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Journal of Cardiovascular Electrophysiology

Katsuhide Hayashi, Ritsuko Kohno, Naoki Akamatsu, David G Benditt, Haruhiko Abe
BACKGROUND: Recently, certain forms of early repolarization (ER) on electrocardiograms (ECGs) have been considered a possible marker of increased sudden cardiac death risk. The frequency, characteristics, and clinical follow-up with which these forms of ER are present in epilepsy patients and whether abnormal ER contributes to Sudden Unexplained Death in Epilepsy Patients (SUDEP) is unknown. METHODS AND RESULTS: The amplitude of J peak and ST segment morphology after ER on 12-lead ECGs were assessed in 354 epilepsy patients (age, 33 ± 16 years; 54% men) and 140 age- and sex-matched control subjects (age, 31 ± 12 years; 50% men)...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Tatsuya Hayashi, Jackson J Liang, Daniele Muser, Yasuhiro Shirai, Andres Enriquez, Fermin C Garcia, Gregory E Supple, Robert D Schaller, David S Frankel, David Lin, Saman Nazarian, Erica S Zado, Jeffrey Arkles, Sanjay Dixit, David J Callans, Francis E Marchlinski, Pasquale Santangeli
INTRODUCTION: The characteristics of the epicardial (EPI) substrate responsible for ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM) are undefined, and data on the long-term outcomes of EPI catheter ablation limited. We evaluated the prevalence, electrophysiologic features, and outcomes of catheter ablation of EPI VT in ICM. METHODS AND RESULTS: From December 2010 to June 2013, a total of 13 out of 93 (14%) patients with ICM underwent catheter ablation at our institution and had conclusive evidence of critical EPI substrate demonstrated to participate in VT with activation, entrainment and/or pace mapping during sinus rhythm (2 other patients underwent epicardial mapping but had no optimal ablation targets)...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Shuanglun Xie, Maciej Kubala, Jackson J Liang, Tatsuya Hayashi, Jaeseok Park, Irene Lucena Padros, Fermin C Garcia, Pasquale Santangeli, Gregory E Supple, David S Frankel, Erica S Zado, David Lin, Robert D Schaller, Sanjay Dixit, David J Callans, Saman Nazarian, Francis E Marchlinski
INTRODUCTION: Differentiation of right (RVOT) versus left ventricular outflow tract (LVOT) arrhythmia origin with left bundle branch block right inferior axis (LBRI) morphology is relevant to ablation planning and risk discussion. Our aim was to determine if lead I R-wave amplitude is useful for differentiation of RVOT from LVOT arrhythmias with LBRI morphology. METHODS AND RESULTS: The R-wave amplitude in lead I was measured in a retrospective cohort of 75 consecutive patients with LBRI pattern VAs successfully ablated from the RVOT (n=54), LVOT (n=16), or the anterior interventricular vein (AIV, n=5)...
September 19, 2018: Journal of Cardiovascular Electrophysiology
João Ferreira-Martins, James Howard, Becker Al-Khayatt, Joseph Shalhoub, Afzal Sohaib, Matthew J Shun-Shin, Paul G Novak, Rick Leather, Laurence D Sterns, Christopher Lane, Phang Boon Lim, Prapa Kanagaratnam, Nicholas S Peters, Darrel P Francis, Markus B Sikkel
OBJECTIVE: We tested whether ablation methodology and study design can explain the varying outcomes in terms of AF-free survival at 1 year. BACKGROUND: There have been numerous paroxysmal AF ablation trials, which are heterogeneous in their use of different ablation techniques and study design. A useful approach to understanding how these factors influence outcome is to dismantle the trials into individual arms and reconstitute them as a large meta-regression. METHODS: Data was collected from 66 studies (6941 patients)...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Marc A Miller, Jalaj Garg, Benjamin Salter, Thomas F Brouwer, Alex J Mittnacht, Morgan L Montgomery, Rafael Honikman, Derya E Arkonac, Subbarao Choudry, Srinivas R Dukkipati, Vivek Y Reddy, Menachem M Weiner
INTRODUCTION: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is most commonly implanted under general anesthesia (GA), due to the intra-operative discomfort associated with tunneling and dissection. Post-operative pain can be substantial, and is often managed with opioids. There is a growing interest in transitioning away from the routine use of GA during S-ICD implantation, while also controlling peri-operative discomfort without the use of narcotics. As such, we assessed the feasibility of a multimodal analgesia regimen that included regional anesthesia techniques in patients undergoing S-ICD implantation...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Ting-Yung Chang, Li-Wei Lo, Abigail Louise D Te, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Fa-Po Chung, Tze-Fan Chao, Jo-Nan Liao, Ta-Chuan Tuan, Chin-Yu Lin, Jennifer Jeanne Vicera, Huang Ting-Chun, Minh Quang Hoang, Shinya Yamada, Shih-Ann Chen
INTRODUCTION: It has not been previously investigated whether the recurrence mechanism after cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (AF) is similar to that of radiofrequency catheter ablation (RFCA). We aimed to evaluate the differences of recurrence characteristics between RFCA and CBA after index procedure. METHODS: A total of 210 patients were enrolled in the study, and 69 patients underwent pulmonary vein (PV) isolation using a 28-mm second-generation CBA...
September 19, 2018: Journal of Cardiovascular Electrophysiology
G Wynn, D Gupta, B Maille, R Snowdon, J Waktare, D Todd, M Hall, S Mahida, S Modi
INTRODUCTION: Demonstration of exit block after pulmonary vein isolation (PVI) is the cornerstone of ablation for atrial fibrillation (AF). It requires the demonstration of local PV capture and absence of conduction to the atrium but is often challenging due to the inability to see local paced PV evoked potentials. We retrospectively examine the ability of Adenosine to augment this technique during CARTO based radiofrequency ablation procedures. METHODS: Retrospective analysis of evoked PV potentials during adenosine administration while testing for PV exit block at a single UK center...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Atul Verma, Andrea Sarkozy, Allan Skanes, Mattias Duytschaever, Alan Bulava, Roy Urman, Yariv A Amos, Tom de Potter
BACKGROUND: Automated algorithms may identify focal (FA) and rotational (RoA) activations during persistent atrial fibrillation (PeAF). OBJECTIVE: To evaluate an automated algorithm for characterizing and assessing significance of FA/RoA. METHODS: 86 PeAF ablation patients (1411 maps) were analyzed. Maps were obtained with a 64-electrode basket using CARTOFINDER that filters/annotates atrial unipolar electrograms over 30 seconds. Operators ablated FA/RoA followed by PVI...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Ersan Akkaya, Alexander Berkowitsch, Sergej Zaltsberg, Harald Greiss, Christian W Hamm, Johannes Sperzel, Thomas Neumann, Malte Kuniss
INTRODUCTION: We analyzed the procedural experience and clinical outcome after pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) gained over 5 years using the second-generation cryoballoon (CB-Adv). METHODS AND RESULTS: For this retrospective study, we enrolled 281 patients undergoing PVI at our institution between 2012 and 2016. The analyzed period was divided into 5 calendar years. Follow-up data, including Holter ECG recordings, were collected during outpatient clinic visits...
September 19, 2018: Journal of Cardiovascular Electrophysiology
Muhammed Kurt, Nikesh Jathanna, Mehran Babady, Jan Schmidt, Patrick Müller, Shqipe Gerguri, Lukas Clasen, Alexandru Bejinariu, Malte Kelm, Alexander Fürnkranz, Hisaki Makimoto
INTRODUCTION: Single-chamber implantable cardioverter-defibrillator (ICD) can be associated with more frequent inappropriate therapies compared to dual-chamber ICDs, while they are accompanied by a simpler implantation procedure. The aim of this study was to investigate whether the use of single-lead ICD system with atrial-sensing electrodes results in a reduction of inappropriate ICD therapy. METHODS AND RESULTS: The study population consisted of 212 consecutive patients who underwent primary prophylactic single-lead ICD implantation at our institute...
September 11, 2018: Journal of Cardiovascular Electrophysiology
Hongming Lyu, Mathews John, David Burkland, Brian Greet, Yutao Xi, Luiz Sampaio, Doris Taylor, Aydin Babakhani, Mehdi Razavi
INTRODUCTION: 15-30% of patients with impaired cardiac function have ventricular dyssynchrony and warrant cardiac resynchronization therapy (CRT). While leadless pacemakers eliminate lead related complications, their current form factor is limited to single chamber pacing. In this study, we demonstrate the feasibility of multisite, simultaneous pacing using miniaturized pacing nodes powered through wireless power transfer (WPT). METHODS: A wireless energy transfer system was developed based on resonant coupling at approximately 200 MHz to power multiple pacing nodes...
September 11, 2018: Journal of Cardiovascular Electrophysiology
Mouhannad M Sadek, F Daniel Ramirez, Pablo B Nery, Mehrdad Golian, Calum J Redpath, Girish M Nair, David H Birnie
INTRODUCTION: Fluoroscopy use during catheter ablation procedures increases the cumulative lifetime radiation exposure of patients and operators, potentially leading to a higher risk of cancer and radiation-related injuries. Non-fluoroscopic ablation (NFA) has been described for supraventricular tachycardia, typical atrial flutter, paroxysmal atrial fibrillation (AF) and outflow tract ventricular tachycardia (VT). Complete transition to NFA of more complex arrhythmias, including persistent AF, left atrial (LA) flutter and structural VT, has not been previously described...
September 11, 2018: Journal of Cardiovascular Electrophysiology
Nathan C Denham, Charles M Pearman, Wern Yew Ding, Johan Waktare, Dhiraj Gupta, Richard Snowdon, Mark Hall, Robert Cooper, Simon Modi, Derick Todd, Saagar Mahida
BACKGROUND: A large number of SCN5A variants have been reported to underlie Brugada syndrome (BrS). However, the evidence supporting individual variants is highly heterogeneous. OBJECTIVE: We systematically re-evaluated all SCN5A variants reported in BrS using the 2015 ACMG-AMP guidelines METHODS: A Pubmed/Embase search was performed to identify all reported SCN5A variants in BrS. Standardized bioinformatic re-analysis (SIFT, PolyPhen, Mutation Taster, Mutation assessor, FATHMM, GERP, PhyloP, and SiPhy) and re-evaluation of frequency in the gnomAD database was performed...
September 11, 2018: Journal of Cardiovascular Electrophysiology
Shinsuke Miyazaki, Kanae Hasegawa, Kenichi Kaseno, Hiroshi Tada
A 67-year-old man with hypertrophic cardiomyopathy underwent a 4`th ablation procedure for persistent atrial tachycardia (AT). He had undergone a pulmonary vein isolation, and left atrial (LA) roof and mitral isthmus linear ablation for persistent atrial fibrillation within the recent 10 years. The starting rhythm was a stable AT with a cycle length of 255ms. This article is protected by copyright. All rights reserved.
September 11, 2018: Journal of Cardiovascular Electrophysiology
Daoyuan Si, Mohammed Ali Azam, Patrick F H Lai, Nima Zamiri, Galina Kichigina, John Asta, Stéphane Massé, Mahmoud M Bokhari, Andreu Porta-Sánchez, Christopher Labos, Huan Sun, Ping Yang, Kaumaraswamy Nanthakumar
INTRODUCTION: Following long-duration ventricular fibrillation (LDVF), re-initiation of ventricular fibrillation (VF) poses a major challenge during resuscitation. Ryanodine receptor-2 (RyR2) becomes dysfunctional following ventricular fibrillation (VF). The relationship between LDVF, RyR2 modulation, and ventricular refibrillation, as well as the role of RyR2 phosphorylation, remain unknown. METHODS: Langendorff-perfused rabbit hearts were subjected to global ischemia and treated with azumolene (or vehicle alone in controls) upon reperfusion...
September 11, 2018: Journal of Cardiovascular Electrophysiology
Shinsuke Miyazaki, Takatsugu Kajiyama, Tomonori Watanabe, Masahiro Hada, Hiroaki Nakamura, Hitoshi Hachiya, Hiroshi Tada, Kenzo Hirao, Yoshito Iesaka
BACKGROUND: Electrical connections between ipsilateral pulmonary veins (PVs) have been reported histologically and electrophysiologically. This study investigated the impact of electrical connections between ipsilateral PVs on PV isolation using second-generation cryoballoons (CB2-PVI). METHODS: Five hundred eleven atrial fibrillation patients, without any PV anomalies, underwent CB2-PVI using one 28-mm balloon and a single 3-minute freeze strategy, without any bonus applications...
September 7, 2018: Journal of Cardiovascular Electrophysiology
Parin J Patel, Rachel Segar, Jyoti Kandlikar Patel, Benzy J Padanilam, Eric N Prystowsky
BACKGROUND: Electrophysiology study (EPS) is an important part of the diagnosis and workup for supraventricular tachycardia (SVT). Provocative medications are used to induce arrhythmias when they are not inducible at baseline. The most common medication is the beta-1 specific agonist isoproterenol, but recent price increases have resulted in a shift toward the nonspecific agonist epinephrine. OBJECTIVES: We hypothesize that isoproterenol is a better induction agent for SVT during EPS than epinephrine...
September 7, 2018: Journal of Cardiovascular Electrophysiology
Zsolt Bari, Mate Vamos, Peter Bogyi, Dwight Reynolds, Todd Sheldon, Dedra H Fagan, Gabor Zoltan Duray
INTRODUCTION: The Micra Transcatheter Pacing System provides rate adaptive pacing utilizing an individually programmable 3-axis accelerometer. We evaluated the short- and mid-term performance of the Micra activity sensor by testing all 3 available activity vectors during exercise tests. METHODS AND RESULTS: Implantation and follow-up data were prospectively collected from patients undergoing Micra implantation at our institution. Patients underwent a 5-minute exercise test for each vector at pre-discharge (initial testing) and at scheduled in-office visits (repeat testing)...
September 3, 2018: Journal of Cardiovascular Electrophysiology
Naomi Kanamori, Takeshi Kato, Satoru Sakagami, Takahiro Saeki, Chieko Kato, Keiichi Kawai, Akio Chikata, Shin-Ichiro Takashima, Hisayoshi Murai, Soichiro Usui, Hiroshi Furusho, Shuichi Kaneko, Masayuki Takamura
INTRODUCTION: A novel real-time lesion size index (LSI) that incorporates contact force (CF), time, and power has been developed for safe and effective catheter ablation. We evaluated the optimal LSI to eliminate gap formation during pulmonary vein isolation (PVI). METHODS AND RESULTS: We enrolled consecutive patients who underwent their first PVI using fiber-optic CF-sensing catheter for atrial fibrillation between December 2016 and October 2017. CF parameters, force-time integral (FTI), and LSI for 3,095 ablation points in 34 patients were evaluated...
September 3, 2018: Journal of Cardiovascular Electrophysiology
Yasuhiro Shirai, Jackson J Liang, Fermin C Garcia, Gregory E Supple, David J Callans, Erica S Zado, Francis E Marchlinski, Pasquale Santangeli
INTRODUCTION: In patients with monomorphic idiopathic outflow tract ventricular arrhythmias (OT-VAs), catheter ablation (CA) at the earliest activation site can result in a shift in QRS morphology indicating a change in activation patterns. This study aimed to investigate the prevalence, mapping features and ablation outcomes of OT-VAs displaying a QRS morphology shift following CA. METHODS AND RESULTS: We retrospectively analyzed 446 patients with monomorphic OT-VAs...
September 3, 2018: Journal of Cardiovascular Electrophysiology
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