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Moriwaki K, Doi A, Nishigaki K, Tsukamoto T, Tanaka S, Yamasaki R, Fukuda K, Yoshiyama T, Kawarabayashi T, Fukuda D. Entrainment response during ventricular tachycardia originating from the para-Hisian region: What is the mechanism? J Cardiovasc Electrophysiol 2024. [PMID: 38802978 DOI: 10.1111/jce.16329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Kazuki Moriwaki
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Keisuke Nishigaki
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Takuya Tsukamoto
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Sawa Tanaka
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Reiko Yamasaki
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Keisuke Fukuda
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Tomotaka Yoshiyama
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Enriquez A, Muser D, Markman TM, Garcia F. Mapping and Ablation of Premature Ventricular Complexes: State of the Art. JACC Clin Electrophysiol 2024:S2405-500X(24)00107-5. [PMID: 38639702 DOI: 10.1016/j.jacep.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/20/2024]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice. Although benign and asymptomatic in most cases, PVCs may result in disabling symptoms, left ventricular systolic dysfunction, or PVC-induced ventricular fibrillation. Catheter ablation has emerged as a first-line therapy in such cases, with high rates of efficacy and low risk of complications. Significant progress in mapping and ablation technology has been made in the past 2 decades, along with the development of a growing body of knowledge and accumulated experience regarding PVC sites of origin, anatomical relationships, electrocardiographic characterization, and mapping/ablation strategies. This paper provides an overview of the main indications for catheter ablation of PVCs, electrocardiographic features, PVC mapping techniques, and contemporary ablation approaches. The authors also review the most common sites of PVC origin and the main considerations and challenges with ablation in each location.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy M Markman
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Simpson J, Al-Sadawi M, Deshmukh A, Liang JJ, Latchamsetty R, Crawford T, Jongnarangsin K, Oral H, Bogun F, Ghannam M. Catheter ablation of parahisian premature ventricular complexes in patients with and without cardiac scar. Heart Rhythm 2024:S1547-5271(24)02308-7. [PMID: 38574787 DOI: 10.1016/j.hrthm.2024.03.1813] [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: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Ablation of premature ventricular complexes (PVCs) originating from the parahisian area is challenging. Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) scar may influence procedural outcomes; the impact of cardiac scar on parahisian PVCs has not been described. OBJECTIVE The objective of this study was to examine the incidence and significance of LGE-CMR scarring in patients undergoing ablation for parahisian PVCs. METHODS Consecutive patients who underwent preprocedure LGE-CMR imaging and ablation of parahisian PVCs were included. Acute and long-term outcomes were examined. RESULTS Forty-eight patients were included (male, n = 37; age, 66 ± 10 years; ejection fraction, 50% ± 12%; preprocedure PVC burden, 21% ± 12%). Intramural LGE-CMR scar was present in 33 of 48 (69%) patients. Cryoablation was used in 9 patients; ablation in multiple chambers was required in 28 (58%) patients. The PVC site of origin (SOO) was intramural (n = 25 patients), left ventricular (n = 5), and right ventricular (n = 18). Patients with LGE-CMR scar were more likely to have intramural PVCs (64% vs 27%; P < .04) and to require ablation in multiple cardiac chambers (58% vs 13%; P < .02). Patients with intramural scar required longer duration of ablation delivery (31 ± 20 minutes vs 17 ± 8 minutes; P < .02). Acute procedural success was 69%; PVC burden on follow-up was 6% ± 9% and similar for those with and without scar. CONCLUSION Ablation of parahisian PVCs often requires mapping and ablation of multiple cardiac chambers, with an intramural SOO identified in most patients. An intramural scar was associated with an intramural SOO of the PVCs requiring more extensive ablation procedures, with similar long-term outcomes compared with those without scar.
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Affiliation(s)
- Jamie Simpson
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Mohamed Al-Sadawi
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Amrish Deshmukh
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Jackson J Liang
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Thomas Crawford
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Hakan Oral
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan
| | - Michael Ghannam
- Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan.
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Complications of catheter ablation for ventricular tachycardia. JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY : AN INTERNATIONAL JOURNAL OF ARRHYTHMIAS AND PACING 2023; 66:221-233. [PMID: 36053374 DOI: 10.1007/s10840-022-01357-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/20/2022] [Indexed: 11/09/2022]
Abstract
With the increasing literature demonstrating benefits of catheter ablation for ventricular tachycardia (VT), the number of patients undergoing VT ablation has increased dramatically. As VT ablation is being performed more routinely, operators must be aware of potential complications of VT ablation. This review delves deeper into the practice of VT ablation with a focus on periprocedural complications.
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Atreya AR, Yalagudri SD, Subramanian M, Rangaswamy VV, Saggu DK, Narasimhan C. Best Practices for the Catheter Ablation of Ventricular Arrhythmias. Card Electrophysiol Clin 2022; 14:571-607. [PMID: 36396179 DOI: 10.1016/j.ccep.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.
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Affiliation(s)
- Auras R Atreya
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India; Division of Cardiovascular Medicine, Electrophysiology Section, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sachin D Yalagudri
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Muthiah Subramanian
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | | | - Daljeet Kaur Saggu
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Calambur Narasimhan
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India.
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Ma C, Chen T, Chen Y, Ge J, Han W, Wang Q, Zhong J. Understanding the scope of intracardiac echocardiography in catheter ablation of ventricular arrhythmia. Front Cardiovasc Med 2022; 9:1037176. [PMID: 36386380 PMCID: PMC9650380 DOI: 10.3389/fcvm.2022.1037176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/14/2022] [Indexed: 01/03/2024] Open
Abstract
Over the last few decades, catheter ablation has emerged as the first-line treatment for ventricular arrhythmias. However, detailed knowledge of cardiac anatomy during the surgery remains the prerequisite for successful ablation. Intracardiac echocardiography (ICE) is a unique imaging technique, which provides real-time visualization of cardiac structures, and is superior to other imaging modalities in terms of precise display of cardiac tissue characteristics as well as the orientation of anatomical landmarks. This article aimed to introduce the various advantages and limitations of ICE in the ablation of ventricular arrhythmias.
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Affiliation(s)
- Chuanzhen Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanbo Chen
- Department of Cardiology, Weifang People’s Hospital, Weifang, China
| | - Junye Ge
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qinhong Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Hu Z, Jiang Y, Wang S. Premature ventricular contractions with acute successful radiofrequency catheter ablation near the atrioventricular node using reversed C curve technique. BMC Cardiovasc Disord 2022; 22:390. [PMID: 36045329 PMCID: PMC9429768 DOI: 10.1186/s12872-022-02832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background We sought to clarify the electrophysiological (EP) characteristics of premature ventricular contractions (PVCs) with acute successful radiofrequency catheter ablation (RFCA) near the atrioventricular node (AVN). Methods and results Eighteen patients with acute successful RFCA near the AVN were included in this study. Systematic mapping was performed with two mapping methods: antegrade mapping technique (group A) and reversed C curve mapping technique (group R). RFCA was preferentially performed underneath the tricuspid valve (TV) with reversed C curve technique in all patients. The a amplitude/v amplitude ratio during sinus rhythm in group A was significantly larger than in group B (0.19 ± 0.10 vs 0.06 ± 0.02, p < 0.01). The earliest bipolar activation preceded the QRS onset in group A was significantly smaller than in group R (19.6 ± 4.9 vs 24.4 ± 6.6 ms (ms), p < 0.01). Pace mapping in group A and group R demonstrated perfect QRS morphology (12/12) match only in 5.6% (one patient) and 16.7% (3 patients) of patients, respectively. The mean duration of successful RFCA was 8.2 ± 2.4 s in 13 patients (72.2%). Early (within 3 days) and late (one-year) recurrence rates were 5.6% (one patient) and 16.7% (3 patients), respectively. No atrioventricular block occurred during RFCA or the one-year follow up. Conclusions PVCs near the AVN are a subgroup of idiopathic PVCs with distinctive EP features. RFCA using reversed C curve technique is effective and safe for the acute elimination of these challenging AVN-PVCs.
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Burak C, Korogyi A, Enriquez A. Ablation of parahisian premature ventricular complex from the noncoronary cusp. J Interv Card Electrophysiol 2022; 65:331. [PMID: 35501624 DOI: 10.1007/s10840-022-01238-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Cengiz Burak
- Division of Cardiology, Queen's University, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada
| | | | - Andres Enriquez
- Division of Cardiology, Queen's University, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada.
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Kong LC, Shuang T, Li Z, Zou ZG, Jiang WL, Pu J, Wang XH. A Systemic Mapping Approach for Right and Left Parahisian Ventricular Arrhythmias Ablation. Front Cardiovasc Med 2022; 9:844320. [PMID: 35310983 PMCID: PMC8924133 DOI: 10.3389/fcvm.2022.844320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCatheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.MethodsForty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.ResultsSequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084–2.676, P = 0.02). “Seeming” right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.ConclusionsThe systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.
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Takasugi N, Yamada T, Naruse G, Nakashima T, Kanamori H, Okura H. Radiofrequency ablation on the right ventricular septum changed a bundle branch block pattern of a ventricular tachycardia: What is the mechanism? J Arrhythm 2021; 38:171-173. [PMID: 35222767 PMCID: PMC8851588 DOI: 10.1002/joa3.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/11/2022] Open
Abstract
A ventricular tachycardia (VT) with a left bundle branch block (BBB) pattern exhibited the earliest activation (EA) at the left ventricular basal septum near the His bundle with no excellent pace map (PM). Radiofrequency ablation at the right ventricular basal septum (opposite site of the EA site) changed the QRS morphology of VT to a right BBB pattern that matched a PM at the opposite site in the left ventricle. VT ablation was successful at the earliest activation site. The VT should have originated from an intramural origin with preferential pathways to the endocardial breakout sites in the right and left ventricular septum.
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Affiliation(s)
- Nobuhiro Takasugi
- Division of Cardiovascular Medicine Gifu University Hospital Gifu Japan
| | - Takumi Yamada
- Cardiovascular Division University of Minnesota Minneapolis Minnesota USA
| | - Genki Naruse
- Division of Cardiovascular Medicine Gifu University Hospital Gifu Japan
| | - Takashi Nakashima
- Division of Cardiovascular Medicine Gifu University Hospital Gifu Japan
| | | | - Hiroyuki Okura
- Division of Cardiovascular Medicine Gifu University Hospital Gifu Japan
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Three-dimensional electroanatomic mapping and radiofrequency catheter ablation of ventricular arrhythmia in a dog without structural heart disease. J Vet Cardiol 2021; 39:14-21. [PMID: 34923431 DOI: 10.1016/j.jvc.2021.11.001] [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] [Received: 07/10/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
A 1.5-year-old, female-spayed mix-breed dog was presented with recurrent episodes of shaking and excessive panting attributed to drug-refractory ventricular arrhythmia (VA) characterized predominantly by incessant periods of ventricular bigeminy. The VA had a narrow QRS morphology, suggestive of an origin near the His bundle or fascicular system. Diagnostic evaluation found no structural heart disease or underlying etiology. Three-dimensional electroanatomic mapping and radiofrequency catheter ablation were pursued. Voltage mapping demonstrated normal bi-ventricular voltage (≥1.5 mV) without any fractionated or multicomponent electrograms, indicating the absence of ventricular myocardial scar. Pace mapping identified an endocardial origin of the VA at the basal anterior septum of the left ventricle, distal to the His bundle and near the left bundle branch. Two ablation lesions were delivered to this site, and a left bundle branch block was temporarily induced. The dog recovered uneventfully. One month later, the owners reported a remarkable improvement in clinical signs, and follow-up 48-h Holter monitor found complete resolution of VA.
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Khan MT, Hameed A, Saeed Y. Interesting presentation of a broad complex tachycardia during the head up tilt table test. BMJ Case Rep 2021; 14:e245083. [PMID: 34607816 PMCID: PMC8491290 DOI: 10.1136/bcr-2021-245083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/04/2022] Open
Abstract
Broad complex tachycardia (BCT) during head up tilt test (HUTT) is infrequent. Electrophysiology Study (EPS) plays an important part in further differentiation of BCT. We present a case of BCT during HUTT in a patient presenting with presyncope which later on EPS with 3D mapping was diagnosed as ventricular tachycardia. This case highlights the unusual occurrence of BCT during HUTT, the differential diagnosis of BCT and the utility of EPS to reliably identify the type and origin of BCT.
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Affiliation(s)
- Muhammad Taha Khan
- Cardiac Electrophysiology, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Aamir Hameed
- Medicine, Section of Cardiology, Agha Khan University Hospital, Karachi, Sindh, Pakistan
| | - Yawer Saeed
- Medicine, Section of Cardiology, Agha Khan University Hospital, Karachi, Sindh, Pakistan
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary. Europace 2021; 22:450-495. [PMID: 31995197 DOI: 10.1093/europace/euz332] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Radiofrequency Ablation of Para-Hisian Ventricular Arrhythmias: Learning Before Burning. JACC Clin Electrophysiol 2021; 7:731-732. [PMID: 34167750 DOI: 10.1016/j.jacep.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022]
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Campbell T, Bennett RG, Kumar S. Intracardiac Echocardiography to Guide the Ablation of Parahisian Arrhythmias. Card Electrophysiol Clin 2021; 13:e1-e16. [PMID: 35365247 DOI: 10.1016/j.ccep.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Arrhythmias from the perinodal region have been described for accessory pathways (APs), atrial tachycardias (AT), premature ventricular complexes (PVCs), and ventricular tachycardia (VT). The parahisian (PH) region encompasses anatomic structures that include the atrioventricular (AV) node and His-Bundle (HB). These locations are at high-risk for inducing AV block during catheter ablation in the electrophysiology laboratory. PH arrhythmias were initially defined as having sites of origin within 10 mm of the largest HB potential (>0.1 mV) recording site, but more recent definitions have included any site that has an HB potential at the ablation site. Intracardiac echocardiography (ICE) use offers real-time visualization of the catheter tip-to-tissue contact and can monitor for acute complications during atrial and ventricular procedures. ICE also enables a broad appreciation of real-time cardiac structures, which is invaluable in navigating the complex anatomy of the PH region.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
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Hanson M, Enriquez A. Intracardiac Echocardiography to Guide Catheter Ablation of Idiopathic Ventricular Arrythmias. Card Electrophysiol Clin 2021; 13:325-335. [PMID: 33990271 DOI: 10.1016/j.ccep.2021.03.010] [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: 11/16/2022]
Abstract
Catheter ablation is the most effective treatment option for idiopathic ventricular arrhythmias. Intracardiac echocardiography (ICE) has been increasingly used during ablation procedures, allowing real-time visualization of cardiac anatomy, and improving our understanding of the relationships between different cardiac structures. In this article we review the adjuvant role of ICE to guide mapping and ablation of ventricular arrhythmias in the structurally normal heart.
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Affiliation(s)
- Matthew Hanson
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
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17
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Khakpour H, Mori S, Bradfield JS, Shivkumar K. How to Use Intracardiac Echocardiography to Recognize Normal Cardiac Anatomy. Card Electrophysiol Clin 2021; 13:273-283. [PMID: 33990266 DOI: 10.1016/j.ccep.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article reviews cardiac anatomy as it pertains to commonly used intracardiac echocardiography segments and views.
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Affiliation(s)
- Houman Khakpour
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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18
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Yue-Chun L, Yuan-Nan L, Jing X, Yang-Qi P, Cheng Z, Yang-Jing X, Jia-Xuan L, Jin L, Jia L, Jia-Feng L. R/S Ratio in Lead III Predicts Successful Ablation of Ventricular Arrhythmias Originating in Para-Hisian Region. JACC Clin Electrophysiol 2021; 7:719-730. [PMID: 33516713 DOI: 10.1016/j.jacep.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/02/2020] [Accepted: 10/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating near the His bundle (HB) and use the R/S ratio in lead III (RIII/SIII ratio) to predict successful ablation of para-Hisian VAs. BACKGROUND Catheter ablation for idiopathic VAs near the HB is often challenging, and data are limited. METHODS The present study included 134 consecutive patients undergoing catheter ablation of para-Hisian VAs. The electrocardiographic characteristics in these patients were retrospectively evaluated with successful ablation and failed ablation. RESULTS Successful ablation was achieved in 115 (85.8%) of the 134 patients. There was no significant difference in QRS duration between the successful and the failed ablation groups. The ablation success rate was significantly lower for para-Hisian VAs with a predominantly positive R wave in lead III than those with a predominantly negative S wave in lead III. The significant factor associated with successful ablation was the RIII/SIII ratio. The RIII/SIII ratio ≤1.1 predicted the successful ablation of para-Hisian VAs with high sensitivity (80.9%) and specificity (94.7%). The RIII/SIII ratio of >1.2 had high sensitivity (100.0%) and specificity (82.8%) to predict the distance <5 mm from the site of origin of para-Hisian VAs to the site recording the largest HB potential. CONCLUSIONS The RIII/SIII ratio was a helpful predictor of the successful ablation of VAs originating in the vicinity of the HB. This may be useful for planning ablation of para-Hisian VAs and minimizing the risk of inadvertent atrioventricular block.
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Affiliation(s)
- Li Yue-Chun
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Yuan-Nan
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xu Jing
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pan Yang-Qi
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zheng Cheng
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xue Yang-Jing
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Jia-Xuan
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Jin
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Li Jia
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lin Jia-Feng
- Department of Cardiology, Second Affiliated Hospital, and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.
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19
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Mizutani Y, Yanagisawa S, Kanashiro M, Inden Y, Murohara T. Safety and efficacy of first-line cryoablation for para-hisian ventricular arrhythmias using a cryomapping protocol approach: A case series. Clin Case Rep 2020; 8:3248-3253. [PMID: 33363914 PMCID: PMC7752434 DOI: 10.1002/ccr3.3401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023] Open
Abstract
A first-line cryoablation for para-Hisian VAs using a strict cryomapping protocol is useful and safe, even if the His bundle potential is recorded on the ablation catheter.
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Affiliation(s)
- Yoshiaki Mizutani
- Department of CardiologyYokkaichi Municipal HospitalYokkaichiJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Satoshi Yanagisawa
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | | | - Yasuya Inden
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
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20
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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21
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. J Interv Card Electrophysiol 2020; 59:81-133. [PMID: 31960344 PMCID: PMC7508755 DOI: 10.1007/s10840-019-00664-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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22
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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23
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Chokr MO, Moura LG, Aiello VD, Santos Sousa ÍB, Lopes HB, Carmo AAL, Pisani CF, Hardy CA, Melo SL, Scanavacca MI. Catheter ablation of the parahisian accessory pathways from the aortic cusps—Experience of 20 cases—Improving the mapping strategy for better results. J Cardiovasc Electrophysiol 2020; 31:1413-1419. [PMID: 32298040 DOI: 10.1111/jce.14499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Muhieddine O. Chokr
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Lucas G. Moura
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Vera D. Aiello
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | | | - Hugo B. Lopes
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Andre A. L. Carmo
- Hospital das Clinicas and Faculdade de MedicinaUniversidade Federal de Minas Gerais Belo Horizonte Brazil
| | - Cristiano F. Pisani
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Carina A. Hardy
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
| | - Sissy L. Melo
- Heart Institute (Incor)University of Sao Paulo Medical School Sao Paulo Brazil
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24
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Futyma P, Ciąpała K, Sander J, Głuszczyk R, Futyma M, Kułakowski P. Bipolar Radiofrequency Ablation of Ventricular Arrhythmias Originating in the Vicinity of His Bundle. Circ Arrhythm Electrophysiol 2020; 13:e008165. [DOI: 10.1161/circep.119.008165] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piotr Futyma
- St. Joseph’s Heart Rhythm Center, Rzeszów (P.F., K.C., J.S., R.G., M.F., P.K.)
| | - Kamil Ciąpała
- St. Joseph’s Heart Rhythm Center, Rzeszów (P.F., K.C., J.S., R.G., M.F., P.K.)
| | - Jarosław Sander
- St. Joseph’s Heart Rhythm Center, Rzeszów (P.F., K.C., J.S., R.G., M.F., P.K.)
| | - Ryszard Głuszczyk
- St. Joseph’s Heart Rhythm Center, Rzeszów (P.F., K.C., J.S., R.G., M.F., P.K.)
| | - Marian Futyma
- St. Joseph’s Heart Rhythm Center, Rzeszów (P.F., K.C., J.S., R.G., M.F., P.K.)
| | - Piotr Kułakowski
- St. Joseph’s Heart Rhythm Center, Rzeszów (P.F., K.C., J.S., R.G., M.F., P.K.)
- Department of Cardiology, Medical Centre for Postgraduate Education, Grochowski Hospital, Warsaw, Poland (P.K.)
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25
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Marinheiro R, Parreira L, Amador P, Lopes C, Farinha J, Caria R. Slow pathway region as the exit site of parahisian premature ventricular contractions: Why choose safety over the earliest activation? J Cardiovasc Electrophysiol 2019; 31:267-270. [PMID: 31840911 DOI: 10.1111/jce.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/21/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Rita Marinheiro
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Leonor Parreira
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Pedro Amador
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Cláudia Lopes
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - José Farinha
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
| | - Rui Caria
- Cardiology department, Hospital de São Bernardo, Setubal, Portugal
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26
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Xie Y, Jin Q, Zhang N, Liu A, Xing C, Jia K, Wei Y, Bao Y, Luo Q, Lin C, Ling T, Chen K, Pan W, Wu L. Strategy of catheter ablation for para‐Hisian premature ventricular contractions with the assistance of remote magnetic navigation. J Cardiovasc Electrophysiol 2019; 30:2929-2935. [DOI: 10.1111/jce.14245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/16/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Yun Xie
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Qi Jin
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Ning Zhang
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Ao Liu
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Chaofan Xing
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Kangni Jia
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Yue Wei
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Yangyang Bao
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Qingzhi Luo
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Changjian Lin
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Tianyou Ling
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Kang Chen
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Wenqi Pan
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
| | - Liqun Wu
- Department of Cardiology, Shanghai Ruijin HospitalShanghai Jiaotong University School of MedicineShanghai China
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27
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Pavri B, Logue J, Tecce M. Concealed bigeminy with manifest trigeminy proven by intracardiac electrograms. J Cardiovasc Electrophysiol 2019; 30:2998-3001. [PMID: 31625213 DOI: 10.1111/jce.14232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/27/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Behzad Pavri
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jonathan Logue
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Marc Tecce
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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28
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Sun J, Zhang P, Wang Q, Xu Q, Wang Z, Yu Y, Zhou Q, Han Y, Li W, Li Y. Catheter ablation of ventricular arrhythmias originating from the para‐Hisian region with reversed C‐curve technique. J Cardiovasc Electrophysiol 2019; 30:2377-2386. [PMID: 31512322 DOI: 10.1111/jce.14170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/01/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
- Clinical Research Unit, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Peng‐Pai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Qun‐Shan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Quan‐Fu Xu
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Zhi‐Quan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Ying Yu
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Qian Zhou
- Department of Cardiology The First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Ya‐Qin Han
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Yi‐Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
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Clinical and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the slow pathway region. Heart Rhythm 2019; 16:1421-1428. [DOI: 10.1016/j.hrthm.2019.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Indexed: 11/21/2022]
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30
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. Heart Rhythm 2019; 17:e155-e205. [PMID: 31102616 PMCID: PMC8459311 DOI: 10.1016/j.hrthm.2019.03.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 12/16/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Wei HQ, Guo XG, Liu X, Zhou GB, Sun Q, Yang JD, Luo B, Zhang S, Ma J. Safety and efficacy of catheter ablation of ventricular arrhythmias with para-Hisian origin via a systematic direct approach from the aortic sinus cusp. Heart Rhythm 2018; 15:1626-1633. [DOI: 10.1016/j.hrthm.2018.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Indexed: 11/17/2022]
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33
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To the Editor- The anatomy of para-Hisian arrhythmias. Heart Rhythm 2018; 15:e282. [PMID: 30217526 DOI: 10.1016/j.hrthm.2018.09.005] [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: 08/21/2018] [Indexed: 11/23/2022]
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