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Devecchi C, Matta M, Magnano M, Dell'Era G, Galiffa VA, Renaudo D, Negro A, Occhetta E, Patti G, Rametta F. Voltage and propagation mapping: New tools to improve successful ablation of atrioventricular nodal reentry tachycardia. J Cardiovasc Electrophysiol 2024; 35:942-949. [PMID: 38462681 DOI: 10.1111/jce.16234] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Mapping system is useful in ablation of atrioventricular nodal reentry tachycardia (AVNRT) and localization of anatomic variances. Voltage mapping identifies a low voltage area in the Koch triangle called low-voltage-bridge (LVB); propagation mapping identifies the collision point (CP) of atrial wavefront convergence. We conducted a prospective study to evaluate the relationship between LVB and CP with successful site of ablation and identify standard value for LVB. MATERIALS AND METHODS Three-dimensional (3D) maps of the right atria were constructed from intracardiac recordings using the ablation catheter. Cut-off values on voltage map were adjusted until LVB was observed. On propagation map, atrial wavefronts during sinus rhythm collide in the site representing CP, indicating the area of slow pathway conduction. Ablation site was selected targeting LVB and CP site, confirmed by anatomic position on fluoroscopy and atrioventricular ratio. RESULTS Twenty-seven consecutive patients were included. LVB and CP were present in all patients. Postprocedural evaluation identified standard cut-off of 0.3-1 mV useful for LVB identification. An overlap between LVB and CP was observed in 23 (85%) patients. Procedure success was achieved in all patient with effective site at first application in 22 (81%) patients. There was a significant correlation between LVB, CP, and the site of effective ablation (p = .001). CONCLUSION We found correlation between LVB and CP with the site of effective ablation, identifying a voltage range useful for standardized LVB identification. These techniques could be useful to identify ablation site and minimize radiation exposure.
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Affiliation(s)
- Chiara Devecchi
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Mario Matta
- Division of Cardiology, AOU Città della Salute e della Scienza, Torino, Italy
| | - Massimo Magnano
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
| | | | | | | | | | - Eraldo Occhetta
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
| | - Giuseppe Patti
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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Abstract
A young male with β-thalassemia major was implanted with a single-chamber Implantable cardioverter-defibrillator (ICD) for a cardiac arrest due to ventricular fibrillation. He received multiple inappropriate shocks due to atrioventricular nodal re-entrant tachycardia (AVNRT) treated with radiofrequency catheter ablation and then to high-rate atrial tachycardia refractory to amiodarone and not inducible during electrophysiological study. He refused empirical pulmonary vein isolation. Upgrading to biventricular ICD and performing atrioventricular node ablation avoided further inappropriate shocks.
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Affiliation(s)
| | - Matteo Astuti
- Department of Cardiology, Ospedale San Paolo, Savona
| | - Silvia Pica
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy
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Mesirca P, Nakao S, Nissen SD, Forte G, Anderson C, Trussell T, Li J, Cox C, Zi M, Logantha S, Yaar S, Cartensen H, Bidaud I, Stuart L, Soattin L, Morris GM, da Costa Martins PA, Cartwright EJ, Oceandy D, Mangoni ME, Jespersen T, Buhl R, Dobrzynski H, Boyett MR, D'Souza A. Intrinsic Electrical Remodeling Underlies Atrioventricular Block in Athletes. Circ Res 2021; 129:e1-e20. [PMID: 33849278 DOI: 10.1161/circresaha.119.316386] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Pietro Mesirca
- IGF, Université de Montpellier, CNRS, INSERM, France (P.M., I.B., M.E.M.)
| | - Shu Nakao
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
- Department of Biomedical Sciences, Ritsumeikan University, Japan (S.N.)
| | - Sarah Dalgas Nissen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (S.D.N., H.C., R.B.), University of Copenhagen, Denmark
| | - Gabriella Forte
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Cali Anderson
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Tariq Trussell
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Jue Li
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Charlotte Cox
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Min Zi
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Sunil Logantha
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, United Kingdom (S.L.)
| | - Sana Yaar
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Helena Cartensen
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (S.D.N., H.C., R.B.), University of Copenhagen, Denmark
| | - Isabelle Bidaud
- IGF, Université de Montpellier, CNRS, INSERM, France (P.M., I.B., M.E.M.)
| | - Luke Stuart
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | | | - Gwilym M Morris
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | | | - Elizabeth J Cartwright
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Delvac Oceandy
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
| | - Matteo E Mangoni
- IGF, Université de Montpellier, CNRS, INSERM, France (P.M., I.B., M.E.M.)
| | - Thomas Jespersen
- Department of Biomedical Sciences (T.J., M.R.B.), University of Copenhagen, Denmark
| | - Rikke Buhl
- Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences (S.D.N., H.C., R.B.), University of Copenhagen, Denmark
| | - Halina Dobrzynski
- Department of Anatomy, Jagiellonian University Medical College, Poland (H.D.)
| | - Mark R Boyett
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
- Department of Biomedical Sciences (T.J., M.R.B.), University of Copenhagen, Denmark
| | - Alicia D'Souza
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom (S.N., G.F., C.A., T.T., J.L., C.C., M.Z., S.L., S.Y., L. Stuart, L. Soattin, G.M.M., E.J.C., D.O., H.D., M.R.B., A.D.)
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Amstetter D, Badt F, Rubi L, Bittner RE, Ebner J, Uhrin P, Hilber K, Koenig X, Todt H. The bradycardic agent ivabradine decreases conduction velocity in the AV node and in the ventricles in-vivo. Eur J Pharmacol 2021; 893:173818. [PMID: 33345856 DOI: 10.1016/j.ejphar.2020.173818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 07/08/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
Ivabradine blocks hyperpolarisation-activated cyclic nucleotide-gated (HCN) channels, thereby lowering the heart rate, an action that is used clinically for the treatment of heart failure and angina pectoris. We and others have shown previously that ivabradine, in addition to its HCN channel blocking activity, also inhibits voltage-gated Na channels in vitro at concentrations that may be clinically relevant. Such action may reduce conduction velocity in cardiac atria and ventricles. Here, we explore the effect of administration of ivabradine on parameters of ventricular conduction and repolarization in the surface ECG of anesthetized mice. We found that 5 min after i.p. administration of 10 mg/kg ivabradine spontaneous heart rate had declined by ~13%, which is within the range observed in human clinical studies. At the same time a significant increase in QRS duration by ~18% was observed, suggesting a reduction in ventricular conduction velocity. During transesophageal pacing at heart rates between 100 and 220 beats/min there was no obvious rate-dependence of ivabradine-induced QRS prolongation. On the other hand, ivabradine produced substantial rate-dependent slowing of AV nodal conduction. We conclude that ivabradine prolongs conduction in the AV-node and in the ventricles in vivo.
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Affiliation(s)
- Daniel Amstetter
- Center for Physiology and Pharmacology, Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Florian Badt
- Center for Physiology and Pharmacology, Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Lena Rubi
- Center for Physiology and Pharmacology, Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Reginald E Bittner
- Neuromuscular Research Department, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Janine Ebner
- Center for Physiology and Pharmacology, Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Pavel Uhrin
- Department of Vascular Biology and Thrombosis Research, Center for Physiology and Pharmacology, Austria
| | - Karlheinz Hilber
- Center for Physiology and Pharmacology, Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Xaver Koenig
- Center for Physiology and Pharmacology, Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria
| | - Hannes Todt
- Center for Physiology and Pharmacology, Department of Neurophysiology and Neuropharmacology, Medical University of Vienna, Vienna, Austria.
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Burnicka-Turek O, Broman MT, Steimle JD, Boukens BJ, Petrenko NB, Ikegami K, Nadadur RD, Qiao Y, Arnolds DE, Yang XH, Patel VV, Nobrega MA, Efimov IR, Moskowitz IP. Transcriptional Patterning of the Ventricular Cardiac Conduction System. Circ Res 2020; 127:e94-e106. [PMID: 32290757 PMCID: PMC8328577 DOI: 10.1161/circresaha.118.314460] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
RATIONALE The heartbeat is organized by the cardiac conduction system (CCS), a specialized network of cardiomyocytes. Patterning of the CCS into atrial node versus ventricular conduction system (VCS) components with distinct physiology is essential for the normal heartbeat. Distinct node versus VCS physiology has been recognized for more than a century, but the molecular basis of this regional patterning is not well understood. OBJECTIVE To study the genetic and genomic mechanisms underlying node versus VCS distinction and investigate rhythm consequences of failed VCS patterning. METHODS AND RESULTS Using mouse genetics, we found that the balance between T-box transcriptional activator, Tbx5, and T-box transcriptional repressor, Tbx3, determined the molecular and functional output of VCS myocytes. Adult VCS-specific removal of Tbx5 or overexpression of Tbx3 re-patterned the fast VCS into slow, nodal-like cells based on molecular and functional criteria. In these cases, gene expression profiling showed diminished expression of genes required for VCS-specific fast conduction but maintenance of expression of genes required for nodal slow conduction physiology. Action potentials of Tbx5-deficient VCS myocytes adopted nodal-specific characteristics, including increased action potential duration and cellular automaticity. Removal of Tbx5 in vivo precipitated inappropriate depolarizations in the atrioventricular (His)-bundle associated with lethal ventricular arrhythmias. TBX5 bound and directly activated cis-regulatory elements at fast conduction channel genes required for fast physiological characteristics of the VCS action potential, defining the identity of the adult VCS. CONCLUSIONS The CCS is patterned entirely as a slow, nodal ground state, with a T-box dependent, physiologically dominant, fast conduction network driven specifically in the VCS. Disruption of the fast VCS gene regulatory network allowed nodal physiology to emerge, providing a plausible molecular mechanism for some lethal ventricular arrhythmias.
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Affiliation(s)
- Ozanna Burnicka-Turek
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Michael T. Broman
- Department of Medicine, The University of Chicago, Chicago, IL, 60637, USA
| | - Jeffrey D. Steimle
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Bastiaan J. Boukens
- Department of Biomedical Engineering, George Washington University, Washington, DC 20052, USA
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nataliya B. Petrenko
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Penn Cardiovascular Institute, Philadelphia, PA 19104, USA
| | - Kohta Ikegami
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Rangarajan D. Nadadur
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Yun Qiao
- Department of Biomedical Engineering, George Washington University, Washington, DC 20052, USA
| | - David E. Arnolds
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Xinan H. Yang
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Vickas V. Patel
- Discovery Medicine, GlaxoSmithKline, Collegeville, PA 19426, USA
| | - Marcelo A. Nobrega
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Igor R. Efimov
- Department of Biomedical Engineering, George Washington University, Washington, DC 20052, USA
| | - Ivan P. Moskowitz
- Department of Pediatrics, University of Chicago, Chicago, IL 60637, USA
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
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Hartmann J, Jungen C, Stec S, Klatt N, Willems S, Makimoto H, Steven D, Pürerfellner H, Martinek M, Meyer C. Outcomes in patients with dual antegrade conduction in the atrioventricular node: insights from a multicentre observational study. Clin Res Cardiol 2020; 109:1025-1034. [PMID: 32002633 PMCID: PMC7375989 DOI: 10.1007/s00392-020-01596-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Supraventricular tachycardias induced by dual antegrade conduction via the atrioventricular (AV) node are rare but often misdiagnosed with severe consequences for the affected patients. As long-term follow-up in these patients was not available so far, this study investigates outcomes in patients with dual antegrade conduction in the AV node. METHODS AND RESULTS In this multicentre observational study, patients from six European centres were studied. Catheter ablation was performed in 17 patients (52 ± 16 years) with dual antegrade conduction via both AV nodal pathways between 2012 and 2018. Patients with the final diagnosis of a manifest dual AV nodal non-re-entrant tachycardia had a mean delay of the correct diagnosis of over 1 year (range 2-31 months). Two patients received prescription of non-indicated oral anticoagulation, two further patients suffered from inappropriate shocks of an implantable cardioverter defibrillator. In 12 patients, a co-existence of dual antegrade and re-entry conduction in the AV node was present. Mean fast pathway conduction time was 138 ± 61 ms and mean slow pathway conduction time was 593 ± 134 ms. Successful radiofrequency catheter ablation was performed in all patients. Post-procedurally oral anticoagulation was discontinued, without detection of cerebrovascular events or atrial fibrillation during a long-term follow-up of median 17 months (range 6-72 months). CONCLUSION This first multicentre study investigating patients with supraventricular tachycardia and dual antegrade conduction in the AV node demonstrates that catheter ablation is safe and effective while long-term patient outcome is good. Autonomic tone dependent changes in ante- vs. retrograde conduction via slow and/or fast pathway can challenge the diagnosis and therapy in some patients.
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Affiliation(s)
- Jens Hartmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Sebastian Stec
- Subcarpathian Center for Cardiovascular Intervention, G.V.M. Carint, Sanok, Poland
- Medinice Research and Development Centre, Aeropolis-Jasionka, Rzeszow, Poland
- ELMedica EP-Network, Kielce, Poland
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Hisaki Makimoto
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Daniel Steven
- Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Helmut Pürerfellner
- Department of Cardiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Martin Martinek
- Department of Cardiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Heart and Vascular Center, Hamburg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.
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Duchateau J, Tixier R, Vlachos K, Nakatani Y, Ramirez FD, André C, Escande W, Chauvel R, Pambrun T, Derval N, Sacher F, Hocini M, Jaïs P, Haissaguerre M. Ventricular-triggered atrial pacing: A new maneuver for slow-fast atrioventricular nodal reentrant tachycardia. Heart Rhythm 2020; 17:955-964. [PMID: 31954857 DOI: 10.1016/j.hrthm.2020.01.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrioventricular (AV) node duality is suggested by several electrophysiological findings, none of which are strong predictors of AV nodal reentrant tachycardia (AVNRT). OBJECTIVE The purpose of this study was to propose a novel maneuver to study conduction over the AV node and attempt to induce slow-fast AVNRT. METHODS Ventricular-triggered atrial pacing (VTAP) with decremental VA delay was carried out in 36 consecutive patients with slow-fast AVNRT and in 21 controls after conventional electrophysiology study. Maneuvers were repeated after ablation in patients with AVNRT. RESULTS VTAP resulted in a hysteretic conduction curve in 21 of 36 patients (58%) in the AVNRT group but only 4 of 21 patients (19%) in the control group (sensitivity 58; specificity 81%). This finding demonstrates sustained conduction in a slow conducting pathway and concealed retrograde conduction over a fast pathway. VTAP resulted in AVNRT induction in 15 of 25 inducible patients at baseline (60%), 4 of which were not inducible with incremental pacing or programmed atrial stimulation. VTAP resulting in a suspended p wave had 51% (39%-64%) sensitivity and 100% (89%-100%) specificity for predicting noninducibility in a given autonomic state. CONCLUSION VTAP is useful in patients with suspected slow-fast AVNRT. A hysteretic conduction curve demonstrates sustained conduction over a slow pathway and concealed retrograde conduction through the fast pathway, a finding in favor of slow-fast AVNRT. VTAP may facilitate AVNRT induction and proves to be an interesting complement to classic maneuvers. A suspended p-wave response specifically predicts noninducibility of slow-fast AVNRT in a given autonomic state, providing an interesting surrogate to noninducibility as a procedural end point.
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Affiliation(s)
- Josselin Duchateau
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France.
| | - Romain Tixier
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Konstantinos Vlachos
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Yosuke Nakatani
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - F Daniel Ramirez
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Clémentine André
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - William Escande
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut Lévèque, CHU de Bordeaux, Pessac, France; IHU-LIRYC, Pessac, France
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Eitel C, Ince H, Brachmann J, Kuck KH, Willems S, Gerds-Li JH, Tebbenjohanns J, Richardt G, Hochadel M, Senges J, Tilz RR. Atrial fibrillation ablation strategies and outcome in patients with heart failure: insights from the German ablation registry. Clin Res Cardiol 2019; 108:815-823. [PMID: 30788620 DOI: 10.1007/s00392-019-01411-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/25/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Heart failure (HF) and atrial fibrillation (AF) often coexist, but data on the prognostic value of differing ablation strategies according to left ventricular ejection fraction (LVEF) are rare. METHODS AND RESULTS From January 2007 until January 2010, 728 patients with HF were enrolled in the multi-center German ablation registry prior to AF catheter ablation. Patients were divided into three groups according to LVEF: HF with preserved LVEF (≥ 50%, HFpEF, n = 333), mid-range LVEF (40-49%, HFmrEF, n = 207), and reduced LVEF (< 40%, HFrEF, n = 188). Ablation strategies differed significantly between the three groups with the majority of patients with HFpEF (83.4%) and HFmrEF (78.4%) undergoing circumferential pulmonary vein isolation vs. 48.9% of patients with HFrEF. The latter underwent ablation of the atrioventricular (AV) node in 47.3%. Major complications did not differ between the groups. Kaplan-Meier survival analysis demonstrated a significant mortality increase in patients with HFrEF (6.1% in HFrEF vs. 1.5% in HFmrEF vs. 1.9% in HFpEF, p = 0.009) that was limited to patients undergoing ablation of the AV node. CONCLUSIONS Catheter ablation strategies differ significantly in patients with HFpEF, HFmrEF, and HFrEF. In almost 50% of patients with HFrEF AV-node ablation was performed, going along with a significant increase in mortality rate. These results should raise efforts to further evaluate the prognostic effect of ablation strategies in HF patients.
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Affiliation(s)
- Charlotte Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Hueseyin Ince
- Vivantes Klinika Am Urban und im Friedrichshain und Universitäres Herzzentrum Rostock, Berlin, Germany
| | | | | | | | | | | | | | | | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Asklepios Klinik St. Georg, Hamburg, Germany
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9
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Bagliani G, Leonelli FM, De Ponti R, Padeletti L. Advanced Concepts of Atrioventricular Nodal Electrophysiology: Observations on the Mechanisms of Atrioventricular Nodal Reciprocating Tachycardias. Card Electrophysiol Clin 2019; 10:277-297. [PMID: 29784484 DOI: 10.1016/j.ccep.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 11/19/2022]
Abstract
Atrioventricular node reentrant tachycardia (AVNRT) is a supraventricular arrhythmia easily diagnosed by 12-lead electrocardiogram. What is far more challenging, is the understanding of the reentrant circuit in its typical and atypical presentations. The function of the atrioventricular node is still incomplete and this knowledge gap is reflected in the reconstruction of the pathways used by AVNRT in its multiform presentations. This article illustrates the heterogeneous electrocardiographic manifestations of AVNRT. We reconstruct the reentrant circuits involved using more recent understanding of the anatomic and electrophysiologic characteristics of the atrioventricular node.
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Affiliation(s)
- Giuseppe Bagliani
- Cardiology Department, Arrhythmology Unit, Foligno General Hospital, Via Massimo Arcamone, Foligno 06034, Italy; Cardiovascular Diseases Department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy.
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Cardiology Department, University of Insubria, Via Ravasi, 2, 21100 Varese, Italy
| | - Luigi Padeletti
- Heart and Vessels Department, University of Florence, Largo Brambilla, 3, Florence 50134, Italy; IRCCS Multimedica, Cardiology Department, Via Milanese, 300, 20099 Sesto San Giovanni, Italy
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10
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Wellens HJ. A 73-year-old woman with high-degree AV block. Heart Rhythm 2018; 15:1587-1588. [PMID: 30274620 DOI: 10.1016/j.hrthm.2018.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Hein J Wellens
- Cardiovascular Research Institute, Maastricht, The Netherlands.
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11
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Huang W, Su L, Wu S. Pacing Treatment of Atrial Fibrillation Patients with Heart Failure: His Bundle Pacing Combined with Atrioventricular Node Ablation. Card Electrophysiol Clin 2018; 10:519-535. [PMID: 30172289 DOI: 10.1016/j.ccep.2018.05.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 06/08/2023]
Abstract
As an alternative to antiarrhythmic drugs and catheter ablation of atrial fibrillation (AF) for rate and rhythm control, pacing combined with atrioventricular node (AVN) ablation is suitable for many AF patients with heart failure (HF) who suffer from symptoms despite optimal medical therapy or have failed AF ablation. Studies have demonstrated His bundle pacing in conjunction with AVN ablation to treat refractory AF patients with HF provide long-term clinical benefits. Here we introduce the clinical application and procedures of His bundle pacing and AVN ablation.
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Affiliation(s)
- Weijian Huang
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou 325000, China; Key Lab of Cardiovascular Disease of Wenzhou, Nanbaixiang, Wenzhou 325000, China.
| | - Lan Su
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou 325000, China; Key Lab of Cardiovascular Disease of Wenzhou, Nanbaixiang, Wenzhou 325000, China
| | - Shengjie Wu
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou 325000, China; Key Lab of Cardiovascular Disease of Wenzhou, Nanbaixiang, Wenzhou 325000, China
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12
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Gold MR, Yu Y, Singh JP, Birgersdotter-Green U, Stein KM, Wold N, Meyer TE, Ellenbogen KA. Effect of Interventricular Electrical Delay on Atrioventricular Optimization for Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2018; 11:e006055. [PMID: 30354310 PMCID: PMC6110372 DOI: 10.1161/circep.117.006055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Routine atrioventricular optimization (AVO) has not been shown to improve outcomes with cardiac resynchronization therapy (CRT). However, more recently subgroup analyses of multicenter CRT trials have identified electrocardiographic or lead positions associated with benefit from AVO. Therefore, the purpose of this analysis was to evaluate whether interventricular electrical delay modifies the impact of AVO on reverse remodeling with CRT. METHODS This substudy of the SMART-AV trial (SMARTDELAY Determined AV Optimization) included 275 subjects who were randomized to either an electrogram-based AVO (SmartDelay) or nominal atrioventricular delay (120 ms). Interventricular delay was defined as the time between the peaks of the right ventricular (RV) and left ventricular (LV) electrograms (RV-LV duration). CRT response was defined prospectively as a >15% reduction in LV end-systolic volume from implant to 6 months. RESULTS The cohort was 68% men, with a mean age of 65±11 years and LV ejection fraction of 28±8%. Longer RV-LV durations were significantly associated with CRT response ( P<0.01) for the entire cohort. Moreover, the benefit of AVO increased as RV-LV duration prolonged. At the longest quartile, there was a 4.26× greater odds of a remodeling response compared with nominal atrioventricular delays ( P=0.010). CONCLUSIONS Baseline interventricular delay predicted CRT response. At long RV-LV durations, AVO can increase the likelihood of reverse remodeling with CRT. AVO and LV lead location optimized to maximize interventricular delay may work synergistically to increase CRT response. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00874445.
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Affiliation(s)
- Michael R. Gold
- Department of Medicine, Medical University of South Carolina, Charleston (M.R.G.)
| | - Yinghong Yu
- Department of Research, Boston Scientific, St. Paul (Y.Y.)
| | - Jagmeet P. Singh
- Department of Medicine, Massachusetts General Hospital, Boston (J.P.S.)
| | | | - Kenneth M. Stein
- Department of Clinical Sciences, Boston Scientific, St. Paul (K.M.S., N.W., T.E.M.)
| | - Nicholas Wold
- Department of Clinical Sciences, Boston Scientific, St. Paul (K.M.S., N.W., T.E.M.)
| | - Timothy E. Meyer
- Department of Clinical Sciences, Boston Scientific, St. Paul (K.M.S., N.W., T.E.M.)
| | - Kenneth A. Ellenbogen
- Department of Medicine, Virginia Commonwealth University Medical Center, Richmond (K.A.E.)
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13
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Fink T, Schlüter M, Kuck KH. From early beginnings to elaborate tools: contribution of German electrophysiology to the interventional treatment of cardiac arrhythmias : The German Cardiac Society welcomes ESC in Munich 2018. Clin Res Cardiol 2018; 107:94-99. [PMID: 30006658 DOI: 10.1007/s00392-018-1319-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Abstract
Catheter ablation evolved from the early days of cardiac electrophysiology (EP), in which invasive electrophysiological studies were mainly a tool to find the correct diagnosis and to evaluate the most effective anti-arrhythmic drug for the patient. Today, catheter ablation is the most effective treatment option for patients suffering from supraventricular and ventricular arrhythmias. The understanding of cardiac arrhythmias and treatment strategies improved because of physicians and scientists from all over the world. The work of German cardiologists led to new achievements in the field of cardiac EP and catheter ablation. In this article, we summarize selective contributions of German EP centres in the field.
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Affiliation(s)
- Thomas Fink
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | | | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
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14
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Wakabayashi Y, Hayashi T, Mitsuhashi T, Momomura SI. Transition of wide QRS tachycardia with left bundle branch block QRS morphology: What is the mechanism? Heart Rhythm 2017; 14:1737-1739. [PMID: 29101966 DOI: 10.1016/j.hrthm.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Yasushi Wakabayashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Takekuni Hayashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan.
| | - Takeshi Mitsuhashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
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15
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Temple IP, Logantha SJRJ, Absi M, Zhang Y, Pervolaraki E, Yanni J, Atkinson A, Petkova M, Quigley GM, Castro S, Drinkhill M, Schneider H, Monfredi O, Cartwright E, Zi M, Yamanushi TT, Mahadevan VS, Gurney AM, White E, Zhang H, Hart G, Boyett MR, Dobrzynski H. Atrioventricular Node Dysfunction and Ion Channel Transcriptome in Pulmonary Hypertension. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.115.003432. [PMID: 27979911 DOI: 10.1161/circep.115.003432] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/10/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Heart block is associated with pulmonary hypertension, and the aim of the study was to test the hypothesis that the heart block is the result of a change in the ion channel transcriptome of the atrioventricular (AV) node. METHODS AND RESULTS The most commonly used animal model of pulmonary hypertension, the monocrotaline-injected rat, was used. The functional consequences of monocrotaline injection were determined by echocardiography, ECG recording, and electrophysiological experiments on the Langendorff-perfused heart and isolated AV node. The ion channel transcriptome was measured by quantitative PCR, and biophysically detailed computer modeling was used to explore the changes observed. After monocrotaline injection, echocardiography revealed the pattern of pulmonary artery blood flow characteristic of pulmonary hypertension and right-sided hypertrophy and failure; the Langendorff-perfused heart and isolated AV node revealed dysfunction of the AV node (eg, 50% incidence of heart block in isolated AV node); and quantitative PCR revealed a widespread downregulation of ion channel and related genes in the AV node (eg, >50% downregulation of Cav1.2/3 and HCN1/2/4 channels). Computer modeling predicted that the changes in the transcriptome if translated into protein and function would result in heart block. CONCLUSIONS Pulmonary hypertension results in a derangement of the ion channel transcriptome in the AV node, and this is the likely cause of AV node dysfunction in this disease.
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Affiliation(s)
- Ian P Temple
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Sunil Jit R J Logantha
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Mais Absi
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Yu Zhang
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Eleftheria Pervolaraki
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Joseph Yanni
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Andrew Atkinson
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Maria Petkova
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Gillian M Quigley
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Simon Castro
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Mark Drinkhill
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Heiko Schneider
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Oliver Monfredi
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Elizabeth Cartwright
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Min Zi
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Tomoko T Yamanushi
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Vaikom S Mahadevan
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Alison M Gurney
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Ed White
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Henggui Zhang
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - George Hart
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
| | - Mark R Boyett
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.).
| | - Halina Dobrzynski
- From the Institute of Cardiovascular Sciences (I.P.T., S.J.R.J.L., M.A., Y.Z., J.Y., A.A., M.P., G.M.Q., H.S., O.M., E.C., M.Z., A.M.G., G.H., M.R.B., H.D.) and School of Physics and Astronomy (S.C., H.Z.), University of Manchester, United Kingdom; School of Biomedical Sciences, University of Leeds, United Kingdom (E.P., M.D., E.W.); Kagawa Prefectural College of Health Sciences, Takamatsu, Japan (T.T.Y.); and Department of Medicine, University of California, San Francisco (V.S.M.)
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Jackman WM. Recording the Accessory His Bundle Potential from a Right Atriofascicular Accessory Pathway. Card Electrophysiol Clin 2016; 8:765-766. [PMID: 27837896 DOI: 10.1016/j.ccep.2016.07.008] [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: 11/18/2022]
Abstract
The author discusses the case of a 42-year-old man with a long history of episodes of rapid palpitations. Recordings from the proximal end of a right atriofascicular accessory pathway at the lateral tricuspid annulus are discussed. There was successful catheter ablation of the right atriofascicular accessory pathway, without recurrence of tachycardia.
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Affiliation(s)
- Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma College of Medicine, 1200 Everett Drive, Rm 6E-103, Oklahoma City, OK 73104, USA.
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Sramko M, Wichterle D, Kautzner J. Feasibility of In-Vivo Simulation of Acute Hemodynamics in Human Atrial Fibrillation. PLoS One 2016; 11:e0165241. [PMID: 27764240 PMCID: PMC5072830 DOI: 10.1371/journal.pone.0165241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/07/2016] [Indexed: 11/18/2022] Open
Abstract
This study evaluated hemodynamic feasibility and reproducibility of a new method for in vivo simulation of human atrial fibrillation (AF). The method was tested during sinus rhythm in 10 patients undergoing catheter ablation for AF. A simple electronic device was assembled that allowed triggering a cardiac stimulator by predefined series of RR intervals. Irregular RR interval sequences with a mean heart rate of 90/min and 130/min were obtained from ECG recordings of another patients with AF. Simultaneous atrioventricular pacing was delivered by catheters placed inside the coronary sinus and at the His bundle region. Hemodynamic effect of the simulated AF was assessed by invasive measurement of the left ventricular (LV) pressure, dP/dt, and Tau. Compared to regular pacing at the same mean heart rate, the simulated AF significantly impaired the LV both systolic and diastolic function. Repeated AF pacing in the same patients generated similar LV hemodynamics. The proposed method provides a realistic and reproducible in-vivo model of AF. It can be exploited for investigation of the hemodynamic consequences of AF in various patient populations.
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Affiliation(s)
- Marek Sramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- * E-mail:
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Wellens HJ, Josephson ME. A woman with a 4-month history of episodes of dizziness. Heart Rhythm 2016; 13:1565-6. [PMID: 27324563 DOI: 10.1016/j.hrthm.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Hein J Wellens
- Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Mark E Josephson
- Cardiovascular Research Institute, Maastricht, The Netherlands; Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Qiu M, Shan Q, Chen C, Geng J, Guo J, Zhou X, Qian W, Tang L, Yin Y. Renal sympathetic denervation improves rate control in patients with symptomatic persistent atrial fibrillation and hypertension. Acta Cardiol 2016; 71:67-73. [PMID: 26853256 DOI: 10.2143/ac.71.1.3132100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The aim of this study was to investigate whether renal sympathetic denervation (RSD) improves ventricular heart rate (HR) control in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS Twenty-one patients (aged 57.5 ± 10.2 years, 76.2% male) with persistent AF and hypertension underwent RSD and completed 7-days follow-up evaluations, including 24-hour Holter monitoring (Holter), blood pressure (BP), 24-hour ambulatory BP monitoring (ABPM). Patients were grouped into tertiles of average HR at baseline Holter recording for evaluation of RSD effects on atrioventricular (AV) node (group 1: HR ≧ 90 bpm; group 2: 80 bpm ≦ HR < 90 bpm; group 3: HR < 80 bpm). RESULTS All patients successfully underwent RSD without any complications. The clinical and procedural characteristics were similar in all groups of patients. No significant changes in BP were observed in the three groups before and after RSD. Compared with baseline, the average HR (Holter) of patients in group 1, 2 and 3 had a reduction of 22.6 ± 13.2 bpm (83.3 ± 4.9 vs 106.0 ± 14.6, P = 0.004), 9.7 ± 7.8 bpm (75.7 ± 7.6 vs 85.4 ± 3.7, P = 0.017) and 2.3 ± 2.9 bpm (71.4 ± 4.0 vs 73.7 ± 4.7, P = 0.089) at 7 days after RSD, respectively. CONCLUSIONS RSD could improve ventricular HR control in patients with persistent AF. RSD slowed AV node conduction in baseline HR-dependent manner. RSD may become an alternative non-pharmaceutical tool for rate control in patients with persistent AF.
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Ferro CRC, de Assis Costa F, Mendonça MA, Rivera I, Ferro FPN, Barbosa JM, Filho ADO, Póvoa R, Cirenza C, de Paola AAV. Correlation of accessory pathway location with gender and their manifest or concealed presentation. Int J Cardiol 2016; 216:43-5. [PMID: 27140335 DOI: 10.1016/j.ijcard.2016.04.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atrioventricular reentrant tachycardias account for approximately one third of cases referred for electrophysiological study (EPS). The anatomical substrate responsible for the reentry is an accessory pathway (AP) able to conduct the electrical stimulus in an anterograde, retrograde or bidirectional manner. OBJECTIVE To evaluate the correlation of AP location with the male and female genders and AP clinical presentation, whether manifest or concealed. METHODS Retrospective observational study including 942 consecutive patients, all diagnosed with EPS-confirmed AP from January 1994 to December 2008. APs were classified into eight anatomical groups: left lateral (LL), left posterior (LP), left posteroseptal (LPS), right posteroseptal (RPS), right midseptal (RMS), right anteroseptal (RAS), right lateral (RL), and right posterior (RP). RESULTS Of the 942 patients, 52.6% were males. The mean age was 31.2±13.8years. As regards gender, APs were more prevalent among men. However, a statistically significant difference was observed only in the LPS (p=0.029) and RL (p=0.003) regions. In relation to the form of presentation of AP, the manifest form was more frequent than the concealed form in six of the eight regions studied, except for the LL and LPS regions. CONCLUSION AP predominated in males and the manifest form was more frequent than the concealed form in most of the regions studied.
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Affiliation(s)
| | | | | | - Ivan Rivera
- Universidade Federal de Alagoas, Universitary Hospital of Alagoas, Brazil
| | | | | | | | - Rui Póvoa
- Universidade Federal de Sao Paulo, Cardiology, Brazil
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Abstract
The classic electrocardiogram in Wolff-Parkinson-White (WPW) syndrome is characterized by a short PR interval and prolonged QRS duration in the presence of sinus rhythm with initial slurring. The clinical syndrome associated with above electrocardiogram finding and the history of paroxysmal supraventricular tachycardia is referred to as Wolff-Parkinson-White syndrome. Various eponyms describing accessory or anomalous conduction pathways in addition to the normal pathway are collectively referred to as preexcitation syndromes. The latter form and associated eponyms are frequently used in literature despite controversy and disagreements over their actual anatomical existence and electrophysiological significance. This communication highlights inherent deficiencies in the knowledge that has existed since the use of such eponyms began. With the advent of curative ablation, initially surgical, and then catheter based, the knowledge gaps have been mostly filled with better delineation of the anatomic and electrophysiological properties of anomalous atrioventricular pathways. It seems reasonable, therefore, to revisit the clinical and electrophysiologic role of preexcitation syndromes in current practice.
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Amasyali B, Tek M. The type of spontaneous termination of supraventricular tachycardia: What does it tell us? Int J Cardiol 2015; 196:29-30. [PMID: 26070180 DOI: 10.1016/j.ijcard.2015.05.172] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/29/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Basri Amasyali
- Dumlupinar University, School of Medicine, Department of Cardiology, Kutahya, Turkey.
| | - Mujgan Tek
- Kecioren Training and Research Hospital, Department of Cardiology, Ankara, Turkey
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Fang F, Sanderson JE, Yu CM. Response to Ivan A. Arenas, MD, PhD, Jason Jacobson, MD, Gervasio A. Lamas, MD. Circ Arrhythm Electrophysiol 2015; 8:738. [PMID: 26280049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Arenas IA, Jacobson J, Lamas GA. Response to Fang Fang, MB, PhD, John E. Sanderson, MD, Cheuk-man Yu, MD. Circ Arrhythm Electrophysiol 2015; 8:729. [PMID: 26280048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Wellens HJ. Electral stimulation of the heart in the study of ventricular tachycardias. Adv Cardiol 2015; 14:65-9. [PMID: 1136893 DOI: 10.1159/000397639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mechanisms of ventricular tachycardia in patients with chronic recurrent tachycardia and patients with acute myocardial infarction were studied by electrical stimulation of the heart. While re-entry was the most likely mechanism in chronic recurrent ventricular tachycardia, focal activity or re-entry in a very small area seemed to be responsible for ventricular tachycardia during acute myocardial infarction.
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Abstract
In patients with WPW syndrome the maximal ventricular rate attained during ectopic rapid supraventricular thythms depended on the type of arrhythmia as well as on the physiological properties of the AP. During reciprocating tachycardias the impulse is almost invariably conducted to the ventricles through the AV node. Therefore, the maxiaml ventricular rate is a function of the AV nodal ERP. On the other hand, when atrial flutter or atrial fibrillation were present the ventricular rate could be moderately elevated (when the ERP of the AP was longer than that of the AV node) or very rapid where the ERP of the AP was significantly short. Therefore, from the electrophysiological viewpoint, the AP appears to behave as His-Purkinje tissue in some cases and as ordinary artrial muscle in other patients. These assumptions await further documentation.
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Homola D, Srnova V. Anomalous atrio-ventricular connections and their features. Adv Cardiol 2015; 16:540-4. [PMID: 5860 DOI: 10.1159/000398457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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von Leitner ER, Meyer V. His electrocardiogram during atrial stimulation in 50 patients with transient cerebral symptoms. Adv Cardiol 2015; 19:273-6. [PMID: 835428 DOI: 10.1159/000399686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Georgiev L, Atanassov A. Significance of impaired conduction between the sinus node and right atrium for appearance of absolute arrhythmia in mitral stenosis. Adv Cardiol 2015; 19:208-10. [PMID: 835409 DOI: 10.1159/000399665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Laucevicius A, Matulis A, Montvila Z. Clinico-experimental approach in the study of intermittent disorders of sinoatrial and atrial electrical activity. Adv Cardiol 2015; 28:126-9. [PMID: 7234560 DOI: 10.1159/000391961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Singh M, LeLorier PA, Celebi MM, Glancy DL. ECG Case of the Month: Unexpected Atrioventricular Conduction in High-Grade Atrioventricular Block. Sinus rhythm; high-grade second degree atrioventricular block with a junctional escape rhythm and three capture complexes, each with right bundle branch block aberration; possible septal myocardial infarct of indeterminate age; ST-T and U wave changes suggesting hypokalemia. J La State Med Soc 2015; 167:97-99. [PMID: 25978059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 90-year-old man with a history of high blood pressure, a cerebrovascular accident without focal residua, dementia, and stage 3 chronic kidney disease went to the emergency department because of dizziness and near syncope. His medications were aspirin 81 mg qd, clopidogrel 75 mg qod, escitalopram oxalate 10 mg qd, Seroquel 25 mg qd, and memantine hydrochloride 10 mg qd. He had orthostatic hypotension with supine blood pressure of 173/77 mm Hg falling to 116/68 on standing, while pulse increased from 66 to 84 beats/ min. He received IV fluid and returned home. Two days later he saw his primary care physician because of episodes of dizziness and confusion. The figure shows an electrocardiogram recorded during that visit.
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Affiliation(s)
| | - Paul A LeLorier
- Associate Professor of Medicine and Neurology and Director of the Electrophysiology Service at the LSUHSC in New Orleans, LA
| | | | - D Luke Glancy
- Emeritus Professor of Medicine in the Cardiology Section of the LSUHSC New Orleans, LA
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Liu GX, Remme CA, Boukens BJ, Belardinelli L, Rajamani S. Overexpression of SCN5A in mouse heart mimics human syndrome of enhanced atrioventricular nodal conduction. Heart Rhythm 2015; 12:1036-45. [PMID: 25623181 DOI: 10.1016/j.hrthm.2015.01.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 09/09/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND In enhanced atrioventricular (A-V) nodal conduction (EAVNC) syndrome, patients have short A-V conduction times. Multiple mechanisms have been proposed to explain EAVNC; however, the electrophysiological or molecular substrate responsible for it remains unclear. OBJECTIVE The purpose of this study was to test the hypothesis that overexpression of SCN5A in the mouse heart may provide an animal model mimicking EAVNC. METHODS Electrocardiogram, atrial, His bundle, and ventricular electrograms were recorded from wild-type (WT) and transgenic (TG) mice overexpressing human SCN5A. The sodium current and NaV1.5 expression were measured using patch-clamp and immunohistochemistry techniques. RESULTS The P-R interval in TG mice (13.6 ± 1.2 ms) was much shorter than that in WT mice (40.2 ± 0.59 ms). In TG isolated hearts, the A-V conduction time (14.4 ± 0.81 ms) during right atrial pacing was also shorter than that in WT hearts (39.5 ± 0.62 ms). Records of His bundle electrograms revealed that atrial-to-His and His-to-ventricular intervals were shorter in TG than in WT hearts. In addition, TG hearts had a shorter Wenckebach cycle length and A-V effective refractory period. The sodium current was 2-fold greater in TG ventricular myocytes than in WT ventricular myocytes. Flecainide prolonged the A-V conduction time in TG hearts to a value close to that in WT hearts. Nifedipine prolonged the atrial-to-His interval in WT hearts but not in TG hearts. Immunohistochemistry studies revealed increased NaV1.5 labeling in TG atrial and ventricular tissues, and NaV1.5 expression in A-V junction and A-V ring regions in TG hearts. CONCLUSION Enhanced A-V conduction in mice overexpressing SCN5A in the heart mimics the human syndrome of EAVNC. Thus, variants in sodium channel expression in the A-V nodal region may be an electrophysiological substrate responsible for EAVNC.
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Affiliation(s)
- Gong Xin Liu
- Department of Biology, Gilead Sciences, Fremont, California
| | - Carol Ann Remme
- Department of Experimental Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Bastiaan J Boukens
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
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Berruezo A, Penela D, Burgos F, Evertz R, Fernández-Armenta J, Roca J, Doltra A, Acosta J, Francino A, Sitges M, Alsina X, Ordoñez A, Villuendas R, Brugada R, Mont L, Brugada J. Optimized pacing mode for hypertrophic cardiomyopathy: Impact of ECG fusion during pacing. Heart Rhythm 2015; 12:909-16. [PMID: 25623178 DOI: 10.1016/j.hrthm.2015.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 12/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) fusion with intrinsic QRS could reduce the benefit of atrial synchronous biventricular pacing (AS-BiVP) in patients with hypertrophic obstructive cardiomyopathy (HOCM). OBJECTIVES The purpose of this study was to assess the benefit of AS-BiVP and the influence of ECG fusion for reduction of left ventricular outflow tract gradient (LVOTG) in these patients. METHODS Twenty-one symptomatic HOCM patients with severe LVOTG were included. Twelve patients were evaluated retrospectively for the prevalence of fusion and its influence on outcomes after AS-BiVP. Eleven patients (2 of the first population were also evaluated retrospectively) were prospectively included to evaluate the benefit of performing atrioventricular node ablation (AVNA) to achieve full ventricular capture if fusion was present during AS-BiVP. RESULTS Seven of the first 12 patients (58%) had ECG fusion. After 54 ± 24 months of AS-BiVP, the presence of fusion was associated with lower values for reduction of resting, dynamic LVOTG and New York Heart Association (NYHA) class. In the prospectively evaluated patients, after 12 months of follow-up, resting LVOTG decreased from 98 ± 39 to 39 ± 24 mm Hg (P = .008); dynamic LVOTG decreased from 112 ± 38 to 60 ± 24 mm Hg (P = .013); NYHA class decreased from 2.8 ± 0.4 to 1.7 ± 0.6 (P = .014); endurance time during constant work rate cycling exercise (80% of peak oxygen consumption) increased from 399 ± 148 to 691 ± 249 seconds (P = .046); quality of life improved from 46 ± 22 to 22 ± 20 points (P = .02); and brain natriuretic peptide levels decreased from 318 ± 238 to 152 ± 118 pg/mL (P = .09). Eight of the 11 prospectively evaluated patients (73%) needed AVNA, which further decreased LVOTG from 108 ± 40 mm Hg at baseline to 89 ± 29 mm Hg after BiVP to 54 ± 22 mm Hg after AVNA (P = .003). CONCLUSION As-BiVP that ensures no ECG fusion, by means of AVNA when needed, appears to be the optimal pacing mode in HOCM patients.
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MESH Headings
- Ablation Techniques/adverse effects
- Ablation Techniques/methods
- Adult
- Aged
- Atrioventricular Node/physiopathology
- Atrioventricular Node/surgery
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathy, Hypertrophic, Familial/complications
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Cardiomyopathy, Hypertrophic, Familial/surgery
- Echocardiography, Doppler, Color/methods
- Electrocardiography/methods
- Female
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Severity of Illness Index
- Spain
- Treatment Outcome
- Ventricular Outflow Obstruction/diagnosis
- Ventricular Outflow Obstruction/etiology
- Ventricular Outflow Obstruction/surgery
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Affiliation(s)
- Antonio Berruezo
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain.
| | - Diego Penela
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Felip Burgos
- Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CibeRes), Palma de Mallorca, Spain
| | - Reinder Evertz
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Juan Fernández-Armenta
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Josep Roca
- Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CibeRes), Palma de Mallorca, Spain
| | - Ada Doltra
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Juan Acosta
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Antonio Francino
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Marta Sitges
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Xavi Alsina
- Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Augusto Ordoñez
- Cardiology Department, Hospital Sant Pau I Santa Tecla, Tarragona, Catalonia, Spain
| | - Roger Villuendas
- Arrhythmia Section, Cardiology Department, Hospital Germans Trias i Pujol de Badalona, Catalonia, Spain
| | - Ramón Brugada
- Department of Medical Sciences, University of Girona, Catalonia, Spain and Cardiology Service, Hospital Josep Trueta, Girona, Catalonia, Spain
| | - Lluis Mont
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
| | - Josep Brugada
- Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain
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Jauregui-Abularach ME, Bazan V, Martí-Almor J, Cian D, Vallès E, Benito B, Meroño O, Bruguera-Cortada J. Characterization of the nodal slow pathway in patients with nodal reentrant tachycardia: clinical implications for guiding ablation. ACTA ACUST UNITED AC 2014; 68:298-304. [PMID: 25440045 DOI: 10.1016/j.rec.2014.04.017] [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] [Received: 10/27/2013] [Accepted: 04/04/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVES Nodal slow pathway ablation is the treatment of choice for nodal reentrant tachycardia. No demographic, anatomic, or electrophysiologic variables have been reported to predict an exact location of the slow pathway in the atrioventricular node or its proximity to the fast pathway. The purpose of this study was to analyze these variables. METHODS The study prospectively included 54 patients (17 men; mean age, 55 [16] years) who had undergone successful slow pathway ablation. The refractory periods of both pathways and their differential conduction time were measured, and calculations were performed to obtain the distance from the His-bundle region (location of the fast pathway) to the coronary sinus ostium (to estimate the anteroposterior length of the triangle of Koch) and to the slow pathway area. RESULTS The differential conduction time (139 [98] ms) did not correlate with the His-coronary sinus distance (19 [6] mm; P=.6) or the His-slow pathway distance (14 [4] mm; P=.4). When the His-coronary sinus distance was larger, the His-slow pathway distance was also larger (r=0.652; P<.01) and the anatomic correlation between the triangle dimensions and the separation between the two pathways was confirmed. In patients older than 70 years, smaller triangle sizes and a shorter distance between both pathways were observed (P<.001). CONCLUSIONS A greater anteroposterior dimension of the triangle of Koch is associated with a slow-pathway location farther from the fast pathway. In elderly patients the two pathways are closer together (higher risk of atrioventricular block).
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Affiliation(s)
| | - Victor Bazan
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Julio Martí-Almor
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Debora Cian
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Ermengol Vallès
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Begoña Benito
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Oona Meroño
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
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Shawa H, Bajaj M, Cunningham GR. Pheochromocytoma-induced atrial tachycardia leading to cardiogenic shock and cardiac arrest: resolution with atrioventricular node ablation and pacemaker placement. Tex Heart Inst J 2014; 41:660-3. [PMID: 25593537 DOI: 10.14503/thij-13-3692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, <0.15) that did not respond to the placement of an intra-aortic balloon pump. A TandemHeart(®) Percutaneous Ventricular Assist Device was inserted emergently. After atrioventricular node ablation and placement of a temporary pacemaker, the TandemHeart was removed. Computed tomography of the abdomen revealed a pheochromocytoma. After placement of a permanent pacemaker, the patient underwent a right adrenalectomy. This is, to our knowledge, the first reported case of pheochromocytoma-induced atrial tachyarrhythmia that led to cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature.
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MESH Headings
- Adrenal Gland Neoplasms/complications
- Adrenal Gland Neoplasms/diagnosis
- Adrenal Gland Neoplasms/surgery
- Adrenalectomy
- Adult
- Atrioventricular Node/physiopathology
- Atrioventricular Node/surgery
- Cardiac Pacing, Artificial
- Catheter Ablation
- Electrocardiography
- Female
- Heart Arrest/diagnosis
- Heart Arrest/etiology
- Heart Arrest/therapy
- Humans
- Pacemaker, Artificial
- Pheochromocytoma/complications
- Pheochromocytoma/diagnosis
- Pheochromocytoma/surgery
- Predictive Value of Tests
- Shock, Cardiogenic/diagnosis
- Shock, Cardiogenic/etiology
- Shock, Cardiogenic/therapy
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/etiology
- Tachycardia, Supraventricular/physiopathology
- Tachycardia, Supraventricular/therapy
- Tomography, X-Ray Computed
- Treatment Outcome
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Li J, Inada S, Schneider JE, Zhang H, Dobrzynski H, Boyett MR. Three-dimensional computer model of the right atrium including the sinoatrial and atrioventricular nodes predicts classical nodal behaviours. PLoS One 2014; 9:e112547. [PMID: 25380074 PMCID: PMC4224508 DOI: 10.1371/journal.pone.0112547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/07/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of the study was to develop a three-dimensional (3D) anatomically-detailed model of the rabbit right atrium containing the sinoatrial and atrioventricular nodes to study the electrophysiology of the nodes. A model was generated based on 3D images of a rabbit heart (atria and part of ventricles), obtained using high-resolution magnetic resonance imaging. Segmentation was carried out semi-manually. A 3D right atrium array model (∼3.16 million elements), including eighteen objects, was constructed. For description of cellular electrophysiology, the Rogers-modified FitzHugh-Nagumo model was further modified to allow control of the major characteristics of the action potential with relatively low computational resource requirements. Model parameters were chosen to simulate the action potentials in the sinoatrial node, atrial muscle, inferior nodal extension and penetrating bundle. The block zone was simulated as passive tissue. The sinoatrial node, crista terminalis, main branch and roof bundle were considered as anisotropic. We have simulated normal and abnormal electrophysiology of the two nodes. In accordance with experimental findings: (i) during sinus rhythm, conduction occurs down the interatrial septum and into the atrioventricular node via the fast pathway (conduction down the crista terminalis and into the atrioventricular node via the slow pathway is slower); (ii) during atrial fibrillation, the sinoatrial node is protected from overdrive by its long refractory period; and (iii) during atrial fibrillation, the atrioventricular node reduces the frequency of action potentials reaching the ventricles. The model is able to simulate ventricular echo beats. In summary, a 3D anatomical model of the right atrium containing the cardiac conduction system is able to simulate a wide range of classical nodal behaviours.
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Affiliation(s)
- Jue Li
- Institute of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, United Kingdom
| | - Shin Inada
- Institute of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, United Kingdom
| | - Jurgen E. Schneider
- Institute of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, United Kingdom
| | - Henggui Zhang
- Institute of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, United Kingdom
| | - Halina Dobrzynski
- Institute of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, United Kingdom
| | - Mark R. Boyett
- Institute of Cardiovascular Sciences, University of Manchester, Core Technology Facility, Manchester, United Kingdom
- * E-mail:
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39
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Sánchez C, Bueno-Orovio A, Wettwer E, Loose S, Simon J, Ravens U, Pueyo E, Rodriguez B. Inter-subject variability in human atrial action potential in sinus rhythm versus chronic atrial fibrillation. PLoS One 2014; 9:e105897. [PMID: 25157495 PMCID: PMC4144914 DOI: 10.1371/journal.pone.0105897] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/26/2014] [Indexed: 02/07/2023] Open
Abstract
AIMS Human atrial electrophysiology exhibits high inter-subject variability in both sinus rhythm (SR) and chronic atrial fibrillation (cAF) patients. Variability is however rarely investigated in experimental and theoretical electrophysiological studies, thus hampering the understanding of its underlying causes but also its implications in explaining differences in the response to disease and treatment. In our study, we aim at investigating the ability of populations of human atrial cell models to capture the inter-subject variability in action potential (AP) recorded in 363 patients both under SR and cAF conditions. METHODS AND RESULTS Human AP recordings in atrial trabeculae (n = 469) from SR and cAF patients were used to calibrate populations of computational SR and cAF atrial AP models. Three populations of over 2000 sampled models were generated, based on three different human atrial AP models. Experimental calibration selected populations of AP models yielding AP with morphology and duration in range with experimental recordings. Populations using the three original models can mimic variability in experimental AP in both SR and cAF, with median conductance values in SR for most ionic currents deviating less than 30% from their original peak values. All cAF populations show similar variations in G(K1), G(Kur) and G(to), consistent with AF-related remodeling as reported in experiments. In all SR and cAF model populations, inter-subject variability in I(K1) and I(NaK) underlies variability in APD90, variability in I(Kur), I(CaL) and I(NaK) modulates variability in APD50 and combined variability in Ito and I(Kur) determines variability in APD20. The large variability in human atrial AP triangulation is mostly determined by I(K1) and either I(NaK) or I(NaCa) depending on the model. CONCLUSION Experimentally-calibrated human atrial AP models populations mimic AP variability in SR and cAF patient recordings, and identify potential ionic determinants of inter-subject variability in human atrial AP duration and morphology in SR versus cAF.
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Affiliation(s)
- Carlos Sánchez
- Biosignal Interpretation and Computational Simulation (BSICoS), Aragón Institute of Engineering Research (I3A) and Aragón Health Research Institute (IIS), University of Zaragoza, Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | | | - Erich Wettwer
- Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany
| | - Simone Loose
- Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany
| | - Jana Simon
- Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany
| | - Ursula Ravens
- Department of Pharmacology and Toxicology, Dresden University of Technology, Dresden, Germany
| | - Esther Pueyo
- Biosignal Interpretation and Computational Simulation (BSICoS), Aragón Institute of Engineering Research (I3A) and Aragón Health Research Institute (IIS), University of Zaragoza, Zaragoza, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Zaragoza, Spain
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Hayashi T, Fukamizu S, Hojo R, Nishizaki M, Hiraoka M, Momomura SI, Sakurada H. Identical atrio-His interval and A-A intervals during long RP tachycardia: what is the mechanism? Diagnosis: Atypical AVNRT. Circ Arrhythm Electrophysiol 2014; 7:352-4. [PMID: 24736425 DOI: 10.1161/circep.113.001010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takekuni Hayashi
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
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41
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Insulander P, Bastani H, Jensen-Urstad M. Cooling of the atrioventricular node to unmask an accessory pathway. Europace 2014; 16:1594. [PMID: 24554522 DOI: 10.1093/europace/euu005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Per Insulander
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, S-141 86 Stockholm, Sweden
| | - Hamid Bastani
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, S-141 86 Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, S-141 86 Stockholm, Sweden
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42
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Corino VDA, Sandberg F, Mainardi LT, Sornmo L. Statistical modeling of the atrioventricular node during atrial fibrillation: data length and estimator performance. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2567-70. [PMID: 24110251 DOI: 10.1109/embc.2013.6610064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The atrioventricular (AV) node plays a central role during atrial fibrillation (AF). We have recently proposed a statistical AV node model defined by parameters characterizing the arrival rate of atrial impulses, the probability of an impulse choosing either one of the dual AV nodal pathways, the refractory periods of the pathways, and the prolongation of refractory periods. All model parameters are estimated from the RR series using maximum likelihood (ML) estimation, except for the mean arrival rate of atrial impulses which is estimated by the AF frequency derived from the f-waves. The aim of this study is to present a unified approach to ML estimation which also involves the shorter refractory period, thus avoiding our previous Poincaré plot analysis which becomes biased. In addition, the number of RR intervals required for accurate parameter estimation is presented. The results show that the shorter refractory period can be accurately estimated, and that the resulting estimates converge to the true values when about 500 RR intervals are available.
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43
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Müggler SA, Iseli SM, Meindl-Fridez C, Nowak A, Brunckhorst CB. [Atrioventricular nodal re-entry tachycardia]. Praxis (Bern 1994) 2013; 102:1155-1164. [PMID: 24025171 DOI: 10.1024/1661-8157/a001452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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44
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Eksik A, Gul M, Uyarel H, Surgit O, Yildirim A, Uslu N, Aksu H, Turen S, Uzun F, Satılmısoglu H, Erol MK, Bakir I. Electrophysiological evaluation of atrioventricular conduction disturbances in transcatheter aortic valve implantation with Edwards SAPIEN prosthesis. J Invasive Cardiol 2013; 25:305-309. [PMID: 23735359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIMS Permanent pacemaker requirement is a known complication after transcatheter aortic valve implantation (TAVI). The aim of the present study was to analyze the effects of Edwards SAPIEN prosthesis implantation on atrioventricular conduction. METHODS The study included 28 patients who underwent TAVI due to severe aortic valve stenosis. An electrophysiological study was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after Edwards SAPIEN prosthesis implantation. RESULTS His-ventricle interval was significantly prolonged postprocedure (55.9 ± 11.5 ms) vs preprocedure (47.3 ± 7.8 ms) (P<.001). The antegrade Wenckebach point was observed to be significantly prolonged postprocedure (354.4 ± 41.3 ms) vs preprocedure (333.7 ± 45.4 ms) (P=.001). Despite atrial-His interval prolongation, it was not statistically significant. After the procedure, we observed significant conduction disturbances in 3 patients (10.7%). These conduction problems recovered before discharge. One of the patients (3.6%) with right bundle branch block + left anterior fascicular block required permanent pacemaker implantation. At postprocedure electrocardiogram, QRS duration increased, QRS axis shifted to the left, and both of the values became normal before discharge. The patient's echocardiographic and clinical parameters were improved during follow-up. CONCLUSION The effect of Edwards SAPIEN on the conduction system was mostly infranodal and temporary. The physical properties of the Edwards SAPIEN prosthesis may explain this observation. This complication may be lessened if the frame height characteristics can be improved.
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Affiliation(s)
- Abdurrahman Eksik
- 1Istanbul Mehmet Akif Ersoy Thoracic – Cardiovascular Surgery Training and Research Hospital Cardiology Department, Istanbul, Turkey.
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Abstract
BACKGROUND The performance of the Reverse Mode Switch (RMS) algorithm, aimed at minimizing right ventricular pacing by operating in the AAI(R) mode with switch to the DDD(R) mode if atrioventricular (AV) conduction loss is detected, is not well known. OBJECTIVE To determine the appropriateness of the RMS episodes available from patient follow-up data at our center. METHODS Patients with the TELIGEN dual-chamber implantable cardioverter-defibrillator and the RMS algorithm activated were identified. The RMS episodes with available electrograms were analyzed and classified as appropriate (AV conduction loss) or inappropriate (non-AV conduction loss) events. Cumulative percentage of ventricular pacing and amount of premature ventricular complexes (PVCs) were recorded. RESULTS Of 21 patients, RMS episodes had occurred in 19 of them, with a mean of 527 episodes per month. Of the 172 RMS episodes available for analysis, 27 (16%) were classified as appropriate and 145 (84%) as inappropriate. Almost all (91%) inappropriate RMS episodes were due to PVC, and there was a positive correlation between the number of total RMS episodes per month and the number of PVCs per month (P < .0005). Considering patients with only inappropriate RMS episodes (n = 11), there was a positive correlation between the percentage of ventricular pacing and the number of RMS episodes per month (P < .05). CONCLUSIONS A large majority of the RMS episodes available for analysis inappropriately triggered switch from the AAI(R) mode to the DDD(R) mode owing to PVCs. Patients with the RMS algorithm and elevated PVC burden are probably at risk of a high percentage of unnecessary right ventricular pacing.
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Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de Salud, Toledo, Spain
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46
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Hostiuc S, Popescu A, Guţu ED, Rusu MC, Pop F. Electrical conduction system apoptosis in type II diabetes mellitus. Rom J Morphol Embryol 2013; 54:953-959. [PMID: 24398990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Even though apoptosis is known to be associated with various cardiovascular pathologies, its presence in cardiac nodal tissue in adults was only scarcely researched. Cardiomyocyte apoptosis was associated with diabetic cardiovascular pathology. Our main objective was to test whether programmed cell death is present in nodal tissue in type II diabetes mellitus and, if present to characterize it. The study was designed as a qualitative one. We used autopsy samples of hearts from 10 patients (56 to 73-year-old, 6:4 male to female ratio), positive for type II diabetes mellitus. Samples from sinoatrial and atrioventricular nodes were stained with Hematoxylin-Eosin. For immunohistochemistry, we used primary antibodies for caspases 3 and 9, cathepsin B, and TRADD. Nodal tissue in all samples was characterized by diffuse interstitial fibrosis and chronic ischemic lesions; nuclear damage and foci of irreversible ischemic necrosis intermingled with isles of relatively morphologically normal myocytes. Sinoatrial and atrioventricular nodes were caspase-3 and -9 positive, and also cathepsin-B-positive, suggesting an overlap between apoptotic and necrotic mechanisms. Central area of the sinus node seemed to have the most severe lesions. As a conclusion, nodal apoptosis is present in nodal tissue in type II diabetes mellitus; it involves the intrinsic pathway and associated concomitant and/or post-apoptotic necrosis.
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Affiliation(s)
- S Hostiuc
- Discipline of Anatomy, Faculty of Dental Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
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47
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Boyle PM, Veenhuyzen GD, Vigmond EJ. Fusion during entrainment of orthodromic reciprocating tachycardia is enhanced for basal pacing sites but diminished when pacing near Purkinje system end points. Heart Rhythm 2012. [PMID: 23207137 DOI: 10.1016/j.hrthm.2012.11.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the electrophysiological laboratory, orthodromic atrioventricular reciprocating tachycardia (ORT) can be distinguished from atrial tachycardia and atrioventricular node reentry tachycardia by identifying orthodromic and antidromic wavefront fusion during ventricular overdrive pacing (VOP). Previous work has shown that basal VOP near the accessory pathway (AP) increases the likelihood of observing fusion; however, in a third of cases, fusion is not appreciable regardless of VOP location. OBJECTIVE To explore the hypothesis that pacing near His-Purkinje system (PS) end points reduces fusion quality, which may explain patients with nonresponsive ORT. METHODS In a novel computer model of ORT, simulations were performed with a variety of AP locations and pacing sites; results were analyzed to assess factors influencing fusion quality in pseudo-electrocardiogram signals. RESULTS Entrainment by basal VOP near the AP was more likely to produce fusion visible on simulated electrocardiograms compared to entrainment by apical VOP, but this advantage was dramatically diminished when the pacing site was also near PS end points. Prediction of fusion quality based on AP proximity alone was dramatically improved when corrected to penalize for PS proximity. CONCLUSIONS These results suggest that basal VOP near the AP and far from the PS is optimal; this could be tested in patients. A denser basal ramification of PS fibers is known to exist in a minority of human hearts; our findings indicate that this unusual PS configuration is a plausible explanation for ORT cases where fusion is never observed in spite of entrainment by basal VOP near the AP.
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Affiliation(s)
- Patrick M Boyle
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD 21218, USA.
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Hein W, Ellringmann U, Vollmann D, Rostock T, Schott P. [Recurrent failed ICD therapy of ventricular tachycardia]. Med Klin Intensivmed Notfmed 2012; 107:641-4. [PMID: 23070331 DOI: 10.1007/s00063-012-0150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022]
Abstract
Implantable cardioverter defibrillators (ICD) are used as standard therapy to prevent sudden cardiac death in heart failure patients. Today, physicians in emergency and intensive care medicine are often confronted with problems of ICD therapy in these patients. We report a case of a patient suffering from recurrent ventricular tachycardia (VT) requiring antiarrhythmia treatment with amiodarone. With an increasing drug loading, the VT cycle length was progressively prolonged resulting in a slow VT undetectable for the ICD. Subsequently, the patient was scheduled for VT ablation after which the patient became free of arrhythmia recurrences.
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Affiliation(s)
- W Hein
- Abteilung Kardiologie und internistische Intensivmedizin, Klinikum Werra-Meißner Eschwege, Elsa-Brändström-Straße 1, Eschwege, Germany.
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Chandra A, Mani BC, Frisch DR. 'Ablation before pacemaker' in a patient with bradycardia: a case report. QJM 2012; 105:1007-9. [PMID: 21880699 DOI: 10.1093/qjmed/hcr147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Chandra
- Department of cardiology, Thomas Jefferson University Hospital, 925 Chestnut Street, Mezzanine, Philadelphia, PA 19107, USA.
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50
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