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Mutsumi Miyakoshi - One of the best experts on this subject based on the ideXlab platform.

  • elongated ascending aorta predicts a short distance between His Bundle Potential recording site and coronary sinus ostium
    Journal of Arrhythmia, 2017
    Co-Authors: Yuichi Momose, Kyoko Soejima, Akiko Ueda, Takahiro Arai, Masamichi Koyanagi, Yo Hagiwara, Ikuko Togashi, Yosuke Miwa, Kyoko Hoshida, Mutsumi Miyakoshi
    Abstract:

    BACKGROUND: When performing catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), it can be difficult to maintain a safe distance from the His recording site to avoid AV block in patients with a short distance between tHis recording site to the coronary sinus (CS) ostium (small triangle of Koch [TOK]). In tHis study, we sought to identify parameters predicting small TOK and test these parameters in patients undergoing AVNRT catheter ablation. METHODS: Twenty-eight patients who underwent catheter ablation of atrial fibrillation using a three-dimensional (3D) electroanatomical mapping system (EAM) with computed tomography (CT) merge (23 males; mean age, 65.8±12.1 years) were included. The shortest distance between the CS ostium and His recording sites (His-CSd) was measured on the EAM. Aortic (Ao) unfolding in chest X-ray scan, Ao angle to the LV, Ao length, Ao to the right ventricular distance, size of the Valsalva in the CT scan, and parameters of echocardiogram were evaluated. The identified parameters were subsequently tested as predictors for small TOK in patients undergoing AVNRT ablation. RESULTS: The size of TOK was associated with Ao length (r = -0.70, p<0.01), left ventricular end-systolic dimension (LVDs) (r = -0.51, p<0.01), and Ao unfolding. In patients with AVNRT, only Ao unfolding predicted a smaller TOK. CONCLUSIONS: Small TOK was associated with longer Ao, larger LVDs, and Ao unfolding. Of these, Ao unfolding was associated with smaller TOK in patients with AVNRT.

  • Elongated ascending aorta predicts a short distance between His-Bundle Potential recording site and coronary sinus ostium.
    Journal of Arrhythmia, 2017
    Co-Authors: Yuichi Momose, Kyoko Soejima, Akiko Ueda, Takahiro Arai, Masamichi Koyanagi, Yo Hagiwara, Ikuko Togashi, Yosuke Miwa, Kyoko Hoshida, Mutsumi Miyakoshi
    Abstract:

    BACKGROUND: When performing catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), it can be difficult to maintain a safe distance from the His recording site to avoid AV block in patients with a short distance between tHis recording site to the coronary sinus (CS) ostium (small triangle of Koch [TOK]). In tHis study, we sought to identify parameters predicting small TOK and test these parameters in patients undergoing AVNRT catheter ablation. METHODS: Twenty-eight patients who underwent catheter ablation of atrial fibrillation using a three-dimensional (3D) electroanatomical mapping system (EAM) with computed tomography (CT) merge (23 males; mean age, 65.8±12.1 years) were included. The shortest distance between the CS ostium and His recording sites (His-CSd) was measured on the EAM. Aortic (Ao) unfolding in chest X-ray scan, Ao angle to the LV, Ao length, Ao to the right ventricular distance, size of the Valsalva in the CT scan, and parameters of echocardiogram were evaluated. The identified parameters were subsequently tested as predictors for small TOK in patients undergoing AVNRT ablation. RESULTS: The size of TOK was associated with Ao length (r = -0.70, p

M Okabe - One of the best experts on this subject based on the ideXlab platform.

  • Orthodromic capture of the atrial electrogram during transient entrainment of atrioventricular nodal reentrant tachycardia.
    Circulation, 1993
    Co-Authors: M Satoh, S Miyajima, J Ishiguro, Koyama S, M Okabe
    Abstract:

    BACKGROUNDThe reentry circuit of atrioventricular nodal reentrant tachycardia (AVNRT) has not been fully demonstrated. We hypothesized that if an upper common pathway was present, the atrial electrogram could not be captured orthodromically during transient entrainment of AVNRT by rapid atrial pacing. Based on tHis hypothesis, the presence of an upper common pathway was investigated.METHODS AND RESULTSThe atrial electrogram at the recording site of the His Bundle Potential was identified during induced AVNRT in 9 patients. To entrain AVNRT transiently, rapid pacing from the high right atrium and coronary sinus was applied at a cycle length 10 milliseconds shorter than that of AVNRT and repeated after a decrement of the paced cycle length in steps of 5 milliseconds until AVNRT was interrupted. In 5 of 7 patients, orthodromic capture of the atrial electrogram at the recording site of the His Bundle Potential was observed during transient entrainment of AVNRT by coronary sinus pacing, ie, the first postpacin...

  • Orthodromic capture of the atrial electrogram during transient entrainment of atrioventricular nodal reentrant tachycardia.
    Circulation, 1993
    Co-Authors: M Satoh, S Miyajima, S Koyama, J Ishiguro, M Okabe
    Abstract:

    The reentry circuit of atrioventricular nodal reentrant tachycardia (AVNRT) has not been fully demonstrated. We hypothesized that if an upper common pathway was present, the atrial electrogram could not be captured orthodromically during transient entrainment of AVNRT by rapid atrial pacing. Based on tHis hypothesis, the presence of an upper common pathway was investigated. The atrial electrogram at the recording site of the His Bundle Potential was identified during induced AVNRT in 9 patients. To entrain AVNRT transiently, rapid pacing from the high right atrium and coronary sinus was applied at a cycle length 10 milliseconds shorter than that of AVNRT and repeated after a decrement of the paced cycle length in steps of 5 milliseconds until AVNRT was interrupted. In 5 of 7 patients, orthodromic capture of the atrial electrogram at the recording site of the His Bundle Potential was observed during transient entrainment of AVNRT by coronary sinus pacing, ie, the first postpacing interval of the atrial electrogram at the recording site of the His Bundle Potential was the same as the paced cycle length. In these 5 patients, the mean minimum paced cycle length capable of orthodromic atrial capture was 349 milliseconds, and the mean difference from the cycle length of AVNRT was only 16 milliseconds. During transient entrainment of AVNRT by high right atrial pacing, the atrial electrogram could not be captured orthodromically. Observation of orthodromic capture of the atrial electrogram at the recording site of the His Bundle Potential by coronary sinus pacing ruled out the presence of an upper common pathway in AVNRT, and the concept that perinodal atrial tissue is involved in the reentry circuit of AVNRT was supported.

David S Cannom - One of the best experts on this subject based on the ideXlab platform.

  • a low amplitude His Bundle Potential predicts failure of the right sided approach for atrioventricular junction ablation
    Japanese Circulation Journal-english Edition, 2000
    Co-Authors: Anil K Bhandari, Robert D Lerman, Nidal Isber, Edward Abdullah, Beverly Firth, David S Cannom
    Abstract:

    : In 30 patients with drug refractory atrial fibrillation-flutter who underwent radiofrequency (RF) ablation of the atrioventricular (AV) junction, 23 were successfully ablated using the conventional right-sided approach (group A). Seven patients required a left-sided approach (group B) after multiple applications from the conventional right-sided approach failed to produce complete AV block. The amplitude of the His-Bundle Potential recorded at the ablation site differed significantly between the 2 groups (0.23+/-0.11 mV in group A vs 0.12+/-0.04 mV in group B; p 0.12mV (p<0.005). Patients in group B had a mean of 20.5+/-13.0 failed right-sided RF applications (5-33 applications), but required a mean of only 2 subsequent RF applications for success on the left side (1-6 applications). The His-amplitude recorded from the left side using the same catheter was significantly greater than that on the corresponding right-side (0.22+/-0.09 mV on the left side vs 0.12+/-0.04 mV on the right side: p<0.05). Total mean fluoroscopic time was 62+/-12min for group B and 20+/-13min for group A patients. In patients that underwent RF ablation of the AV junction, a maximum His amplitude <0.12 mV predicted a success rate of approximately 50% in the present study. An early switch to a left-sided approach may avoid multiple RF applications and prolonged fluoroscopic time in patients with a low amplitude His-Bundle Potential.

  • A low amplitude His-Bundle Potential predicts failure of the right-sided approach for atrioventricular junction ablation.
    Japanese Circulation Journal-english Edition, 2000
    Co-Authors: Anil K Bhandari, Robert D Lerman, Nidal Isber, Edward Abdullah, Beverly Firth, David S Cannom
    Abstract:

    : In 30 patients with drug refractory atrial fibrillation-flutter who underwent radiofrequency (RF) ablation of the atrioventricular (AV) junction, 23 were successfully ablated using the conventional right-sided approach (group A). Seven patients required a left-sided approach (group B) after multiple applications from the conventional right-sided approach failed to produce complete AV block. The amplitude of the His-Bundle Potential recorded at the ablation site differed significantly between the 2 groups (0.23+/-0.11 mV in group A vs 0.12+/-0.04 mV in group B; p 0.12mV (p

Warren M Jackman - One of the best experts on this subject based on the ideXlab platform.

  • recording the accessory His Bundle Potential from a right atriofascicular accessory pathway
    Cardiac Electrophysiology Clinics, 2016
    Co-Authors: Warren M Jackman
    Abstract:

    : The author discusses the case of a 42-year-old man with a long History of episodes of rapid palpitations. Recordings from the proximal end of a right atriofascicular accessory pathway at the lateral tricuspid annulus are discussed. There was successful catheter ablation of the right atriofascicular accessory pathway, without recurrence of tachycardia.

  • Para-Hisian pacing: Useful clinical technique to differentiate retrograde conduction between accessory atrioventricular pathways and atrioventricular nodal pathways
    Heart Rhythm, 2005
    Co-Authors: Hiroshi Nakagawa, Warren M Jackman
    Abstract:

    Para-Hisian pacing is a useful tool to differentiate between retrograde conduction over an accessory pathway and retrograde conduction over the fast or slow atrioventricular (AV) nodal pathways. 1-3 Para-Hisian pacing uses right ventricular (RV) pacing close to the His Bundle or proximal right Bundle branch (RBB). As the position of the ventricular pacing catheter changes subtly during respiration (or by changing pacing output), the pacing stimulus changes capture among (1) basal anteroseptal RV plus His Bundle or proximal RBB (His Bundle-RBB capture); (2) capture of basal anteroseptal RV alone; and (3) His Bundle-RBB capture alone. These changes in pacing capture result in abrupt changes in the timing of His Bundle activation relative to the timing of ventricular activation. The presence or absence of a change in atrial activation sequence, stimulus-atrial (SA) intervals, and His Bundle-atrial (HA) interval identifies whether retrograde conduction is dependent on ventricular activation (retrograde conduction over an accessory pathway) or His Bundle activation (retrograde conduction over the AV node) or both (accessory pathway and AV node; Figures 1 and 2). The loss of His Bundle-RBB capture is usually identified by the widening of the QRS complex, indicating that some of the ventricular myocardium (farthest from the RV basal septal pacing site) is activated by the His-Purkinje system during both RV and His Bundle-RBB capture. Our preferred approach is to position the RV pacing catheter toward the RV outflow tract, 1‐2 cm superior to the His Bundle catheter. While pacing at moderate output (5‐10 mA and 2 ms pulse width), the RV catheter is slowly withdrawn toward the His Bundle catheter (proximal RBB) until intermittent His Bundle-RBB capture occurs because of changes in catheter position during respiration. As the pacing catheter is moved closer to the His Bundle, the ventricular Potential in the His Bundle electrogram becomes earlier and the retrograde His Bundle Potential becomes later, providing greater separation between the local ventricular and His Bundle Potentials. The use of closely spaced electrodes (1 mm edge-to-edge) on the His Bundle catheter shortens the duration of the local ventricular Potential in the His Bundle electrogram, preventing the masking of the His Bundle Potential by the local ventricular Potential. Closely spaced electrodes on the pacing catheter may provide a smaller pacing field, facilitating intermittent loss of His Bundle-RBB capture with small changes in catheter position during respiration. A deflectable RV pacing catheter is positioned more easily for para-Hisian pacing and subsequent positioning of the pacing catheter close to the location of an accessory pathway (Figure 3A). In patients with proximal RBB block (such as resulting from previous ablation), His Bundle-RBB capture requires pacing proximal to the RBB block site and may not be achieved from the RV. Other approaches include changing pacing output to achieve intermittent His Bundle-RBB capture and use of the distal electrodes on the His Bundle catheter for pacing. 4

Yuichi Momose - One of the best experts on this subject based on the ideXlab platform.

  • elongated ascending aorta predicts a short distance between His Bundle Potential recording site and coronary sinus ostium
    Journal of Arrhythmia, 2017
    Co-Authors: Yuichi Momose, Kyoko Soejima, Akiko Ueda, Takahiro Arai, Masamichi Koyanagi, Yo Hagiwara, Ikuko Togashi, Yosuke Miwa, Kyoko Hoshida, Mutsumi Miyakoshi
    Abstract:

    BACKGROUND: When performing catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), it can be difficult to maintain a safe distance from the His recording site to avoid AV block in patients with a short distance between tHis recording site to the coronary sinus (CS) ostium (small triangle of Koch [TOK]). In tHis study, we sought to identify parameters predicting small TOK and test these parameters in patients undergoing AVNRT catheter ablation. METHODS: Twenty-eight patients who underwent catheter ablation of atrial fibrillation using a three-dimensional (3D) electroanatomical mapping system (EAM) with computed tomography (CT) merge (23 males; mean age, 65.8±12.1 years) were included. The shortest distance between the CS ostium and His recording sites (His-CSd) was measured on the EAM. Aortic (Ao) unfolding in chest X-ray scan, Ao angle to the LV, Ao length, Ao to the right ventricular distance, size of the Valsalva in the CT scan, and parameters of echocardiogram were evaluated. The identified parameters were subsequently tested as predictors for small TOK in patients undergoing AVNRT ablation. RESULTS: The size of TOK was associated with Ao length (r = -0.70, p<0.01), left ventricular end-systolic dimension (LVDs) (r = -0.51, p<0.01), and Ao unfolding. In patients with AVNRT, only Ao unfolding predicted a smaller TOK. CONCLUSIONS: Small TOK was associated with longer Ao, larger LVDs, and Ao unfolding. Of these, Ao unfolding was associated with smaller TOK in patients with AVNRT.

  • Elongated ascending aorta predicts a short distance between His-Bundle Potential recording site and coronary sinus ostium.
    Journal of Arrhythmia, 2017
    Co-Authors: Yuichi Momose, Kyoko Soejima, Akiko Ueda, Takahiro Arai, Masamichi Koyanagi, Yo Hagiwara, Ikuko Togashi, Yosuke Miwa, Kyoko Hoshida, Mutsumi Miyakoshi
    Abstract:

    BACKGROUND: When performing catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT), it can be difficult to maintain a safe distance from the His recording site to avoid AV block in patients with a short distance between tHis recording site to the coronary sinus (CS) ostium (small triangle of Koch [TOK]). In tHis study, we sought to identify parameters predicting small TOK and test these parameters in patients undergoing AVNRT catheter ablation. METHODS: Twenty-eight patients who underwent catheter ablation of atrial fibrillation using a three-dimensional (3D) electroanatomical mapping system (EAM) with computed tomography (CT) merge (23 males; mean age, 65.8±12.1 years) were included. The shortest distance between the CS ostium and His recording sites (His-CSd) was measured on the EAM. Aortic (Ao) unfolding in chest X-ray scan, Ao angle to the LV, Ao length, Ao to the right ventricular distance, size of the Valsalva in the CT scan, and parameters of echocardiogram were evaluated. The identified parameters were subsequently tested as predictors for small TOK in patients undergoing AVNRT ablation. RESULTS: The size of TOK was associated with Ao length (r = -0.70, p