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https://www.readbyqxmd.com/read/28438722/propagation-of-meandering-rotors-surrounded-by-high-dominant-frequency-areas-in-persistent-atrial-fibrillation
#1
João Salinet, Fernando S Schlindwein, Peter Stafford, Tiago P Almeida, Xin Li, Frederique J Vanheusden, María S Guillem, G André Ng
BACKGROUND: identification of arrhythmogenic regions remains a challenge in persistent atrial fibrillation (persAF). Frequency and phase analysis allows identification of potential ablation targets. OBJECTIVE: This study aims to investigate the spatiotemporal association between dominant frequency (DF) and re-entrant phase activation areas. METHODS: Eight persAF patients undergoing first-time catheter ablation procedure were enrolled. A non-contact array catheter was deployed into the left atrium (LA) and 2048 AF electrograms (AEG) were acquired for 15 seconds following ventricular far-field cancellation...
April 21, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28436549/atrial-undersensing-secondary-to-quiet-timer-blanking-in-pediatric-and-congenital-heart-disease-patients
#2
Johannes C von Alvensleben, Michael Schaffer, Caitlin Brateng, Kathryn K Collins
BACKGROUND: Atrial undersensing despite normal atrial lead parameters and high amplitude electrograms has been described in adult patients as a consequence of atrial amplifier saturation. Repetitive inputs cause amplifier ringing and undersensing occurs as consequence of quiet timer blanking. High amplitude ventricular electrograms can also result in atrial blanking secondary to cross chamber effect. This has not been described in pediatric patients or epicardial pacing systems and specific risk factors are not known...
April 24, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28432805/pitfalls-in-electrogram-interpretation-subcutaneous-cardioverter-defibrillator-malfunction-in-brugada-syndrome
#3
Giovanni Morani, Bruna Bolzan, Luca Tomasi, Ruggero Tomei, Corrado Vassanelli
A patient with Brugada Syndrome implanted with subcutaneous cardioverter defibrillator (S-ICD) had oversensing episodes treated with S-ICD shocks. Comparable artefacts weren't evocable with S-ICD pocket manipulation. The fluoroscopy excluded S-ICD macroscopic damage. The device extraction revealed undamaged pulse generator and connector, but the lead was inappropriately tunnelled under the sixth rib. Then the S-ICD malfunction was due to lead microscopic damage caused by lead rubbing the rib surface. This article is protected by copyright...
April 22, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28432503/high-voltage-zones-within-the-pulmonary-vein-antra-major-determinants-of-acute-pulmonary-vein-reconnections-after-atrial-fibrillation-ablation
#4
Koichi Nagashima, Ichiro Watanabe, Yasuo Okumura, Kazuki Iso, Keiko Takahashi, Ryuta Watanabe, Masaru Arai, Sayaka Kurokawa, Toshiko Nakai, Kimie Ohkubo, Shunichi Yoda, Atsushi Hirayama
PURPOSE: Recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) is mainly due to PV reconnections. Patient-specific tissue characteristics that may contribute remain unidentified. This study aimed to assess the relationship between the bipolar electrogram voltage amplitudes recorded from the PV-left atrial (LA) junction and acute PV reconnection sites. METHODS: Three-dimensional LA voltage maps created before an extensive encircling PVI in 47 AF patients (31 men; mean age 62 ± 11 years) were examined for an association between the EGM voltage amplitude recorded from the PV-LA junction and acute post-PVI PV reconnections (spontaneous PV reconnections and/or ATP-provoked dormant PV conduction)...
April 21, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28431065/cha2ds2-vasc-score-and-blood-biomarkers-to-identify-patients-with-atrial-high-rate-episodes-and-paroxysmal-atrial-fibrillation
#5
Paulina Wakula, Benjamin Neumann, Jens Kienemund, Eva Thon-Gutschi, Tatjana Stojakovic, Martin Manninger, Daniel Scherr, Hubert Scharnagl, Martin Kapl, Burkert Pieske, Frank R Heinzel
Aims: Paroxysmal atrial fibrillation (PAF) is often asymptomatic but nonetheless harmful. We evaluated the performance of disease-related blood biomarkers and CHA2DS2-VASc score to discriminate for PAF in patients with continuous rhythm monitoring. Methods and Results: Clinical data and blood samples were obtained from patients with dual-chamber pacemakers selected according to the absence (no_AHRE) or presence of Atrial High-Rate Episodes (AHRE) >6 min in recent device history (case-control approach)...
April 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28431051/safety-long-term-outcomes-and-predictors-of-recurrence-after-first-line-combined-endoepicardial-ventricular-tachycardia-substrate-ablation-in-arrhythmogenic-cardiomyopathy-impact-of-arrhythmic-substrate-distribution-pattern-a-prospective-multicentre-study
#6
Antonio Berruezo, Juan Acosta, Juan Fernández-Armenta, Alonso Pedrote, Alberto Barrera, Eduardo Arana-Rueda, Andrés Ignacio Bodegas, Ignasi Anguera, Luis Tercedor, Diego Penela, David Andreu, Rosario Jesus Perea, Susana Prat-González, Lluis Mont
Background: First-line endoepicardial ventricular tachycardia (VT) ablation has been proposed for patients with arrhythmogenic cardiomyopathy (AC). This study reports procedural safety, outcomes, and predictors of recurrence. Methods and Results: Forty-one consecutive patients [12 with left ventricle (LV) involvement, 7 left-dominant] underwent first-line endoepicardial VT substrate ablation. Standard bipolar and unipolar thresholds were used to define low-voltage areas (LVA)...
April 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28426919/unknown-intracardiac-electrogram
#7
Eric N Prystowsky
Watch a video presentation of this article. For additional educational resources, please visit Medtronic Academy .
April 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28421394/waveform-integrity-in-atrial-fibrillation-the-forgotten-issue-of-cardiac-electrophysiology
#8
Miguel Martínez-Iniesta, Juan Ródenas, Raúl Alcaraz, José J Rieta
Atrial fibrillation (AF) is the most common arrhythmia in clinical practice with an increasing prevalence of about 15% in the elderly. Despite other alternatives, catheter ablation is currently considered as the first-line therapy for the treatment of AF. This strategy relies on cardiac electrophysiology systems, which use intracardiac electrograms (EGM) as the basis to determine the cardiac structures contributing to sustain the arrhythmia. However, the noise-free acquisition of these recordings is impossible and they are often contaminated by different perturbations...
April 18, 2017: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/28419605/radiofrequency-catheter-ablation-of-atrial-fibrillation-electrical-modification-suggesting-transmurality-is-faster-achieved-with-remote-magnetic-catheter-in-comparison-with-contact-force-use
#9
Sok-Sithikun Bun, Anis Ayari, Decebal Gabriel Latcu, Abdelkarim Errahmouni, Nadir Saoudi
BACKGROUND: Remote magnetic navigation (RMN) and contact force (CF) sensing catheters are available technologies for radiofrequency (RF) catheter ablation of atrial fibrillation (AF). Our purpose was to compare time to electrogram (EGM) modification suggesting transmural lesions between RMN and CF-guided AF ablation. METHODS AND RESULTS: 1008 RF applications were analyzed in 21 patients undergoing RMN (n = 11) or CF-guided ablation (n = 10) for paroxysmal AF. All procedures were performed in sinus rhythm during general anaesthesia...
April 17, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28407062/voltage-gradient-mapping-and-electrophysiologically-guided-cryoablation-in-children-with-avnrt
#10
Fabrizio Drago, Irma Battipaglia, Mario Salvatore Russo, Romolo Remoli, Vincenzo Pazzano, Gino Grifoni, Greta Allegretti, Massimo Stefano Silvetti
Aims: Recently, voltage gradient mapping of Koch's triangle to find low-voltage connections, or 'voltage bridges', corresponding to the anatomic position of the slow pathway, has been introduced as a method to ablate atrioventricular nodal reentry tachycardia (AVNRT) in children. Thus, we aimed to assess the effectiveness of voltage mapping of Koch's triangle, combined with the search for the slow potential signal in 'low-voltage bridges', to guide cryoablation of AVNRT in children. Methods and results: From June 2015 to May 2016, 35 consecutive paediatric patients (mean age 12...
April 12, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28406705/tolerance-of-isolated-rabbit-hearts-to-short-ischemic-periods-is-affected-by-increased-lv-mass-fraction
#11
M Hlaváčová, V Olejníčková, M Ronzhina, T Stračina, O Janoušek, M Nováková, P Babula, J Kolářová, I Provazník, H Paulová
Hypertrophied hearts are known for increased risk of arrhythmias and are linked with reduced ischemic tolerance. However, still little is known about state characterized only by increased left ventricle (LV) mass fraction. Seventeen isolated rabbit hearts with various LV mass were divided into two groups according to LV weight/heart weight ratio (LVW/HW ratio), namely group H and L (with higher and lower LVW/HW ratio, respectively) and underwent three short cycles of global ischemia and reperfusion. The differences in electrogram (heart rate, QRS(max), mean number, onset and dominant form of ventricular premature beats) and in biochemical markers of myocardial injury (creatine kinase, lactate dehydrogenase - LDH) and lipid peroxidation (4-hydroxy-2-nonenal - 4-HNE) were studied...
April 12, 2017: Physiological Research
https://www.readbyqxmd.com/read/28401455/what-is-the-appropriate-lesion-set-for-ablation-in-patients-with-persistent-atrial-fibrillation
#12
REVIEW
Jorge Romero, Carola Gianni, Andrea Natale, Luigi Di Biase
Special attention must be paid to detect, diagnose, and optimize management of reversible or treatable causes of long-standing persistent atrial fibrillation (LSPAF) such as obesity, obstructive sleep apnea (OSA), hypertension, hypo or hyperthyroidism, inflammatory and infectious diseases, and stress. Though, we strongly believe that the role of the pulmonary veins (PVs) is more pronounced in paroxysmal atrial fibrillation (AF) than in persistent AF, performing an adequate pulmonary vein isolation is still key in LSPAF...
May 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28395996/atrial-fibrillation-ablation-guided-by-a-novel-nonfluoroscopic-navigation-system
#13
Gabriel Ballesteros, Pablo Ramos, Renzo Neglia, Diego Menéndez, Ignacio García-Bolao
INTRODUCTION AND OBJECTIVES: Rhythmia is a new nonfluoroscopic navigation system that is able to create high-density electroanatomic maps. The aim of this study was to describe the acute outcomes of atrial fibrillation (AF) ablation guided by this system, to analyze the volume provided by its electroanatomic map, and to describe its ability to locate pulmonary vein (PV) reconnection gaps in redo procedures. METHODS: This observational study included 62 patients who underwent AF ablation with Rhythmia compared with a retrospective cohort who underwent AF ablation with a conventional nonfluoroscopic navigation system (Ensite Velocity)...
April 5, 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/28395893/occurrence-and-natural-history-of-clinically-silent-episodes-of-atrial-fibrillation-in-hypertrophic-cardiomyopathy
#14
Ethan J Rowin, Alexander Orfanos, N A Mark Estes, Wendy Wang, Mark S Link, Martin S Maron, Barry J Maron
Overt symptomatic atrial fibrillation (AF) occurs in over 20% of patients with hypertrophic cardiomyopathy (HC) leading to impaired quality of life, loss of productivity, and the risk for embolic stroke. However, the overall burden presented by AF in the HC population is unresolved due to the unknown frequency of silent asymptomatic episodes that do not necessarily achieve clinical recognition but nevertheless may have important disease-related implications. Therefore, stored electrograms were analyzed retrospectively for AF in 75 consecutive patients with HC (without AF history) implanted with dual-chamber cardioverter-defibrillators...
March 16, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28387462/identification-and-electrophysiological-characterization-of-early-left-atrial-structural-remodeling-as-a-predictor-for-atrial-fibrillation-recurrence-after-pulmonary-vein-isolation
#15
Atsuhiko Yagishita, Dina Sparano, Ivan Cakulev, J Rod Gimbel, Timothy Phelan, Hossam Mustafa, Samer De Oliveira, Judith Mackall, Mauricio Arruda
BACKGROUND: Voltage-guided substrate ablation following pulmonary vein isolation (PVI) improves atrial fibrillation (AF) ablation outcomes. However, by setting upper voltage cutoff of 0.5 mV during sinus rhythm (SR) to guided substrate ablation using electroanatomic voltage mapping (EAVM), mildly affected low voltage area (maLVA) may be undetected. We sought to determine the optimal bipolar voltage cutoff to identify maLVA, its electrogram complexity, and the implication on ablation outcome...
April 7, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28386822/rapid-mapping-and-differentiation-in-ventricular-outflow-tract-arrhythmia-using-non-contact-mapping
#16
Kazuo Miyazawa, Marehiko Ueda, Yusuke Kondo, Tomohiko Hayashi, Miyo Nakano, Masayuki Ishimura, Masahiro Nakano, Yoshio Kobayashi
PURPOSE: Ventricular outflow tract arrhythmias (VOTAs) can be successfully treated by catheter ablation. However, it is sometimes difficult to differentiate the origin of VOTAs between the right ventricular outflow tract (RVOT) and the other sites, leading to a long fluoroscopy time and unnecessary radiofrequency applications. This study aimed to clarify distinguishable characteristics of the propagation pattern obtained from non-contact mapping (NCM) for VOTA ablation. METHODS: Consecutive 45 patients with VOTAs who underwent catheter ablation using the NCM system were included in this study...
April 6, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28372867/prospective-evaluation-of-a-novel-catheter-equipped-with-mini-electrodes-on-a-10-mm-tip-for-cavotricuspid-isthmus-ablation-the-efficacy-of-a-mini-electrode-guided-ablation
#17
Takamitsu Takagi, Shinsuke Miyazaki, Takayuki Niida, Takatsugu Kajiyama, Tomonori Watanabe, Shigeki Kusa, Hiroaki Nakamura, Hiroshi Taniguchi, Hitoshi Hachiya, Yoshito Iesaka, Mitsuaki Isobe, Kenzo Hirao
BACKGROUND: Clinical utility of large-tip ablation catheters for cavo-tricuspid isthmus (CTI) ablation has been reported, however, it is limited by the impaired near-field electrogram resolution. This study evaluated the efficiency of a novel mini-electrode (ME) equipped 10-mm tip CTI ablation catheter. METHODS: Thirty-four patients were prospectively enrolled (Group-A). Initially, radiofrequency energy was applied point-by-point guided by ME signals. If it failed, RF applications were applied conventionally guided by tip-ring signals...
March 29, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28364320/repetitive-atrial-activation-during-ongoing-atrial-fibrillation-comparison-using-different-mapping-algorithms-preliminary-findings
#18
Philipp Halbfass, Patrick Müller, Karin Nentwich, Kai Sonne, Karsten Hamm, Sebastian Barth, Franziska Fochler, Andreas Mügge, Thomas Deneke
PURPOSE: Targeting repetitive sources identified during atrial fibrillation (focal impulse and rotor modulation, FIRM) has been used as an ablation strategy using specific mapping tools. Aim of this study was to evaluate FIRM mapped rotors with a new multipolar mapping algorithm. METHODS: Patients with persistent atrial fibrillation undergoing FIRM ablation were included. Mapping of left atrial rotors was performed with a 64-pole basket catheter in conjunction with a specialized phase mapping algorithm...
March 31, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28356307/visualizing-localized-reentry-with-ultra-high-density-mapping-in-iatrogenic-atrial-tachycardia-beware-pseudo-reentry
#19
Vishal Luther, Markus Sikkel, Nathan Bennett, Fernando Guerrero, Kevin Leong, Norman Qureshi, Fu Siong Ng, Sajad A Hayat, S M Afzal Sohaib, Louisa Malcolme-Lawes, Elaine Lim, Ian Wright, Michael Koa-Wing, David C Lefroy, Nick W F Linton, Zachary Whinnett, Prapa Kanagaratnam, D Wyn Davies, Nicholas S Peters, Phang Boon Lim
BACKGROUND: The activation pattern of localized reentry (LR) in atrial tachycardia remains incompletely understood. We used the ultra-high density Rhythmia mapping system to study activation patterns in LR. METHODS AND RESULTS: LR was suggested by small rotatory activations (carousels) containing the full spectrum of the color-coded map. Twenty-three left-sided atrial tachycardias were mapped in 15 patients (age: 64±11 years). 16 253±9192 points were displayed per map, collected over 26±14 minutes...
April 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/28344442/voltage-directed-cavo-tricuspid-isthmus-ablation-using-a-novel-ablation-catheter-mapping-technology-in-a-myotonic-dystrophy-type-i-patient
#20
Vincenzo Russo, Anna Rago, Andrea Antonio Papa, Federica Di Meo, Carmine Ciardiello, Giovanni Cimmino, Gerardo Nigro
A successful case of maximum voltage-directed cavo-tricuspid isthmus (CTI) ablation using a novel ablation catheter mapping technology in a myotonic dystrophy type I (DM1) patient is reported. The patient complained recurrent episodes of atrial flutter, revealed by the atrio-ventricular electrograms analysis during the routine pacemaker controls.
October 2016: Acta Myologica: Myopathies and Cardiomyopathies: Official Journal of the Mediterranean Society of Myology
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