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Joustra R, Boulaksil M, Meijburg HW, Smeets JL. Dizziness and slow heart rate during exercise. Neth Heart J 2017; 25:461-462. [PMID: 28401472 PMCID: PMC5513998 DOI: 10.1007/s12471-017-0983-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Affiliation(s)
- R Joustra
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M Boulaksil
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H W Meijburg
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - J L Smeets
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Joustra R, Polderman FN, Smeets JL, Daniëls MC, Boulaksil M. Typical ECG findings in an unconscious patient. Neth Heart J 2016; 25:215-216. [PMID: 27785617 PMCID: PMC5313442 DOI: 10.1007/s12471-016-0909-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R Joustra
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F N Polderman
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - J L Smeets
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M C Daniëls
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M Boulaksil
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. .,Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Boulaksil M, Robbers-Visser D, Westra S, Smeets JL. Recurrent syncope: a slow heart rate? Neth Heart J 2013; 21:423. [PMID: 23864482 PMCID: PMC3751020 DOI: 10.1007/s12471-013-0449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- M Boulaksil
- Department of Cardiology 670, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands,
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Boulaksil M, Robbers-Visser D, Westra S, Smeets JL. Recurrent syncope: a slow heart rate? Neth Heart J 2013; 21:420. [PMID: 23852750 PMCID: PMC3751021 DOI: 10.1007/s12471-013-0448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- M Boulaksil
- Department of Cardiology 670, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, the Netherlands,
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Abstract
A catheter-based method of mapping left ventricular electromechanical regional function may be used to optimize application of local myocardial therapies by demarcating zones of ischemia or infarction. We thus performed a detailed comparison between electromechanical parameters and segmental function as assessed by echocardiography in 10 patients (3 with normal ventricles and 7 with old infarcts). Using a 16-segment model, unipolar voltage and local shortening were significantly and independently related to echo score by multivariate analysis, having a concordance with echo score of 73% for shortening and 79% for voltage. Area under ROC curves, expressing the ability to differentiate normal from abnormal segments, had values of 0.75 and 0.81 for local shortening and unipolar voltage, respectively. In conclusion, automatic assessment of regional ventricular function can be achieved independently by electrical and mechanical parameters, compared with echocardiography, permitting an integrated approach to the evaluation of ventricular function and aiding localization of catheter-based therapies.
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Affiliation(s)
- J Lessick
- Department of Cardiology, Rambam Medical Center, Haifa, Israel.
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Nabar A, Rodriguez LM, Timmermans C, Smeets JL, Wellens HJ. Isoproterenol to evaluate resumption of conduction after right atrial isthmus ablation in type I atrial flutter. Circulation 1999; 99:3286-91. [PMID: 10385504 DOI: 10.1161/01.cir.99.25.3286] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND After radiofrequency (RF) ablation of atrial flutter (AFL), the demonstration of bidirectional isthmus conduction (BIC) block is considered the hallmark of a successful procedure. The purpose of our study was to test the persistence of BIC block after isoproterenol administration and to evaluate the importance of this finding with regard to AFL recurrences. METHODS AND RESULTS RF ablation of AFL was performed in 44 consecutive patients with type I AFL by linear ablation of the posterior isthmus (n=29 patients), septal isthmus (n=4 patients), or both right atrial (RA) isthmi (n=11 patients). The procedural end point was complete BIC block and noninducibility of AFL. In case of noninducibility and apparent BIC block, the pacing protocol was repeated under isoproterenol infusion (1 to 3 microgram/min). Reversal of apparent BIC block occurred in 7 (15.9%) of 44 patients. Six patients had bidirectional and 1 had unidirectional resumption of isthmus conduction. Counterclockwise AFL could be reinduced in 4 of these patients. Two to 24 (median, 4) additional RF applications were required to achieve permanent BIC block. At a mean follow-up of 7.3+/-7.6 months (range, 2 to 31 months), 2 (4.5%) of 44 patients had AFL recurrences. CONCLUSIONS Partial linear RF ablation could possibly aggravate preexisting nonuniform anisotropic conduction in the RA isthmus, resulting in profound conduction slowing and apparent BIC block. Isoproterenol can unmask apparent BIC block, thus providing an opportunity to assess the possibility of reversal of BIC block and completeness of isthmus ablation during the same procedure. The low incidence (4.5%) of AFL recurrences at follow-up suggests that noninducibility and BIC block under isoproterenol infusion may be a better end point for successful AFL ablation.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands
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Timmermans C, Rodriguez LM, Ayers GM, Lambert H, Smeets JL, Vlaeyen JW, Albert A, Wellens HJ. Effect of butorphanol tartrate on shock-related discomfort during internal atrial defibrillation. Circulation 1999; 99:1837-42. [PMID: 10199880 DOI: 10.1161/01.cir.99.14.1837] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with atrial fibrillation, intracardiac atrial defibrillation causes discomfort. An easily applicable, short-acting analgesic and anxiolytic drug would increase acceptability of this new treatment mode. METHODS AND RESULTS In a double-blind, placebo-controlled manner, the effect of intranasal butorphanol, an opioid, was evaluated in 47 patients with the use of a step-up internal atrial defibrillation protocol (stage I). On request, additional butorphanol was administered and the step-up protocol continued (stage II). Thereafter, if necessary, patients were intravenously sedated (stage III). After each shock, the McGill Pain Questionnaire was used to obtain a sensory (S), affective (A), evaluative (E), and total (T) pain rating index (PRI) and a visual analogue scale analyzing pain (VAS-P) and fear (VAS-F). For every patient, the slope of each pain or fear parameter against the shock number was calculated and individual slopes were averaged for the placebo and butorphanol group. All patients were cardioverted at a mean threshold of 4.4+/-3.3 J. Comparing both patient groups for stage II, the mean slopes for PRI-T (P=0.0099), PRI-S (P=0.019), and PRI-E (P=0.015) became significantly lower in the butorphanol group than in the placebo group. Comparing patients who received the same shock intensity ending stage I and going to stage II, in those patients randomized to placebo the mean VAS-P (P=0.023), PRI-T (P=0. 029), PRI-S (P=0.030), and PRI-E (P=0.023) became significantly lower after butorphanol administration. CONCLUSIONS During a step-up internal atrial defibrillation protocol, intranasal butorphanol decreased or stabilized the value of several pain variables and did not affect fear. Of the 3 qualitative components of pain, only the affective component was not influenced by butorphanol. The PRI evaluated pain more accurately than the VAS.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Nabar A, Rodriguez LM, Timmermans C, van den Dool A, Smeets JL, Wellens HJ. Effect of right atrial isthmus ablation on the occurrence of atrial fibrillation: observations in four patient groups having type I atrial flutter with or without associated atrial fibrillation. Circulation 1999; 99:1441-5. [PMID: 10086967 DOI: 10.1161/01.cir.99.11.1441] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The goal of this study was to test the hypothesis that the occurrence of atrial fibrillation (AF), in at least some patients with coexisting type I atrial flutter (AFL), is based on macro-reentry around the tricuspid valve orifice, including the right atrial (RA) isthmus, by evaluation of AF recurrences after successful ablation of AFL. METHODS AND RESULTS Eighty-two consecutive patients with type I AFL, with or without concomitant AF, underwent radiofrequency ablation (RFA) of the RA isthmus by an anatomical approach. The results were analyzed in 4 groups of patients: group 1 (only AFL; 29 patients), group 2 (AFL >AF; 22 patients), group 3 (AF >AFL; 15 patients), and group 4 (developing AFL while receiving class IC antiarrhythmic drug therapy for AF, the "class IC atrial flutter"; 16 patients). In all groups, RFA of type I AFL was performed with a high (>/=93%) procedural success rate. In group 1, only 2 patients (8%) had AF after (18+/-14 months) AFL ablation. These figures were 38% (20+/-14 months) and 86% (13+/-8 months) in groups 2 and 3, respectively. Group 4 patients (4+/-2 months) had a 73% freedom of AF recurrences with continuation of the class IC agent. CONCLUSIONS The low incidence of new AF during long-term follow-up after RFA of type I AFL makes it unlikely that radiofrequency lesions promote the development of AF. The impact of isthmus ablation on AF recurrences differs according to the clinically predominant atrial arrhythmia and suggests a possible role of the RA isthmus in the occurrence of AF in some patients. Ablation of class IC atrial flutter in patients with therapy-resistant AF is a novel approach to management of this patient subset. Careful classification of AF patients plays a role in the selection of the site of ablation therapy.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands
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10
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Abstract
In some patients with atrial fibrillation, atrial flutter develops after administration of class IC antiarrhythmic drugs, the so-called class IC atrial flutter. Radiofrequency ablation of the right atrial isthmus results in clinical improvement in 85% of patients and provides an alternative management strategy for a subset of patients with therapy-resistant atrial fibrillation.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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Rodriguez LM, Leunissen J, Hoekstra A, Korteling BJ, Smeets JL, Timmermans C, Vos M, Daemen M, Wellens HJ. Transvenous cold mapping and cryoablation of the AV node in dogs: observations of chronic lesions and comparison to those obtained using radiofrequency ablation. J Cardiovasc Electrophysiol 1998; 9:1055-61. [PMID: 9817557 DOI: 10.1111/j.1540-8167.1998.tb00883.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Radiofrequency (RF) is the most commonly used energy source for the treatment of cardiac arrhythmias. Surgical experience has shown that cryoablation also is effective for ablating arrhythmias. The aims of this study were to (1) investigate the feasibility of inducing permanent complete AV block (CAVB), (2) investigate the value of cold mapping to select the cryoablation site to produce permanent CAVB, (3) study the macro- and microscopic lesion characteristics 6 weeks later, and (4) compare them to those produced with RF energy. METHODS AND RESULTS A new steerable 8.5-French bipolar electrode catheter having a thermocouple with a 3-mm tip using N2O as the refrigerant controlled by a cryoconsole was used. Six mongrel dogs were anesthetized, and the catheter was positioned via the femoral vein across the tricuspid valve to record a large low right atrial and a small His-bundle potential. After cold mapping (-15 degrees to -20 degrees C tip temperature) resulted in ECG modifications, cryothermia (-70 degrees C) was given twice, lasting 5 minutes each, to create permanent CAVB (Cryo group). Additionally, RF catheter ablation of the AV node was performed in two anesthetized mongrel dogs (RF group). In the Cryo group, a permanent proximal CAVB was created in four dogs (block occurred within 10 to 20 sec of cryothermia). Permanent right bundle branch block was obtained in one dog and transient CAVB in the remaining dog. In both dogs of the RF group, permanent CAVB was obtained. The cryolesions consisted of well-circumscribed, homogeneous areas of fibrotic tissue without viable cardiomyocytes. Lesions produced with RF were less circumscribed and inhomogeneous, with clear evidence of viable cardiomyocytes and cartilage formation (patchy lesions). CONCLUSIONS (1) Permanent CAVB can be created by using a steerable cryoablation catheter. (2) Histologically, cryoablated sites were homogeneous and showed fibrotic tissue without signs of chronic inflammation and no evidence of viable myocytes. (3) Lesions created with RF were less homogenous and still contained viable myocytes within the lesion and cartilage formation. (4) The arrhythmogenic significance of these differences requires further study. (5) The technology of using reversible cold mapping has the potential to identify the successful ablation site and warrants further clinical study.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands.
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Wellens HJ, Sie HT, Smeets JL, Ramdat Misier AR, Beukema WP, Doevendans PA. Surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol 1998; 9:S151-4. [PMID: 9727691] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surgical therapy has been applied in the treatment of atrial fibrillation for almost two decades. At present, the most commonly used approach is the maze operation developed by Cox. In this operation, atrial fibrillation is prevented by critically located incisional lines. Currently, these lines also are drawn during operation using cryoablation or radiofrequency current. To document the value of the maze operation, randomized studies, not only on arrhythmia prevention but also on atrial transport function and thromboembolic complications, should be performed.
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Affiliation(s)
- H J Wellens
- Department of Cardiology, University Hospital Maastricht, The Netherlands
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Smeets JL, Ben-Haim SA, Rodriguez LM, Timmermans C, Wellens HJ. New method for nonfluoroscopic endocardial mapping in humans: accuracy assessment and first clinical results. Circulation 1998; 97:2426-32. [PMID: 9641695 DOI: 10.1161/01.cir.97.24.2426] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate mapping of the site of origin and activation sequence of a cardiac arrhythmia is essential for a successful catheter ablation procedure. To achieve this, precise and reproducible catheter manipulation is mandatory. The aim of this study was (1) to assess the accuracy of a new nonfluoroscopic mapping system in humans and (2) to report the first result of endocardial activation mapping with this system during sinus rhythm and several types of supraventricular and ventricular tachycardias. METHODS AND RESULTS Fifteen patients were studied. Accuracy measurements were performed in 5 of them (patients 5, 6, 7, 8, and 14). The distances between two subsequent catheter positions in the inferior caval vein as determined by the nonfluoroscopic mapping system were compared with measurements made with calipers by four independent investigators using identification marks on the catheter shaft. The difference between these two methods was 0.95+/-0.8 mm. In 15 patients, activation of the right atrium and/or the right or left ventricle was recorded during sinus rhythm. Three-dimensional activation maps were constructed in patients with atrial and ventricular tachycardias and Wolff-Parkinson-White syndrome. CONCLUSIONS With this new nonfluoroscopic mapping technique, accurate positioning of the catheter tip is possible. A three-dimensional activation map can be reconstructed during sinus rhythm and during supraventricular and ventricular tachycardias of different compartments of the heart.
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Affiliation(s)
- J L Smeets
- Department of Cardiology of the University Hospital Maastricht, The Netherlands.
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Hatzinikolaou H, Rodriguez LM, Smeets JL, Timmermans C, Vrouchos G, Grecas G, Wellens HJ. Isoprenaline and inducibility of atrioventricular nodal re-entrant tachycardia. Heart 1998; 79:165-8. [PMID: 9538310 PMCID: PMC1728591 DOI: 10.1136/hrt.79.2.165] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine the effect of isoprenaline on slow and fast pathway properties and tachycardia initiation. DESIGN Consecutive patients, prospective study. SETTING Referral centre for cardiology, academic hospital. PATIENTS 24 patients suffering from common type atrioventricular nodal reentrant tachycardia (AVNRT). INTERVENTIONS Programmed electrical stimulation and radiofrequency catheter ablation of the slow pathway. MEASUREMENTS AND MAIN RESULTS AVNRT was induced before and after the administration of isoprenaline in nine patients (group 1), before isoprenaline only in five (group 2), and after isoprenaline only in 10 (group 3). The anterograde effective refractory period of the fast pathway was prolonged significantly during isoprenaline administration in group 1 (405 (31) v 335 (34) ms, p < 0.001) and shortened in group 2 (308 (57) v 324 (52) ms, p = 0.005). There was also significant shortening in group 3 (346 (85) v 395 (76) ms, p < 0.001). Isoprenaline administration did not result in a significant change of the anterograde effective refractory period of the slow pathway in groups 1 and 3, but eliminated slow pathway conduction in group 2. Isoprenaline significantly shortened the minimal and maximal atrial to His bundle conduction interval recording in response to each extrastimulus of the slow pathway (210 (24) v 267 (25) ms, p < 0.001 and 275 (25) v 328 (25) ms, p < 0.001, respectively) in group 1 and significantly prolonged these intervals (331 (34) v 274 (34) ms and 407 (33) v 351 (33) ms, respectively) in group 3. In all groups only minimal changes in the refractory period of the atrium occurred after isoprenaline administration. The effect of isoprenaline was also measured on the ventricular effective refractory period and on the minimal and maximal length of the ventriculoatrial (V2-A2) interval during ventricular pacing. Isoprenaline did not result in a significant change of the ventricular effective refractory period in groups 1 and 2 nor of the shortest and longest V2-A2 interval. In group 3, however, the ventricular effective refractory period and the shortest and longest V2-A2 interval shortened significantly after isoprenaline administration. CONCLUSIONS In group 1 isoprenaline did not affect inducibility of AVNRT because it prolonged the fast pathway refractory period without affecting slow pathway conduction. In group 2 isoprenaline shortened the fast pathway refractory period and appeared to abolish slow pathway conduction. Consequently, isoprenaline prevented induction of AVNRT. In group 3 isoprenaline facilitated induction of AVNRT. This effect seemed primarily to be the result of shortening of retrograde refractoriness of the fast pathway with prolongation of slow pathway anterograde conduction and refractory period.
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Affiliation(s)
- H Hatzinikolaou
- Department of Cardiology, G Papanikolaou General Hospital, Exohi, Thessaloniki, Greece
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Abstract
INTRODUCTION Although the recurrence rate of atrial fibrillation has been reported to be similar to that after external and internal cardioversion, little is known about immediate reinitiation of atrial fibrillation (IRAF) following internal cardioversion. METHODS AND RESULTS Thirty-eight patients (24 men; mean age 63 +/- 13 years) underwent internal atrial defibrillation. Catheter-based defibrillation electrodes were positioned in the anterolateral right atrium and the coronary sinus. All patients were cardioverted at a mean threshold of 4.6 +/- 3.4 J. Five of 38 patients (13%) had 1 to 4 episodes of IRAF. No difference in clinical and echocardiographic characteristics were observed when patients with and without IRAF were compared. Atrial fibrillation was always reinitiated by an atrial premature beat. When the earliest atrial endocardial activation time on the defibrillation catheters was analyzed, these atrial premature beats did not seem to originate from the defibrillation catheters. Twenty-one patients had atrial premature beats without IRAF. When the coupling intervals of the first atrial premature beat in patients without and with IRAF after conversion were compared, a significant difference was found (661 +/- 229 vs 418 +/- 79 msec, P < 0.05). IRAF was successfully treated with repeated shock delivery after the administration of atropine in 1 patient and intravenous flecainide in 2. Only repeated shock delivery was sufficient to treat IRAF in another 2 patients. Late recurrences of atrial fibrillation occurred in 3 of 5 with IRAF and in 19 of 33 patients without IRAF (P = NS). CONCLUSION IRAF after internal atrial defibrillation occurred in 13% of patients, was always initiated by an atrial premature beat having a short coupling interval not originating from the defibrillation catheters, and was prevented by repeated shock delivery with or without preceding administration of pharmacologic agents. IRAF did not predict early recurrences of the arrhythmia after discharge from the hospital, emphasizing the necessity to treat immediate reinitiation promptly to achieve a successful cardioversion.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Timmermans C, Rodriguez LM, Smeets JL. Cycle length and QRS alternation during a narrow QRS tachycardia. J Cardiovasc Electrophysiol 1997; 8:963-4. [PMID: 9261723 DOI: 10.1111/j.1540-8167.1997.tb00858.x] [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: 02/05/2023]
Affiliation(s)
- C Timmermans
- Department of Cardiology, University Hospital Maastricht, The Netherlands.
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Abstract
We performed radiofrequency catheter ablation of idiopathic ventricular tachycardia in six children. In four, the ventricular tachycardia originated in the left ventricle, in two it originated in the right ventricular outflow tract. In 5/6 (83%) the RF procedure was successful; there were no complications.
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Affiliation(s)
- J L Smeets
- Department of Cardiology, Academic Hospital Maastricht, Limburg, The Netherlands.
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Rodriguez LM, Smeets JL, Timmermans C, Blommaert D, van Dantzig JM, de Muinck EB, Wellens HJ. Radiofrequency catheter ablation of sustained monomorphic ventricular tachycardia in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 1997; 8:803-6. [PMID: 9255687 DOI: 10.1111/j.1540-8167.1997.tb00838.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Incessant monomorphic ventricular tachycardia (VT) with a right bundle branch block morphology and a northwest axis is a rare arrhythmic complication in a patient with hypertrophic cardiomyopathy and apical left ventricular aneurysm. METHODS AND RESULTS The origin of this VT was localized using the following criteria: the presence of entrainment without fusion, equal intervals from the stimulus to the beginning of the QRS complex and from the electrogram to the QRS complex during VT, and the first postpacing interval identical to the tachycardia cycle length. Radiofrequency energy applied to the septoapical part of the apical left ventricular aneurysm terminated the tachycardia within 2 seconds. CONCLUSION Using criteria to guide radiofrequency (RF) ablation of VT in patients with coronary artery disease, an incessant monomorphic VT in a patient with hypertrophic cardiomyopathy was successfully ablated.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, University Hospital Maastricht, The Netherlands.
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19
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Abstract
BACKGROUND During atrial fibrillation (AF), the atrium is activated by multiple wavelets that continuously change in size and direction. The aim of this study was to correlate the temporal variation in AF electrogram configuration with the varying spatial patterns of activation. METHODS AND RESULTS In a group of 25 Wolff-Parkinson-White patients undergoing cardiac surgery, the free wall of the right atrium was mapped (244 points) during electrically induced AF. The unipolar electrograms recorded during 4 seconds of AF were classified into four categories: (1) single deflections, (2) short-double potentials, (3) long-double potentials, and (4) fragmented potentials. The proportion of these four types of electrograms during AF was as follows: singles, 77 +/- 12%; short-doubles, 7 +/- 3%; long-doubles, 10 +/- 7%; and fragmented, 6 +/- 4%. Electrogram morphology was an indicator for rapid uniform conduction (single potentials; positive predictive value [PPV] of 0.96), collision (short-double potentials; PPV of 0.33), conduction block (long-double potentials; PPV of 0.84), and pivoting points or slow conduction (fragmented potentials; PPV of 0.87). In type I, II, and III AF, the proportion of long-double potentials was 4 +/- 2%, 12 +/- 3%, and 18 +/- 7% (P < .05); the proportion of fragmented complexes was 2 +/- 2%, 6 +/- 3%, and 10 +/- 4% (P < .05), respectively. During electrically induced and self-terminating episodes of AF, no preferential anatomic sites for double or fragmented potentials were found in the right atrium. CONCLUSIONS The morphology of single unipolar electrograms during AF reflects the occurrence of various specific patterns of conduction. This might be used to differentiate between different types of AF and to identify regions with structural conduction disturbances involved in perpetuation of chronic AF.
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Affiliation(s)
- K T Konings
- Department of Physiology, Cardiology and Cardiopulmonary Surgery, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
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Abstract
This study reports on predictors for successful radiofrequency (RF) ablation of idiopathic ventricular tachycardia (VT) in 48 patients--35 with right ventricular (RV) outflow tract and 13 with left ventricular VT. In RV outflow tract idiopathic VT, RF ablation was successful in 29 of 35 patients (83%). The following information allowed differentiation between patients with and without a successful RF ablation: > 1 induced VT morphology (O vs 3); presence of delta wave-like beginning of the QRS (2 vs 3) and > or = 11 of 12 leads showing a "match" between the clinical VT and the pacemap (28 vs 1). Endocardial activation times were not different between both groups (-15 +/- 18 vs -4 +/- 5 ms). In left ventricle idiopathic VT, RF ablation was successful in 12 of 13 patients (92%). In patients who underwent successful ablation, 1 VT morphology was induced and no delta wave-like beginning of the QRS was present; a correlation between clinical VT and the pacemap > or = 11 of 12 leads was found and the endocardial activation time preceded the QRS (range of -5 to -58 ms [mean -30 +/- 14]). Purkinje activity was observed in 5 of 7 patients with an idiopathic VT originating from the inferoposterior region but not from the inferoapical region of the left ventricle. Four patients (14%) with RV outflow tract idiopathic VT had recurrence during a mean follow-up of 2 to 50 months (mean 30 +/- 12). Thus, (1) in RV outflow tract idiopathic VT a good pacemap was more important than an early endocardial activation time; (2) an optimal pacemap as well as an early endocardial activation time were important predictors for successful ablation of the left ventricle idiopathic VT; (3) Purkinje activity was recorded in VTs arising in the inferoposterior region of the left ventricle; and (4) factors for unsuccessful ablation for idiopathic VT were > 1 induced VT morphology, a delta wave-like beginning of the QRS, and a VT/pacemap correlation < 11 of 12 leads. Idiopathic VT can be successfully ablated with both immediate and long-term success.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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Rosenquist M, Brembilla-Perrot B, Meinertz T, Neugebauer A, Crijns HJ, Smeets JL, van der Vring JA, Fromer M, Kobrin I. The acute effects of intravenously administered mibefradil, a new calcium antagonist, on the electrophysiologic characteristics of the human heart. Eur J Clin Pharmacol 1997; 52:7-12. [PMID: 9143860 DOI: 10.1007/s002280050241] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This multicenter, double-blind, placebo-controlled, parallel-group study was designed to assess the acute effects of intravenous mibefradil on the electrophysiologic characteristics of the human heart. METHODS Seventy-one patients referred for routine electrophysiologic testing were randomized to receive one of three intravenous treatments: placebo n = 23, 15 mg mibefradil in 15 min followed by 25 mg in 60 min (group 1, n = 24), or 35 mg mibefradil in 15 min followed by 45 mg in 60 min (group 2, n = 24). Electrophysiologic evaluations were performed prior to study drug administration and 30 min after the start of the infusion. Plasma samples were obtained at the start of the infusion and after 15, 75, and 105 min. RESULTS Sinus node recovery time decreased significantly in Group 1 patients (-103 ms). Corrected sinus node recovery time in group 2 patients was 68.7 ms (P = 0.053). Compared to placebo, mibefradil produced mild but significant slowing of conduction in group 2 patients as manifested by an increase in the AH interval of 6.7 ms. Atrioventricular (AV) nodal refractoriness was increased, as indicated by a prolongation of the Wenckebach point in patients in both group 1 (32.1 ms) and group 2 (32.5 ms), compared to placebo. All adverse events were classified as mild to moderate and only one event (vasovagal attack) was considered to be treatment related. CONCLUSIONS At plasma levels close to those found after chronic oral administration of 50 and 100 mg mibefradil, the higher dose produced an increase in corrected sinus node recovery time. Mibefradil also produced small but significant effects on AV nodal conduction and increased AV nodal refractoriness. Mibefradil had no effect on any other electrophysiologic parameter and was well tolerated.
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Rodriguez LM, Smeets JL, Timmermans C, Trappe HJ, Wellens HJ. Radiofrequency catheter ablation of idiopathic ventricular tachycardia originating in the anterior fascicle of the left bundle branch. J Cardiovasc Electrophysiol 1996; 7:1211-6. [PMID: 8985810 DOI: 10.1111/j.1540-8167.1996.tb00500.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Idiopathic ventricular tachycardia (VT) originating in or close to the anterior fascicle of the left bundle is rare. A patient with no structural heart disease and VT with a right bundle branch block configuration and right-axis deviation underwent an electrophysiologic examination. METHODS AND RESULTS Both endocardial activation mapping during VT and pacemapping were performed via a transseptal approach to localize the site of origin of the VT. Endocardial recordings of the His bundle and the posterior and anterior fascicles of the left bundle branch revealed an origin of the VT in or close to the anterior fascicle. The Purkinje potential at that site preceded the QRS complex by 20 msec, with pacemapping showing an optimal match between the paced rhythm and the clinical VT. RF energy delivered at this site terminated the VT. A left anterior hemiblock appeared after RF ablation. Ten months later, the patient is free from recurrences of VT. CONCLUSIONS Idiopathic VT originating in or close to the anterior fascicle was cured by RF ablation. A Purkinje potential preceding the QRS during tachycardia and an optimal pacemap were used to guide RF ablation.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, University Hospital Maastricht, The Netherlands.
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23
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Oreto G, Smeets JL, Rodriguez LM, Timmermans C, Wellens HJ. Wide complex tachycardia with atrioventricular dissociation and QRS morphology identical to that of sinus rhythm: a manifestation of bundle branch reentry. Heart 1996; 76:541-7. [PMID: 9014806 PMCID: PMC484610 DOI: 10.1136/hrt.76.6.541] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine the features that distinguish bundle branch reentry (BBR) ventricular tachycardia from a supraventricular tachycardia with aberration on the 12 lead electrocardiogram (ECG). PATIENTS Three patients in whom premature beats (2 cases) or sustained tachycardia (2 cases) showed a QRS configuration identical to that observed during sinus rhythm. INTERVENTIONS Programmed electrical stimulation. RESULTS These arrhythmias were ventricular in origin and caused by a BBR mechanism, as suggested by the following data obtained during electrophysiological study: (a) an H-V interval shorter during tachycardia than during sinus rhythm; (b) A-V dissociation; (c) activation of the right bundle branch before activation of the bundle of His. The ECG of all 3 patients showed right bundle branch block with very prolonged QRS duration (0.16 to 0.20 s). Characteristically, all 3 had prolonged H-V interval during sinus rhythm. All patients had had a previous myocardial infarction and had a dilated left ventricle. CONCLUSION The presence of (a) wide complex extrasystoles or tachycardia with a QRS morphology identical to that of sinus rhythm; (b) A-V dissociation; and (c) a very prolonged QRS duration (0.16 s or more) is suggestive of ventricular tachycardia caused by bundle branch reentry.
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Affiliation(s)
- G Oreto
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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24
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Timmermans C, Rodriguez LM, Den Dulk K, Dijkman B, Smeets JL, Wellens HJ. Cure of incessant pacemaker circus movement tachycardia by radiofrequency catheter ablation. J Cardiovasc Electrophysiol 1996; 7:862-6. [PMID: 8884514 DOI: 10.1111/j.1540-8167.1996.tb00598.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of pacemaker circus movement tachycardia (PCMT) in patients with very long VA conduction times may present a problem. METHODS AND RESULTS PCMT occurred in a 46-year-old woman with an uncommon AV nodal reentrant tachycardia who developed 2:1 AV block after fast pathway radiofrequency catheter (RF) ablation performed at another institution. Due to the long VA conduction time, PCMT could not be prevented by reprogramming the pacemaker or by the addition of antiarrhythmic drugs. Cure of the PCMT was obtained after selective RF ablation of the slow AV nodal pathway. CONCLUSION RF ablation of the retrograde conduction offers another alternative for treatment of PCMT.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, University Hospital Maastricht, The Netherlands
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25
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Gorgels AP, van den Dool A, Hofs A, Mulleneers R, Smeets JL, Vos MA, Wellens HJ. Comparison of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia. Am J Cardiol 1996; 78:43-6. [PMID: 8712116 DOI: 10.1016/s0002-9149(96)00224-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Efficacy of procainamide and lidocaine in terminating spontaneous monomorphic ventricular tachycardia (VT) was assessed in a randomized parallel study. Patients with acute myocardial infarction and those with poor hemodynamic tolerance of VT were excluded. Procainamide 10 mg/kg was given intravenously with an injection speed of 100 mg/min, and lidocaine was administered at an intravenous dose of 1.5 mg/kg in 2 minutes. Fourteen patients were randomized to lidocaine and 15 to procainamide. Termination occurred in 3 of 14 patients after lidocaine and in 12 of 15 patients after procainamide (p <0.01). Procainamide stopped 8 of 11 VTs not responding to lidocaine, and lidocaine stopped 1 of 1 not responding to procainamde. Of a total of 41 VT episodes, 4 of 15 responded to lidocaine and 20 of 26 to procainamide (p <0.01). Because of VT recurrences, 16 patients could be studied repeatedly with drugs given in the reversed order. This resulted in a total of 55 trials of 79 drug injections. Lidocaine terminated 6 of 31 VTs and procainamide 38 of 48 (p <0.001). The protocol was stopped in 4 cases because of adverse effects. A comparison of the QRS width and QT interval before and at the end of the injection revealed significant lengthening of these values after procainamide but no change after lidocaine. In conclusion, procainamide is superior to lidocaine in terminating spontaneously occurring monomorphic VT.
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Affiliation(s)
- A P Gorgels
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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26
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Lokhandwala YY, Smeets JL, vd Steld B, Narula DD, Stockman D, Wellens HJ. Early intrinsic deflection--a marker for successful radiofrequency ablation of overt accessory pathways. Indian Heart J 1996; 48:138-44. [PMID: 8682553] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Precise localization of accessory pathways (APs) is crucial to minimize radiofrequency (RF) energy applications in the Wolff-Parkinson-White (WPW) syndrome. Although several markers have been described for identifying APs, no gold standard has thus far been established. The present study attempted to validate the hypothesis that an early intrinsic deflection (ID) would be identifiable in the unipolar ventriculogram, if this was recorded at or near the site of endocardial breakthrough of the AP. The electrograms of 23 patients with the WPW syndrome who underwent RF ablation were analysed using a computer-based system. A total of 50 electrograms (19 successful and 31 unsuccessful RF energy applications) were studied. The downstroke of the unipolar ventriculogram was measured at 1 msec intervals for the dV/dt; the maximal dV/dt (the most rapid segement of the downstroke) was considered as the ID. The following parameters were found to differentiate between successful and unsuccessful RF ablation attempts: (i) Timing of the ID relative to the delta wave onset (ID-delta = plus 11 +/- 21 msec versus minus 18 +/- 22 msec, p < 0.001). (ii) Timing of the ID relative to the onset of the unipolar ventriculogram (Vu-ID = 14 +/- 7 msec versus 29 +/- 15 msec, p < 0.001). (iii) Maximal dV/dt in the initial 20 msec of the unipolar ventriculogram (367 +/- 146 microV/msec versus 207 +/- 97 microV/msec, p < 0.001). The other parameters (probable AP potential, bipolar ventriculogram timing, continuous electrical activity, unipolar signal morphology) were not helpful in this regard. Hence, the identification of the ID and measurement of its timing is helpful in localising overt APs for successful delivery of RF energy.
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Affiliation(s)
- Y Y Lokhandwala
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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27
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Rodríguez LM, Sternick EB, Smeets JL, Timmermans C, den Dulk K, Oreto G, Wellens HJ. Induction of ventricular fibrillation predicts sudden death in patients treated with amiodarone because of ventricular tachyarrhythmias after a myocardial infarction. Heart 1996; 75:23-8. [PMID: 8624866 PMCID: PMC484216 DOI: 10.1136/hrt.75.1.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine the value of programmed electrical stimulation of the heart in predicting sudden death in patients receiving amiodarone to treat ventricular tachyarrhythmias after myocardial infarction. DESIGN Consecutive patients; retrospective study. SETTING Referral centre for cardiology, academic hospital. PATIENTS 106 patients with ventricular tachycardia (n = 77) or ventricular fibrillation (n = 29) late after myocardial infarction. INTERVENTIONS Programmed electrical stimulation was performed while on amiodarone treatment for at least one month. MEASUREMENTS AND MAIN RESULTS In 80/106 patients either ventricular fibrillation (n = 15) or sustained monomorphic ventricular tachycardia (n = 65) was induced. After a mean follow up of 50 (SD 40) months (1-144), 11 patients died suddenly and two used their implantable cardioverter debfibrillator. By multivariate analysis two predictors for sudden death were found: (1) inducibility of ventricular fibrillation under amiodarone treatment (P << 0.001), and (2) a left ventricular ejection fraction of < 40% (P < 0.05). The survival rate at one, two, three, and five years was 70%, 62%, 62%, and 40% respectively for patients in whom ventricular fibrillation was induced, and 98%, 96%, 94%, 94% for patients with induced sustained monomorphic ventricular tachycardia. Where there was no sustained arrhythmia, five year survival was 100%. CONCLUSIONS In patients receiving amiodarone because of life threatening ventricular arrhythmias after myocardial infarction, inducibility of ventricular fibrillation, but not of sustained monomorphic ventricular tachycardia, indicates a high risk of sudden death.
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Affiliation(s)
- L M Rodríguez
- Department of Cardiology, University of Limburg, Academic Hospital, Maastricht, The Netherlands
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28
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Abstract
In a population of 690 patients with Wolff-Parkinson-White (WPW) syndrome referred to our hospital from January 1979 to February 1995, 15 patients (2.2%) had an aborted sudden death out of the hospital. This retrospective study examines their clinical and electrophysiologic characteristics. Gender, accessory pathway localization, and presence of multiple accessory pathways were compared between patients with and without spontaneous ventricular fibrillation (VF). Whereas gender and the presence of multiple accessory pathways did not significantly differ between both groups, septally located pathways occurred significantly more often in the VF group. In patients with aborted sudden death, spontaneous VF was found significantly more often in men (13 of 15). VF was the first manifestation of the WPW syndrome in 8 patients. The remaining 7 patients had documented episodes of atrial fibrillation, circus movement tachycardia, or both (n = 2). Ten of the 15 patients were exercising or under emotional stress at the time of aborted sudden death. Only 1 patient had 2 accessory pathways. The location of the accessory pathway was septal (midseptal or posteroseptal) in 11 patients, left lateral in 4, and right lateral in 1).
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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29
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Crijns HJ, Smeets JL, Rodriguez LM, Meijer A, Wellens HJ. Cure of interfascicular reentrant ventricular tachycardia by ablation of the anterior fascicle of the left bundle branch. J Cardiovasc Electrophysiol 1995; 6:486-92. [PMID: 7551317 DOI: 10.1111/j.1540-8167.1995.tb00421.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Fascicular reentrant ventricular tachycardia (VT) using the anterior fascicle of the left bundle anterogradely is rare and may produce identical QRS morphology during sinus rhythm and VT. Catheter ablation of this type of VT has not been described in detail. METHODS AND RESULTS In a postinfarct patient with dilated left ventricle and recurrent VT (showing a QRS configuration of right bundle branch, left posterior fascicular block), endocardial recordings from the His-Purkinje system showed that VT was due to interfascicular reentry. Induction of VT occurred after progressive retrograde conduction delay on increasing the prematurity of the extrastimulus. Anterograde conduction occurred exclusively over the left anterior fascicle, which caused identical QRS morphology during sinus rhythm and VT. During VT, the left posterior fascicle was used retrogradely. The usual target for bundle branch reentry ablation, the right bundle, did not participate in the reentrant circuit. While performing left ventricular endocardial mapping, VT was interrupted when positioning the catheter on the left anterior fascicle, and "reversed" nonsustained bundle branch reentry occurred with anterograde conduction over the posterior fascicle and retrograde conduction over the anterior fascicle. Ablation of conduction in the anterior fascicle led to cure of the VT. CONCLUSION Interfascicular reentrant VT with right bundle branch block, right-axis QRS configuration can be cured by catheter ablation of anterior fascicle conduction.
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Affiliation(s)
- H J Crijns
- Department of Cardiology, University Hospital Maastricht, The Netherlands
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30
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Dassen WR, Karthaus VL, Talmon JL, Mulleneers RG, Smeets JL, Wellens HJ. Evaluation of new self-learning techniques for the generation of criteria for differentiation of wide-QRS tachycardia in supraventricular tachycardia and ventricular tachycardia. Clin Cardiol 1995; 18:103-8. [PMID: 7720284 DOI: 10.1002/clc.4960180213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This study presents a comparison of three different methods for differentiating between supraventricular and ventricular tachycardias with wide-QRS complex. One set of criteria, derived using classical statistical techniques, was compared with two new self-learning computer techniques: the artificial neural networks and the induction algorithm approach. By analyzing the results obtained in an independent test set, using these new techniques, the criteria defined by the classical method could be improved.
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Affiliation(s)
- W R Dassen
- Department of Cardiology, University of Limburg, Maastricht, The Netherlands
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31
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Timmermans C, Smeets JL, Rodriguez LM, Oreto G, Medina E, Notheis W, Vrouchos G, Weide A, Wellens HJ. Recurrence rate after accessory pathway ablation. Br Heart J 1994; 72:571-4. [PMID: 7857742 PMCID: PMC1025646 DOI: 10.1136/hrt.72.6.571] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate characteristics of patients and accessory pathways as well as additional technical factors involved in the reappearance of accessory pathway conduction after successful ablation. DESIGN Analysis of recurrences after radiofrequency ablation. SETTING 163 consecutive patients with 167 accessory pathways. SUBJECTS 97 men and 66 women with a mean (SD) age of 36 (14) range (11 to 75) years. RESULTS After a mean (SD) follow up of 14 (7) range (2 to 27) months, conduction recurred in 13 out of 167 (7.8%) accessory pathways. The initial manifestation of recurrence was circus movement tachycardia in 7 patients and reappearance of delta waves on a 12 lead electrocardiogram in 6 patients. The interval to the return of accessory pathway conduction ranged from 3 hours to 90 days. Age, sex, presence of multiple accessory pathways, criteria to determine the target ablation site, number and duration of radiofrequency applications, and cumulative energy did not significantly differ between the groups with recurrence and without. Recurrence was less common with concealed accessory pathways (2/44) than with overt accessory pathways (11/110). The difference was not significant. The only variable to influence the recurrences in this study group was the location of the accessory pathway. Reappearance of conduction through right sided accessory pathways occurred significantly more often than through left sided ones (8/40 v 5/114, P = 0.01). CONCLUSION After radiofrequency ablation the recurrence rate of accessory pathways is low and there are no predictors of the risk of reappearance of conduction apart from the right sided location of the accessory pathway.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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Vainer J, Cheriex EC, van der Steld B, Dassen WR, Smeets JL, Wellens HJ. Effects of acute volume changes on P wave characteristics: correlation with echocardiographic findings in healthy men. J Cardiovasc Electrophysiol 1994; 5:999-1005. [PMID: 7697210 DOI: 10.1111/j.1540-8167.1994.tb01142.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION This study was performed to determine the effect on the P wave of different hemodynamic loads to the heart. METHODS AND RESULTS Signal-averaged P wave ECG and atrial echocardiographic measurements were obtained from eight healthy male volunteers at rest and after infusion of 1000 mL of plasma expander (Haemaccel) over 15 minutes. These measurements were repeated 24 hours later at rest and after 0.8 mg of nitroglycerin given sublingually. The effect of positional changes was also studied. At rest the amplitude of the P wave and the time of the maximal the P wave amplitude were reproducible. Sitting increased heart rate variability; no significant changes of the P wave were found. Volume overload decreased the heart rate and increased the atrial size on echocardiography with changes in lead V1 (earlier appearance of the first positive deflection). Nitroglycerin administration increased heart rate and decreased the echocardiographic size of the atria, the latter not reaching statistical significance. Administration of nitroglycerin induced P wave amplitude rise in leads I and II. The maximal power in fast Fourier transformation for calculated orthogonal leads X and Y increased as well. CONCLUSIONS Amplitude behavior in leads I, II, and V1 appears to correlate with load conditions, particularly with volume redistribution. In healthy men subtle changes in the P wave morphology after volume changes can be detected by the signal-averaged ECG. Application of these findings in patients following acute changes in circulation needs further investigation.
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Affiliation(s)
- J Vainer
- Department of Cardiology, Academic Hospital Maastricht, University of Limburg, The Netherlands
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33
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Lokhandwala YY, Smeets JL, Rodriguez LM, Metzger J, Grekas GF, Chaginikolaou H, Meijer A, Wellens HJ. Idiopathic ventricular tachycardia--characterisation and radiofrequency ablation. Indian Heart J 1994; 46:281-5. [PMID: 7797211] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Forty patients (14 women and 26 men; mean age 40 +/- 13 years, range 7 to 60) diagnosed to have idiopathic ventricular tachycardia (right ventricular 28, left ventricular 12) underwent electrophysiologic study and radiofrequency catheter ablation. Echocardiography, signal averaging, magnetic resonance imaging and cardiac catheterisation with angiography were used as indicated to rule out identifiable underlying etiologies. Gross localisation of the area of origin of the ventricular tachycardia from the surface electrocardiogram could be made in all cases. Accurate localisation of the site of origin was done by activation mapping and pace mapping. Radiofrequency application was successful in achieving a cure in 34 (85%) patients, with a mean of 8.3 +/- 4.7 energy applications and a fluoroscopy time of 38 +/- 19 minutes. Unsuccessful cases were characterised by wide and slurred QRS complexes during ventricular tachycardia, possibly indicating a deeper intramyocardial or epicardial site of origin of the tachycardia. Radiofrequency ablation appears to be the treatment of choice for symptomatic idiopathic ventricular tachycardia, having a high success and safety rate.
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Affiliation(s)
- Y Y Lokhandwala
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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34
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Vainer J, Van der Steld B, Smeets JL, Gorgels AP, Sreeram N, Wellens HJ. Beat-to-beat behavior of QT interval during conducted supraventricular rhythm in the normal heart. Pacing Clin Electrophysiol 1994; 17:1469-76. [PMID: 7991417 DOI: 10.1111/j.1540-8159.1994.tb01511.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To assess beat-to-beat behavior of QT interval under different conditions, high resolution recordings and computerized beat-to-beat analysis of the electrocardiogram were performed at rest, during recovery after short exercise, and during atrial pacing. Beat-to-beat variations of QT interval during sinus rhythm at rest and after short exercise were measured in ten healthy men. In an additional three patients with supraventricular tachycardia, beat-to-beat QT changes were studied after abrupt sustained acceleration and deceleration of heart rate by atrial pacing. Beat-to-beat changes in RR interval at rest are followed by minimal changes of the QT interval. The measured proportional change of the QT interval compared with the change in RR interval (delta QT/delta RR) was 0.02. This value represents 10% of the value expected for QT changes from Bazett's formula. Following short exercise QT interval did not change for 15 seconds and reached a maximal value 80 seconds later as compared to the RR interval (192 vs 115 secs, P < 0.001). The steady state of the QT interval during sustained atrial pacing was achieved after 132, 135, and 133 seconds for pacing intervals of 600, 500, and 600 msec, respectively. Our data indicate a relatively slow adaptation of the QT interval to changes in heart rate.
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Affiliation(s)
- J Vainer
- Department of Cardiology, Academic Hospital, Maastricht, University of Limburg, The Netherlands
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35
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de Chillou C, Rodriguez LM, Doevendans P, Loutsidis K, van den Dool A, Metzger J, Bär FW, Smeets JL, Wellens HJ. Factors influencing changes in the signal-averaged electrocardiogram within the first year after a first myocardial infarction. Am Heart J 1994; 128:263-70. [PMID: 8037092 DOI: 10.1016/0002-8703(94)90478-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
One hundred twenty-nine patients were prospectively studied after a first myocardial infarction. A first signal-averaged electrocardiogram (SAECG-1) was performed in the acute phase (within 48 hours after onset of symptoms) and a second one (SAECG-2) in the late phase (6 to 18 months after hospital discharge). We studied the influence of nine parameters on the evolution of the signal-averaged electrocardiogram: age, gender, myocardial infarction location, number of diseased coronary vessels, infarct-related coronary artery patency, use of thrombolytic therapy or percutaneous transluminal coronary angioplasty in the acute phase, left ventricular ejection fraction, and recurrence of ischemic events. No follow-up data were available in 15 patients. Of the remaining 114 patients, an ischemic event occurred in 25 (22%). The signal-averaged electrocardiogram remained unchanged in 97 (85%) (remaining normal in 78 and abnormal in 19). It became abnormal in 13 (11.5%) and became normal in 4 (3.5%). In patients with a normal SAECG-1, two factors were associated with the change to an abnormal SAECG-2: (1) an ischemic event occurred in 11 (85%) of 13 patients whose SAECG-2 was abnormal compared with only 13 (17%) of 78 patients whose SAECG-2 remained normal (p < 0.0001), and (2) 100% of patients with an abnormal SAECG-2 had an inferior myocardial infarction compared with 54% of patients with a normal SAECG-2 (p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C de Chillou
- Department of Cardiology, University of Limburg Academic Hospital, Maastricht, The Netherlands
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36
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Metzger JT, Cheriex EC, Smeets JL, Vanagt E, Rodriguez LM, Pieters FA, Weide A, Wellens HJ. Safety of radiofrequency catheter ablation of accessory atrioventricular pathways. Am Heart J 1994; 127:1533-8. [PMID: 8197980 DOI: 10.1016/0002-8703(94)90382-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The acute anatomic and valvular consequences of radiofrequency catheter ablation of accessory pathways were evaluated in 62 patients by means of serial echocardiographic examinations. Semiquantitative assessment of valvular incompetence and classification into one of four grades according to the width and the extension of the jet from the valvular orifice were carried out. Segmental wall motion abnormalities were evaluated semiquantitatively with four grades of severity (normal, hypokinesia, akinesia, or dyskinesia). New echocardiographic abnormalities were observed in five patients. One thrombus on the ventricular aspect of the mitral valve, three hemodynamically insignificant pericardial effusions, and one increase in severity of tricuspid incompetence were found 1 day after radiofrequency catheter ablation. We conclude that echocardiographic changes after radiofrequency ablation of accessory pathways are rare and of minor significance. These findings confirm the safety of the procedure.
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Affiliation(s)
- J T Metzger
- Department of Cardiology, Academic Hospital, University of Limburg, Maastricht, The Netherlands
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37
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Abstract
This report describes a patient with tachycardia-dependent left bundle branch block (LBBB) and atrial extrasystoles, some of which were followed by an unexpectedly narrow QRS complex. His-bundle recordings and premature atrial stimulation were performed to analyze the mechanism underlying the normalized intraventricular conduction of some of the early atrial impulses. The results suggested the presence of supernormal conduction in the left bundle branch (LBB), because: (1) the HV interval was identical in LBBB complexes and in early narrow QRS complexes; (2) during single test stimulation using different paced atrial cycle lengths, there was a well-defined range of H1H2 intervals resulting in normalization of intraventricular conduction; and (3) atrial pacing with a cycle length of 500 msec resulted in alternation between wide and narrow QRS complexes. These findings rule out alternative mechanisms that could explain the unexpectedly normal intraventricular conduction of early impulses.
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Affiliation(s)
- G Oreto
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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38
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Abstract
In 49 consecutive patients (27 men and 22 women, age range 44 to 86 years) presenting with acute symptoms and with subsequently proven pulmonary embolism, and without previous lung disease, the 12-lead electrocardiograms obtained at hospital admission were reviewed in a blinded fashion to identify electrocardiographic features suggestive of right ventricular overload. Pulmonary embolism was considered probable in 37 patients (76%), from the presence of > or = 3 of the following abnormalities: (1) incomplete or complete right bundle branch block (n = 33); which was associated with ST-segment elevation (n = 17) and positive T wave (n = 3) in lead V1; (2) S waves in leads I and aVL of > 1.5 mm (n = 36); (3) a shift in the transition zone in the precordial leads to V5 (n = 25); (4) Q waves in leads III and aVF, but not in lead II (n = 24); (5) right-axis deviation, with a frontal QRS axis of > 90 degrees (n = 16), or an indeterminate axis (n = 15); (6) a low-voltage QRS complex of < 5 mm in the limb leads (n = 10); and (7) T-wave inversion in leads III and aVF (n = 16) or leads V1 to V4 (n = 13), which occurred more often in patients with symptoms for > 7 days. In the 12 patients with normal electrocardiograms at admission, serial electrocardiograms revealed diagnostic features of embolism in an additional 3 patients. Two-dimensional Doppler echocardiography at admission revealed tricuspid valve regurgitation and an increased right ventricular end-diastolic diameter in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N Sreeram
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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39
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Abstract
We performed radiofrequency catheter ablation of idiopathic ventricular tachycardia arising from the left ventricle, in two 15-year-old patients. Activation mapping during induced tachycardia revealed an origin from the mid-septal region of the left ventricle in both patients. Local activation times and pacemapping were used to select the target site for successful ablation. At follow-up, both patients are without symptoms.
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Affiliation(s)
- N Sreeram
- Department of Cardiology, Academic Hospital Maastricht, Netherlands
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40
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41
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Rodriguez LM, Smeets JL, de Chillou C, Metzger J, Schläpfer J, Penn O, Weide A, Wellens HJ. The 12-lead electrocardiogram in midseptal, anteroseptal, posteroseptal and right free wall accessory pathways. Am J Cardiol 1993; 72:1274-80. [PMID: 8256703 DOI: 10.1016/0002-9149(93)90296-o] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The 12-lead electrocardiograms of 50 patients with 1 anterogradely conducting accessory pathway were analyzed to obtain characteristics of electrocardiographic findings in the midseptal, anteroseptal, true posteroseptal and right free wall accessory pathway locations. Locations were confirmed by surgery (33 patients) or radiofrequency catheter ablation (17 patients). This study analyzed (1) QRS in the frontal plane, (2) delta wave axis in the frontal plane, (3) the angle between QRS and delta wave axes, (4) the R/S ratio in lead III, (5) negativity of delta wave in inferior leads, and (6) the R/S ratio in precordial leads.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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42
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Rodriguez LM, Smeets JL, Xie B, de Chillou C, Cheriex E, Pieters F, Metzger J, den Dulk K, Wellens HJ. Improvement in left ventricular function by ablation of atrioventricular nodal conduction in selected patients with lone atrial fibrillation. Am J Cardiol 1993; 72:1137-41. [PMID: 8237802 DOI: 10.1016/0002-9149(93)90982-i] [Citation(s) in RCA: 140] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Left ventricular (LV) function was studied in 30 patients with lone atrial fibrillation (AF) (paroxysmal [n = 27] and persistent [n = 3]) before and after ablation of atrioventricular conduction. In all patients, drug treatment did not control ventricular rate during AF or prevent recurrences of the arrhythmia, or both. LV ejection fraction, and LV end-systolic and end-diastolic, and left atrial dimensions were measured by echocardiography before (mean 7 +/- 10 months, range < 1 to 37) and after (14 +/- 20 months, < 1 to 77) ablation. Before ablation, LV ejection fraction was < or = 50% in 12 patients (group I) and > 50% in 18 (group II). After ablation, LV ejection fraction increased significantly in group I from 43 +/- 8% to 54 +/- 7% (p < 0.0001). There were also significant decreases in LV-end systolic and end-diastolic, and left atrial dimensions. No changes in these parameters were observed in group II. Groups I and II had a significant difference in the duration of AF (group I: mean 11 years, range 8 to 28; and group II: 5 years, 2 to 14) (p < 0.05). No difference was present in age, sex, New York Heart Association functional class for dyspnea, or type of ablation procedure. Thus, some patients with lone AF may show deterioration of LV function, which appears to be related to the duration of the arrhythmia; in these cases, LV function may improve significantly after ventricular rate control is accomplished by ablation of atrioventricular conduction.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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43
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Cheriex EC, Smeets JL, Wellens HJ. Two unusual complications after surgical interruption of an accessory pathway. Heart 1993; 70:471-3. [PMID: 8260281 PMCID: PMC1025362 DOI: 10.1136/hrt.70.5.471] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In a patient with the Wolff-Parkinson-White syndrome, Ebstein's anomaly of the tricuspid valve, a right atrial Chiari net and a patent foramen ovale two unusual complications developed after surgical epicardial dissection combined with cryoablation of the anomalous pathway. The first complication was that ablation of the right atrial wall led to changes in interatrial pressure gradients and the development of a right to left shunt necessitating surgical closure of the atrial septal defect. The second complication was the development of a thrombotic mass in the Chiari net simulating on intracavity tumour, which also had to be removed surgically.
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Affiliation(s)
- E C Cheriex
- Department of Cardiology, Academic Hospital of Maastricht, University of Limburg, The Netherlands
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44
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Metzger JT, de Chillou C, Cheriex E, Rodriguez LM, Smeets JL, Wellens HJ. Value of the 12-lead electrocardiogram in arrhythmogenic right ventricular dysplasia, and absence of correlation with echocardiographic findings. Am J Cardiol 1993; 72:964-7. [PMID: 8213556 DOI: 10.1016/0002-9149(93)91115-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The 12-lead electrocardiogram during sinus rhythm was studied in 20 patients with arrhythmogenic right ventricular (RV) dysplasia with symptomatic ventricular tachycardia. Findings were analyzed, together with echocardiographic evaluation of site, extent and progression of RV wall abnormalities. Electrocardiographic abnormalities were found in 90% of patients. No correlation was found between abnormalities on the initial 12-lead electrocardiogram, and the echocardiographic extent and location of RV involvement. Over time, echocardiographic progression of the disease was observed; RV size increased in 6 of 7 patients from 34 +/- 3 to 39 +/- 3 mm (p = 0.01), and there was progression in the extent of RV wall motion abnormalities in 4 of 7 patients. Analysis of serial electrocardiographic recordings did not reveal changes indicative of progression of the disease during follow-up of 71 +/- 48 months. It is concluded that electrocardiographic abnormalities suggesting arrhythmogenic RV dysplasia are present in 90% of symptomatic patients on the first electrocardiogram recorded during sinus rhythm. However, serial electrocardiographic recordings in these patients do not provide information regarding anatomic progression of the disease.
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Affiliation(s)
- J T Metzger
- Department of Cardiology, Academic Hospital, University of Limburg, Maastricht, The Netherlands
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45
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Abstract
OBJECTIVE To assess the efficacy of radiofrequency ablation for reentrant tachyarrhythmias in children and young adults. SETTING A tertiary cardiac referral centre. PATIENTS AND INTERVENTIONS Over a 16 month period 22 patients aged less than 20 years (median age 16.5 years) underwent 26 radiofrequency ablation procedures for atrioventricular reentry tachycardia through an accessory pathway. The results of radiofrequency ablation were compared with those in a group of 16 patients (median age 14 years) who had had surgical ablation for atrioventricular reentry tachycardia over a preceding six year period. RESULTS Ablation of an accessory atrioventricular pathway was accomplished for 18 (76%) of 25 pathways in 16 (73%) of 22 patients. There were no procedure-related complications. Surgery was eventually curative in 15/16 patients (94%). However, three patients required a second open heart surgical procedure because tachyarrhythmia recurred. There were no surgical deaths. Failures for radiofrequency ablation were related to accessory pathway location, and were greater for right free wall and posteroseptal pathways (success rate of 50% and 57% respectively). Recurrence after surgery was also associated with pathways in these locations. CONCLUSIONS Transcatheter radiofrequency current ablation was safe and achieved a cure with less patient morbidity and improved cost efficiency. It is an attractive alternative to long-term drug therapy or surgery in older children and adolescents. A higher success rate may be expected with increased experience.
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Affiliation(s)
- N Sreeram
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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46
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de Chillou C, Doevendans P, Cheriex E, Rodriguez LM, Metzger J, Pieters F, Smeets JL, Wellens HJ. Echocardiographic wall motion abnormalities and the signal averaged electrocardiogram in the acute phase of a first myocardial infarction. Eur Heart J 1993; 14:795-8. [PMID: 8325307 DOI: 10.1093/eurheartj/14.6.795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We studied the relationship between wall motion abnormalities determined by echocardiography and the signal-averaged electrocardiogram in 82 consecutive patients during the acute phase of a first myocardial infarction. An abnormal signal-averaged electrocardiogram was defined as the presence of two of the following criteria: a QRS duration > or = 114 ms, a root mean square voltage (RMS) of the last 40 ms < or = 25 microV and an amplitude signal lower than 40 microV lasting > or = 39 ms. The left ventricle was divided into 13 segments and the contraction pattern divided into akinesia alone (including dyskinesia) (group A), hypokinesia alone (group B) and both hypokinesia and akinesia (group C). An abnormal signal-averaged electrocardiogram was found in 14/82 patients (17%) and was correlated with the persistence of occlusion of the infarct-related vessel (32% vs 9%, P < 0.02). In patients with a patent vessel, the incidence of an abnormal signal-averaged electrocardiogram was 14% in group A, 9% in group B and 0% in group C (NS). In patients with an occluded vessel an abnormal signal-averaged electrocardiogram was found in 10% of group A patients, in 36% in group B patients and in 75% of group C patients (P = 0.05). Our study suggests that the presence of hypokinetic areas during the acute phase of a first myocardial infarction and an abnormal signal-averaged electrocardiogram indicate an occluded infarct-related vessel.
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Affiliation(s)
- C de Chillou
- Department of Cardiology, University of Limburg Academic Hospital, Maastricht, The Netherlands
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47
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de Chillou C, Rodriguez LM, Doevendans P, Loutsidis K, van den Dool A, Metzger J, Bär FW, Smeets JL, Wellens HJ. Effects on the signal-averaged electrocardiogram of opening the coronary artery by thrombolytic therapy or percutaneous transluminal coronary angioplasty during acute myocardial infarction. Am J Cardiol 1993; 71:805-9. [PMID: 8456758 DOI: 10.1016/0002-9149(93)90828-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
One hundred twenty-nine patients were retrospectively analyzed and divided into 3 groups according to (1) the presence of a patent artery obtained either spontaneously or after thrombolytic therapy but without percutaneous transluminal coronary angioplasty (PTCA) (group I, n = 83), (2) the presence of a patent artery after opening by PTCA (group II, n = 29), or (3) absence of reperfusion despite thrombolytic therapy or PTCA (group III, n = 17). Thrombolytic therapy was given within 4 hours after onset of symptoms (mean 2.5 +/- 1.0 hours) and PTCA was performed within 24 hours after the onset of symptoms (mean 6 +/- 6 hours). Signal averaging was performed within 24 hours after cardiac catheterization. An abnormal signal-averaged electrocardiogram was present in 10 of 83 (12%) group I, 9 of 29 (31%) group II and 7 of 17 (41%) group III patients (p < 0.05 group I vs II, p < 0.01 group I vs III, no statistical difference group II vs III). Therefore, in contrast to reperfusion by thrombolytic therapy the incidence of abnormalities on the signal-averaged electrocardiogram early after myocardial infarction is not reduced by an early opening of the culprit vessel by PTCA.
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Affiliation(s)
- C de Chillou
- Department of Cardiology, University of Limburg Academic Hospital, Maastricht, The Netherlands
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48
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Tamás F, Smeets JL, Penn OC, Wellens HJ. [Double supraventricular tachycardia and its surgical treatment]. Orv Hetil 1993; 134:469-72. [PMID: 8446417] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A case history is presented of a patient in whom a left-free-wall accessory pathway was surgically ablated to treat symptomatic Wolff--Parkinson--White syndrome. Subsequently, AV-nodal reentrant tachycardia became manifest. The patients's AV-nodal reentrant tachycardia was interrupted by Cox's discrete cryosurgical procedure. As a result of analysis of these cases of dual substrates for reentrant supraventricular tachycardia, ECG and electrophysiological means for differential diagnosis has been developed. These are discussed herein.
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Affiliation(s)
- F Tamás
- Department of Cardiology, Limburg Egyetem, Maastricht, Hollandia
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49
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Cruz Filho FE, Wellens HJ, Peres A, Seixas T, Brugada P, Smeets JL. [Supraventricular tachycardia due to retrograde decremental conduction over accessory pathways]. Arq Bras Cardiol 1992; 59:447-51. [PMID: 1341868] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To discuss the clinical and the electrophysiologic findings, the differential diagnosis and the behaviour of concealed retrograde long conduction time accessory pathways. METHODS Seventeen patients were submitted to electrophysiologic study using programmed electrical stimulation of the heart to assess the electrophysiologic properties of the accessory pathway. RESULTS In all 17 studied patients, it was possible to advance the next atrial activation by giving a ventricular premature beat during the refractoriness of the His bundle. Of 17 patients, 7 developed signs and symptoms of heart failure (tachycardia-induced cardiomyopathy) due to the presence of incessant tachycardia. Eight patients were cured surgically and 1 underwent DC catheter ablation of the AV node. Six patients were successfully treated with antiarrhythmic drugs, one die of cancer and one still presents incessant tachycardia. CONCLUSION The electrophysiologic study is essential for the differential diagnosis of the supraventricular tachycardias with a R-P' interval longer than P'-R interval where the incidence of tachycardiomyopathy is high in this group of patients. Surgery provides definitive cure of those patients leading to the regression of the signs and symptoms of heart failure.
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Affiliation(s)
- F E Cruz Filho
- Hospital Acadêmico de Maastricht, Universidade de Limburg, Holanda
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50
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Rodriguez LM, de Chillou C, Schläpfer J, Metzger J, Baiyan X, van den Dool A, Smeets JL, Wellens HJ. Age at onset and gender of patients with different types of supraventricular tachycardias. Am J Cardiol 1992; 70:1213-5. [PMID: 1414950 DOI: 10.1016/0002-9149(92)90060-c] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.3] [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: 12/26/2022]
Affiliation(s)
- L M Rodriguez
- Department of Cardiology, University of Limburg, Academic Hospital, Maastricht, The Netherlands
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