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Hisao Ogawa - One of the best experts on this subject based on the ideXlab platform.
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prevalence and mechanism of rotor activation identified during Atrial fibrillation by noncontact mapping lack of evidence for a role in the maintenance of Atrial fibrillation
Heart Rhythm, 2016Co-Authors: Hiroshige Yamabe, Hisanori Kanazawa, Miwa Ito, Shozo Kaneko, Hisao OgawaAbstract:Background It remains unclear whether Atrial fibrillation (AF) is maintained by the rotor. Objective We evaluated the role of the rotor and examined its mechanism. Methods Among 75 patients with AF (60 paroxysmal, 15 persistent AF) who underwent 3-dimensional noncontact left Atrial mapping during AF, we examined the prevalence and location of rotor activation and elucidated its mechanism. Catheter ablation was performed in a stepwise fashion (linear roof lesion and complex fractionated Atrial Electrogram ablation after pulmonary vein [PV) isolation) until AF termination. Results Rotor activation was observed in 11 patients (14.7%; 10 paroxysmal and 1 persistent AF) (tachycardia cycle length 160.0 ± 19.8 ms). Rotors were observed transiently (duration 6128 ± 9094 ms) during AF at the roof (n = 5), septum (n = 3), and ostium of the left superior PV (n = 3). Five rotors circulated in clockwise and 6 in counterclockwise directions. The length of the block line at the center of the rotor was 15.2 ± 6.9 mm. The Electrograms at the block line showed low-amplitude multiple deflections (n = 7) or double potentials (n = 4), and the amplitudes during rotor activation were significantly lower than those during sinus rhythm (0.27 ± 0.18 mV vs 1.22 ± 0.92 mV; P Conclusion Functionally formed rotor activation was observed during AF in a limited number of patients. These rotor activations may not be related to AF maintenance, but rather may reflect a transient organization of random propagation.
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importance of pericardial fat in the formation of complex fractionated Atrial Electrogram region in Atrial fibrillation
International Journal of Cardiology, 2014Co-Authors: Hisanori Kanazawa, Hiroshige Yamabe, Kenji Morihisa, Koji Enomoto, Junjiroh Koyama, Tadashi Hoshiyama, Kunihiko Matsui, Hisao OgawaAbstract:Abstract Background/Objectives Pericardial fat (PF) and complex fractionated Atrial Electrogram (CFAE) are both associated with Atrial fibrillation (AF). Therefore, we examined the relation between PF and CFAE area in AF. Methods The study population included 120 control patients without AF and 120 patients with AF (80 paroxysmal AF and 40 persistent AF) who underwent catheter ablation. Total cardiac PF volume, representing all adipose tissue within the pericardial sac, was measured by contrast-enhanced computed tomography. The location and distribution of CFAE region were identified by left Atrial endocardial mapping using a three-dimensional mapping system. We analyzed the significance of total cardiac PF volume and total area of CFAE region on AF, persistence of AF from paroxysmal to persistent form, and the relation between total cardiac PF volume and total CFAE area. We also evaluated the regional distribution of PF volume and CFAE area in five areas of the left atrium (LA). Results Total cardiac PF volume correlated with AF (odds ratio [OR]: 1.024, p p =0.018, OR: 1.144, p =0.002, respectively). Multivariate linear regression analysis identified total cardiac PF volume as a significant and independent determinant of total CFAE area ( r =0.488, p Conclusions PF volume correlated significantly with CFAE area in patients with AF. This finding suggests that PF is directly related to the progression of CFAE area and promotes the pathogenic process of AF.
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demonstration of anatomic reentrant circuit in verapamil sensitive Atrial tachycardia originating from the atrioventricular annulus other than the vicinity of the atrioventricular node
American Journal of Cardiology, 2014Co-Authors: Hiroshige Yamabe, Junjiroh Koyama, Hisanori Kanazawa, Ken Okumura, Tadashi Hoshiyama, Hisao OgawaAbstract:The mechanism and tachycardia circuit of verapamil-sensitive Atrial tachycardia originating from the atrioventricular annulus (AVA-AT) other than the atrioventricular node vicinity are not well clarified. In 23 patients, we examined the mechanism and anatomic tachycardia circuit of AVA-AT. While recording the Atrial Electrogram at the earliest Atrial activation site (EAAS) during tachycardia, rapid Atrial pacing at a rate 5 beats/min faster than the tachycardia rate was delivered from multiple sites of the right atrium (RA) to demonstrate manifest entrainment and define the direction of proximity of slow conduction area (SCA) of reentry circuit. When EAAS was orthodromically captured, radiofrequency energy was delivered starting at a site 2 cm away from the EAAS in the direction of entrainment pacing site. Then application site was gradually advanced toward the EAAS until termination of tachycardia to define the entrance of SCA of reentry circuit. Manifest entrainment was demonstrated in all AVA-ATs. The EAAS, distributed along the tricuspid annulus from 3- to the 12-o'clock position, was orthodromically captured by pacing delivered from high anterolateral RA (n = 6), high anteroseptal RA (n = 7), high posteroseptal RA (n = 3), low anterolateral RA (n = 6), and coronary sinus ostium (n = 1). Radiofrequency energy delivery to the site, 10.4 ± 2.4 mm proximal to the EAAS where the Atrial Electrogram was observed 13.9 ± 5.7 ms later than the EAAS, terminated AVA-AT immediately after the onset of energy delivery (2.9 ± 1.1 seconds). In conclusion, it was shown that the AVA-AT is organized as reentry involving the verapamil-sensitive SCA with its entrance and exit at different distinct locations.
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Analysis of the mechanisms initiating random wave propagation at the onset of Atrial fibrillation using noncontact mapping: Role of complex fractionated Electrogram region
Heart rhythm, 2011Co-Authors: Hiroshige Yamabe, Kenji Morihisa, Koji Enomoto, Junjiroh Koyama, Hisanori Kanazawa, Hisao OgawaAbstract:Background The complex fractionated Atrial Electrogram (CFAE) region has been suggested to contribute to the maintenance of Atrial fibrillation (AF), but its role for the initiation of AF has not been clarified. Objective We analyzed the mechanisms of the initiation of random reentrant wave propagation at AF onset, especially in relation to CFAE region. Methods Endocardial mapping of the left atrium using a 3-dimensional noncontact mapping system was performed in 19 patients. Results Thirty-two spontaneous AF onset episodes, which were initiated by the focal repetitive discharges (9 ± 9 beats), deriving from the pulmonary veins (PV) (n = 17) and from non-PV CFAE regions (n = 15) were observed. The coupling intervals of the focal discharges that initiated AF (AF-D) were significantly shorter than those that did not initiate AF (non–AF-D) (179 ± 33 ms vs. 217 ± 45 ms, P = .0005). After the AF-D, localized conduction blocks occurred in the CFAE region. Subsequently, the waves propagated to the remainder of the atrium, accompanying the anchored activation around the localized conduction block lines in the CFAE regions. Left Atrial activation times of AF-D were significantly longer than those of non–AF-D (151 ± 35 ms vs. 83 ± 17 ms, P Conclusion Unidirectional conduction block in the CFAE region and subsequent prolonged left Atrial activation time following short coupled premature discharge were the underlying mechanisms of AF initiation, suggesting the importance of the CFAE region as the substrate for AF onset.
Hiroshige Yamabe - One of the best experts on this subject based on the ideXlab platform.
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analysis of the preferable site and stability of rotational reentry its role for the maintenance of Atrial fibrillation
Heart and Vessels, 2019Co-Authors: Shozo Kaneko, Hiroshige Yamabe, Hisanori Kanazawa, Tadashi Hoshiyama, Miwa Ito, Yusuke Kanemaru, Takuya Kiyama, Kenichi TsujitaAbstract:It remains unclear whether AF is maintained by rotor. We evaluated the significance of rotor during Atrial fibrillation (AF). Prevalence, location, and stability of rotational reentry (RR) in the left atrium were clarified by endocardial non-contact mapping in 66 AF patients. RR was classified into three categories: RR continued at stable site (Stable-RR), RR observed intermittently at the same site (Intermittent-RR), and RR observed at different locations (Different-RR). Catheter ablation was performed in a stepwise fashion (linear roof lesion and complex fractionated Atrial Electrogram ablation following pulmonary vein isolation) until AF termination and elucidated the consequence of radiofrequency lesion delivered within RR site on AF termination and recurrence. One hundred and nineteen RRs were observed. There were 54 patients with RR (RR Group) and 22 patients without RR (Non-RR Group). Prevalence of Different-RR (n = 81) was significantly higher than Stable-RR (n = 16, p < 0.001) and Intermittent-RR (n = 22, p < 0.001). The intervals involved in RR occupied only 22.4% of total activation time. There was no significant difference in the prevalence of AF termination nor AF/Atrial tachycardia recurrence between RR and non-RR Groups (46 vs. 9 patients, p = 0.317, and 13 vs. 1 patients, p = 0.271) and between patients in whom radiofrequency lesion was involved in RR and those was not (24 vs. 22 patients, p = 0.210, and 6 vs. 7 patients, p = 0.506). In conclusion, most RRs were observed transiently and often shifted its locations. Radiofrequency lesion delivered within RR site did not correlate with AF termination nor recurrence, suggesting that RR is not a driving source during AF.
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prevalence and mechanism of rotor activation identified during Atrial fibrillation by noncontact mapping lack of evidence for a role in the maintenance of Atrial fibrillation
Heart Rhythm, 2016Co-Authors: Hiroshige Yamabe, Hisanori Kanazawa, Miwa Ito, Shozo Kaneko, Hisao OgawaAbstract:Background It remains unclear whether Atrial fibrillation (AF) is maintained by the rotor. Objective We evaluated the role of the rotor and examined its mechanism. Methods Among 75 patients with AF (60 paroxysmal, 15 persistent AF) who underwent 3-dimensional noncontact left Atrial mapping during AF, we examined the prevalence and location of rotor activation and elucidated its mechanism. Catheter ablation was performed in a stepwise fashion (linear roof lesion and complex fractionated Atrial Electrogram ablation after pulmonary vein [PV) isolation) until AF termination. Results Rotor activation was observed in 11 patients (14.7%; 10 paroxysmal and 1 persistent AF) (tachycardia cycle length 160.0 ± 19.8 ms). Rotors were observed transiently (duration 6128 ± 9094 ms) during AF at the roof (n = 5), septum (n = 3), and ostium of the left superior PV (n = 3). Five rotors circulated in clockwise and 6 in counterclockwise directions. The length of the block line at the center of the rotor was 15.2 ± 6.9 mm. The Electrograms at the block line showed low-amplitude multiple deflections (n = 7) or double potentials (n = 4), and the amplitudes during rotor activation were significantly lower than those during sinus rhythm (0.27 ± 0.18 mV vs 1.22 ± 0.92 mV; P Conclusion Functionally formed rotor activation was observed during AF in a limited number of patients. These rotor activations may not be related to AF maintenance, but rather may reflect a transient organization of random propagation.
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importance of pericardial fat in the formation of complex fractionated Atrial Electrogram region in Atrial fibrillation
International Journal of Cardiology, 2014Co-Authors: Hisanori Kanazawa, Hiroshige Yamabe, Kenji Morihisa, Koji Enomoto, Junjiroh Koyama, Tadashi Hoshiyama, Kunihiko Matsui, Hisao OgawaAbstract:Abstract Background/Objectives Pericardial fat (PF) and complex fractionated Atrial Electrogram (CFAE) are both associated with Atrial fibrillation (AF). Therefore, we examined the relation between PF and CFAE area in AF. Methods The study population included 120 control patients without AF and 120 patients with AF (80 paroxysmal AF and 40 persistent AF) who underwent catheter ablation. Total cardiac PF volume, representing all adipose tissue within the pericardial sac, was measured by contrast-enhanced computed tomography. The location and distribution of CFAE region were identified by left Atrial endocardial mapping using a three-dimensional mapping system. We analyzed the significance of total cardiac PF volume and total area of CFAE region on AF, persistence of AF from paroxysmal to persistent form, and the relation between total cardiac PF volume and total CFAE area. We also evaluated the regional distribution of PF volume and CFAE area in five areas of the left atrium (LA). Results Total cardiac PF volume correlated with AF (odds ratio [OR]: 1.024, p p =0.018, OR: 1.144, p =0.002, respectively). Multivariate linear regression analysis identified total cardiac PF volume as a significant and independent determinant of total CFAE area ( r =0.488, p Conclusions PF volume correlated significantly with CFAE area in patients with AF. This finding suggests that PF is directly related to the progression of CFAE area and promotes the pathogenic process of AF.
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demonstration of anatomic reentrant circuit in verapamil sensitive Atrial tachycardia originating from the atrioventricular annulus other than the vicinity of the atrioventricular node
American Journal of Cardiology, 2014Co-Authors: Hiroshige Yamabe, Junjiroh Koyama, Hisanori Kanazawa, Ken Okumura, Tadashi Hoshiyama, Hisao OgawaAbstract:The mechanism and tachycardia circuit of verapamil-sensitive Atrial tachycardia originating from the atrioventricular annulus (AVA-AT) other than the atrioventricular node vicinity are not well clarified. In 23 patients, we examined the mechanism and anatomic tachycardia circuit of AVA-AT. While recording the Atrial Electrogram at the earliest Atrial activation site (EAAS) during tachycardia, rapid Atrial pacing at a rate 5 beats/min faster than the tachycardia rate was delivered from multiple sites of the right atrium (RA) to demonstrate manifest entrainment and define the direction of proximity of slow conduction area (SCA) of reentry circuit. When EAAS was orthodromically captured, radiofrequency energy was delivered starting at a site 2 cm away from the EAAS in the direction of entrainment pacing site. Then application site was gradually advanced toward the EAAS until termination of tachycardia to define the entrance of SCA of reentry circuit. Manifest entrainment was demonstrated in all AVA-ATs. The EAAS, distributed along the tricuspid annulus from 3- to the 12-o'clock position, was orthodromically captured by pacing delivered from high anterolateral RA (n = 6), high anteroseptal RA (n = 7), high posteroseptal RA (n = 3), low anterolateral RA (n = 6), and coronary sinus ostium (n = 1). Radiofrequency energy delivery to the site, 10.4 ± 2.4 mm proximal to the EAAS where the Atrial Electrogram was observed 13.9 ± 5.7 ms later than the EAAS, terminated AVA-AT immediately after the onset of energy delivery (2.9 ± 1.1 seconds). In conclusion, it was shown that the AVA-AT is organized as reentry involving the verapamil-sensitive SCA with its entrance and exit at different distinct locations.
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Analysis of the mechanisms initiating random wave propagation at the onset of Atrial fibrillation using noncontact mapping: Role of complex fractionated Electrogram region
Heart rhythm, 2011Co-Authors: Hiroshige Yamabe, Kenji Morihisa, Koji Enomoto, Junjiroh Koyama, Hisanori Kanazawa, Hisao OgawaAbstract:Background The complex fractionated Atrial Electrogram (CFAE) region has been suggested to contribute to the maintenance of Atrial fibrillation (AF), but its role for the initiation of AF has not been clarified. Objective We analyzed the mechanisms of the initiation of random reentrant wave propagation at AF onset, especially in relation to CFAE region. Methods Endocardial mapping of the left atrium using a 3-dimensional noncontact mapping system was performed in 19 patients. Results Thirty-two spontaneous AF onset episodes, which were initiated by the focal repetitive discharges (9 ± 9 beats), deriving from the pulmonary veins (PV) (n = 17) and from non-PV CFAE regions (n = 15) were observed. The coupling intervals of the focal discharges that initiated AF (AF-D) were significantly shorter than those that did not initiate AF (non–AF-D) (179 ± 33 ms vs. 217 ± 45 ms, P = .0005). After the AF-D, localized conduction blocks occurred in the CFAE region. Subsequently, the waves propagated to the remainder of the atrium, accompanying the anchored activation around the localized conduction block lines in the CFAE regions. Left Atrial activation times of AF-D were significantly longer than those of non–AF-D (151 ± 35 ms vs. 83 ± 17 ms, P Conclusion Unidirectional conduction block in the CFAE region and subsequent prolonged left Atrial activation time following short coupled premature discharge were the underlying mechanisms of AF initiation, suggesting the importance of the CFAE region as the substrate for AF onset.
Fred Morady - One of the best experts on this subject based on the ideXlab platform.
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A simplified differential pacing technique for the evaluation of bidirectional cavo-tricuspid isthmus block during ablation of typical Atrial flutter
Journal of Interventional Cardiac Electrophysiology, 2021Co-Authors: Demosthenes G. Katritsis, Ronpichai Chokesuwattanaskul, Theodoros Zografos, Sina Jame, George Paxinos, Fred MoradyAbstract:Purpose Bidirectional block of the cavo-tricuspid isthmus (CTI) is an established endpoint of CTI-dependent Atrial flutter (AFl) ablation. Differential pacing has been used to evaluate the CTI block. The purpose of this study is to describe a modified differential pacing technique to evaluate the CTI block. Methods Sixty-two patients underwent radiofrequency (RF) ablation of CTI-dependent AFl. The acute endpoints were non-inducibility of the AFl, and verification of the bidirectional CTI block by our methodology. Pacing was performed in the CS with an ablation catheter positioned immediately lateral to the CTI ablation line, and then 1–2 cm more laterally. The stimulus-to-ablation catheter Atrial Electrogram intervals were measured at these sites (Stim_CS-Abl_1 and Stim_CS-Abl_2, respectively). Pacing with the ablation catheter also was performed at these 2 sites, and the stimulus-to-CS Electrogram intervals (Stim_ABL1-CS and Stim_ABL2-CS) were measured. The criteria for the bidirectional block were Stim_CS-Abl_1 > Stim_CS-Abl_2, and Stim_ABL1-CS > Stim_ABL2-CS. Clinical efficacy was defined as freedom from recurrent AFl during follow-up. Results Following 12.2 ± 3.7 min of RF delivery across the CTI, intervals were Stim_CS-Abl_1 = 181.2 ± 22.7 ms and Stim_ABL1-CS = 181.0 ± 23.6 ms, and Stim_CS-Abl_2 = 152.2 ± 26.5 ms and Stim_ABL2-CS = 151.2 ± 22.7 ( P < 0.001). Atrial flutter was rendered not inducible in all patients, and no procedural complications were encountered. During the next 15.9 ± 0.7 months, two patients were lost to follow-up, and among the 62 other patients, one (1.7%) had flutter recurrence. Conclusions The bidirectional CTI block can be assessed quickly and easily using only the ablation and CS catheters for differential pacing.
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Extent of Atrial Participation in Atrioventricular-Reciprocating Tachycardia
2016Co-Authors: Fred Morady, Yin Shi Wang, Melvin M. ScheinmanAbstract:SUMMARY Twenty-one patients with atrioventricular (AV) bypass tracts underwent electrophysiologic studies. The bypass tract was left-sided in 15 patients, septal in five and right-sided in one patient. Orthodromic AV-reciprocating tachycardia was induced in all 21 patients, with a mean tachycardia cycle length of 342 59 msec. The introduction of single stimuli in the high right atrium during tachycardia resulted in simultaneous dissociation of the high right Atrial and low septal Atrial Electrograms in nine patients. In six patients, high right Atrial overdrive pacing during tachycardia resulted in simultaneous dissociation of the high right Atrial and low septal Atrial Electrograms for two to five consecutive beats. All patients in whom the low septal Atrial Electrogram was dissociated from the tachycardia had a left-sided bypass tract. In no patient was the coronary sinus Atrial Electrogram dissociated from the tachycardia by high right Atrial pacing. Dissociation of the low septal Atrial Electrogram (as recorded in the His bundle Electrogram) from AV-reciprocating tachycardia suggests that the portion of the right atrium adjacent to the AV node may not be a necessary link in the tachycardia circuit. This observation suggests that the site of entry of left-sided impulses into the AV node may be different from that of right-sided impulses. IN PATIENTS with atrioventricular (AV) nodal reen
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Autonomic Innervation, Atrial Electrogram Morphology, and Atrial Fibrillation⁎
Journal of the American College of Cardiology, 2007Co-Authors: Hakan Oral, Fred MoradyAbstract:Several lines of evidence suggest that autonomic innervation plays a role in the generation of Atrial fibrillation (AF). Ganglionated plexi (GPs) that modulate autonomic innervation have been identified over both atria, particularly the pulmonary vein (PV) antral regions. Stimulation of GPs results
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randomized comparison of anatomic and Electrogram mapping approaches to ablation of the slow pathway of atrioventricular node reentrant tachycardia
Journal of the American College of Cardiology, 1994Co-Authors: Steven J Kalbfleisch, John D Hummel, Adam S Strickberger, Brian D Williamson, Vicken R Vorperian, Ching Man, Jonathan J Langberg, Fred MoradyAbstract:Abstract Objectives . The purpose of this study was to prospectively compare in random fashion an anatomic and an Electrogram mapping approach for ablation of the slow pathway of atrioventricular (AV) node reentrant tachycardia. Background . Ablation of the slow pathway in patients with AV node reentrant tachycardia can be performed by using either an anatomic or an Electrogram mapping approach to identify target sites for ablation. These two approaches have never been compared prospectively. Methods . Fifty consecutive patients with typical AV node reentrant tachycardia were randomly assigned to undergo either an anatomic or an Electrogram mapping approach for ablation of the slow AV node pathway. In 25 patients randomly assigned to the anatomic approach, sequential radiofrequency energy applications were delivered along the tricuspid annulus from the level of the coronary sinus ostium to the His bundle position. In 25 patients assigned to the Electrogram mapping approach, target sites along the posteromedial tricuspid annulus near the coronary sinus ostium were sought where there was a multicomponent Atrial Electrogram or evidence of a possible slow pathway potential. If the initial approach was ineffective after 12 radiofrequency energy applications, the alternative approach was then used. Results . The anatomic approach was effective in 21 (84%) of 25 patients, and the Electrogram mapping approach was effective in all 25 patients (100%) randomly assigned to this technique (p = 0.1). The four patients with an ineffective anatomic approach had a successful outcome with the Electrogram mapping approach. On the basis of intention to treat analysis, there were no significant differences between the Electrogram mapping approach and the anatomic approach with respect to the time required for ablation (28 ± 21 and 31 ± 31 min, respectively, mean ± SD, p = 0.7) duration of fluoroscopic exposure (27 ± 20 and 27 ±18 min, respectively, p = 0.9) or mean number of radiofrequency applications delivered (6.3 ± 3.9 vs. 7.2 ± 8.0, p s 0.6). With both the anatomic and Electrogram mapping approaches, the Atrial Electrogram duration and number of peaks in the Atrial Electrogram were significantly greater at successful target sites than at unsuccessful target sites. Conclusions . The anatomic and Electrogram mapping approaches for ablation of the slow AV nodal pathway are comparable in efficacy and duration. If the anatomic approach is initially attempted and fails, the Electrogram mapping approach may be successful at sites outside the areas targeted in the anatomic approach. With both the anatomic and Electrogram mapping approaches, there are significant differences in the Atrial Electrogram configuration between successful and unsuccessful target sites.
Demosthenes G. Katritsis - One of the best experts on this subject based on the ideXlab platform.
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A simplified differential pacing technique for the evaluation of bidirectional cavo-tricuspid isthmus block during ablation of typical Atrial flutter
Journal of Interventional Cardiac Electrophysiology, 2021Co-Authors: Demosthenes G. Katritsis, Ronpichai Chokesuwattanaskul, Theodoros Zografos, Sina Jame, George Paxinos, Fred MoradyAbstract:Purpose Bidirectional block of the cavo-tricuspid isthmus (CTI) is an established endpoint of CTI-dependent Atrial flutter (AFl) ablation. Differential pacing has been used to evaluate the CTI block. The purpose of this study is to describe a modified differential pacing technique to evaluate the CTI block. Methods Sixty-two patients underwent radiofrequency (RF) ablation of CTI-dependent AFl. The acute endpoints were non-inducibility of the AFl, and verification of the bidirectional CTI block by our methodology. Pacing was performed in the CS with an ablation catheter positioned immediately lateral to the CTI ablation line, and then 1–2 cm more laterally. The stimulus-to-ablation catheter Atrial Electrogram intervals were measured at these sites (Stim_CS-Abl_1 and Stim_CS-Abl_2, respectively). Pacing with the ablation catheter also was performed at these 2 sites, and the stimulus-to-CS Electrogram intervals (Stim_ABL1-CS and Stim_ABL2-CS) were measured. The criteria for the bidirectional block were Stim_CS-Abl_1 > Stim_CS-Abl_2, and Stim_ABL1-CS > Stim_ABL2-CS. Clinical efficacy was defined as freedom from recurrent AFl during follow-up. Results Following 12.2 ± 3.7 min of RF delivery across the CTI, intervals were Stim_CS-Abl_1 = 181.2 ± 22.7 ms and Stim_ABL1-CS = 181.0 ± 23.6 ms, and Stim_CS-Abl_2 = 152.2 ± 26.5 ms and Stim_ABL2-CS = 151.2 ± 22.7 ( P < 0.001). Atrial flutter was rendered not inducible in all patients, and no procedural complications were encountered. During the next 15.9 ± 0.7 months, two patients were lost to follow-up, and among the 62 other patients, one (1.7%) had flutter recurrence. Conclusions The bidirectional CTI block can be assessed quickly and easily using only the ablation and CS catheters for differential pacing.
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Atrial activation during atrioventricular nodal reentrant tachycardia studies on retrograde fast pathway conduction
Heart Rhythm, 2006Co-Authors: Demosthenes G. Katritsis, Kenneth A Ellenbogen, Anton E BeckerAbstract:Background Detailed right and left septal mapping of retrograde Atrial activation during typical atrioventricular nodal reentrant tachycardia (AVNRT) has not been undertaken and may provide insight into the complex physiology of AVNRT, especially the anatomic localization of the fast and slow pathways. Objectives The purpose of this study was to investigate the pattern of retrograde Atrial activation during typical AVNRT by means of right-sided and left-sided septal mapping and implementation of pacing maneuvers for separating Atrial and ventricular Electrograms recorded during tachycardia. Methods Twenty-two patients with slow-fast AVNRT were studied by means of simultaneous His-bundle recordings from the right and left sides of the septum. Patterns of retrograde Atrial activation were recorded during tachycardia following specific pacing maneuvers and during right ventricular apical (RVA) pacing at the tachycardia cycle length. Results The pattern of retrograde Atrial activation could be mapped in 17 of 22 patients during AVNRT. In 9 (53%) patients, the earliest retrograde Atrial activation was recorded on the left side of the septum, in 3 (17%) patients on the right side, and in 5 (29%) patients both right and left Atrial septal Electrograms occurred simultaneously. Stimulus to Atrial Electrogram times recorded during RVA pacing in 14 patients were 138.5 ms from the right His bundle, 134.5 ms from the left His bundle, and 148.0 ms from the ostium of the coronary sinus ( P Conclusion Earliest retrograde Atrial activation during AVNRT is most often recorded on the left side of the septum. Breakthrough of Atrial activation may be discordant from that observed during RVA pacing.
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identification and catheter ablation of extracardiac and intracardiac components of ligament of marshall tissue for treatment of paroxysmal Atrial fibrillation
Journal of Cardiovascular Electrophysiology, 2001Co-Authors: Demosthenes G. Katritsis, P John A M D Ioannidis, E Constantine M D Anagnostopoulos, E George M D Sarris, M Eleftherios D Giazitzoglou, M Socrates D Korovesis, John A CammAbstract:INTRODUCTION: The ligament of Marshall is a left Atrial neuromuscular bundle with sympathetic innervation that may be a source of Atrial fibrillation (AF)-inducing automatic activity. METHODS AND RESULTS: Twenty-four patients with paroxysmal AF (including 18 with adrenergic AF) and 25 with other arrhythmias underwent catheter mapping. In cases of adrenergic AF, radiofrequency ablation was attempted when Marshall potentials were recorded. Patients were followed for 2 months before and 11.2 +/- 4.2 months after the procedure. Catheterization of the distal superoposterior coronary sinus was feasible in 14 patients with AF (10 with adrenergic AF) and 12 patients without AF. A discrete Marshall potential was recorded in 12 patients with AF versus 3 patients without AF (P = 0.004). In 10 patients with adrenergic AF, this potential followed the Atrial Electrogram during sinus rhythm by 26 +/- 5 msec on left Atrial recordings and 24 +/- 4 msec on coronary sinus recordings, and preceded it during Atrial ectopy by 29 +/- 5 msec and 26 +/- 5 msec, respectively. It was abolished by epicardial (n = 1), endocardial (n = 4), or combined epicardial and endocardial ablation (n = 5). Seven patients with ablation showed significant reductions in adrenergic AF, whereas no significant change was seen in 8 adrenergic AF patients not undergoing ablation (P = 0.004). No improvement was seen in 3 of 4 patients with only endocardial ablation, whereas all 6 patients with epicardial ablation improved (P = 0.033). CONCLUSION: Recording of Marshall potential is feasible in patients with paroxysmal AF. Combined epicardial and endocardial catheter ablation of ligament of Marshall tissue may reduce the paroxysms of adrenergic AF.
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identification and catheter ablation of extracardiac and intracardiac components of ligament of marshall tissue for treatment of paroxysmal Atrial fibrillation
Journal of Cardiovascular Electrophysiology, 2001Co-Authors: Demosthenes G. Katritsis, P John A M D Ioannidis, E Constantine M D Anagnostopoulos, E George M D Sarris, M Eleftherios D Giazitzoglou, M Socrates D Korovesis, John A CammAbstract:Catheter Ablation of Ligament of Marshall Tissue. Introduction: The ligament of Marshall is a left Atrial neuromuscular bundle with sympathetic innervation that may be a source of Atrial e brillation (AF)-inducing automatic activity. Methods and Results: Twenty-four patients with paroxysmal AF (including 18 with adrenergic AF) and 25 with other arrhythmias underwent catheter mapping. In cases of adrenergic AF, radiofrequency ablation was attempted when Marshall potentials were recorded. Patients were followed for 2 months before and 11.2 6 4.2 months after the procedure. Catheterization of the distal superoposterior coronary sinus was feasible in 14 patients with AF (10 with adrenergic AF) and 12 patients without AF. A discrete Marshall potential was recorded in 12 patients with AF versus 3 patients without AF (P 5 0.004). In 10 patients with adrenergic AF, this potential followed the Atrial Electrogram during sinus rhythm by 26 6 5 msec on left Atrial recordings and 24 6 4 msec on coronary sinus recordings, and preceded it during Atrial ectopy by 29 6 5 msec and 26 6 5 msec, respectively. It was abolished by epicardial (n 5 1), endocardial (n 5 4), or combined epicardial and endocardial ablation (n 5 5). Seven patients with ablation showed signie cant reductions in adrenergic AF, whereas no signie cant change was seen in 8 adrenergic AF patients not undergoing ablation (P 5 0.004). No improvement was seen in 3 of 4 patients with only endocardial ablation, whereas all 6 patients with epicardial ablation improved (P 5 0.033). Conclusion: Recording of Marshall potential is feasible in patients with paroxysmal AF. Combined epicardial and endocardial catheter ablation of ligament of Marshall tissue may reduce the paroxysms of
Gregory M Marcus - One of the best experts on this subject based on the ideXlab platform.
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abstract 12996 use of premature ventricular extrastimuli during supraventricular tachycardia to differentiate atrioventricular nodal reentrant tachycardia from atrioventricular reentrant tachycardia
Circulation, 2016Co-Authors: Hiroyuki Ito, Nitish Badhwar, Akash R Patel, Ronn E Tanel, Kurt S Hoffmayer, Cara N Pellegrini, Henry H Hsia, Vasanth Vedantham, Randall J Lee, Gregory M MarcusAbstract:Introduction: Ventricular entrainment is useful to distinguish atrioventricular nodal reentrant tachycardia (AVNRT) from atrioventricular reentrant tachycardia (AVRT) by subtracting the ventriculoAtrial (VA) interval during tachycardia from the interval between the last pacing stimulus and the last entrained Atrial Electrogram (SA). We tested the hypothesis whether induced right ventricular (RV) extrastimuli (V2) resetting tachycardia would be equivalent or superior to ventricular entrainment to distinguish AVNRT from AVRT. Methods: Patients with either AVNRT or AVRT who underwent electrophysiological study in three institutions were investigated. The entire tachycardia cycle length (TCL) was scanned with V2 delivered from the RV apex. SA-VA differences were calculated with V2 clearly resetting the tachycardia even when it was delivered prior to His refractory period. The prematurity of V2 was assessed the V2 coupling interval (CI) divided by the TCL. Results: A total of 189 patients (age 37.0 ± 22.3 year...
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his overdrive pacing during supraventricular tachycardia a novel maneuver for distinguishing atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia
Heart Rhythm, 2014Co-Authors: David Singh, Ronn E Tanel, Vasanth Vedantham, Randall J Lee, Gregory M Marcus, Mohan N Viswanathan, Byron K Lee, Jeffrey E Olgin, Frederick T Han, Zian H TsengAbstract:Background Because the His bundle is intrinsic to the circuit in orthodromic reciprocating tachycardia and remote from that of atrioventricular nodal reentrant tachycardia (AVNRT), pacing the His bundle during supraventricular tachycardia (SVT) may be useful to distinguish these arrhythmias. Objective The purpose of this study was to test the hypothesis that His overdrive pacing (HOP) would affect SVT immediately for orthodromic reciprocating tachycardia and in a delayed manner for AVNRT. Methods Once SVT was induced, HOP was performed by pacing the His bundle 10–30 ms faster than the SVT cycle length. The maneuver was determined to have entered the tachycardia circuit when a nonfused His-capture beat advanced or delayed the subsequent Atrial Electrogram by ≥10 ms or when the tachycardia was terminated. The number of beats required to enter each tachycardia with HOP was recorded. Results HOP was performed during 66 SVTs (26 atrioventricular reciprocating tachycardia [AVRT] and 40 AVNRT). Entry into the tachycardia within 1 beat had sensitivity of 92%, specificity of 92%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 95% to confirm the diagnosis of AVRT. A cutoff ≥3 beats to enter the circuit had sensitivity of 90%, specificity of 92%, PPV of 95% and NPV of 86% to confirm the diagnosis of AVNRT. HOP had sensitivity, specificity, PPV, and NPV of 100% for distinguishing septal AVRT from atypical AVNRT. Conclusion HOP during SVT is a novel technique for distinguishing orthodromic reciprocating tachycardia from AVNRT. It can reliably distinguish between these arrhythmias with high sensitivity and specificity.