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Arrhythmia ablation

Jeffrey P Gordon, Jackson J Liang, Rajeev Pathak, Erica S Zado, Fermin C Garcia, Matthew D Hutchinson, Pasquale Santangeli, Robert D Schaller, David S Frankel, Francis E Marchlinski, Gregory E Supple
BACKGROUND: Catheter ablation of ventricular arrhythmias (VA) from the papillary muscles (PM) is challenging due to limited catheter stability and contact on the PMs with their anatomic complexity and mobility. OBJECTIVE: To evaluate the effectiveness of cryoablation as an adjunctive therapy for PM VAs when radiofrequency (RF) ablation has failed. METHODS: We evaluated a retrospective series of patients who underwent cryoablation for PM VAs when RF ablation had failed...
August 14, 2018: Journal of Cardiovascular Electrophysiology
Kay Weipert, Malte Kuniss, Thomas Neumann
BACKGROUND: CardioInsight™ is a noninvasive three-dimensional mapping system technology which offers a unique method for arrhythmia characterization and localization. With a 252-lead ECG vest on the patient's torso and a noncontrast CT scan, epicardial potentials are detected and by means of reconstruction algorithms activation and phase maps are created, offering a deeper understanding of localization and mechanisms of arrhythmias including atrial fibrillation without the need for an endocardial catheter...
August 13, 2018: Herzschrittmachertherapie & Elektrophysiologie
Roy Chung, Oussama Wazni, Thomas Dresing, Mina Chung, Walid Saliba, Bruce Lindsay, Patrick Tchou
BACKGROUND: Narrow QRS tachycardia or premature beats (PB) with bystander atrial activation or ventricular-atrial (VA) dissociation is an unusual arrhythmia that can present diagnostic and therapeutic challenges. When VA conduction is robust, these arrhythmias can be difficult to distinguish from atrioventricular nodal reentry. OBJECTIVE: To describe the electrophysiology characteristics, diagnostic maneuvers, and treatment of these types arrhythmias in a series of 7 cases...
August 10, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Fleur M M Meijer, Philippine Kies, Monique R M Jongbloed, Mark G Hazekamp, David R Koolbergen, Nico A Blom, Albert de Roos, Martin J Schalij, Hubert W Vliegen
OBJECTIVES: In repaired tetralogy of Fallot, surgical pulmonary valve replacement (PVR) is in certain cases required. Our institution reported earlier about 26 patients who received a pulmonary homograft via PVR. To date, we have data from more than 17 years of follow-up. The aim of this retrospective study was to evaluate the late haemodynamic and clinical outcomes in this predefined patient group. METHODS: Between 1993 and 2001, 26 patients underwent PVR for pulmonary regurgitation (58% men; 30...
August 8, 2018: Interactive Cardiovascular and Thoracic Surgery
Katie Walsh, Francis Marchlinski
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Ablation is an excellent treatment option for appropriately selected patients. Catheter ablation tools and techniques have evolved since AF ablation was first introduced, but pulmonary vein isolation remains the cornerstone of the procedure. Outcomes from ablation have improved dramatically over the last twenty years, but remain less than optimal for certain patient groups. Areas covered: This review outlines the process of patient selection for AF ablation in contemporary practice, from diagnosis and AF classification to procedural risk assessment...
August 13, 2018: Expert Review of Cardiovascular Therapy
Marek Sramko, Jarieke C Hoogendoorn, Claire A Glashan, Katja Zeppenfeld
Over the last decades, substrate-based approaches to ventricular tachycardia (VT) ablation have evolved into an important therapeutic option for patients with various structural heart diseases (SHD) and unmappable VT. The well-recognized limitations of conventional electroanatomical mapping (EAM) to delineate the complex 3D architecture of scar, and the potential capability of advanced cardiac imaging technologies to provide adjunctive information, have stimulated electrophysiologists to evaluate the role of imaging to improve safety and efficacy of catheter ablation...
August 7, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jamie Sy Ho, Edwin R Chilvers, Muhunthan Thillai
Sarcoidosis is a multisystem granulomatous disease predominantly affecting the lungs, with increased risk of cardiovascular disease, pulmonary hypertension and cardiac sarcoidosis (CS), the latter due to direct granuloma infiltration. Sarcoidosis is often managed by chest physicians who need to understand the diagnostic pathways and initial management plans for patients with cardiac involvement. Areas covered: The most serious consequence of CS is sudden cardiac death due to ventricular tachyarrhythmias or complete atrioventricular block...
August 13, 2018: Expert Review of Respiratory Medicine
Young Choi, Sung-Hwan Kim, Ju Youn Kim, Yoo Ri Kim, Tae-Seok Kim, Youmi Hwang, Ji-Hoon Kim, Sung-Won Jang, Man Young Lee, Tai-Ho Rho, Yong-Seog Oh
PURPOSE: The presence of inducible atrial tachyarrhythmia after pulmonary vein isolation (PVI) during radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) may indicate the necessity of further substrate modification, but the optimal ablation endpoint is unknown. We sought to assess the impact of procedural termination of inducible atrial tachyarrhythmia after PVI in comparison with continued atrial tachyarrhythmia after PVI. METHODS: Among patients who underwent RFCA for persistent AF, we enrolled 93 patients who were in sinus rhythm after PVI and had inducible atrial tachyarrhythmia and 157 patients with continued atrial tachyarrhythmia after PVI...
August 10, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Edward J Ciaccio, Nicholas S Peters, Hasan Garan
BACKGROUND: Atrial fibrillation (AF) is the most common heart arrhythmia, and permanent AF is an intractable medical problem. If cessation of permanent AF were possible, via extensive substrate ablation or multisite stimulation, it could significantly improve the public health. METHOD: A cellular automaton composed of 576 × 576 computerized grid nodes, described in detail previously, was used to test hypotheses concerning the cessation of fibrillatory electrical activity...
August 2, 2018: Computers in Biology and Medicine
Alexandre Costet, Elaine Wan, Lea Melki, Ethan Bunting, Julien Grondin, Hasan Garan, Elisa Konofagou
There is currently no established method for the non-invasive characterization of arrhythmia and differentiation between endocardial and epicardial triggers at the point of care. Electromechanical wave imaging (EWI) is a novel ultrasound-based imaging technique based on time-domain transient strain estimation that can map and characterize electromechanical activation in the heart in vivo. The objectives of this initial feasibility study were to determine that EWI is capable of differentiating between endocardial and epicardial sources of focal rhythm and, as a proof-of-concept, that EWI could characterize focal arrhythmia in one patient with premature ventricular contractions (PVCs) before radiofrequency (RF) ablation treatment...
August 6, 2018: Ultrasound in Medicine & Biology
Koji Miyamoto, Suraj Kapa, Siva K Mulpuru, Abhishek J Deshmukh, Samuel J Asirvatham, Thomas M Munger, Paul A Friedman, Douglas L Packer
OBJECTIVES: This study aimed to assess the outcome of cryoablation in patients with ventricular arrhythmias (VAs) originating from the para-Hisian region. BACKGROUND: There are few data regarding the outcome of cryoablation in patients with VAs originating from the para-Hisian region, where there is the risk of injury to the conduction system. METHODS: The study analyzed all patients undergoing cryoablation at the Mayo Clinic (Rochester, Minnesota) as part of an ablation for VAs originating from the para-Hisian region...
March 2018: JACC. Clinical Electrophysiology
Masaharu Masuda, Mitsutoshi Asai, Osamu Iida, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takashi Kanda, Takuya Tsujimura, Yasuhiro Matsuda, Shota Okuno, Takuya Ohashi, Aki Tsuji, Toshiaki Mano
OBJECTIVES: The aim of this study was to assess the use of wave front propagation speed on a right ventricular map for determining the earliest activation site as the origin of outflow tract ventricular arrhythmias (VAs). BACKGROUND: VAs with centrifugal right ventricular outflow tract (RVOT) activation can be from an RVOT focus or a focus outside the RVOT. METHODS: This prospective observational study included 23 patients with idiopathic outflow tract VAs...
March 2018: JACC. Clinical Electrophysiology
Edward Koźluk, Dorota Zyśko, Agnieszka Piątkowska, Marek Kiliszek, Piotr Lodziński, Sylwia Małkowska, Paweł Balsam, Dariusz Rodkiewicz, Małgorzata Żukowska, Grzegorz Opolski
BACKGROUND: Atrial fibrillation (AF) is a common clinical problem. The left atrium anatomy makes up a factor that may significantly affect the effectiveness of the AF ablation. OBJECTIVES: The aim of the study was to evaluate a long-term effectiveness ablation in patients with common pulmonary vein trunk (CPVT) and AF. MATERIAL AND METHODS: The outcomes of 129 procedures in 95 patients with CPVT out of 1,475 procedures carried out in 1,150 patients with AF treated with ablation, were analyzed...
August 8, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Yoav Michowitz, Jeremy Ben-Shoshan, Oholi Tovia-Brodie, Aharon Glick, Bernard Belhassen
BACKGROUND: The incidence, characteristics, and clinical significance of catheter-induced mechanical suppression (trauma) of ventricular arrhythmias originating in the outflow tract (OT) area have not been thoroughly evaluated. OBJECTIVES: To determine these variables among our patient cohort. METHODS: All consecutive patients with right ventricular OT (RVOT) and left ventricular OT (LVOT) arrhythmias ablated at two medical centers from 1998 to 2014 were included...
August 2018: Israel Medical Association Journal: IMAJ
Borislav Dinov, Sabrina Oebel, Sebastian Hilbert, Susanne Loebe, Arash Arya, Andreas Bollmann, Philipp Sommer, Cosima Jahnke, Ingo Paetsch, Gerhard Hindricks
BACKGROUND: In human patients, studies about the cardiac magnetic resonance (CMR) appearance of the acute radiofrequency (RF) lesions in relation to the procedural outcomes after catheter ablation (CA) of ventricular arrhythmias (VA) are scarce. We aimed to investigate the RF lesions characteristics in relation to the procedural success. METHODS: Patients referred for ablation of VA received CMR (1.5 T) using gadolinium contrast before and after ablation. CA in left ventricle was performed using a 3...
August 2, 2018: American Heart Journal
Livio Bertagnolli, Federica Torri, Sergio Richter, Borislav Dinov, Andreas Müssigbrodt, Arash Arya, Philipp Sommer, Andreas Bollmann, Gerhard Hindricks, Sebastian Hilbert
The precise target location for radiofrequency energy delivery was initially determined through electrophysiological signals and with the help of fluoroscopy. The introduction of the 3D mapping system CARTO® (Biosense Webster Inc., Diamond Bar, CA, USA) in recent years for radiofrequency ablation of arrhythmias has provided new therapeutic options. These improvements have led to reduced procedural and fluoroscopic times. The introduction of new software and technology has also improved clinical outcome and helped to understand the substrate of complex arrhythmias...
August 3, 2018: Herzschrittmachertherapie & Elektrophysiologie
Celestino Sardu, Raffaele Marfella, Gianluca Testa, Matteo Santamaria, Cosimo Sacra, Alfredo Ranauro, Giuseppe Paolisso, Maria Rosaria Rizzo, Michelangela Barbieri
BACKGROUND: The aim of this study was to investigate syncope recurrence in patients with a 2A cardioinhibitory response to the head up tilt testing (HUT). METHODS: In this study, we enrolled 72 consecutive patients affected by syncope with cardioinhibitory response without asystolic significant pause to HUT (2A type). In these patients, we randomly performed electrophysiological study (ES). In case of sino-atrial node, atrio-ventricular node dysfunction, and sustained arrhythmias induction, the ES resulted positive...
August 2018: Medicine (Baltimore)
Zhao-Lian Ouyang, Li-Ping Sun, Hui Chi, Ling Xia, Ying-Lan Gong, Yu-Bo Fan
Two clinical ablation protocols, 2C3L and stepwise, have been routinely used in our group to treat atrial fibrillation (AF), but with a less than 60% long-term arrhythmia-free outcome achieved in patients. The goal of this study was to examine the underlying mechanism of low success in clinical outcome. MRI images from one patient were used to reconstruct a human atrial anatomical model, and fibrotic tissue was manually added to represent the arrhythmia substrate. AF was induced with standard protocols used in clinical practice...
June 2018: Current medical science
David Brieger, John Amerena, John R Attia, Beata Bajorek, Kim H Chan, Cia Connell, Ben Freedman, Caleb Ferguson, Tanya Hall, Haris M Haqqani, Jeroen Hendriks, Charlotte M Hespe, Joseph Hung, Jonathan M Kalman, Prashanthan Sanders, John Worthington, Tristan Yan, Nicholas A Zwar
Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care...
August 2, 2018: Medical Journal of Australia
Amir Jadidi, Björn Müller-Edenborn, Juan Chen, Cornelius Keyl, Reinhold Weber, Jürgen Allgeier, Zoraida Moreno-Weidmann, Dietmar Trenk, Franz-Josef Neumann, Heiko Lehrmann, Thomas Arentz
OBJECTIVES: Left atrial (LA) low-voltage substrate (LVS) potentially slows intra-atrial conduction, which might identify patients at risk for arrhythmia recurrence following pulmonary vein isolation (PVI). BACKGROUND: Up to 50% of patients with persistent atrial fibrillation (AF) have arrhythmia recurrence following PVI, mostly due to arrhythmogenic LA LVS. METHODS: Seventy-two patients with persistent AF underwent electrocardioversion to sinus rhythm and high-density voltage mapping of the left atrium...
April 2018: JACC. Clinical Electrophysiology
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