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Li F, Zeng R. Reply: PFA May Not Be Appropriate to Use for AVNRT Ablation. JACC Clin Electrophysiol 2024; 10:980. [PMID: 38811073 DOI: 10.1016/j.jacep.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Fanghui Li
- West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zeng
- West China Hospital, Sichuan University, Chengdu, China.
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Watanabe T, Hachiya H, Watanabe H, Anno K, Okuyama T, Harunari T, Yokota A, Kamioka M, Komori T, Torigoe‐Kurosu Y, Makimoto H, Kabutoya T, Kimura Y, Imai Y, Kario K. Relationship between the atrial-activation pattern around the triangle of Koch and successful ablation sites in slow-fast atrioventricular nodal reentrant tachycardia. J Arrhythm 2024; 40:363-373. [PMID: 38586857 PMCID: PMC10995602 DOI: 10.1002/joa3.12999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 04/09/2024] Open
Abstract
Background The precise details of atrial activation around the triangle of Koch (ToK) remain unknown. We evaluated the relationship between the atrial-activation pattern around the ToK and success sites for slow-pathway (SP) modification ablation in slow-fast atrioventricular reentrant tachycardia (AVNRT). Methods Thirty patients with slow-fast AVNRT who underwent successful ablation were enrolled. Atrial activation around the ToK during sinus rhythm was investigated using ultra-high-density mapping pre-ablation. The relationships among features of atrial-activation pattern and success sites were examined. Results Of 30 patients (22 cryoablation; 8 radiofrequency ablation), 26 patients had a collision site of two wavefronts of delayed atrial activation within ToK, indicating a success site. The activation-search function of Lumipoint software, which highlights only atrial activation with a spatiotemporal consistency, showed non-highlighted area on the tricuspid-annulus side of ToK. In 23 of the patients, a spiky potential was recorded at that collision site outside the Lumipoint-highlighted area. Fifteen cryoablation patients with a success site coincident with a collision site outside the Lumipoint-highlighted area had significantly more frequent disappearances of SP after initial cryoablation (46.7% vs. 0%, p = .029), fewer cryoablations (3.7 ± 1.8 vs. 5.3 ± 1.3, p = .045), and shorter procedure times (170 ± 57 vs. 228 ± 91 min, p = .082) compared to the seven cryoablation patients without such sites. Four patients had transient AV block by ablation inside the Lumipoint-highlighted area with fractionated signals, but no patient developed permanent AV block or recurrence post-procedure (median follow-up: 375 days). Conclusions SP modification ablation at the collision site of atrial activation of the tricuspid-annulus side along with a spiky potential could provide a better outcome.
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Affiliation(s)
- Tomonori Watanabe
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Hitoshi Hachiya
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
- Cardiovascular Center, Tsuchiura Kyodo HospitalIbarakiJapan
| | - Hiroaki Watanabe
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazunori Anno
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takafumi Okuyama
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomohiko Harunari
- Division of Cardiovascular Medicine, Shin‐Oyama City HospitalTochigiJapan
| | - Ayako Yokota
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Masashi Kamioka
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Takahiro Komori
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuko Torigoe‐Kurosu
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Hisaki Makimoto
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yoshifumi Kimura
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yasushi Imai
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
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Nakahara S. Editorial comment to "Relationship between the atrial-activation pattern around the triangle of Koch and successful ablation sites in slow-fast atrioventricular nodal reentrant tachycardia". J Arrhythm 2024; 40:222-223. [PMID: 38586853 PMCID: PMC10995592 DOI: 10.1002/joa3.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Shiro Nakahara
- Department of CardiologyDokkyo Medical University Saitama Medical CenterKoshigayaSaitamaJapan
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Pandozi C, Botto GL, Loricchio ML, D'Ammando M, Lavalle C, Del Giorno G, Matteucci A, Mariani MV, Nicolis D, Segreti L, Papa AA, Casale MC, Galeazzi M, Russo M, Di Belardino N, Pelargonio G, Centurion Aznaran C, Malacrida M, Maddaluno F, Treglia S, Piccolo F, Colivicchi F. High-density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re-entrant tachycardia, integrated with direct recording of atrio-ventricular node structure potential. J Cardiovasc Electrophysiol 2024; 35:379-388. [PMID: 38185855 DOI: 10.1111/jce.16168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND The mechanism of typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known. OBJECTIVE To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit. METHODS Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh-density mapping and a modified signal-filtering toolset to record the potentials of the AV nodal structures. RESULTS Forty-five consecutive cases of successful ablation of typical slow-fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p < .001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p < .001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time-window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow-fast AVNRT. CONCLUSION Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh-density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right-septal and para-septal arrhythmias.
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Affiliation(s)
- Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | | | | | - Carlo Lavalle
- Azienda ospedaliero-universitaria Policlinico Umberto I, Rome, Italy
| | | | - Andrea Matteucci
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
- Department of System and Experimental Medicine, University of Rome 'Tor Vergata, Rome, Italy
| | | | | | | | - Andrea Antonio Papa
- Cardiology and Syncope Unit, Department of Medical Translational Sciences, University of Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy
| | | | - Marco Galeazzi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | | | - Gemma Pelargonio
- Istituto di Cardiologia Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Cardiovascular Sciences, Arrhythmology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Zeng R, Li F, Jiang J, Cui K, Yang Q, Gao J, Zhu X, Shi T, Li W, Tong Y, Zhang Q, Hu H, Fu H. The Safety and Feasibility of Pulsed-Field Ablation in Atrioventricular Nodal Re-Entrant Tachycardia: First-in-Human Pilot Trial. JACC Clin Electrophysiol 2024; 10:82-92. [PMID: 37831032 DOI: 10.1016/j.jacep.2023.08.030] [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] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The incidence of atrioventricular conduction system damage during the catheter ablation procedure has long been a safety concern in patients with atrioventricular nodal re-entrant tachycardia (AVNRT). Pulsed-field ablation (PFA) with high tissue selectivity is a promising technique to address this problem in patients with AVNRT. OBJECTIVES This study aimed to evaluate the safety and feasibility of PFA in patients with AVNRT. METHODS This was an investigator-initiated, single-center, single-arm, prospective study performed in West China Hospital, Sichuan University. Patients diagnosed with AVNRT by electrophysiological examination were included and treated using PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcomes were ablation success after 6 months and safety incidents reported. RESULTS A total of 30 patients with AVNRT with a mean age of 47.9 ± 13.9 years were included and underwent PFA. Acute ablation success was achieved in all patients. The skin-to-skin procedure time was 109.1 ± 32.1 minutes, and fluoroscopy time was 4.1 ± 0.9 minutes. A median of 8 (range: 6.5 to 11.0) PFA applications were delivered. The average distance of the closest ablation site to the His bundle was 6.5 ± 2.5 mm, with a minimum distance of 2.0 mm. All patients maintained sinus rhythm after 6 months. No adverse events occurred in any patient during the ablation or the 6-month follow-up. CONCLUSIONS PFA showed favorable feasibility and safety in patients with AVNRT in this pilot study. Further study with larger population and longer follow-up time is warranted to verify the results.
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Affiliation(s)
- Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fanghui Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinnian Gao
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Xiaolin Zhu
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Tiancai Shi
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Wentao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Tong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
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Vijayaraman P, Chelu MG, Curila K, Dandamudi G, Herweg B, Mori S, Jastrzebski M, Sharma PS, Shivkumar K, Tung R, Upadhyay G, Vernooy K, Welter-Frost A, Whinnett Z, Zanon F, Ellenbogen KA. Cardiac Conduction System Pacing: A Comprehensive Update. JACC Clin Electrophysiol 2023; 9:2358-2387. [PMID: 37589646 DOI: 10.1016/j.jacep.2023.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 08/18/2023]
Abstract
The field of cardiac pacing has changed rapidly in the last several years. Since the initial description of His bundle pacing targeting the conduction system, recent advances in pacing the left bundle branch and its fascicles have evolved. The field and investigators' knowledge of conduction system pacing including relevant anatomy and physiology has advanced significantly. The aim of this review is to provide a comprehensive update on recent advances in conduction system pacing.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA.
| | - Mihal G Chelu
- Division of Cardiology, Baylor College of Medicine and Baylor St. Luke's Medical Center and Texas Heart Institute, Houston, Texas, USA
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Gopi Dandamudi
- Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Bengt Herweg
- University of South Florida Morsani College of Medicine, Department of Cardiovascular Sciences, Tampa, Florida, USA
| | - Shumpei Mori
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Parikshit S Sharma
- Department of Cardiology, Rush University School of Medicine, Chicago, Illinois, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roderick Tung
- Division of Cardiology, University of Arizona College of Medicine-Phoenix, Banner-University Medical Center, Phoenix, Arizona, USA
| | - Gaurav Upadhyay
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kevin Vernooy
- Center for Arrhythmia Care, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Allan Welter-Frost
- Cleveland Clinic Indian River Hospital, Heart Vascular and Thoracic Institute, Vero Beach, Florida, USA
| | - Zachary Whinnett
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | - Kenneth A Ellenbogen
- Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Chieffo E, D’Amore S, De Regibus V, Dossena C, Frigerio L, Taravelli E, Ferrazzano C, De Iuliis P, Cacucci M, Landolina ME. Atrioventricular nodal reentry tachycardia treatment using CARTO 3 V7 activation mapping: a new era of slow pathway radiofrequency ablation is under coming. Front Cardiovasc Med 2023; 10:1144988. [PMID: 37840959 PMCID: PMC10570829 DOI: 10.3389/fcvm.2023.1144988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Background Slow pathway (SP) ablation is the cornerstone for atrioventricular nodal reentry tachycardia (AVNRT) treatment, and a low-voltage bridge offers a good target during mapping using low x-ray exposure. We aimed to assess a new tool to identify SP by activation mapping using the last CARTO3® version, i.e., CARTO PRIME® V7 (Biosense Webster, Diamond Bar, CA, USA). Methods and results Right atrial septum and triangle of Koch 3D-activation map were obtained from intracardiac contact mapping during low x-ray CARTO 3® procedure. In 60 patients (mean age 60.3 ± 14.7, 61% females) undergoing ablation for AVNRT, an automatic activation map using a DECANAV® mapping catheter and CARTO® Confidense™, Coherent, and FAM DX software modules were obtained. The SP was identified in all patients as the latest atrioventricular node activation area; RF catheter ablation (RFCA) in that region elicited junctional beats. The mean procedural time was 150.3 ± 48.3 min, the mean fluoroscopy time exposure was 2.9 ± 2 min, the mean dose-area product (DAP) was 16.5 ± 2.7 cGy/cm2. The mean number of RF applications was 3.9 ± 2, the mean ablation index was 428.6 ± 96.6, and the mean contact force was 8 ± 2.8 g. There were no adverse event during the procedure, and no AVNRT recurrences occurred during a mean follow-up of 14.3 ± 8.3 months. Conclusion Ablation of the SP by automatic mapping using Confidense™, Coherent, and FAM DX software modules is an innovative, safe, and effective approach to AVNRT ablation. The CARTO3® V7 system shows on a 3D map the latest AV node activation area during sinus rhythm allowing low fluoroscopy time and highly effective RFCA.
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Affiliation(s)
- Enrico Chieffo
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | - Sabato D’Amore
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | | | - Cinzia Dossena
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | - Laura Frigerio
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
| | - Erika Taravelli
- Department of Cardiology, S. Croce e Carle Hospital, Cuneo, Italy
| | | | | | - Michele Cacucci
- Department of Cardiology, ASST Ospedale Maggiore, Crema, Italy
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Ballatore A, Maass AH, Peretto G, Soliman EZ, Takigawa M, Anselmino M. Editorial: Case reports in cardiac rhythmology: 2022. Front Cardiovasc Med 2023; 10:1276721. [PMID: 37711560 PMCID: PMC10497861 DOI: 10.3389/fcvm.2023.1276721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Andrea Ballatore
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta della Salute e della Scienza” Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alexander H. Maass
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elsayed Z. Soliman
- Section on Cardiovascular Medicine, Epidemiological Cardiology Research Center,Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Masateru Takigawa
- Division of Advanced Arrhythmia Research, Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, “Citta della Salute e della Scienza” Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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