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de Alencar Neto JN, Sakai MH, de Almeida Neto RG, Scheffer MK, Alencar E Silva GPS, Cirenza C, de Paola AAV. EPM algorithm: A stepwise approach to accessory pathway localization in ventricular pre-excitation. J Electrocardiol 2024; 84:1-8. [PMID: 38430664 DOI: 10.1016/j.jelectrocard.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/05/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Accurate estimation of accessory pathway (AP) localization in patients with ventricular pre-excitation or Wolff-Parkinson-White (WPW) syndrome remains a diagnostic challenge. Existing algorithms have contributed significantly to this area, but alternative algorithms can offer additional perspectives and approaches to AP localization. OBJECTIVE This study introduces and evaluates the diagnostic accuracy of the EPM algorithm in AP localization, comparing it with established algorithms Arruda and EASY. METHODS A retrospective analysis was conducted on 138 patients from Hospital São Paulo who underwent catheter ablation. Three blinded examiners assessed the EPM algorithm's diagnostic accuracy against the Arruda and EASY algorithms. The gold standard for comparison was the radioscopic position of the AP where radiofrequency ablation led to pre-excitation disappearance on the ECG. RESULTS EPM showed a diagnostic accuracy of 51.45%, closely aligning with Arruda (53.29%) and EASY (44.69%). Adjacency accuracy for EPM was 70.67%, with Arruda at 66.18% and EASY at 72.22%. Sensitivity for EPM in distinguishing left vs. right APs was 95.73%, with a specificity of 74.33%. For identifying septal vs. lateral right APs, EPM sensitivity was 82.79% with a specificity of 46.15%. These measures were comparable to those of Arruda and EASY. Inter-observer variability was excellent for EPM, with Kappa statistics over 0.9. CONCLUSION The EPM algorithm emerges as a reliable tool for AP localization, offering a systematic approach beneficial for therapeutic decision-making in electrophysiology. Its comparable diagnostic accuracy and excellent inter-observer variability underscore its potential clinical applicability. Future research may further validate its efficacy in a broader clinical setting.
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Affiliation(s)
- José Nunes de Alencar Neto
- Tele-Electrocardiography Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil.
| | - Marcel Henrique Sakai
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
| | | | - Matheus Kiszka Scheffer
- Tele-Electrocardiography Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Claudio Cirenza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
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Dalili M, Rahimpour F. Catheter ablation for an incessant arrhythmia in a preterm low-weight neonate. J Cardiol Cases 2023; 28:253-256. [PMID: 38126057 PMCID: PMC10730276 DOI: 10.1016/j.jccase.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 12/23/2023] Open
Abstract
A 15-day-old neonate weighing 1800 g presented with incessant long-RP tachycardia. Temporary cessation of the arrhythmia with adenosine confirmed the diagnosis of permanent junctional reciprocating tachycardia (PJRT). The arrhythmia was refractory to multiple drugs. An electrophysiological study confirmed diagnosis. The arrhythmia was successfully treated with radiofrequency. Learning objective Transcatheter radiofrequency ablation can be done safely in infants who are unresponsive to medical therapy, regardless of age and body weight.
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Affiliation(s)
- Mohammad Dalili
- Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Feisal Rahimpour
- Rajaie Cardiovascular Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
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3
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Gómez-Flores J, Cueva-Parra Á, Gallegos-Cortéz A, Nava S, Márquez MF, Iturralde-Torres P. Validation of qrs-polarity algorithm with special emphasis in parahisian pathways. Arch Cardiol Mex 2023; 93:164-171. [PMID: 37054739 PMCID: PMC10161820 DOI: 10.24875/acm.22000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND In 1996 Iturralde et al. published an algorithm based on the QRS polarity to determine the location of the accessory pathways (AP), this algorithm was developed before the massive practice of invasive electrophysiology. PURPOSE To validate the QRS-Polarity algorithm in a modern cohort of subjects submitted to radiofrequency catheter ablation (RFCA). Our objective was to determinate its global accuracy and its accuracy for parahisian AP. METHODS We conducted a retrospective analysis of patients with Wolff-Parkinson-White (WPW) syndrome who underwent an electrophysiological study (EPS) and RFCA. We employed the QRS-Polarity algorithm to predict the AP anatomical location and we compared this result with the real anatomic location determined in the EPS. To determine accuracy, the Cohen's kappa coefficient (k) and the Pearson correlation coefficient were used. RESULTS A total of 364 patients were included (mean age 30 years, 57% male). The global k score was 0.78 and the Pearson's coefficient was 0.90. The accuracy for each zone was also evaluated, the best correlation was for the left lateral AP (k of 0.97). There were 26 patients with a parahisian AP, who showed a great variability in the ECG features. Employing the QRS-Polarity algorithm, 34.6% patients had a correct anatomical location, 42.3% had an adjacent location and only 23% an incorrect location. CONCLUSION The QRS-Polarity algorithm has a good global accuracy; its precision is high, especially for left lateral AP. This algorithm is also useful for the parahisian AP.
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Affiliation(s)
- Jorge Gómez-Flores
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ángel Cueva-Parra
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Antonio Gallegos-Cortéz
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Santiago Nava
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Manlio F Márquez
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Pedro Iturralde-Torres
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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Jemtrén A, Bergfeldt L, Insulander P, Rubulis A, Tapanainen J, Jensen-Urstad M. Accessory pathway properties are similar in symptomatic and asymptomatic preexcitation. J Interv Card Electrophysiol 2022; 65:193-199. [PMID: 35618980 PMCID: PMC9550742 DOI: 10.1007/s10840-022-01252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation. METHODS This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36 ± 17 years with a range of 3-89 years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18 years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization. RESULTS A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤ 250 ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P = 0.40) as was the mean APERP (303 ± 68 ms vs. 307 ± 75) (P = 0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P < 0.001). CONCLUSION The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.
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Affiliation(s)
- Anette Jemtrén
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lennart Bergfeldt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Aigars Rubulis
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Richardson C, Silver ES, Liberman L. Conduction Properties and Ablation of Adenosine Sensitive Accessory Pathways in Children. Pediatr Cardiol 2021; 42:1350-1355. [PMID: 33893526 DOI: 10.1007/s00246-021-02618-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
Block in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs </ = 21 years old who underwent an EP study from 2014 to 2017 were included in our study. Patients with adenosine sensitive APs were identified (group 1). Demographic and AP conduction characteristics were compared between group 1 and the entire cohort of patients. Local atrioventricular (AV) or ventriculoatrial (VA) time, cycle length and need for isoproterenol were compared to a control group matched by age and AP location (group 2). Student's t test, Wilcoxon rank sum, χ2 and Fisher's exact were used for analysis. Fourteen (7%) out of 207 patients had an adenosine sensitive AP. The median age of patients with adenosine sensitive APs was 11.8 (IQR 8.5-13.5) years vs. 14 (IQR 10.6-16.7) for the rest of the cohort (p = 0.04). Three of the 134 patients with preexcitation had adenosine sensitive APs (2%) vs. 11 of the 73 patients with concealed APs (15%) (p = 0.001). The median local AV/VA time at the site of successful ablation was longer in group 1 vs group 2 [78 ms, IQR 62-116 vs. 31 ms, IQR 30-38; p < 0.001]. Antegrade AP effective refractory period and total procedure time were longer in patients with adenosine sensitive APs (p = 0.03 & p = 0.04, respectively). Adenosine sensitive APs which occur in children are more often concealed. These APs have a longer conduction time at the site of successful ablation.
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Affiliation(s)
- Chalese Richardson
- Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Department of Pediatrics, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, 3959 Broadway, 2 North, New York, NY, 10032, USA.
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6
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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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Affiliation(s)
- Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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8
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Yazici M, Lakič N, Prolič Kalinšek T, Žižek D, Ažman Juvan K, Topalović M, Mijovski G, Jan M. Fluoroless catheter ablation of accessory pathways in adult and pediatric patients: a single centre experience. Int J Cardiovasc Imaging 2021; 37:1873-82. [PMID: 33528712 DOI: 10.1007/s10554-021-02168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Catheter radio-frequency ablation (RFA) and cryo-ablation (CRA) procedures are an effective and safe treatment options for adult and pediatric patients with accessory pathway (AP) mediated tachycardias. Non-fluoroscopic techniques during catheter ablation (CA) procedures reduce potentially harmful effects of radiation. Our aim was to investigate the efficacy and safety of completely fluoroless RFA and CRA procedures in pediatric and adult patients with APs. Consecutive patients with AP-related tachycardia and high risk asymptomatic ventricular pre-excitation were assessed in retrospective analysis. Three-dimensional (3D) electro-anatomical mapping (EAM) and intra-cardiac echocardiography (ICE) were used as principal imaging modalities. Fluoroscopy was not used during any stage of the procedures. Among 116 included patients (22.76 ± 16.1 years, 68 patients < 19 years), 60 had left-sided APs, 16 right-sided APs and 40 septal APs. Altogether, 96 had RFA and 20 CRA procedures. The acute success rates (ASR) of RFA and CRA were 97.9% and 95%, respectively (p = 0.43), with recurrence rates (RR) of 8.33% and 40%, respectively (p < 0.0001). The outcome difference was principally driven by lower RR with RFA in septal APs (9.1% vs. 38.9%, p = 0.025). Pediatric patients with APs (12.21 ± 3.76 years) had similar procedural parameters and outcomes compared to adult patients. There were no procedure-related complications. In adult and pediatric patients with AP-related tachycardias, both CRA and RFA can be effectively and safely performed without the use of fluoroscopy. In addition, RFA resulted in better outcomes compared to CRA.
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10
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Abstract
In rare cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic features that may be related to their specific anatomy. Most of these bundles show decremental nodelike conduction properties and sustain peculiar forms of arrhythmias that require careful differential diagnosis. On the other hand, some pathways do not actively sustain any reentrant circuit and should nevertheless be promptly recognized to avoid unnecessary ablation attempts. Although rare, these variants of accessory pathway should be known to warrant a safe and effective catheter ablation procedure.
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Affiliation(s)
- Mario Matta
- Cardiology Division, Sant'Andrea Hospital, corso Mario Abbiate, 21, Vercelli 13100, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fiorenzo Gaita
- Cardiology Unit, J Medical Via Druento, 153/56, Turin 10151, Italy
| | - Matteo Anselmino
- Cardiology Division, Department of Medical Sciences, "Città della Salute e della Scienza di Torino" Hospital, University of Turin, Corso Bramante, 88, Turin 10126, Italy.
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Brown MT, Kiani S, Black GB, Lu MLR, Lloyd M, Leon AR, Shah A, Westerman S, Merchant FM, El-Chami M. Ablation of manifest septal accessory pathways: a single-center experience. J Interv Card Electrophysiol 2020; 61:349-355. [PMID: 32666409 DOI: 10.1007/s10840-020-00823-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/09/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ablation of septal accessory pathways (SAPs) is associated with an increased risk of heart block. Data on outcomes of SAP ablation in adults are limited. OBJECTIVES To describe outcomes of SAP ablation in our center. METHODS Patients with Wolff-Parkinson-White syndrome (WPW) undergoing an EP study at our center between January 2008 and August 2019 were identified from our institutional database. Location of the pathway was noted as anteroseptal (AS), midseptal (MS), or posteroseptal (PS). Outcomes of the ablation including success, complication rates, and recurrences were also recorded. RESULTS Thirty-three patients with SAP underwent 35 EP studies: AS (n = 13), MS (n = 5), and PS (n = 15). Thirty pathways were targeted for ablation, two of which required a 2nd procedure resulting in 32 attempts at ablation in 30 patients. In the remaining 3 patients, SAP did not have malignant features and were not targeted for ablation. Single-procedure success rate was 28/30 (93.33%): 9/10 AS, 5/5 MS, and 14/15 PS ablations. One AS pathway was successfully ablated during a 2nd procedure. Two complications were observed: 1 pericardial effusion in a patient who underwent epicardial mapping and ablation of both PS and right free wall APs. Additionally, transient 2:1 AV block occurred during an MS pathway ablation that recovered during follow-up and did not require permanent pacing procedure. CONCLUSION In this single-center experience, ablation of manifest SAP was associated with high success rates and low complication rates. No instances of permanent heart block requiring pacing occurred.
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Affiliation(s)
- Matthew T Brown
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Soroosh Kiani
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - George B Black
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Marvin L R Lu
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Michael Lloyd
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Angel R Leon
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Anand Shah
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Stacy Westerman
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Faisal M Merchant
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Mikhael El-Chami
- Emory University School of Medicine, Medical office Tower 12th Floor, 550 Peachtree Street NE, Atlanta, GA, 30308, USA.
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Patel RK, Roman MJ, Lerman BB, Cheung JW. A wide QRS complex tachycardia: What is the mechanism? Heart Rhythm 2020; 17:831-832. [PMID: 32354572 DOI: 10.1016/j.hrthm.2019.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Rohan K Patel
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Mary J Roman
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York.
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13
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Abstract
The term paroxysmal supraventricular tachycardia encompasses a heterogeneous group of arrhythmias with different electrophysiologic characteristics. Knowledge of the mechanism of each supraventricular tachycardia is important in determining management in the office, at the bedside, and in the electrophysiology laboratory. Paroxysmal supraventricular tachycardias have an abrupt onset and offset, typically initiating and terminating with premature atrial ectopic beats. In the acute setting, both vagal maneuvers and pharmacologic therapy can be effective in arrhythmia termination. Catheter ablation has revolutionized therapy for many supraventricular tachycardias, and newer techniques have significantly improved ablation efficacy and decreased periprocedural complications and procedure times.
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Affiliation(s)
- Arun Umesh Mahtani
- Department of Cardiac Electrophysiology, St. Bernard's Heart and Vascular Center, Jonesboro, AR, USA
| | - Devi Gopinath Nair
- Department of Cardiac Electrophysiology, St. Bernard's Heart and Vascular Center, Jonesboro, AR, USA.
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14
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Telishevska M, Hebe J, Paul T, Nürnberg JH, Krause U, Gebauer R, Gass M, Balmer C, Berger F, Molatta S, Emmel M, Lawrenz W, Kriebel T, Hessling G. Catheter ablation in ASymptomatic PEDiatric patients with ventricular preexcitation: results from the multicenter "CASPED" study. Clin Res Cardiol 2019; 108:683-90. [PMID: 30519781 DOI: 10.1007/s00392-018-1397-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND As there are limited data about the clinical practice of catheter ablation in asymptomatic children and adolescents with ventricular preexcitation on ECG, we performed the multicenter "CASPED" (Catheter ablation in ASymptomatic PEDiatric patients with Ventricular Preexcitation) study. METHODS AND RESULTS In 182 consecutive children and adolescents aged between 8 and 18 years (mean age 12.9 ± 2.6 years; 65% male) with asymptomatic ventricular preexcitation, a total of 196 accessory pathways (APs) were targeted. APs were right sided (62%) or left sided (38%). The most common right-sided AP location was the posteroseptal region (38%). Ablation was performed using radiofrequency (RF) energy (93%), cryoablation (4%) or both (3%). Mean procedure time was 137.6 ± 62.0 min with a mean fluoroscopy time of 15.6 ± 13.8 min. A 3D mapping or catheter localization system was used in 32% of patients. Catheter ablation was acutely successful in 166/182 patients (91.2%). Mortality was 0% and there were no major periprocedural complications. AP recurrence was observed in 14/166 patients (8.4%) during a mean follow-up time of 19.7 ± 8.5 months. A second ablation attempt was performed in 20 patients and was successful in 16/20 patients (80%). Overall, long-term success rate was 92.3%. CONCLUSION In this retrospective multicenter study, the outcome of catheter ablation for asymptomatic preexcitation in children and adolescents irrespective of antegrade AP conduction properties is summarized. The complication rate was low and success rate was high, the latter mainly depending on pathway location. The promising results of the study may have future impact on the ongoing risk-benefit discussion regarding catheter ablation in the setting of asymptomatic preexcitation in children and adolescents.
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15
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Enriquez A, Tapias C, Rodriguez D, Ramirez J, Rosso R, Viskin S, Schaller R, Marchlinski F, Saenz L, Garcia F. Role of intracardiac echocardiography for guiding ablation of tricuspid valve arrhythmias. HeartRhythm Case Rep 2018; 4:209-213. [PMID: 29922578 PMCID: PMC6006487 DOI: 10.1016/j.hrcr.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carlos Tapias
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia
| | - Diego Rodriguez
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia.,Universidad de la Sabana, Bogotá, Colombia
| | - Juan Ramirez
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia
| | - Raphael Rosso
- Department of Cardiac Electrophysiology, Cardiology Division, Sourasky Medical Center, Tel Aviv, Israel
| | - Sami Viskin
- Department of Cardiac Electrophysiology, Cardiology Division, Sourasky Medical Center, Tel Aviv, Israel
| | - Robert Schaller
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luis Saenz
- International Arrhythmia Center at CardioInfantil Foundation-Cardiac Institute, Bogotá, Colombia.,Universidad de la Sabana, Bogotá, Colombia
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Abstract
Radiofrequency (RF) catheter ablation is the treatment of choice in patients with accessory pathways (APs) and Wolff-Parkinson-White syndrome. Endocardial catheter ablation has limitations, including the inability to map and ablate intramural or subepicardial APs. Some of these difficulties can be overcome using an epicardial approach performed through the epicardial venous system or by percutaneous catheterisation of the pericardial space. When a suspected left inferior or infero-paraseptal AP is refractory to ablation or no early activation is found at the endocardium, a transvenous approach via the coronary sinus is warranted because such epicardial pathways can be in close proximity to the coronary venous system. Associated congenital abnormalities, such as right atrial appendage, right ventricle diverticulum, coronary sinus diverticulum and absence of coronary sinus ostium, may also hamper a successful outcome. Percutaneous epicardial subxiphoid approach should be considered when endocardial or transvenous mapping and ablation fails. Epicardial mapping may be successful. It can guide and enhance the effectiveness of endocardial ablation. The finding of no epicardial early activation leads to a more persistent new endocardial attempt. When both endocardial and epicardial ablation are unsuccessful, open-chest surgery is the only option to eliminate the AP.
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Affiliation(s)
- Eduardo Back Sternick
- Arrhythmia Unit, Biocor Instituto, Nova Lima, Brazil.,Medical Sciences Faculty of Minas Gerais, Belo Horizonte, Brazil
| | - Mariana Faustino
- Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal
| | | | - Cristiano Pisani
- Arrhythmia Clinical Unit, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Akhtar M. Human His-Purkinje System: Normal Electrophysiologic Behavior. Card Electrophysiol Clin 2016; 8:641-682. [PMID: 27837891 DOI: 10.1016/j.ccep.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The His-Purkinje system (HPS) plays a significant role in human pathophysiology, but knowledge is scattered. This article highlights some of the relevant concepts, phenomena, and mechanisms; clarifies, expands, confirms, or modifies commonly encountered clinical events; and adds new information, which is often available but obscure. Also included are the essentials of HPS anatomy and physiology. It is important to abandon inaccurate concepts that are still taught and occasionally appear in text books.
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Affiliation(s)
- Masood Akhtar
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, Suite 777, Milwaukee, WI, USA.
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18
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Ottaviani G, Buja LM. Anatomopathological changes of the cardiac conduction system in sudden cardiac death, particularly in infants: advances over the last 25 years. Cardiovasc Pathol 2016; 25:489-499. [PMID: 27616614 DOI: 10.1016/j.carpath.2016.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/23/2016] [Revised: 08/04/2016] [Accepted: 08/23/2016] [Indexed: 02/08/2023] Open
Abstract
Sudden cardiac death (SCD) is defined as the unexpected death without an obvious noncardiac cause that occurs within 1 h of witnessed symptom onset (established SCD) or within 24 h of unwitnessed symptom onset (probable SCD). In the United States, its incidence is 69/100,000 per year. Dysfunctions of the cardiac conduction and autonomic nervous systems are known to contribute to SCD pathogenesis, even if most clinicians and cardiovascular pathologists lack experience with detailed examination of the cardiac conduction system and fail to recognize lesions that are crucial to explain the SCD itself. In this review, we sought to describe the advances over the last 25 years in the study of the anatomopathological changes of the conducting tissue, in SCD, in mature hearts and particularly in sudden infant death syndrome (SIDS) and sudden intrauterine unexpected death syndrome (SIUDS), through the articles published in our journal Cardiovascular Pathology (CVP). We carried out an extensive Medline search to retrieve and review all articles published in CVP in which the sudden unexpected death of one or more subjects believed healthy was reported, especially if associated with lesions of the conducting tissue in settings that revealed no other explained causes of death, particularly in infants and fetuses. The cardiac conduction findings of resorptive degeneration, His bundle dispersion, Mahaim fibers, cartilaginous meta-hyperplasia, persistent fetal dispersion, left-sided His bundle, septation of the bifurcation, atrioventricular node dispersion, sinus node hypoplasia, Zahn node, His bundle hypoplasia, atrioventricular node, and His bundle dualism were similarly detected in SIDS and SIUDS victims.
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Affiliation(s)
- Giulia Ottaviani
- "Lino Rossi" Research Center for the Study and Prevention of Unexpected Perinatal Death and Sudden Infant Death Syndrome (SIDS), Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy; Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Abstract
Paroxysmal supraventricular tachycardia (PSVT) is a well-known and thoroughly studied clinical syndrome, characterized by regular tachycardia rhythm with sudden onset and abrupt termination. Most patients present with palpitations and dizziness, and their electrocardiogram demonstrates a narrow QRS complex and regular tachycardia with hidden or inverted P waves. PSVT is caused by re-entry due to the presence of inhomogeneous, accessory, or concealed conducting pathways. Hemodynamically stable patients are treated by vagal maneuvers, intravenous adenosine, diltiazem, or verapamil, hemodynamically unstable patients are treated by cardioversion. Patients with symptomatic and recurrent PSVT can be treated with long-term drug treatment or catheter ablation.
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Affiliation(s)
- Salah S Al-Zaiti
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 336 VB, Pittsburgh, PA 15261, USA.
| | - Kathy S Magdic
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 336 VB, Pittsburgh, PA 15261, USA
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20
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Gonzalez JE, Zipse MM, Nguyen DT, Sauer WH. Antidromic Atrioventricular Reciprocating Tachycardia Using a Concealed Retrograde Conducting Left Lateral Accessory Pathway. Card Electrophysiol Clin 2016; 8:37-43. [PMID: 26920167 DOI: 10.1016/j.ccep.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atrioventricular reciprocating tachycardia is a common cause of undifferentiated supraventricular tachycardia. In patients with manifest or concealed accessory pathways, it is imperative to assess for the presence of other accessory pathways. Multiple accessory pathways are present in 4% to 10% of patients and are more common in patients with structural heart disease. In rare cases, multiple accessory pathways can act as the anterograde and retrograde limbs of the tachycardia.
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Affiliation(s)
- Jaime E Gonzalez
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - Matthew M Zipse
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - Duy T Nguyen
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA
| | - William H Sauer
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
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21
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Sharma K, Brinker JA, Henrikson CA. Computed Tomography Imaging in Atrial Fibrillation Ablation. J Atr Fibrillation 2011; 4:319. [PMID: 28496689 PMCID: PMC5152998 DOI: 10.4022/jafib.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/18/2010] [Accepted: 01/14/2011] [Indexed: 06/07/2023]
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia in adults and catheter ablation has increasingly become the therapy of choice for symptomatic, recurrent, drug refractory AF. The purpose of this review is to evaluate the utility of computed tomography (CT) imaging in guiding radiofrequency catheter ablation (RFCA), as well as highlight the additional radiographic and functional anatomic data provided by CT in comparison to alternative radiographic modalities.
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Affiliation(s)
- Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey A Brinker
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles A Henrikson
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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