysmal (53%), and the retrograde slowly conducting, decremental AP is not infrequently in a non-posteroseptal location. Radiofrequency catheter ablation is highly effective and should be considered as the treatment of first choice in adult patients with PJRT.
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Affiliation(s)
- Alexandre Meiltz
- Cardiovascular Department, Hôpital de La Tour 1 Avenue JD Maillard, CH-1217 Meyrin, Geneva, Switzerland
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Vaksmann G, D'Hoinne C, Lucet V, Guillaumont S, Lupoglazoff JM, Chantepie A, Denjoy I, Villain E, Marçon F. Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome. Heart 2005; 92:101-4. [PMID: 15831598 PMCID: PMC1860982 DOI: 10.1136/hrt.2004.054163] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the clinical profile, natural history, and optimal management of persistent or permanent junctional reciprocating tachycardia (PJRT) in children. METHODS AND RESULTS 85 patients meeting the ECG criteria for PJRT were enrolled in a retrospective multicentre study. Age at diagnosis varied from birth to 20 years (median 3 months). Follow up ranged from 0.1 to 26.0 (median 8.2) years. At the time of referral, 24 of 85 patients (28%) had congestive heart failure that was resolved with medical treatment in all patients. Eighty three patients received drug treatment initially. Amiodarone and verapamil were the most effective with a success rate of 84-94% alone or in association with digoxin. Radiofrequency ablation of the accessory pathway was performed in 18 patients. There was a trend for a relation between age at ablation and the result of the procedure, failures being more common in younger patients (three of six procedures in younger and 15 of 18 in older children were successful; p = 0.14). Two patients with persistent left ventricular dysfunction on echocardiography but with no symptoms of congestive heart failure died suddenly one month and three years after diagnosis. PJRT resolved spontaneously in 19 patients (22%). Age at diagnosis of PJRT was not a predictor of spontaneous resolution. CONCLUSIONS PJRT is a potentially lethal arrhythmia in children with tachycardia induced cardiomyopathy. Spontaneous resolution of tachycardia is not uncommon. Antiarrhythmic treatment is often effective. Radiofrequency ablation should be performed in older children or when rate is not controlled, especially in patients with persistent left ventricular dysfunction.
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Affiliation(s)
- G Vaksmann
- Department of Paediatric Cardiology, Cardiological Hospital, Lille, France.
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Manita M, Kaneko Y, Kurabayashi M, Yeh SJ, Wen MS, Wang CC, Lin FC, Wu D. Electrophysiological characteristics and radiofrequency ablation of accessory pathways with slow conductive properties. Circ J 2004; 68:1152-9. [PMID: 15564699 DOI: 10.1253/circj.68.1152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrioventricular accessory pathways (AP) with unusually long ventriculo-atrial (VA) conduction times are present in a significant subset of patients with the Wolff-Parkinson-White (WPW) syndrome, not including patients with the permanent form of atrioventricular junctional reciprocating tachycardia. METHODS AND RESULTS We compared the electrophysiological characteristics and outcomes after radiofrequency (RF) ablation in 34 patients with the WPW syndrome, a VA interval >80 ms, and paroxysmal tachycardia with an RP/PR ratio <1 (the slow group), vs 80 patients with WPW syndrome and a VA interval <80 ms (the fast group). AP were found in the posteroseptal region significantly more often in the slow than in the fast group. In addition, the decremental conductive properties of the AP were more common in the slow than in the fast group. Catheter ablation of AP was highly successful in both groups, although ablation required a greater number of RF applications and longer procedure times in the slow group, especially for AP with decremental conductive properties. CONCLUSIONS A posteroseptal AP location was more common in AP associated with long conduction times than in AP with typical conductive properties. Both types of AP were successfully ablated, although the slow group required longer procedures and more RF energy deliveries.
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Affiliation(s)
- Mamoru Manita
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan.
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Gaita F, Montefusco A, Riccardi R, Giustetto C, Grossi S, Caruzzo E, Bianchi F, Vivalda L, Gabbarini F, Calabro R. Cryoenergy Catheter Ablation:. J Cardiovasc Electrophysiol 2004; 15:263-8. [PMID: 15030412 DOI: 10.1046/j.1540-8167.2004.03426.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of reciprocating tachycardia, almost incessant from childhood and usually refractory to drug therapy. Radiofrequency catheter ablation currently is the first-line therapy for PJRT, but its application in the septal region may be associated with complications. In contrast, cryoenergy has several advantages, such as the ability to test the effects of ablation while the lesion is still forming, thus reducing the number of ineffective, useless, and potentially harmful lesions. The aim of this study was to investigate the potential clinical utility of percutaneous cryoenergy catheter ablation for treatment of pediatric patients with PJRT. METHODS AND RESULTS Four patients (age 14 +/- 5 years; mean +/- SD) with a clinical diagnosis of PJRT underwent catheter cryoablation. The ablation was successfully accomplished in 4 (100%) of 4 patients. The mean +/- SD number of cryoapplications was 1.8 +/- 0.8, and from 1 to 6 cryomappings were performed for each permanent cryolesion. The successful site was in the mid-septal region (2 patients), at the coronary sinus orifice (1 patient), and in the middle cardiac vein (1 patient). No complications with cryoablation were reported, nor was there prolongation of the AH interval during cryomapping or cryoablation. No pain was reported by patients during the cryoenergy catheter ablation procedure. PJRT recurrence occurred in 1 patient who underwent a second successful cryoablation procedure. CONCLUSION The outcomes of cryoenergy catheter ablation in these 4 patients treated for PJRT suggest that cryoablation is a safe, effective, and pain-free technique for treating pediatric patients with PJRT.
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Affiliation(s)
- Fiorenzo Gaita
- Division of Cardiology, Ospedale Mauriziano di Torino, Italy.
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34
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Affiliation(s)
- Andre J Gauri
- Division of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois 60637, USA
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35
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Calabrò MP, Luzza F, Carerj S, Oreto G. Narrow QRS tachycardia with negative P waves in leads I and aVL: what is the mechanism? J Cardiovasc Electrophysiol 2003; 14:1013-4. [PMID: 12950551 DOI: 10.1046/j.1540-8167.2003.03113.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Maria Pia Calabrò
- Department of Cardiology, University of Messina, Via Terranova 9, 98122 Messina, Italy
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36
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Blaufox AD, Saul JP. Radiofrequency ablation of right-sided accessory pathways in pediatric patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2001; 13:25-40. [PMID: 11413056 DOI: 10.1016/s1058-9813(01)00081-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Right free-wall and septal accessory pathways encompass the full spectrum of accessory pathway electrophysiology and are situated in complex anatomical arrangements. Understanding this diversity of physiology is necessary for the successful and safe elimination of these connections with transcatheter radiofrequency ablation. When radiofrequency catheter ablation of these pathways is attempted in children, anatomical relationships often become more complex, and spatial constraints require more adaptive techniques than in adults. It is clear that considerable progress has been made with radiofrequency catheter ablation, such that it is now first-line therapy for most children who have been diagnosed with one of the broad spectrum of clinical manifestations that result from the presence of these accessory connections. This review will discuss how accessory pathway electrophysiology and anatomy impact the clinical syndromes observed in children, and how these factors, as well as others particular to children, determine the approach, results and potential long-term consequences of radiofrequency catheter ablation of right-sided accessory pathways in the pediatric population.
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Affiliation(s)
- A D. Blaufox
- Medical University of South Carolina, Charleston, SC, USA
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37
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38
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Grimm W, Hoffmann J, Menz V, Maisch B. Transient QT prolongation with torsades de pointes tachycardia after ablation of permanent junctional reciprocating tachycardia. J Cardiovasc Electrophysiol 1999; 10:1631-5. [PMID: 10636193 DOI: 10.1111/j.1540-8167.1999.tb00227.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Catheter ablation with radiofrequency energy is a curative therapy in patients with permanent junctional reciprocating tachycardia (PJRT). METHODS AND RESULTS For the first time, we report a case of transient QT prolongation with torsades de pointes tachycardia 18 hours after successful radiofrequency energy ablation of PJRT in a 25-year-old woman with tachycardia-induced cardiomyopathy. Of note, the torsades de pointes occurred in the absence of bradycardia, electrolyte disturbances, or QT-prolonging drugs. This patient initially was thought to have a hereditary long QT syndrome that was unmasked by PJRT ablation. Therefore, the patient received an implantable defibrillator in addition to beta-blocker therapy, which was discontinued 6 months later. Surprisingly, the QT interval completely normalized within 1 week after PJRT ablation, and the patient remained free of arrhythmias during a follow-up period of 4.5 years. CONCLUSION Patients with incessant tachyarrhythmias should undergo ECG monitoring for at least 24 hours following successful radiofrequency catheter ablation because transient QT prolongation with torsades de pointes may occur even in the absence of bradycardia, QT-prolonging drugs, or electrolyte disturbances.
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Affiliation(s)
- W Grimm
- Department of Medicine, Hospital of the Philipps-University of Marburg, Germany
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39
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Jaeggi E, Lau KC, Cooper SG. Successful radiofrequency ablation in an infant with drug-resistant permanent junctional reciprocating tachycardia. Cardiol Young 1999; 9:621-3. [PMID: 10593276 DOI: 10.1017/s1047951100005709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Over the past decade, the technique of radiofrequency ablation has evolved substantially. Currently, most forms of cardiac arrhythmias seen in children can be treated with good long-term results and low risk of adverse outcome. Curative arrhythmia treatment with this technique, however, is still uncommon in neonates and infants. Reported here is our experience in the management of an 8-week-old with drug-resistant permanent junctional reciprocating tachycardia.
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Affiliation(s)
- E Jaeggi
- Adolph Basser Cardiac Institute, Royal Alexandra Hospital for Children, University of Sydney, New South Wales, Australia.
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40
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Tai CT, Chen SA, Chiang CE, Chang MS. Characteristics and radiofrequency catheter ablation of septal accessory atrioventricular pathways. Pacing Clin Electrophysiol 1999; 22:500-11. [PMID: 10192859 DOI: 10.1111/j.1540-8159.1999.tb00478.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Septal accessory AV pathways are located in the complex AV septal space that also contains the specialized conduction system. They have unique electrocardiographical and electrophysiological characteristics to be differentiated from free-wall accessory pathways. Some of the septal pathways have AV nodelike conduction properties and produce a similar activation sequence in the retrograde conduction. Several methods have been developed to distinguish them from AV nodal pathways. Radiofrequency catheter ablation using the titration method and endocardial approach without entrance into the coronary sinus is effective in eliminating most of the septal accessory pathways without impairment of AV conduction. However, some posteroseptal accessory pathways may require energy application inside the coronary sinus, thus information of the coronary sinus anatomy is important for preventing complication.
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Affiliation(s)
- C T Tai
- Department of Medicine, National Yang-Ming University, School of Medicine, Taiwan, R.O.C
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41
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Moriña P, Venegas J, Barba R, Herrera M, García M, Tristancho A. Narrow complex tachycardia showing an uncommon electrophysiological phenomenon during its induction. Pacing Clin Electrophysiol 1999; 22:512-6. [PMID: 10192860 DOI: 10.1111/j.1540-8159.1999.tb00479.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Moriña
- Department of Intensive Care Medicine, Hospital Juan Ramón Jiménez, Huelva, Spain
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42
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Hirao K, Toshida N, Kawabata M, Motokawa K, Suzuki F, Hiejima K. New diagnostic finding to assess para-Hisian pacing observed in a patient with a permanent form of junctional reciprocating tachycardia. J Cardiovasc Electrophysiol 1998; 9:1363-9. [PMID: 9869536 DOI: 10.1111/j.1540-8167.1998.tb00112.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Para-Hisian pacing, a useful method to differentiate conduction over an accessory pathway from conduction over the AV node, is assessed essentially by comparing the timing of local atrial electrograms between His-bundle captured beats and His-bundle noncaptured beats. We describe the case of a patient with a permanent form of junctional reciprocating tachycardia, in whom an atrial double potential was recorded only during the tachycardia at the right posterior septum. During para-Hisian pacing, a morphologic change in the atrial electrogram at the posterior septum was also identified, as well as a change in the retrograde atrial sequence. Since the morphologic change of atrial electrograms during para-Hisian pacing cannot be demonstrated in a patient without an accessory pathway, this new finding could be considered a new additional diagnostic criterion suggesting the presence of an accessory pathway.
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Affiliation(s)
- K Hirao
- First Department of Internal Medicine, School of Medicine, Tokyo Medical and Dental University, Japan.
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43
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Aguinaga L, Primo J, Anguera I, Mont L, Valentino M, Brugada P, Brugada J. Long-term follow-up in patients with the permanent form of junctional reciprocating tachycardia treated with radiofrequency ablation. Pacing Clin Electrophysiol 1998; 21:2073-8. [PMID: 9826859 DOI: 10.1111/j.1540-8159.1998.tb01126.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study sought to determine the long-term follow-up, safety, and efficacy of radiofrequency catheter ablation of patients with the permanent form of junctional reciprocating tachycardia (PJRT). We assessed the reversibility of tachycardia induced LV dysfunction and we detailed the location and electrophysiological characteristics of these retrograde atrioventricular decremental pathways. PJRT is an infrequent form of reciprocating tachycardia, commonly incessant, and usually drug refractory. The ECG hallmarks include an RP interval > PR with inverted P waves in leads II, III, a VF, and V3-V6. During tachycardia, retrograde VA conduction occurs over an accessory pathway with slow and decremental conduction properties, located predominantly in the posteroseptal zone. It is known that long-lasting and incessant tachycardia may result in tachycardia induced severe ventricular dysfunction. We included 36 patients (13 men, 23 women, mean +/- SD, aged 44 +/- 22 years) with the diagnosis of PJRT. Seven patients had tachycardia induced left ventricular dysfunction. Radiofrequency energy was delivered at the site of earliest retrograde atrial activation during ventricular pacing or during reciprocating tachycardia. All patients were followed at the outpatient clinic and serial echocardiograms were performed in those who presented with depressed LV function. Radiofrequency ablation was performed in 36 decremental accessory pathways. Earliest retrograde atrial activation was right posteroseptal in 32 patients (88%), right mid-septal in 2 (6%), right posterolateral in 1 (3%), and left anterolateral in 1 (3%). Thirty-five accessory pathways were successfully ablated with a mean of 5 +/- 3 applications. A mid-septal accessory pathway could not be ablated. After a mean follow-up of 21 +/- 16 months (range 1-64) 34 patients are asymptomatic. There were recurrences in 8 patients after the initial successful ablation (mean of 1.2 months), 5 were ablated in a second ablation procedure, 2 patients required a third procedure, and 1 patient required four ablation sessions. All patients with LV dysfunction experienced a remarkable improvement after ablation. Mean preablation LV ejection fraction in patients with tachycardiomyopathy was 28% +/- 6% and rose to 51% +/- 16% after ablation (P < 0.02). Our study supports the concept that radiofrequency catheter ablation is a safe and effective treatment for patients with PJRT. Radiofrequency ablation should be the treatment of choice in these patients because this arrhythmia is usually drug refractory. The majority of accessory pathways are located in the posteroseptal zone. Cessation of the arrhythmia after successful ablation results in recovery of LV dysfunction.
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MESH Headings
- Adolescent
- Adult
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Atrioventricular Node/physiopathology
- Atrioventricular Node/surgery
- Cardiac Pacing, Artificial
- Catheter Ablation
- Child
- Child, Preschool
- Drug Resistance
- Echocardiography
- Electrocardiography
- Female
- Follow-Up Studies
- Heart Septum/innervation
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Neural Conduction/physiology
- Recurrence
- Reoperation
- Safety
- Stroke Volume/physiology
- Tachycardia, Paroxysmal/diagnostic imaging
- Tachycardia, Paroxysmal/physiopathology
- Tachycardia, Paroxysmal/surgery
- Tachycardia, Supraventricular/diagnostic imaging
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/surgery
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/surgery
- Ventricular Function, Left/physiology
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Affiliation(s)
- L Aguinaga
- Arrhythmia Unit, University of Barcelona, Spain
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44
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Frey B, Kreiner G, Berger R, Gössinger HD. Unusual locations for adenosine-sensitive accessory atrioventricular pathways with decremental conduction. J Cardiovasc Electrophysiol 1998; 9:909-15. [PMID: 9786071 DOI: 10.1111/j.1540-8167.1998.tb00131.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Accessory AV pathways with decremental conduction are uncommon and, in particular, are thought not to occur at the anterior portion of the mitral annulus. METHODS AND RESULTS This report describes successful catheter ablation in three patients with accessory AV pathways that were adenosine sensitive and showed decremental conduction properties. The pathways were located at the anteroseptal, anteroparaseptal, and anterolateral aspects of the mitral annulus. CONCLUSION Accessory pathways with decremental conduction do occur anywhere around the mitral annulus, even in the area of fibrous continuity between the aortic leaflet of the mitral valve and the aortic valve itself.
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Affiliation(s)
- B Frey
- Department of Cardiology, University of Vienna, Wien, Austria
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Hindricks G, Kottkamp H, Borggrefe M, Breithardt G. [High frequency current catheter ablation of accessory conduction pathways]. Herz 1998; 23:219-30. [PMID: 9690110 DOI: 10.1007/bf03044318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiofrequency catheter ablation has established as the first line therapy for the curative treatment of patients with accessory pathway. Atrioventricular accessory pathways irrespective of the exact localisation can be successfully ablated in more than 90% of all cases. Severe complications associated with the ablation procedure are rare and occur in approximately 2% of patients treated. The recurrence rate after successful ablation is approximately 8 to 10%. Recurrence of accessory pathway conduction occurs almost exclusively within the first 3 months following successful ablation, late recurrences are rare. Patients with variants of accessory pathways such as atriofascicular pathways or retrogradely conducting accessory pathways with decremental conduction properties can also be cured with a high success rate. Because of its well balanced efficacy-risk profile radiofrequency catheter ablation should be recommended as the first line therapy to all symptomatic patients with accessory pathway.
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Affiliation(s)
- G Hindricks
- Medizinische Klinik und Poliklinik, Innere Medizin C, Westfälischen Wilhelms-Universität Münster.
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Aguinaga L, Brugada J, Anguera I, Mont L, Valentino M, Eizmendi I, Guillamón L, Sánchez J, Matas M, Navarro-López F. [Long term follow-up in patients with the permanent form of junctional reciprocating tachycardia treated with radiofrequency ablation]. Rev Esp Cardiol 1998; 51:218-23. [PMID: 9577167 DOI: 10.1016/s0300-8932(98)74736-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to determine the long-term follow-up, safety and efficacy of radiofrequency catheter ablation in patients with the permanent form of junctional reciprocating tachycardia. We assessed the reversibility of tachycardia-related left ventricular dysfunction and we detailed the location and electrophysiologic characteristics of these atrioventricular decremental pathways. BACKGROUND Permanent junctional reciprocating tachycardia is an infrequent form on reciprocating tachycardia, commonly incessant and usually drug-refractory. The electrocardiographic hallmarks include an RP interval > PR with inverted P waves in leads II, III, aVF and V3-V6. During tachycardia, retrograde ventriculo-atrial conduction occurs over an accessory pathway with decremental conduction properties, located predominantly in the posteroseptal zone. It is known that long lasting and incessant tachycardia may result in tachycardia-related severe ventricular dysfunction, the so called tachycardiomyopathy. PATIENTS AND METHODS We included 24 patients (9 males, 15 females; mean age 42 +/- 22 years) with the diagnosis of permanent junctional reciprocating tachycardia at electrophysiologic study. Six patients had tachycardia-related left ventricular dysfunction. Radiofrequency energy was delivered at the site of earliest retrograde atrial activation during reciprocating tachycardia (n = 22) or ventricular pacing (n = 2). All patients were followed at the outpatient clinic and serial echocardiograms were performed in those who presented depressed left ventricular function. RESULTS Radiofrequency catheter ablation was performed in 24 decremental accessory pathways. Earliest retrograde atrial activation was right posteroseptal in 22 patients (92%), right midseptal in 1 (4%) and right posterolateral in 1 (4%). Twenty-three accessory pathways were successfully ablated with a mean of 5 +/- 3 (median, 4) radiofrequency applications of a mean duration of 48 +/- 13 s. Only the midseptal accessory pathway could not be ablated. After a mean follow-up of 21 +/- 16 months (median, 15; range 2 to 64) 22 patients remain asymptomatic. There were recurrences in 4 patients after the initial successful ablation (three during the first month and one during the second month after the procedure), two were ablated in a second ablation procedure, one patient required a third procedure and one required a fourth. All patients with left ventricular dysfunction experienced an improvement after ablation. Mean preablation left ventricular ejection fraction in patients with tachycardiomyopathy was 28 +/- 6% (median, 27) and raised to 51 +/- 16% (median, 47) after ablation (p < 0.02). CONCLUSIONS Our study supports the concept that radiofrequency catheter ablation is a safe and useful treatment for patients with permanent junctional reciprocating tachycardia. Radiofrequency current should be the treatment of choice in these patients because this arrhythmia is usually drug-refractory. The majority of accessory pathways with decremental conduction properties are localized in the posteroseptal zone. Cessation of the arrhythmia after successful ablation results in recovery of left ventricular dysfunction.
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Affiliation(s)
- L Aguinaga
- Unidad de Arritmias, Instituto de Enfermedades Cardiovasculares, Hospital Clínic, Barcelona
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Sánchez Fernández-Bernal C, Benito Bartolomé F. [Reversibility of myocardiopathy induced by incessant supraventricular tachycardia in children after radiofrequency ablation]. Rev Esp Cardiol 1997; 50:643-9. [PMID: 9380934 DOI: 10.1016/s0300-8932(97)73276-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The so called tachycardia-induced cardiomyopathy may develop as a complication of persistent abnormal high rates. It is especially common in patients who have either a permanent form of junctional reciprocating tachycardia or an ectopic atrial tachycardia. Radiofrequency catheter ablation has become established as an effective and safe treatment to eliminate both arrhythmias. METHODS AND RESULTS Four children aged from 3 months to 8 years, who had incessant tachyarrhythmias and left ventricular dysfunction (shortening fraction of mean +/- SD, 21.7 +/- 1.2%) underwent radiofrequency catheter ablation. The youngest patient had permanent junctional reciprocating tachycardia caused by a left posteroseptal pathway. She was presented with severe heart failure that did not improve with digoxin and amiodarone. The other patients had palpitations and exercise intolerance. Two of them had an ectopic atrial tachycardia caused by a single atrial focus localized in the left atrial appendage apex and the orifice of the right atrial appendage respectively. The other patient had the permanent form of junctional reciprocating tachycardia caused by a right posteroseptal pathway. All four patients underwent one successful ablation. The average procedure mean time was 3.7 hours with an fluoroscopy time of 44 minutes. There were no complications. Subsequently shortening fraction improved progressively. After a mean follow-up of 21.7 months all patients are asymptomatic without medical treatment. CONCLUSIONS Radiofrequency catheter ablation is the therapy of choice in children with either the permanent form of junctional reciprocating tachycardia or ectopic atrial tachycardia refractory to medical treatment. The tachycardia-induced cardiomyopathy is reversible after the elimination of the arrhythmia. The presence of tachycardia-induced cardiomyopathy is an indication for radiofrequency ablation even in small infants.
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MESH Headings
- Catheter Ablation
- Child
- Child, Preschool
- Echocardiography
- Electrocardiography
- Female
- Humans
- Infant
- Tachycardia, Atrioventricular Nodal Reentry/complications
- Tachycardia, Atrioventricular Nodal Reentry/physiopathology
- Tachycardia, Atrioventricular Nodal Reentry/surgery
- Tachycardia, Ectopic Atrial/complications
- Tachycardia, Ectopic Atrial/physiopathology
- Tachycardia, Ectopic Atrial/surgery
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/surgery
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Shah DC, Jaïs P, Haïssaguerre M, Takahashi A, Clémenty J. Negative lead I P waves during anteroseptal accessory pathway orthodromic reciprocating tachycardia. Am J Cardiol 1997; 80:227-9. [PMID: 9230171 DOI: 10.1016/s0002-9149(97)00329-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although a negative retrograde P wave in lead I during orthodromic reciprocating tachycardia is thought to indicate a left free wall accessory pathway, we describe similar negative P waves in lead I during orthodromic reciprocating tachycardia through anteroseptally situated accessory pathways.
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Affiliation(s)
- D C Shah
- CHU de Bordeaux, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
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Critelli G. Recognizing and managing permanent junctional reciprocating tachycardia in the catheter ablation era. J Cardiovasc Electrophysiol 1997; 8:226-36. [PMID: 9048253 DOI: 10.1111/j.1540-8167.1997.tb00784.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is general agreement that an orthodromic AV reentry using a concealed slow conducting accessory pathway as the retrograde limb of the circuit constitutes the underlying mechanism of the permanent form of junctional reciprocating tachycardia (PJRT). In this arrhythmia, the standard ECG typically shows a "long R-P' tachycardia" with retrograde P wave negative in the inferior leads. A careful electrophysiologic evaluation is necessary to confirm the diagnosis of PJRT. Recent reports have demonstrated that the radiofrequency current catheter technique provides a safe and highly effective therapeutic tool for patients suffering from this arrhythmia.
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Affiliation(s)
- G Critelli
- Department of Cardiology and Cardiovascular Surgery, University of Rome La Sapienza, Italy
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Yagi T, Ito M, Odakura H, Namekawa A, Otomo J, Ishida A. Electrophysiologic comparison between incessant and paroxysmal tachycardia in patients with permanent form of junctional reciprocating tachycardia. Am J Cardiol 1996; 78:697-700. [PMID: 8831413 DOI: 10.1016/s0002-9149(96)00402-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To clarify the differences between the incessant and paroxysmal types of the permanent form of junctional reciprocating tachycardia, we performed electrophysiologic studies in 11 patients with long RP' tachycardia using a slowly conducting accessory pathway as the retrograde conduction, and concluded that the short AH intervals during sinus rhythm and tachycardia are very important factors in the development of incessant tachycardia.
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Affiliation(s)
- T Yagi
- Department of Cardiology, Sendai City Hospital, Japan
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