The Experts below are selected from a list of 1275 Experts worldwide ranked by ideXlab platform
Eric N Prystowsky - One of the best experts on this subject based on the ideXlab platform.
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differentiating Junctional Tachycardia and atrioventricular node re entry Tachycardia based on response to atrial extrastimulus pacing
Journal of the American College of Cardiology, 2008Co-Authors: Benzy J Padanilam, Joseph A Manfredi, Leonard A Steinberg, Jeff A Olson, Richard I Fogel, Eric N PrystowskyAbstract:Objectives The purpose of this study was to differentiate non–re-entrant Junctional Tachycardia (JT) and typical atrioventricular node re-entry Tachycardia (AVNRT). Background JT may mimic AVNRT. Ablation of JT is associated with a lower success rate and a higher incidence of heart block. Electrophysiologic differentiation of these Tachycardias is often difficult. Methods We hypothesized that JT can be distinguished from AVNRT based on specific responses to premature atrial complexes (PACs) delivered at different phases of the Tachycardia cycle: when a PAC is timed to His refractoriness, any perturbation of the subsequent His indicates that anterograde slow pathway conduction is involved and confirms a diagnosis of AVNRT. A PAC that advances the His potential immediately after it without terminating Tachycardia indicates that retrograde fast pathway is not essential for the circuit and confirms a diagnosis of JT. This protocol was tested in 39 patients with 44 Tachycardias suggesting either JT or AVNRT based on a short ventriculo-atrial interval and apparent AV node dependence. Tachycardias were divided into 3 groups: clinically obvious AVNRT, clinically obvious JT, and clinically indeterminate rhythm. Results In the 26 cases of clinically obvious AVNRT, the sensitivity and specificity of the test were 61% and 100%, respectively. In the 9 cases of clinically obvious JT, the sensitivity and specificity were 100% and 100%, respectively. In the 9 cases of clinically indeterminate rhythm, the technique indicated AVNRT in 1 patient and JT in 7 patients, and the test was indeterminate in 1 patient. Conclusions The response to PACs during Tachycardia can distinguish JT and AVNRT with 100% specificity in adult patients.
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differentiating Junctional Tachycardia and atrioventricular node re entry Tachycardia based on response to atrial extrastimulus pacing
Journal of the American College of Cardiology, 2008Co-Authors: Benzy J Padanilam, Joseph A Manfredi, Leonard A Steinberg, Jeff A Olson, Richard I Fogel, Eric N PrystowskyAbstract:Objectives The purpose of this study was to differentiate non–re-entrant Junctional Tachycardia (JT) and typical atrioventricular node re-entry Tachycardia (AVNRT). Background JT may mimic AVNRT. Ablation of JT is associated with a lower success rate and a higher incidence of heart block. Electrophysiologic differentiation of these Tachycardias is often difficult. Methods We hypothesized that JT can be distinguished from AVNRT based on specific responses to premature atrial complexes (PACs) delivered at different phases of the Tachycardia cycle: when a PAC is timed to His refractoriness, any perturbation of the subsequent His indicates that anterograde slow pathway conduction is involved and confirms a diagnosis of AVNRT. A PAC that advances the His potential immediately after it without terminating Tachycardia indicates that retrograde fast pathway is not essential for the circuit and confirms a diagnosis of JT. This protocol was tested in 39 patients with 44 Tachycardias suggesting either JT or AVNRT based on a short ventriculo-atrial interval and apparent AV node dependence. Tachycardias were divided into 3 groups: clinically obvious AVNRT, clinically obvious JT, and clinically indeterminate rhythm. Results In the 26 cases of clinically obvious AVNRT, the sensitivity and specificity of the test were 61% and 100%, respectively. In the 9 cases of clinically obvious JT, the sensitivity and specificity were 100% and 100%, respectively. In the 9 cases of clinically indeterminate rhythm, the technique indicated AVNRT in 1 patient and JT in 7 patients, and the test was indeterminate in 1 patient. Conclusions The response to PACs during Tachycardia can distinguish JT and AVNRT with 100% specificity in adult patients.
Samuel J Asirvatham - One of the best experts on this subject based on the ideXlab platform.
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abstract 20203 electrophysiologic features and ablation of Junctional Tachycardia
Circulation, 2014Co-Authors: Elisa Ebrille, Sudip Nanda, Amit Noheria, Samuel J AsirvathamAbstract:Introduction: Junctional Tachycardias (JTs) originate from different foci within or close to the atrioventricular (AV) junction and can exit to the atrium from various extensions of the AV node. Ca...
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differentiating atrioventricular nodal reentrant Tachycardia from Junctional Tachycardia novel application of the delta h a interval
Journal of Cardiovascular Electrophysiology, 2007Co-Authors: Komandoor Srivathsan, Apoor S Gami, Renee Barrett, Kristi H Monahan, Douglas L Packer, Samuel J AsirvathamAbstract:Introduction: Junctional Tachycardia (JT) and atrioventricular nodal reentrant Tachycardia (AVNRT) can be difficult to differentiate. Yet, the two arrhythmias require distinct diagnostic and therapeutic approaches. We explored the utility of the delta H-A interval as a novel technique to differentiate these two Tachycardias. Methods: We included 35 patients undergoing electrophysiology study who had typical AVNRT, 31 of whom also had JT during slow pathway ablation, and four of whom had spontaneous JT during isoproterenol administration. We measured the H-A interval during Tachycardia (H-AT) and during ventricular pacing (H-AP) from the basal right ventricle. Interobserver and intraobserver reliability of measurements was assessed. Ventricular pacing was performed at approximately the same rate as Tachycardia. The delta H-A interval was calculated as the H-AP minus the H-AT. Results: There was excellent interobserver and intraobserver agreement for measurement of the H-A interval. The average delta H-A interval was −10 ms during AVNRT and 9 ms during JT (P < 0.00001). For the diagnosis of JT, a delta H-A interval ≥ 0 ms had the sensitivity of 89%, specificity of 83%, positive predictive value of 84%, and negative predictive value of 88%. The delta H-A interval was longer in men than in women with JT, but no gender-based differences were seen with AVNRT. There was no difference in the H-A interval based on age ≤ 60 years. Conclusion: The delta H-A interval is a novel and reproducibly measurable interval that aids the differentiation of JT and AVNRT during electrophysiology studies.
Benzy J Padanilam - One of the best experts on this subject based on the ideXlab platform.
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differentiating Junctional Tachycardia and atrioventricular node re entry Tachycardia based on response to atrial extrastimulus pacing
Journal of the American College of Cardiology, 2008Co-Authors: Benzy J Padanilam, Joseph A Manfredi, Leonard A Steinberg, Jeff A Olson, Richard I Fogel, Eric N PrystowskyAbstract:Objectives The purpose of this study was to differentiate non–re-entrant Junctional Tachycardia (JT) and typical atrioventricular node re-entry Tachycardia (AVNRT). Background JT may mimic AVNRT. Ablation of JT is associated with a lower success rate and a higher incidence of heart block. Electrophysiologic differentiation of these Tachycardias is often difficult. Methods We hypothesized that JT can be distinguished from AVNRT based on specific responses to premature atrial complexes (PACs) delivered at different phases of the Tachycardia cycle: when a PAC is timed to His refractoriness, any perturbation of the subsequent His indicates that anterograde slow pathway conduction is involved and confirms a diagnosis of AVNRT. A PAC that advances the His potential immediately after it without terminating Tachycardia indicates that retrograde fast pathway is not essential for the circuit and confirms a diagnosis of JT. This protocol was tested in 39 patients with 44 Tachycardias suggesting either JT or AVNRT based on a short ventriculo-atrial interval and apparent AV node dependence. Tachycardias were divided into 3 groups: clinically obvious AVNRT, clinically obvious JT, and clinically indeterminate rhythm. Results In the 26 cases of clinically obvious AVNRT, the sensitivity and specificity of the test were 61% and 100%, respectively. In the 9 cases of clinically obvious JT, the sensitivity and specificity were 100% and 100%, respectively. In the 9 cases of clinically indeterminate rhythm, the technique indicated AVNRT in 1 patient and JT in 7 patients, and the test was indeterminate in 1 patient. Conclusions The response to PACs during Tachycardia can distinguish JT and AVNRT with 100% specificity in adult patients.
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differentiating Junctional Tachycardia and atrioventricular node re entry Tachycardia based on response to atrial extrastimulus pacing
Journal of the American College of Cardiology, 2008Co-Authors: Benzy J Padanilam, Joseph A Manfredi, Leonard A Steinberg, Jeff A Olson, Richard I Fogel, Eric N PrystowskyAbstract:Objectives The purpose of this study was to differentiate non–re-entrant Junctional Tachycardia (JT) and typical atrioventricular node re-entry Tachycardia (AVNRT). Background JT may mimic AVNRT. Ablation of JT is associated with a lower success rate and a higher incidence of heart block. Electrophysiologic differentiation of these Tachycardias is often difficult. Methods We hypothesized that JT can be distinguished from AVNRT based on specific responses to premature atrial complexes (PACs) delivered at different phases of the Tachycardia cycle: when a PAC is timed to His refractoriness, any perturbation of the subsequent His indicates that anterograde slow pathway conduction is involved and confirms a diagnosis of AVNRT. A PAC that advances the His potential immediately after it without terminating Tachycardia indicates that retrograde fast pathway is not essential for the circuit and confirms a diagnosis of JT. This protocol was tested in 39 patients with 44 Tachycardias suggesting either JT or AVNRT based on a short ventriculo-atrial interval and apparent AV node dependence. Tachycardias were divided into 3 groups: clinically obvious AVNRT, clinically obvious JT, and clinically indeterminate rhythm. Results In the 26 cases of clinically obvious AVNRT, the sensitivity and specificity of the test were 61% and 100%, respectively. In the 9 cases of clinically obvious JT, the sensitivity and specificity were 100% and 100%, respectively. In the 9 cases of clinically indeterminate rhythm, the technique indicated AVNRT in 1 patient and JT in 7 patients, and the test was indeterminate in 1 patient. Conclusions The response to PACs during Tachycardia can distinguish JT and AVNRT with 100% specificity in adult patients.
Jean Wertheimer - One of the best experts on this subject based on the ideXlab platform.
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incidence and mechanism of presyncope and or syncope associated with paroxysmal Junctional Tachycardia
American Journal of Cardiology, 2001Co-Authors: B Brembillaperrot, Daniel Beurrier, P Houriez, O Claudon, Jean WertheimerAbstract:The objectives of this study were to: (1) define the incidence of presyncope and/or syncope in patients with paroxysmal Junctional Tachycardias, (2) determine their causes, and (3) determine the outcome of symptoms. Syncope is a frequent problem and is often caused by paroxysmal Tachycardia. The mechanism of hemodynamic instability is unknown. The population study consisted of 281 patients, consecutively recruited because they had paroxysmal Tachycardia and a sinus rhythm on a normal electrocardiogram. Fifty-two patients (group I) had presyncope and/or syncope associated with Tachycardia. The remaining patients (group II) had no loss of consciousness. Transesophageal programmed atrial stimulation used 1 and 2 atrial extrastimuli, delivered in a control state, and if necessary, after infusion of 20 to 30 μg of isoproterenol. Arterial blood pressure was monitored. Vagal maneuvers and echocardiogram were performed in all patients. Paroxysmal Tachycardia was induced in 51 group I patients and 227 group II patients. Comparisons of groups I and II revealed that age (50 ± 21 vs 49 ± 17 years), presence of heart disease (10% vs 10%), mechanism of Tachycardia with a predominance of atrioventricular nodal reentrant Tachycardia (70.5% vs 76%), and rate of Tachycardia (196 ± 42 vs 189 ± 37 beats/min) did not differ between the groups. However, there were differences in both groups with regard to significantly higher incidences of positive vasovagal maneuvers (35% vs 4%, p <0.01), isoproterenol infusion required to induce Tachycardia (55% vs 17%, p <0.001), and vasovagal reaction at the end of Tachycardia (41% vs 4%, p <0.05). Thirty-seven group I patients underwent radiofrequency ablation of the reentrant circuit, which suppressed presyncope and/or syncope in 36 of the 37 patients. Thus, presyncope and/or syncope frequently complicated the history of patients with paroxysmal Junctional Tachycardia (18.5%). Several mechanisms are implicated, but vasovagal reaction was the most frequent cause. Treatment of the Tachycardia typically suppressed presyncope and/or syncope.
B Brembillaperrot - One of the best experts on this subject based on the ideXlab platform.
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incidence and mechanism of presyncope and or syncope associated with paroxysmal Junctional Tachycardia
American Journal of Cardiology, 2001Co-Authors: B Brembillaperrot, Daniel Beurrier, P Houriez, O Claudon, Jean WertheimerAbstract:The objectives of this study were to: (1) define the incidence of presyncope and/or syncope in patients with paroxysmal Junctional Tachycardias, (2) determine their causes, and (3) determine the outcome of symptoms. Syncope is a frequent problem and is often caused by paroxysmal Tachycardia. The mechanism of hemodynamic instability is unknown. The population study consisted of 281 patients, consecutively recruited because they had paroxysmal Tachycardia and a sinus rhythm on a normal electrocardiogram. Fifty-two patients (group I) had presyncope and/or syncope associated with Tachycardia. The remaining patients (group II) had no loss of consciousness. Transesophageal programmed atrial stimulation used 1 and 2 atrial extrastimuli, delivered in a control state, and if necessary, after infusion of 20 to 30 μg of isoproterenol. Arterial blood pressure was monitored. Vagal maneuvers and echocardiogram were performed in all patients. Paroxysmal Tachycardia was induced in 51 group I patients and 227 group II patients. Comparisons of groups I and II revealed that age (50 ± 21 vs 49 ± 17 years), presence of heart disease (10% vs 10%), mechanism of Tachycardia with a predominance of atrioventricular nodal reentrant Tachycardia (70.5% vs 76%), and rate of Tachycardia (196 ± 42 vs 189 ± 37 beats/min) did not differ between the groups. However, there were differences in both groups with regard to significantly higher incidences of positive vasovagal maneuvers (35% vs 4%, p <0.01), isoproterenol infusion required to induce Tachycardia (55% vs 17%, p <0.001), and vasovagal reaction at the end of Tachycardia (41% vs 4%, p <0.05). Thirty-seven group I patients underwent radiofrequency ablation of the reentrant circuit, which suppressed presyncope and/or syncope in 36 of the 37 patients. Thus, presyncope and/or syncope frequently complicated the history of patients with paroxysmal Junctional Tachycardia (18.5%). Several mechanisms are implicated, but vasovagal reaction was the most frequent cause. Treatment of the Tachycardia typically suppressed presyncope and/or syncope.
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significance and prevalence of inducible atrial tachyarrhythmias in patients undergoing electrophysiologic study for presyncope or syncope
International Journal of Cardiology, 1996Co-Authors: B Brembillaperrot, Daniel Beurrier, Arnaud Terrier De La Chaise, C Sutyselton, L Jacquemin, B Thiel, P LouisAbstract:The purpose of the study was to report the prevalence of inducible supraventricular tachyarrhythmias (SVTA) in 827 consecutive patients aged 17 to 90 years who did not have spontaneous documented SVTA and who had unexplained presyncope and/or syncope. The electrophysiologic study (EPS) included programmed atrial and ventricular stimulation up to two extrastimuli at three cycle lengths, and the study of sino-atrial and AV conduction. The results were as follows. EPS was normal in 386 patients. Inducible Junctional Tachycardia or atrial flutter and fibrillation was the only finding in 187 patients (23%). In the remaining patients we found ventricular Tachycardia in 103 (12%), heart block in 67 (8%), sick sinus syndrome in 56 (7%) and increased vagal tone in 28 (3%). The presence of an underlying heart disease (47%) and salvos of atrial premature beats on Holter monitoring (39%) were significantly correlated with the induction of SVTA. However, the comparison with similar groups without syncope indicates that only the induction of SVTA in patients with hypertrophic cardiomyopathy and mitral valve prolapse was significantly correlated with the history of syncope. In patients without heart disease or with prior myocardial infarction or decreased left ventricular function, the induction of SVTA, which is not associated with hypotension in the supine position, could require an induction after head-up tilting, because of the lack of specificity of programmed stimulation in these patients. Programmed atrial stimulation should be systematically performed in patients with unexplained syncope, in particular in those with hypertrophic cardiomyopathy and mitral valve prolapse, who require a specific treatment, if a SVTA is induced. In other patients the results of programmed atrial stimulation should be interpreted cautiously.
