The Experts below are selected from a list of 555 Experts worldwide ranked by ideXlab platform
William G. Stevenson - One of the best experts on this subject based on the ideXlab platform.
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coronary artery injury due to catheter ablation in adults presentations and outcomes
Circulation, 2009Co-Authors: Kurt C Robertsthomson, Jens Seiler, Keiichi Inada, Usha B. Tedrow, Bruce A Koplan, Daniel Steven, Laurence M. Epstein, William G. StevensonAbstract:Background— Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures. Methods and Results— Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients’ mean age was 45±11 years, and 1.8±0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the Middle Cardiac Vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as...
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coronary artery injury due to catheter ablation in adults presentations and outcomes
Circulation, 2009Co-Authors: Kurt C Robertsthomson, Jens Seiler, Keiichi Inada, Usha B. Tedrow, Bruce A Koplan, Daniel Steven, Laurence M. Epstein, William G. StevensonAbstract:BACKGROUND: Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures. METHODS AND RESULTS: Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45+/-11 years, and 1.8+/-0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the Middle Cardiac Vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37+/-53 months of follow-up. CONCLUSIONS: Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.
Alberto J Lopez - One of the best experts on this subject based on the ideXlab platform.
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implantable cardioverter defibrillator lead placement in the Middle Cardiac Vein after tricuspid valve surgery
Europace, 2012Co-Authors: Alberto J LopezAbstract:Aims Pacing and defibrillation with an implantable cardioverter defibrillator (ICD) after tricuspid valve surgery can be challenging if right ventricular (RV) lead placement is contraindicated or safe lead placement in the RV apex is impossible. Methods and results In six patients for whom RV lead placement and repeat thoracotomy were contraindicated, ventricular pacing and sensing were achieved with bipolar leads placed in the lateral branch of the coronary sinus or in the atrialized portion of the RV or without helix exposure of the pace-sense electrodes of the defibrillator leads. After cannulation of the Middle Cardiac Vein (MCV), a defibrillator coil lead was delivered there and placed in the farthest apical position. An ‘active can’ pulse generator was implanted in the left retromammary region. Biphasic shocks were delivered between the MCV coil, SVC coil, and the ‘active can’, or between the MCV coil, azygous Vein coil, and the ‘active can’. All six patients underwent successful implantation. All patients had a defibrillation safety margin of at least 10 J (at least two successful shocks at 25 J). During follow-up, one patient received a successful internal shock for ventricular fibrillation, and two received successful overdrive ventricular pacing for ventricular tachycardia. Three patients underwent defibrillation threshold testing to evaluate safety margins. No late complications have been reported at 60 months' follow-up. Conclusion Defibrillator coil lead placement in the MCV is a safe alternative to epicardial lead placement via a thoracotomy in selected patients for whom RV lead placement is contraindicated or impossible.
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total transvenous approach to pacing and defibrillation after ebstein s anomaly
The Annals of Thoracic Surgery, 2009Co-Authors: Alberto J LopezAbstract:We describe the successful use of a percutaneous, transvenous endocardial approach to atrioventricular pacing and Cardiac defibrillation in an adult born with Ebstein's anomaly who had undergone tricuspid valve repair. The patient has systolic left ventricular dysfunction, congestive heart failure, and sinus node dysfunction. Ventricular pacing and sensing was obtained with a bipolar lead placed in the inferolateral Cardiac Vein; atrial pacing was obtained at the low interatrial septum. Internal Cardiac defibrillation was achieved with a coil lead placed in the Middle Cardiac Vein and the active can in the left retro mammary pre-pectoral position. With this approach, we avoided a thoracotomy and epicardial patch in a patient whose previous tricuspid valve surgery precluded an endocardial right ventricular lead position.
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a novel approach to transvenous dual chamber pacing lead placement and Cardiac defibrillator implantation after tricuspid valve replacement
Journal of Cardiovascular Electrophysiology, 2008Co-Authors: Alberto J Lopez, M Roberto D LufschanowskiAbstract:Pacing and Defibrillation Therapy. We report the successful use of a percutaneous, totally transvenous endocardial approach to atrioventricular pacing and internal Cardiac defibrillation in an adult patient with tetralogy of Fallot who had undergone three previous Cardiac operations, including a tricuspid valve replacement. Ventricular pacing and sensing were achieved with a bipolar lead in the lateral Cardiac Vein, and atrial pacing was attained in the region of Bachmann's bundle. Internal defibrillation was achieved with a coil lead in the Middle Cardiac Vein and an "active can" pulse generator in the retromammary position. This minimally invasive method has significant potential benefits because it avoids epicardial placement via a thoracotomy and allows endocardial placement without crossing the tricuspid valve.
Ersoy Isik - One of the best experts on this subject based on the ideXlab platform.
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a permanent junctional reciprocating tachycardia with an atypically located accessory pathway successfully ablated from within the Middle Cardiac Vein
Heart and Vessels, 2006Co-Authors: Basri Amasyali, Sedat Kose, Kudret Aytemir, Ayhan Kilic, Hurkan Kursaklioglu, Ersoy IsikAbstract:Permanent form of junctional reciprocating tachycardia (PJRT) is an uncommon form of atrioventricular re-entrant tachycardia due to an accessory pathway characterized by slow and decremental retrograde conduction. The majority of accessory pathways in PJRT are localized in the posteroseptal zone. Despite the high success rate, failure may occur during endocardial radiofrequency catheter ablation due to epicardial insertion of the accessory pathway. We report a case of PJRT in a 25-year-old man in whom the accessory pathway was located epicardially in the posteroinferior region and ablated from within the Middle Cardiac Vein by radiofrequency catheter ablation.
Kurt C Robertsthomson - One of the best experts on this subject based on the ideXlab platform.
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coronary artery injury due to catheter ablation in adults presentations and outcomes
Circulation, 2009Co-Authors: Kurt C Robertsthomson, Jens Seiler, Keiichi Inada, Usha B. Tedrow, Bruce A Koplan, Daniel Steven, Laurence M. Epstein, William G. StevensonAbstract:Background— Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures. Methods and Results— Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients’ mean age was 45±11 years, and 1.8±0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the Middle Cardiac Vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as...
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coronary artery injury due to catheter ablation in adults presentations and outcomes
Circulation, 2009Co-Authors: Kurt C Robertsthomson, Jens Seiler, Keiichi Inada, Usha B. Tedrow, Bruce A Koplan, Daniel Steven, Laurence M. Epstein, William G. StevensonAbstract:BACKGROUND: Currently, only anecdotal information exists on the presentation and outcome of coronary arterial injury after ablation procedures. METHODS AND RESULTS: Four patients who sustained coronary artery injury of a cohort of patients undergoing 4655 consecutive ablation procedures (0.09%) are described. The patients' mean age was 45+/-11 years, and 1.8+/-0.5 prior ablation attempts had been unsuccessful. Coronary injury occurred from epicardial ventricular tachycardia ablation in 2 patients (irrigated radiofrequency ablation in one and cryoablation in the other) and ablation within the Middle Cardiac Vein with irrigated radiofrequency in 2 patients. All involved branches of the right coronary artery. Acute occlusion presenting with ST-segment elevation immediately after ablation was recognized during the procedure in 2 cases. Occlusion failed to respond to nitroglycerin or balloon dilation, and stenting was required in both cases. Acute myocardial infarction occurred 2 weeks after epicardial ablation as a result of occlusion of a right ventricular branch of the right coronary artery giving rise to the posterior descending coronary artery in 1 patient. A moderate asymptomatic stenosis was seen on angiography after epicardial cryoablation in 1 patient. All patients recovered and remained asymptomatic from the coronary injury and arrhythmias during 37+/-53 months of follow-up. CONCLUSIONS: Coronary arterial injury after ablation procedures is rare. It may present acutely or several weeks after an ablation procedure. Acute occlusion appears to require coronary stenting. Unanticipated anatomic variations can predispose to coronary injury.
Hakan Oral - One of the best experts on this subject based on the ideXlab platform.
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mapping and ablation of epicardial idiopathic ventricular arrhythmias from within the coronary venous system
Circulation-arrhythmia and Electrophysiology, 2010Co-Authors: Timir S Baman, Karl J Ilg, Sanjaya Gupta, Eric Good, Aman Chugh, Krit Jongnarangsin, Frank Pelosi, Matthew Ebinger, Thomas Crawford, Hakan OralAbstract:Background— The prevalence of epicardial idiopathic ventricular arrhythmias that can be ablated from within the coronary venous system (CVS) has not been described. Methods and Results— In a consecutive group of 189 patients with idiopathic ventricular arrhythmias referred for ablation, the site of origin (SOO) of ventricular tachycardia and/or premature ventricular contractions was determined by activation mapping and pace mapping. Mapping was performed within the CVS if endocardial mapping did not reveal an SOO. Venography of the CVS and coronary angiography were performed before ablation in the CVS. In 27 of 189 patients (14%±5%; 95% confidence interval), the SOO of the ventricular arrhythmia was identified from within the coronary venous system, either in the great Cardiac Vein (n=26) or the Middle Cardiac Vein (n=1). The mean activation time at the SOO was −29±8 ms. Twenty of 27 patients (74%) underwent successful ablation within the CVS. Epicardial ventricular arrhythmias displayed a broader R wave in V1 compared with arrhythmias in the control group (85 ms [interquartile range, 40] versus 65 ms [interquartile range, 95]; P <0.01). Two patients had recurrent premature ventricular contractions within 2 weeks after ablation, and no recurrences occurred in the remaining patients during a median follow-up of 13 months (range, 25). In the 7 patients with unsuccessful ablation, failure was because the ablation catheter could not be advanced to the SOO within the great Cardiac Vein (n=4), inadequate power delivery at the SOO (n=1), proximity to the phrenic nerve (n=1), or proximity of the SOO to a major coronary artery (n=1). Transcutaneous epicardial ablation was effective in 1 of 2 patients in whom it was attempted. Conclusions— Almost 15% of idiopathic ventricular arrhythmias have an epicardial origin. ECG characteristics help to differentiate epicardial arrhythmias from endocardial ventricular arrhythmias. The SOO of epicardial arrhythmias can be ablated from within the CVS in approximately 70% of patients.