The Experts below are selected from a list of 5019 Experts worldwide ranked by ideXlab platform
Feifan Ouyang - One of the best experts on this subject based on the ideXlab platform.
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idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp prevalence electrocardiographic electrophysiological characteristics and catheter ablation
Journal of the American College of Cardiology, 2015Co-Authors: Zili Liao, Xianzhang Zhan, Yumei Xue, Xianhong Fang, Hongtao Liao, Hai Deng, Yuanhong Liang, Wei Wei, Yang Liu, Feifan OuyangAbstract:Abstract Background Idiopathic ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) have not been sufficiently clarified. Objectives The goal of this study was to investigate the prevalence, electrocardiographic characteristics, mapping, and ablation of idiopathic VAs arising from the PSC. Methods Data were analyzed from 218 patients undergoing successful endocardial ablation of idiopathic VAs with a left bundle branch block morphology and inferior axis deviation. Results Twenty-four patients had VAs originating from the PSC. In the first 7 patients, initial ablation performed in the right ventricular outflow tract failed to abolish the clinical VAs but produced a small change in the QRS morphology in 3 patients. In all 24 patients, the earliest activation was eventually identified in the PSC, at which a sharp potential was observed preceding the QRS complex onset by 28.2 ± 2.9 ms. The successful ablation site was in the right cusp (RC) in 10 patients (42%), the left cusp (LC) in 8 (33%), and the anterior cusp (AC) in 6 (25%). Electrocardiographic analysis showed that RC-VAs had significantly larger R-Wave Amplitude in lead I and a smaller aVL/aVR ratio of Q-Wave Amplitude compared with AC-VAs and LC-VAs, respectively. The R-Wave Amplitude in inferior leads was smaller in VAs localized in the RC than in the LC but did not differ between VAs from the AC and LC. Conclusions VAs arising from the PSC are not uncommon, and RC-VAs have uniQue electrocardiographic characteristics. These VAs can be successfully ablated within the PSC.
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ventricular arrhythmias arising from the left ventricular outflow tract below the aortic sinus cusps mapping and catheter ablation via transseptal approach and electrocardiographic characteristics
Circulation-arrhythmia and Electrophysiology, 2014Co-Authors: Feifan Ouyang, Xianzhang Zhan, Yumei Xue, Shibu Mathew, Masashi Kamioka, Andreas Metzner, Bing Yang, Andreas Rillig, Tina Lin, Peter RauschAbstract:Background— Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach. Methods and Results— This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations. LVOT endocardial 3-dimensional mapping via retrograde transaortic and antegrade transseptal approaches was performed. Previous ECG markers for procedure failure were analyzed. In all patients, earliest activation with low-Amplitude potentials was identified at the anterosuperior LVOT 5.1±2.8 mm below the aortic cusp and preceded the QRS onset by 39.5±7.7 ms only via an antegrade transseptal approach using a reversed S curve. In all patients, pace mapping failed to demonstrate perfect QRS morphology match. The anatomic location was below the left coronary cusp in 16, below the left coronary cusp/right coronary cusp junction in 8, and below the right coronary cusp in 3 patients. RadiofreQuency energy resulted in rapid disappearance of VAs in all patients. ECG analysis showed aVL/aVR Q-Wave Amplitude ratio >1.4 in 7, lead III/II R-Wave Amplitude ratio >1.1 in 10, and peak deflection index >0.6 in 11 patients. There were no complications or clinical VA recurrence during a mean follow-up of 8.4±2.5 months. Conclusions— The anterosuperior LVOT can be reached via a transseptal approach with a reversed S curve of the ablation catheter. The rapid effect from radiofreQuency energy indicates that the VA is most likely located under the endocardium. Also, previous ECG markers for procedure failure need further investigation.
Xianzhang Zhan - One of the best experts on this subject based on the ideXlab platform.
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idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp prevalence electrocardiographic electrophysiological characteristics and catheter ablation
Journal of the American College of Cardiology, 2015Co-Authors: Zili Liao, Xianzhang Zhan, Yumei Xue, Xianhong Fang, Hongtao Liao, Hai Deng, Yuanhong Liang, Wei Wei, Yang Liu, Feifan OuyangAbstract:Abstract Background Idiopathic ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) have not been sufficiently clarified. Objectives The goal of this study was to investigate the prevalence, electrocardiographic characteristics, mapping, and ablation of idiopathic VAs arising from the PSC. Methods Data were analyzed from 218 patients undergoing successful endocardial ablation of idiopathic VAs with a left bundle branch block morphology and inferior axis deviation. Results Twenty-four patients had VAs originating from the PSC. In the first 7 patients, initial ablation performed in the right ventricular outflow tract failed to abolish the clinical VAs but produced a small change in the QRS morphology in 3 patients. In all 24 patients, the earliest activation was eventually identified in the PSC, at which a sharp potential was observed preceding the QRS complex onset by 28.2 ± 2.9 ms. The successful ablation site was in the right cusp (RC) in 10 patients (42%), the left cusp (LC) in 8 (33%), and the anterior cusp (AC) in 6 (25%). Electrocardiographic analysis showed that RC-VAs had significantly larger R-Wave Amplitude in lead I and a smaller aVL/aVR ratio of Q-Wave Amplitude compared with AC-VAs and LC-VAs, respectively. The R-Wave Amplitude in inferior leads was smaller in VAs localized in the RC than in the LC but did not differ between VAs from the AC and LC. Conclusions VAs arising from the PSC are not uncommon, and RC-VAs have uniQue electrocardiographic characteristics. These VAs can be successfully ablated within the PSC.
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ventricular arrhythmias arising from the left ventricular outflow tract below the aortic sinus cusps mapping and catheter ablation via transseptal approach and electrocardiographic characteristics
Circulation-arrhythmia and Electrophysiology, 2014Co-Authors: Feifan Ouyang, Xianzhang Zhan, Yumei Xue, Shibu Mathew, Masashi Kamioka, Andreas Metzner, Bing Yang, Andreas Rillig, Tina Lin, Peter RauschAbstract:Background— Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach. Methods and Results— This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations. LVOT endocardial 3-dimensional mapping via retrograde transaortic and antegrade transseptal approaches was performed. Previous ECG markers for procedure failure were analyzed. In all patients, earliest activation with low-Amplitude potentials was identified at the anterosuperior LVOT 5.1±2.8 mm below the aortic cusp and preceded the QRS onset by 39.5±7.7 ms only via an antegrade transseptal approach using a reversed S curve. In all patients, pace mapping failed to demonstrate perfect QRS morphology match. The anatomic location was below the left coronary cusp in 16, below the left coronary cusp/right coronary cusp junction in 8, and below the right coronary cusp in 3 patients. RadiofreQuency energy resulted in rapid disappearance of VAs in all patients. ECG analysis showed aVL/aVR Q-Wave Amplitude ratio >1.4 in 7, lead III/II R-Wave Amplitude ratio >1.1 in 10, and peak deflection index >0.6 in 11 patients. There were no complications or clinical VA recurrence during a mean follow-up of 8.4±2.5 months. Conclusions— The anterosuperior LVOT can be reached via a transseptal approach with a reversed S curve of the ablation catheter. The rapid effect from radiofreQuency energy indicates that the VA is most likely located under the endocardium. Also, previous ECG markers for procedure failure need further investigation.
Yumei Xue - One of the best experts on this subject based on the ideXlab platform.
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idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp prevalence electrocardiographic electrophysiological characteristics and catheter ablation
Journal of the American College of Cardiology, 2015Co-Authors: Zili Liao, Xianzhang Zhan, Yumei Xue, Xianhong Fang, Hongtao Liao, Hai Deng, Yuanhong Liang, Wei Wei, Yang Liu, Feifan OuyangAbstract:Abstract Background Idiopathic ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) have not been sufficiently clarified. Objectives The goal of this study was to investigate the prevalence, electrocardiographic characteristics, mapping, and ablation of idiopathic VAs arising from the PSC. Methods Data were analyzed from 218 patients undergoing successful endocardial ablation of idiopathic VAs with a left bundle branch block morphology and inferior axis deviation. Results Twenty-four patients had VAs originating from the PSC. In the first 7 patients, initial ablation performed in the right ventricular outflow tract failed to abolish the clinical VAs but produced a small change in the QRS morphology in 3 patients. In all 24 patients, the earliest activation was eventually identified in the PSC, at which a sharp potential was observed preceding the QRS complex onset by 28.2 ± 2.9 ms. The successful ablation site was in the right cusp (RC) in 10 patients (42%), the left cusp (LC) in 8 (33%), and the anterior cusp (AC) in 6 (25%). Electrocardiographic analysis showed that RC-VAs had significantly larger R-Wave Amplitude in lead I and a smaller aVL/aVR ratio of Q-Wave Amplitude compared with AC-VAs and LC-VAs, respectively. The R-Wave Amplitude in inferior leads was smaller in VAs localized in the RC than in the LC but did not differ between VAs from the AC and LC. Conclusions VAs arising from the PSC are not uncommon, and RC-VAs have uniQue electrocardiographic characteristics. These VAs can be successfully ablated within the PSC.
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ventricular arrhythmias arising from the left ventricular outflow tract below the aortic sinus cusps mapping and catheter ablation via transseptal approach and electrocardiographic characteristics
Circulation-arrhythmia and Electrophysiology, 2014Co-Authors: Feifan Ouyang, Xianzhang Zhan, Yumei Xue, Shibu Mathew, Masashi Kamioka, Andreas Metzner, Bing Yang, Andreas Rillig, Tina Lin, Peter RauschAbstract:Background— Ventricular arrhythmias (VAs) originating from the anterosuperior left ventricular outflow tract (LVOT) represent a challenging location for catheter ablation. This study investigates mapping and ablation of VA from anterosuperior LVOT via a transseptal approach. Methods and Results— This study included 27 patients with symptomatic VA, of which 13 patients had previous failed ablations. LVOT endocardial 3-dimensional mapping via retrograde transaortic and antegrade transseptal approaches was performed. Previous ECG markers for procedure failure were analyzed. In all patients, earliest activation with low-Amplitude potentials was identified at the anterosuperior LVOT 5.1±2.8 mm below the aortic cusp and preceded the QRS onset by 39.5±7.7 ms only via an antegrade transseptal approach using a reversed S curve. In all patients, pace mapping failed to demonstrate perfect QRS morphology match. The anatomic location was below the left coronary cusp in 16, below the left coronary cusp/right coronary cusp junction in 8, and below the right coronary cusp in 3 patients. RadiofreQuency energy resulted in rapid disappearance of VAs in all patients. ECG analysis showed aVL/aVR Q-Wave Amplitude ratio >1.4 in 7, lead III/II R-Wave Amplitude ratio >1.1 in 10, and peak deflection index >0.6 in 11 patients. There were no complications or clinical VA recurrence during a mean follow-up of 8.4±2.5 months. Conclusions— The anterosuperior LVOT can be reached via a transseptal approach with a reversed S curve of the ablation catheter. The rapid effect from radiofreQuency energy indicates that the VA is most likely located under the endocardium. Also, previous ECG markers for procedure failure need further investigation.
Zili Liao - One of the best experts on this subject based on the ideXlab platform.
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idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp prevalence electrocardiographic electrophysiological characteristics and catheter ablation
Journal of the American College of Cardiology, 2015Co-Authors: Zili Liao, Xianzhang Zhan, Yumei Xue, Xianhong Fang, Hongtao Liao, Hai Deng, Yuanhong Liang, Wei Wei, Yang Liu, Feifan OuyangAbstract:Abstract Background Idiopathic ventricular arrhythmias (VAs) originating from the pulmonary sinus cusp (PSC) have not been sufficiently clarified. Objectives The goal of this study was to investigate the prevalence, electrocardiographic characteristics, mapping, and ablation of idiopathic VAs arising from the PSC. Methods Data were analyzed from 218 patients undergoing successful endocardial ablation of idiopathic VAs with a left bundle branch block morphology and inferior axis deviation. Results Twenty-four patients had VAs originating from the PSC. In the first 7 patients, initial ablation performed in the right ventricular outflow tract failed to abolish the clinical VAs but produced a small change in the QRS morphology in 3 patients. In all 24 patients, the earliest activation was eventually identified in the PSC, at which a sharp potential was observed preceding the QRS complex onset by 28.2 ± 2.9 ms. The successful ablation site was in the right cusp (RC) in 10 patients (42%), the left cusp (LC) in 8 (33%), and the anterior cusp (AC) in 6 (25%). Electrocardiographic analysis showed that RC-VAs had significantly larger R-Wave Amplitude in lead I and a smaller aVL/aVR ratio of Q-Wave Amplitude compared with AC-VAs and LC-VAs, respectively. The R-Wave Amplitude in inferior leads was smaller in VAs localized in the RC than in the LC but did not differ between VAs from the AC and LC. Conclusions VAs arising from the PSC are not uncommon, and RC-VAs have uniQue electrocardiographic characteristics. These VAs can be successfully ablated within the PSC.
Fermin C Garcia - One of the best experts on this subject based on the ideXlab platform.
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percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit outcomes and electrocardiogram correlates of success
Circulation-arrhythmia and Electrophysiology, 2015Co-Authors: Pasquale Santangeli, David S Frankel, Francis E Marchlinski, Erica S Zado, Daniel Benhayon, Mathew D Hutchinson, David Lin, Michael P Riley, Gregory E Supple, Fermin C GarciaAbstract:Background— Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit is limited by the presence of major coronary vessels and epicardial fat. We report the outcomes of percutaneous epicardial mapping and ablation of ventricular arrhythmias arising from the left ventricular summit and the ECG features associated with successful ablation. Methods and Results— Between January 2003 and December 2012, a total of 23 consecutive patients (49±14 years; 39% men) with ventricular arrhythmias arising from the left ventricular summit underwent percutaneous epicardial instrumentation for mapping and ablation because of unsuccessful ablation from the coronary venous system and multiple endocardial LV/right ventricular sites. Successful epicardial ablation was achieved in 5 (22%) patients. In the remaining 18 (78%) cases, ablation was aborted for either close proximity to major coronary arteries or poor energy delivery over epicardial fat. The Q-Wave Amplitude ratio in aVL/aVR was higher in the successful group, with a ratio of >1.85 present in 4 (80%) patients in the successful group versus 2 (11%) in the unsuccessful group ( P =0.008). The ratio of R/S Wave in V1 was greater in the successful group, with 4 (80%) patients in the successful group having a R/S ratio of >2 in V1 versus 5 (28%) in the unsuccessful group ( P =0.056). None of the patients in the successful group had an initial Q Wave in lead V1, as opposed to 6 (33%) in the unsuccessful group. The presence of at least 2 of the 3 ECG criteria above predicted successful ablation with 100% sensitivity and 72% specificity. Conclusions— Epicardial instrumentation for mapping and ablation of ventricular arrhythmias arising from the left ventricular summit is successful only in a minority of patients because of close proximity to major coronary arteries and epicardial fat. A Q-Wave ratio of >1.85 in aVL/aVR, a R/S ratio of >2 in V1, and absence of Q Waves in lead V1 help identify appropriate candidates for epicardial ablation.
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ablation of ventricular arrhythmias arising near the anterior epicardial veins from the left sinus of valsalva region ecg features anatomic distance and outcome
Heart Rhythm, 2012Co-Authors: Miguel Jauregui E Abularach, Bieito Campos, Kyoung Min Park, Cory M Tschabrunn, David S Frankel, Robert E Park, Edward P Gerstenfeld, Stavros E Mountantonakis, Fermin C Garcia, Sanjay DixitAbstract:Background Left ventricular outflow tract tachycardia/premature depolarizations (VT/VPDs) arising near the anterior epicardial veins may be difficult to eliminate through the coronary venous system. Objective To describe the characteristics of an alternative successful ablation strategy targeting the left sinus of Valsalva (LSV) and/or the adjacent left ventricular (LV) endocardium. Methods Of 276 patients undergoing mapping/ablation for outflow tract VT/VPDs, 16 consecutive patients (8 men; mean age 52 ± 17 years) had an ablation attempt from the LSV and/or the adjacent LV endocardium for VT/VPDs mapped marginally closer to the distal great cardiac vein (GCV) or anterior interventricular vein (AIV). Results Successful ablation was achieved in 9 of the 16 patients (56%) targeting the LSV (5 patients), adjacent LV endocardium (2 patients), or both (2 patients). The R-Wave Amplitude ratio in lead III/II and the Q-Wave Amplitude ratio in aVL/aVR were smaller in the successful group (1.05 ± 0.13 vs 1.34 ± 0.37 and 1.24 ± 0.42 vs 2.15 ± 1.05, respectively; P = .043 for both). The anatomical distance from the earliest GCV/AIV site to the closest point in the LSV region was shorter for the successful group (11.0 ± 6.5 mm vs 20.4 ± 12.1 mm; P = .048). A Q-Wave ratio of Conclusions VT/VPDs originating near the GCV/AIV can be ablated from the LSV/adjacent LV endocardium. A Q-Wave ratio of
