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Stefan Georg Spitzer, László Károlyi, Carola Rämmler, Frank Scharfe, Thomas Weinmann, Mirko Zieschank, Anke Langbein
INTRODUCTION: A patient-tailored ablation approach focused on the elimination of both pulmonary vein triggers as well as substrate drivers may result in favourable outcomes with recurrent persistent AF patients. OBJECTIVE: We evaluated the long-term outcomes of rotor ablation combined with conventional pulmonary vein isolation (PVI) in patients with recurrent non-paroxysmal AF. METHODS: 58 consecutive patients underwent FIRM-guided rotor ablation followed by conventional PVI for the treatment of recurrent non-paroxysmal AF...
October 21, 2016: Journal of Cardiovascular Electrophysiology
Steven Swiryn, Michael V Orlov, David G Benditt, John P DiMarco, Donald M Lloyd-Jones, Edward Karst, Fujian Qu, Mara T Slawsky, Melanie Turkel, Albert L Waldo
BACKGROUND: The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear...
October 18, 2016: Circulation
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)...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Tomos E Walters, Jonathan M Kalman, Sheila K Patel, Megan Mearns, Elena Velkoska, Louise M Burrell
AIM: Angiotensin converting enzyme 2 (ACE2) is an integral membrane protein whose main action is to degrade angiotensin II. Plasma ACE2 activity is increased in various cardiovascular diseases. We aimed to determine the relationship between plasma ACE2 activity and human atrial fibrillation (AF), and in particular its relationship to left atrial (LA) structural remodelling. METHODS AND RESULTS: One hundred and three participants from a tertiary arrhythmia centre, including 58 with paroxysmal AF (PAF), 20 with persistent AF (PersAF), and 25 controls, underwent clinical evaluation, echocardiographic analysis, and measurement of plasma ACE2 activity...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Martin Huemer, Daniel Qaiyumi, Philipp Attanasio, Abdul Parwani, Burkert Pieske, Florian Blaschke, Leif-Hendrik Boldt, Wilhelm Haverkamp, Alexander Wutzler
AIMS: In persistent atrial fibrillation (AF), left atrial low-voltage areas and complex fractionated atrial electrograms (CFAEs) have been thoroughly discussed as critical substrate points for AF perpetuation. Thus, in patients undergoing pulmonary vein isolation, these sites are often considered additional ablation targets. Currently, mapping techniques for these substrate indicators are still under discussion. The aim of this study was to evaluate the impact of different mapping catheters on the detection of low-voltage areas and CFAE...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Tobias Opthof, Carol Ann Remme, Esther Jorge, Francisco Noriega, Rob F Wiegerinck, Arlin Tasiam, Leander Beekman, Jesus Alvarez-Garcia, Cristian Munoz-Guijosa, Ruben Coronel, Juan Cinca
BACKGROUND: The repolarization pattern of the human heart is unknown. OBJECTIVE: We performed a multisite analysis of the activation-repolarization patterns and mRNA expression patterns of ion channel subunits in isolated human hearts. METHODS: Hearts from three donors without reported cardiac disease were Langendorff perfused with the patient's own blood. A standard ECG was obtained prior to explantation. Up to 92 unipolar electrograms from 24 transmural needles were obtained during right atrial pacing...
October 10, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Daniele Muser, Pasquale Santangeli, Simon A Castro, Rajeev K Pathak, Jackson J Liang, Tatsuya Hayashi, Silvia Magnani, Fermin C Garcia, Mathew D Hutchinson, Gregory G Supple, David S Frankel, Michael P Riley, David Lin, Robert D Schaller, Sanjay Dixit, Erica S Zado, David J Callans, Francis E Marchlinski
BACKGROUND: Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy. METHODS AND RESULTS: We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT...
October 2016: Circulation. Arrhythmia and Electrophysiology
Liang Zhao, Kai Xu, Weifeng Jiang, Li Zhou, Yuanlong Wang, Xiaodong Zhang, Shaohui Wu, Daoliang Zhang, Xu Liu
OBJECTIVE: The long-term outcomes of catheter ablation of atrial fibrillation (AF) developing post-cardiac valve replacement (VR) remain undefined. METHODS AND RESULTS: Eighty-nine post-VR patients with AF (44% longstanding persistent AF, LSP-AF) were enrolled. Cumulative success rate of circumferential pulmonary vein ablation (CPVA for paroxysmal AF) and bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs for persistent and LSP-AF) as index and repeat procedural endpoints reached 57% (mean, 1...
October 1, 2016: International Journal of Cardiology
Christine M Tompkins, Scott McNitt, Bronislava Polonsky, James P Daubert, Paul J Wang, Arthur J Moss, Wojciech Zareba, Valentina Kutyifa
INTRODUCTION: Approximately 10-20% of ICD recipients receive inappropriate device therapies. The purpose of this study was to compare the frequency of inappropriate therapies (IT) between men and women enrolled in MADIT II and MADIT-CRT, and assess for potential adverse outcomes. METHODS: The electrograms for each ICD or CRT-D therapy, defined as either ATP or shock, were reviewed by adjudication committees for both studies. ICD therapy was considered inappropriate if it was delivered for reasons other than VT/VF...
October 2, 2016: Journal of Cardiovascular Electrophysiology
Massimo Giammaria, Gianluca Quirino, Enrico Cecchi, Gaetano Senatore, Paolo Pistelli, Mario Bocchiardo, Roberto Mureddu, Paolo Diotallevi, Eraldo Occhetta, Andrea Magnani, Mauro Bensoni, Catia Checchinato, Valentina Conti, Sandra Badolati, Antonio Mazza
BACKGROUND: AtrioVentricular (AV) and InterVentricular (VV) delay optimization can improve ventricular function in Cardiac Resynchronization Therapy (CRT) and is usually performed by means of echocardiography. St Jude Medical has developed an automated algorhythm which calculates the optimal AV and VV delays (QuickOpt™) based on Intracardiac ElectroGrams, (IEGM), within 2 min. So far, the efficacy of the algorhythm has been tested acutely with standard lead position at right ventricular (RV) apex...
March 2016: Indian Pacing and Electrophysiology Journal
Hannah Friedman, John V Higgins, James D Ryan, Thomas Konecny, Samuel J Asirvatham, Yong-Mei Cha
BACKGROUND: In the USA, the number of people needing implantable cardioverter defibrillators (ICDs) has grown dramatically. Many ICD recipients will need to undergo a surgical procedure at some point following ICD implantation. Most surgeries involve the use of electrocautery. Currently, the effects of electrocautery-induced electromagnetic interference (EI-EMI) on ICDs are poorly understood. The aim of this study was to study EI-EMI using prospectively collected clinical data. METHODS: We analyzed prospectively collected ICD data from patients undergoing a surgical procedure at Mayo Clinic between 2011 and 2012...
September 24, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Uyên Châu Nguyên, Masih Mafi-Rad, Jean-Paul Aben, Martijn W Smulders, Elien B Engels, Antonius M W van Stipdonk, Justin G L M Luermans, Sebastiaan C A M Bekkers, Frits W Prinzen, Kevin Vernooy
BACKGROUND: Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response. OBJECTIVE: To integrate coronary venous electro-anatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar. METHODS: Eighteen CRT candidates with focal scar on DE-CMR were prospectively included...
September 20, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Sandeep A Saha, Kousik Krishnan, Christopher Madias, Richard G Trohman
A 34-year-old man with Brugada syndrome (BrS) presented with electrical storm, manifested as multiple appropriate shocks from his implantable cardioverter-defibrillator over a period of 7 hours. He had not tolerated prior treatment with quinidine, and had self-discontinued cilostazol citing persistent palpitations. After stabilization with intravenous isoproterenol, an electrophysiology study was performed but no spontaneous or induced ventricular ectopic beats were identified. A three-dimensional (3D) endocardial electro-anatomic map of the right ventricular outflow tract (RVOT), pulmonic valve, and pulmonary artery, as well as a 3D epicardial map of the RVOT, were created...
September 19, 2016: Cardiology and Therapy
Carsten W Israel
During the CARDIOSTIM/EUROPACE meeting in Nice, France, the First World Championship of Device Electrogram (EGM) Interpretation was held and more than 120 physicians participated actively. In the first round, questions on 20 EGMs had to be answered, and the eight finalists had to solve another seven EGM questions before gold, silver, and bronze medals were distributed. This activity prepared by STIMUPRAT - an organization in which electrophysiologists, other physicians, residents, fellows, and students share their tracings and thoughts with others - demonstrates that knowledge about the way devices think and document their events is not only important so as to optimize the treatment of device patients but can also be great fun...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Mark L Brown, Charles D Swerdlow
Ensuring sensing and detection of ventricular tachycardia (VT) and ventricular fibrillation (VF) was a prerequisite for the clinical trials that established the survival benefit of implantable cardioverter defibrillators (ICDs). However, for decades, a high incidence of unnecessary shocks limited patients' and physicians' acceptance of ICD therapy. Oversensing, misclassification of supraventricular tachycardia (SVT) as VT, and self-terminating VT accounted for the vast majority of unnecessary shocks. Medtronic ICDs utilize sensitive baseline settings with minimal blanking periods to ensure accurate sensing of VF, VT, and SVT electrograms...
September 2016: Herzschrittmachertherapie & Elektrophysiologie
Veronique M F Meijborg, Mark Potse, Chantal E Conrath, Charly N W Belterman, Jacques M T De Bakker, Ruben Coronel
BACKGROUND: J-waves in inferolateral leads are associated with a higher risk for idiopathic ventricular fibrillation. We aimed to test potential mechanisms (depolarization or repolarization dependent) responsible for inferolateral J-waves. We hypothesized that inferolateral J-waves can be caused by regional delayed activation of myocardium that is activated late during normal conditions. METHODS: Computer simulations were performed to evaluate how J-point elevation is influenced by reducing sodium current conductivity (GNa), increasing transient outward current conductivity (Gto), or cellular uncoupling in three predefined ventricular regions (lateral, anterior, or septal)...
2016: Frontiers in Physiology
M A Oyama, M J Hezzell, D S Laughlin, C L Thorn, M S Kraus, A R Gelzer
Management of symptomatic bradyarrhythmias such as complete atrioventricular block often involves permanent implantation of a transvenous pacemaker. Both during and after implantation, the operator can telemetrically assess and adjust a variety of electrical parameters associated with the pacemaker function in order to optimize the sensitivity, reliability, and power consumption of the device. Herein, we report an unexpected change in the paced electrocardiographic QRS complex morphology in two dogs undergoing bipolar pacing associated with changes in the pacemaker output amplitude settings first detected during threshold testing...
September 6, 2016: Journal of Veterinary Cardiology: the Official Journal of the European Society of Veterinary Cardiology
Jun-Seop Song, Young-Seon Lee, Minki Hwang, Jung-Kee Lee, Changyong Li, Boyoung Joung, Moon-Hyoung Lee, Eun Bo Shim, Hui-Nam Pak
Although 3D-complex fractionated atrial electrogram (CFAE) mapping is useful in radiofrequency catheter ablation for persistent atrial fibrillation (AF), the directions and configuration of the bipolar electrodes may affect the electrogram. This study aimed to compare the spatial reproducibility of CFAE by changing the catheter orientations and electrode distance in an in-silico left atrium (LA). We conducted this study by importing the heart CT image of a patient with AF into a 3D-homogeneous human LA model...
September 2016: Korean Journal of Physiology & Pharmacology
Kyle Weigand, Russell Witte, Talal Moukabary, Ike Chinyere, Jordan Lancaster, Mary Kaye Pierce, Steven Goldman, Elizabeth Juneman
OBJECTIVE: The objective of this study was to define the clinical relevance of in-vivo electrophysiologic (EP) studies in a rat model of chronic ischemic heart failure (CHF). METHODS: Electrical activation sequences, voltage amplitudes, and monophasic action potentials (MAPs) were recorded from adult male Sprague-Dawley rats six weeks after left coronary artery ligation. Programmed electrical stimulation (PES) sequences were developed to induce sustained ventricular tachycardia (VT)...
September 2, 2016: IEEE Transactions on Bio-medical Engineering
Paul A Gould, Cameron Booth, Kieran Dauber, Kevin Ng, Andrew Claughton, Gerald C Kaye
INTRODUCTION: This study sought to investigate specific contact force (CF) parameters to guide Cavotricuspid Isthmus (CTI) ablation and compare the outcome with a historical control cohort. METHODS AND RESULTS: Patients (30) undergoing CTI ablation were enrolled prospectively in the Study cohort and compared with a retrospective Control cohort of 30 patients. Ablation in the Study cohort was performed using CF parameters >10g and < 40 g and a Force Time Integral (FTI) of 800 ± 10 gs...
August 29, 2016: Journal of Cardiovascular Electrophysiology
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