1
|
Hale ZD, Greet BD, Burkland DA, Greenberg S, Razavi M, Rasekh A, Molina Razavi JE, Saeed M. Slow-pathway visualization by using voltage-time relationship: A novel technique for identification and fluoroless ablation of atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2020; 31:1430-1435. [PMID: 32270564 DOI: 10.1111/jce.14481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) is treatable by catheter ablation. Advances in mapping-system technology permit fluoroless workflow during ablations. As national practice trends toward fluoroless approaches, easily obtained, reproducible methods of slow-pathway identification, and ablation become increasingly important. We present a novel method of slow-pathway identification and initial ablation results from this method. METHODS AND RESULTS We examined AVNRT ablations performed at our institution over a 12-month period. In these cases, the site of the slow pathway was predicted by latest activation in the inferior triangle of Koch during sinus rhythm. Ablation was performed in this region. Proximity of the predicted site to the successful ablation location, complication rates, and patient outcomes were recorded. Junctional rhythm was seen in 40/41 ablations (98%) at the predicted site (mean, 1.3 lesions and median, 1 lesion per case). One lesion was defined as 5 mm of ablation. The initial ablation was successful in 39/41 cases (95%); in two cases, greater or equal to 2 echo beats were detected after the initial ablation, necessitating further lesion expansion. In 8/41 cases (20%), greater than one lesion was placed during initial ablation before attempted reinduction. Complications included one transient heart block and one transient PR prolongation. During follow-up (median, day 51), one patient had lower-extremity deep-vein thrombosis and pulmonary embolus, and one had a lower-extremity superficial venous thrombosis. There was one tachycardia recurrence, which prompted a redo ablation. CONCLUSIONS Mapping-system detection of late-activation, low-amplitude voltage during sinus rhythm provides an objective, and fluoroless means of identifying the slow pathway in typical AVNRT.
Collapse
Affiliation(s)
- Zachary D Hale
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Brian D Greet
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Department of Cardiology, University of Texas, Houston, Texas
| | - David A Burkland
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Texas Cardiac Arrhythmia, Houston, Texas
| | - Scott Greenberg
- Department of Cardiology, Baylor College of Medicine, The Woodlands, Texas
| | - Mehdi Razavi
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Abdi Rasekh
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Joanna E Molina Razavi
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Mohammad Saeed
- Department of Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.,Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| |
Collapse
|
2
|
Hale ZD, Kong X, Haymart B, Gu X, Kline-Rogers E, Almany S, Kozlowski J, Krol GD, Kaatz S, Froehlich JB, Barnes GD. Prescribing trends of atrial fibrillation patients who switched from warfarin to a direct oral anticoagulant. J Thromb Thrombolysis 2017; 43:283-288. [PMID: 27837309 DOI: 10.1007/s11239-016-1452-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Direct oral anticoagulant (DOAC) agents offer several lifestyle and therapeutic advantages for patients relative to warfarin in the treatment of atrial fibrillation (AF). These alternative agents are increasingly used in the treatment of AF, however the adoption practices, patient profiles, and reasons for switching to a DOAC from warfarin have not been well studied. Through the Michigan Anticoagulation Quality Improvement Initiative, abstracted data from 3873 AF patients, enrolled between 2010 and 2015, were collected on demographics and comorbid conditions, stroke and bleeding risk scores, and reasons for anticoagulant switching. Over the study period, patients who switched from warfarin to a DOAC had similar baseline characteristics, risk scores, and insurance status but differed in baseline CrCl. The most common reasons for switching were patient related ease of use concerns (37.5%) as opposed to clinical reasons (16.5% of patients). Only 13% of patients that switched to a DOAC switched back to warfarin by the end of the study period.
Collapse
Affiliation(s)
- Zachary D Hale
- Texas Heart Institute, CHI-Baylor St. Luke's Medical Center, 6720 Bertner Ave. MC-1-133, Houston, TX, 77030, USA.
| | - Xiowen Kong
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA
| | - Brian Haymart
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA
| | - Xiaokui Gu
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA
| | - Eva Kline-Rogers
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA
| | - Steve Almany
- William Beaumont Hospital, 4600 Investment Drive Suite 200, Troy, MI, 48098, USA
| | - Jay Kozlowski
- Huron Valley Sinai Hospital, 1 William Carls Drive, Commerce, MI, 48382, USA
| | - Gregory D Krol
- Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI, 48202, USA
| | - Scott Kaatz
- Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI, 48202, USA
| | - James B Froehlich
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA
| | - Geoffrey D Barnes
- University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA
| |
Collapse
|