The Experts below are selected from a list of 213 Experts worldwide ranked by ideXlab platform
Kathryn K. Collins - One of the best experts on this subject based on the ideXlab platform.
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Incidental dual Atrioventricular Nodal Physiology in children and adolescents: clinical follow-up and implications.
Pacing and clinical electrophysiology : PACE, 2010Co-Authors: Anthony C. Mccanta, Kathryn K. Collins, Michael SchafferAbstract:Background: Dual Atrioventricular (AV) Nodal Physiology is a substrate for the development of AV Nodal reentrant tachycardia (AVNRT). However, the risk of developing AVNRT in patients with dual AV Nodal Physiology is not known. The purpose of this study is to identify the risk of developing AVNRT in children and adolescents with incidental findings of dual AV Nodal Physiology after accessory pathway ablation. Methods: This is a single center retrospective study of patients who underwent intracardiac electroPhysiology study at The Children's Hospital, Denver, from March 1993 to August 2008, with findings of dual AV Nodal Physiology after successful ablation of an accessory pathway. Follow-up was obtained by chart review with the primary outcome of recurrent supraventricular tachycardia. Extended clinical follow-up was also achieved through phone contact with patients or parents of patients. Results: Mean age at initial electroPhysiology study was 12.8 years (±3.7 years). Follow-up was obtained on all 66 patients for a mean duration of 3.1 years (±2.8 years). Mean age at follow-up was 15.8 years (±4.6 years). Recurrent supraventricular tachycardia occurred in nine of the 66 patients (13.6%). AVNRT was induced in two of the 66 patients (3.0%). Conclusion: This study supports the hypothesis that incidental dual AV Nodal Physiology does not predict AVNRT in children and adolescents with after successful accessory pathway ablation. (PACE 2010; 33:1528–1532)
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characterizing dual Atrioventricular Nodal Physiology in pediatric patients with Atrioventricular Nodal reentrant tachycardia
Journal of Cardiovascular Electrophysiology, 2006Co-Authors: J Dominic M D Blurton, M Anne M D Dubin, A Nancy R N Chiesa, F George M D Van Hare, Kathryn K. CollinsAbstract:Dual Atrioventricular (AV) Nodal Physiology, defined as an AH jump ≥50 msec with a 10 msec decrease in A1A2, is the substrate for Atrioventricular Nodal reentrant tachycardia (AVNRT) and yet it is present in a minority of pediatric patients with AVNRT. Our objective was to characterize dual AV Nodal Physiology as it pertains to a pediatric population. Methods/Results: We retrospectively reviewed invasive electroPhysiology studies in 92 patients with AVNRT (age12.1 ± 3.7 yrs) and in 46 controls without AVNRT (age 13.3 ± 3.7 yrs). Diagnoses in controls: syncope (N = 31), palpitations (N = 6), atrial flutter (N = 3), history of atrial tachycardia with no inducible arrhythmia (N = 3), and ventricular tachycardia (N = 3). General anesthesia was used in 49% of AVNRT and 52% of controls, P = 0.86. There were no differences in PR, AH, HV, or AV block cycle length. With A1A2 atrial stimulation, AVNRT patients had a significantly longer maximum AH achieved (324 ± 104 msec vs 255 ± 67 msec, P = 0.001), and a shorter AVNERP (276 ± 49 msec vs 313 ± 68 msec P = 0.0005). An AH jump ≥50 msec was found in 42% of AVNRT versus 30% of controls (P = 0.2). Using a ROC graph we found that an AH jump of any size is a poor predictor of AVNRT. With atrial overdrive pacing, PR ≥ RR was seen more commonly in AVNRT versus controls, (55/91(60%) vs 6/46 (13%) P = 0.000). Conclusions: Neither the common definition of dual AV nodes or redefining an AH jump as some value <50 msec are reliable methods to define dual AV nodes or to predict AVNRT in pediatric patients. PR ≥ RR is a relatively good predictor of AVNRT. (J Cardiovasc Electrophysiol, Vol. 17, pp. 638-644, June 2006)
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Characterizing dual Atrioventricular Nodal Physiology in pediatric patients with Atrioventricular Nodal reentrant tachycardia.
Journal of cardiovascular electrophysiology, 2006Co-Authors: Dominic J. Blurton, Anne M. Dubin, A R N Nancy Chiesa, George F. Van Hare, Kathryn K. CollinsAbstract:Dual Atrioventricular (AV) Nodal Physiology, defined as an AH jump ≥50 msec with a 10 msec decrease in A1A2, is the substrate for Atrioventricular Nodal reentrant tachycardia (AVNRT) and yet it is present in a minority of pediatric patients with AVNRT. Our objective was to characterize dual AV Nodal Physiology as it pertains to a pediatric population. Methods/Results: We retrospectively reviewed invasive electroPhysiology studies in 92 patients with AVNRT (age12.1 ± 3.7 yrs) and in 46 controls without AVNRT (age 13.3 ± 3.7 yrs). Diagnoses in controls: syncope (N = 31), palpitations (N = 6), atrial flutter (N = 3), history of atrial tachycardia with no inducible arrhythmia (N = 3), and ventricular tachycardia (N = 3). General anesthesia was used in 49% of AVNRT and 52% of controls, P = 0.86. There were no differences in PR, AH, HV, or AV block cycle length. With A1A2 atrial stimulation, AVNRT patients had a significantly longer maximum AH achieved (324 ± 104 msec vs 255 ± 67 msec, P = 0.001), and a shorter AVNERP (276 ± 49 msec vs 313 ± 68 msec P = 0.0005). An AH jump ≥50 msec was found in 42% of AVNRT versus 30% of controls (P = 0.2). Using a ROC graph we found that an AH jump of any size is a poor predictor of AVNRT. With atrial overdrive pacing, PR ≥ RR was seen more commonly in AVNRT versus controls, (55/91(60%) vs 6/46 (13%) P = 0.000). Conclusions: Neither the common definition of dual AV nodes or redefining an AH jump as some value
Fred Morady - One of the best experts on this subject based on the ideXlab platform.
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comparison of atrial his intervals in patients with and without dual Atrioventricular Nodal Physiology and Atrioventricular Nodal reentrant tachycardia
American Heart Journal, 1996Co-Authors: Frank Bogun, Emile G. Daoud, Rajiva Goyal, Mark Harvey, Bradley P. Knight, Raoul Weiss, Marwan Bahu, Ching K Man, Adam S Strickberger, Fred MoradyAbstract:Abstract The purpose of this study was to compare the atrial—His intervals generated during programmed atrial stimulation in patients with and without dual Atrioventricular Nodal Physiology and with and without inducible Atrioventricular Nodal reentrant tachycardia. Programmed atrial stimulation at a basic-drive cycle length of 500 to 600 msec was performed in 180 patients. The minimum atrial—His interval was defined as the atrial—His interval of the basic-drive beats. The maximum atrial—His interval was defined as the longest A2H2 interval. The criterion for dual Atrioventricular Nodal Physiology was an increment of 50 msec in the A2H2 interval in association with a 10 msec decrement in the A1A2 interval. The minimum atrial—His interval was significantly shorter (106 ± 34 msec vs 116 ± 29 msec; p p p p
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Comparison of atrial—his intervals in patients with and without dual Atrioventricular Nodal Physiology and Atrioventricular Nodal reentrant tachycardia
American heart journal, 1996Co-Authors: Frank Bogun, Emile G. Daoud, Rajiva Goyal, Mark Harvey, Bradley P. Knight, Raoul Weiss, Marwan Bahu, K. Ching Man, S. Adam Strickberger, Fred MoradyAbstract:Abstract The purpose of this study was to compare the atrial—His intervals generated during programmed atrial stimulation in patients with and without dual Atrioventricular Nodal Physiology and with and without inducible Atrioventricular Nodal reentrant tachycardia. Programmed atrial stimulation at a basic-drive cycle length of 500 to 600 msec was performed in 180 patients. The minimum atrial—His interval was defined as the atrial—His interval of the basic-drive beats. The maximum atrial—His interval was defined as the longest A2H2 interval. The criterion for dual Atrioventricular Nodal Physiology was an increment of 50 msec in the A2H2 interval in association with a 10 msec decrement in the A1A2 interval. The minimum atrial—His interval was significantly shorter (106 ± 34 msec vs 116 ± 29 msec; p p p p
Felix K. Wegner - One of the best experts on this subject based on the ideXlab platform.
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Occurrence of primarily noninducible Atrioventricular Nodal reentry tachycardia after radiofrequency delivery in the slow pathway region during empirical slow pathway modulation.
Clinical cardiology, 2017Co-Authors: Felix K. Wegner, Nils Bögeholz, Patrick Leitz, Gerrit Frommeyer, Dirk G. Dechering, Simon Kochhäuser, Philipp Lange, Julia Köbe, Kristina Wasmer, Gerold MönnigAbstract:Background The first-line therapy for Atrioventricular Nodal reentry tachycardia (AVNRT) is catheter-based slow pathway modulation. If AVNRT is not inducible during an electrophysiological study, an empirical slow pathway modulation (ESPM) may be considered in patients with dual Atrioventricular Nodal Physiology and/or a typical electrocardiogram (ECG). Methods We screened 149 symptomatic patients who underwent ESPM in our department between 1993 and 2013. All patients fulfilled the following criteria: (1) either dual Atrioventricular Nodal (AVN) Physiology with up to 2 AVN echo beats or characteristic ECG documentation or both, (2) noninducibility of AVNRT by programmed stimulation, and (3) completion of a telephone questionnaire for long-term follow-up. Out of this population we retrospectively investigated 13 patients who were primarily noninducible but in whom an AVNRT occurred during or after radiofrequency (RF) delivery. Results When AVNRT occurred, the procedure lost its empirical character, and RF delivery was continued until the procedural endpoint of noninducibility of AVNRT. This endpoint was reached in all but one patient (92%). After a follow-up of 73 ± 15 months, this patient was the only one who reported no benefit from the procedure. Conclusions Out of 149 initially noninducible patients, a considerable number (9%) exhibited AVNRT during or after RF delivery. These patients crossed over from empirical to controlled slow pathway modulation resulting in a good clinical outcome. Our observations should encourage electrophysiologists to repeat programmed stimulation even after initial empirical RF delivery to retest for inducibility.
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supraventricular extrasystole due to 1 2 Atrioventricular conduction procedural characteristics and long term follow up of slow pathway modulation
European Heart Journal, 2013Co-Authors: Christian Pott, Felix K. Wegner, Nils Bögeholz, Kristina Wasmer, Alicia Fischer, E Kaya, Peter Milberg, J Koebe, G Moennig, Lars EckardtAbstract:Background: Dual Atrioventricular Nodal Physiology can cause Atrioventricular Nodal reentrant tachycardia (ANVRT). However, dual AVN Physiology can sometimes also cause atrial extrasystole by 1:2 separate AV conduction via the fast and the slow pathway. This arrhythmia may be treated by radiofrequency modulation of the slow pathway (SPM). So far, only case reports have been published. We here present procedural characteristics and long-term follow-up in a series of five patients who underwent SPM for the treatment of 1:2 AVN conduction. Outcome: A population of 2927 patients who underwent SPM in our institution between 1994 and 2012 was screened for 1:2 AVN conduction. Five patients (2 male; mean age 55±14 yrs) were identified. All patients were highly symptomatic with palpitations. ECG documentation of 1:2 supraventricular extrasystole had been obtained in all patients. During electrophysiological study dual AVN Physiology with separate AV Nodal conduction via the fast and slow pathway in a 1:2 pattern was revealed in four patients. Mean fast pathway conduction measured as the AH interval was 149±70 ms while mean slow pathway conduction was 536±99 ms. In none of the 5 patients AVNRT was inducible. SPM was performed in all patients with the endpoint of absence of 1:2 conduction, which was tested by programmed atrial stimulation including orciprenaline challenge. In one patient, no dual AVN Physiology was inducible despite extensive programmed stimulation and application of chatecholamines. On the ground of typical ECG documentation and severe symptoms, empirical SPM was performed in this case. There were no complications in any of the patients. Long term follow up (69.6±54.8 months) was performed by a telephone questionnaire. 4 patients were free of symptoms. The patient with empirical SPM remained symptomatic; however, he also reported improvement of clinical symptoms due to lower frequency of occurrence and shorter duration of episodes. Conclusion: 1:2 AVN conduction is a rhythm disorder that can be highly symptomatic. Although rare, this diagnosis should be considered in patients with palpitations and ECG documentation compatible with 1:2 AV conduction. Our data show that in this clinical setting catheter ablation is an effective and safe therapy with good long term outcome.
Frank Bogun - One of the best experts on this subject based on the ideXlab platform.
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comparison of atrial his intervals in patients with and without dual Atrioventricular Nodal Physiology and Atrioventricular Nodal reentrant tachycardia
American Heart Journal, 1996Co-Authors: Frank Bogun, Emile G. Daoud, Rajiva Goyal, Mark Harvey, Bradley P. Knight, Raoul Weiss, Marwan Bahu, Ching K Man, Adam S Strickberger, Fred MoradyAbstract:Abstract The purpose of this study was to compare the atrial—His intervals generated during programmed atrial stimulation in patients with and without dual Atrioventricular Nodal Physiology and with and without inducible Atrioventricular Nodal reentrant tachycardia. Programmed atrial stimulation at a basic-drive cycle length of 500 to 600 msec was performed in 180 patients. The minimum atrial—His interval was defined as the atrial—His interval of the basic-drive beats. The maximum atrial—His interval was defined as the longest A2H2 interval. The criterion for dual Atrioventricular Nodal Physiology was an increment of 50 msec in the A2H2 interval in association with a 10 msec decrement in the A1A2 interval. The minimum atrial—His interval was significantly shorter (106 ± 34 msec vs 116 ± 29 msec; p p p p
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Comparison of atrial—his intervals in patients with and without dual Atrioventricular Nodal Physiology and Atrioventricular Nodal reentrant tachycardia
American heart journal, 1996Co-Authors: Frank Bogun, Emile G. Daoud, Rajiva Goyal, Mark Harvey, Bradley P. Knight, Raoul Weiss, Marwan Bahu, K. Ching Man, S. Adam Strickberger, Fred MoradyAbstract:Abstract The purpose of this study was to compare the atrial—His intervals generated during programmed atrial stimulation in patients with and without dual Atrioventricular Nodal Physiology and with and without inducible Atrioventricular Nodal reentrant tachycardia. Programmed atrial stimulation at a basic-drive cycle length of 500 to 600 msec was performed in 180 patients. The minimum atrial—His interval was defined as the atrial—His interval of the basic-drive beats. The maximum atrial—His interval was defined as the longest A2H2 interval. The criterion for dual Atrioventricular Nodal Physiology was an increment of 50 msec in the A2H2 interval in association with a 10 msec decrement in the A1A2 interval. The minimum atrial—His interval was significantly shorter (106 ± 34 msec vs 116 ± 29 msec; p p p p
Ulrich Krause - One of the best experts on this subject based on the ideXlab platform.
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Long-Term Follow-Up After Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Children
Circulation. Arrhythmia and electrophysiology, 2016Co-Authors: David Backhoff, Sophia Klehs, Matthias J. Müller, Heike E. Schneider, Thomas Kriebel, Thomas Paul, Ulrich KrauseAbstract:Background— Catheter ablation of the slow conducting pathway (SP) is treatment of choice for Atrioventricular Nodal reentrant tachycardia (AVNRT). Although there are abundant data on AVNRT ablation in adult patients, little is known about the long-term results ≥3 years after AVNRT ablation in pediatric patients. Methods and Results— Follow-up data from 241 patients aged ≤18 years who had undergone successful AVNRT ablation were analyzed. Median age at ablation had been 12.5 years, and median follow-up was 5.9 years. Radiofrequency current had been used in 168 patients (70%), whereas cryoenergy had been used in 73 patients (30%). Procedural end point of AVNRT ablation had been either SP ablation (no residual dual Atrioventricular Nodal Physiology) or SP modulation (residual SP conduction allowing for a maximum of one atrial echo beat). After the initial AVNRT ablation, calculated freedom from AVNRT was 96% at 1 year, 94% at 3 years, 93% at 5 years, and 89% at 8 years. Age, sex, body weight, the choice of ablation energy, and the procedural end point of AVNRT ablation did not impact freedom from AVNRT. Six of 22 AVNRT recurrences (27%) occurred ≥5 years after ablation. No late complications including Atrioventricular block were noted. Conclusions— Cumulatively, catheter ablation of AVNRT continued to be effective in >90% of our pediatric patients during the long-term course. A significant part of recurrences occurred >5 years post ablation. Body weight, energy source, and the end point of ablation had no impact on long-term results. No adverse sequelae were noted.