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Frank A. Fish - One of the best experts on this subject based on the ideXlab platform.
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entrainment to distinguish orthodromic reciprocating Tachycardia from atrioventricular nodal Reentry Tachycardia in children
Pacing and Clinical Electrophysiology, 2010Co-Authors: Prince J Kannankeril, William J Bonney, Matthew V Dzurik, Frank A. FishAbstract:Background: Studies in adults suggest that after entrainment from the right ventricle, a post-pacing interval (PPI) minus Tachycardia cycle length (TCL), when corrected for atrioventricular node delay (cPPI-TCL), is useful to distinguish atrioventricular nodal Reentry Tachycardia (AVNRT) from orthodromic reciprocating Tachycardia (ORT), but this has not been evaluated in children. Methods: In 100 children undergoing catheter ablation, entrainment of ORT or AVNRT was performed from the right ventricular apex. The atrial-His (AH) interval was measured on the return cycle (post-AH) and during Tachycardia just prior to pacing (pre-AH). The cPPI-TCL was calculated as (PPI-TCL) − (post-AH − pre-AH). In the first 50 children, the best cutoff was identified and then validated in the next 50 children. Results: In the first 50 children, cPPI-TCL was longer in AVNRT compared with ORT (122 ± 19 ms vs 63 ± 23 ms, P 95 ms was 95% specific for AVNRT. There was even greater separation of cPPI-TCL values comparing AVNRT with ORT utilizing a septal accessory pathway. Conclusions: The cPPI-TCL is a useful technique to distinguish AVNRT from ORT in children. Our data suggest that in children a cPPI-TCL 95 ms is rarely observed in ORT. This technique is particularly useful to distinguish AVNRT from ORT utilizing a septal accessory pathway. (PACE 2010; 469–474)
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sustained slow pathway conduction superior to dual atrioventricular node physiology in young patients with atrioventricular nodal Reentry Tachycardia
Pacing and Clinical Electrophysiology, 2006Co-Authors: Prince J Kannankeril, Frank A. FishAbstract:Background: Young patients with atrioventricular nodal Reentry Tachycardia (AVNRT) frequently do not display discrete dual AV node physiology (DAVNP) as classically defined. The purpose of the study was to investigate the prevalence of sustained slow pathway conduction (SSPC; PR > RR during atrial pacing) in young patients with AVNRT and compare it to dual atrioventricular node physiology. Methods: The presence of SSPC and DAVNP was prospectively assessed before and after radiofrequency catheter ablation in 61 young patients (age 4–23 years) with typical AVNRT. Results: Prior to ablation, 32 (52%) displayed DAVNP, while 46 (75%) displayed SSPC; 7 patients (11%) had neither marker. Patients with DAVNP were older than those without (15 ± 3 vs 13 ± 4, P = 0.027) and the prevalence increased with age (38% 15, P = 0.041), while SSPC showed no age predilection. Patients under 13 years displayed SSPC more commonly than DAVNP (81% vs 38%, P = 0.004). DAVNP persisted after ablation in 10/32 (31%) patients, compared to 6/46 (13%) with persistent SSPC after ablation. The ability to use loss of the marker (present before, absent after ablation) as a surrogate for successful ablation was greater for SSPC than for DAVNP (66% vs 36%, P = 0.001). Conclusion: SSPC is more common than DAVNP in young patients with AVNRT. SSPC is eliminated more frequently than DAVNP after acutely successful ablation, and appears to be a better indicator of the substrate for AVNRT. Elimination of SSPC may serve as a useful surrogate endpoint for slow pathway ablation.
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frequency of late recurrence of intra atrial Reentry Tachycardia after radiofrequency catheter ablation in patients with congenital heart disease
American Journal of Cardiology, 2003Co-Authors: Prince J Kannankeril, Mark E Anderson, Jeffrey N Rottman, Mark S Wathen, Frank A. FishAbstract:Forty-seven catheter ablation procedures for intra-atrial Reentry Tachycardia were performed in 40 patients with palliated congenital heart disease. The acute success rate was 87% and the recurrence rate was 34% during an average follow-up of 36 months. Of those patients who had recurrence, 88% did so within 1 year of ablation. Of the 23 patients who were free of recurrence 1 year after ablation, 21 (91%) remain free from recurrence at an average of 45 months (median 39; range 15 to 88) after ablation.
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Inducible atrioventricular nodal Reentry Tachycardia in infants with a history of neonatal orthodromic reciprocating Tachycardia.
Pacing and Clinical Electrophysiology, 2003Co-Authors: J. Kannankeril, James A. Johns, Frank A. FishAbstract:Atrioventricular nodal Reentry Tachycardia (AVNRT) is an uncommon mechanism of supraventricular Tachycardia in neonates in whom orthodromic reciprocating Tachycardia (ORT) predominates. We report three patients with structurally normal hearts who presented with neonatal ORT, documented by transesophageal electrophysiology studies at 2 to 3 weeks of age. At follow-up study at 8-12 months of age, no infant had inducible ORT, suggesting spontaneous regression of congenital accessory pathways; however, each had inducible Tachycardia consistent with the typical form of AVNRT. The clinical significance of this finding is unknown and warrants further study.
Prince J Kannankeril - One of the best experts on this subject based on the ideXlab platform.
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entrainment to distinguish orthodromic reciprocating Tachycardia from atrioventricular nodal Reentry Tachycardia in children
Pacing and Clinical Electrophysiology, 2010Co-Authors: Prince J Kannankeril, William J Bonney, Matthew V Dzurik, Frank A. FishAbstract:Background: Studies in adults suggest that after entrainment from the right ventricle, a post-pacing interval (PPI) minus Tachycardia cycle length (TCL), when corrected for atrioventricular node delay (cPPI-TCL), is useful to distinguish atrioventricular nodal Reentry Tachycardia (AVNRT) from orthodromic reciprocating Tachycardia (ORT), but this has not been evaluated in children. Methods: In 100 children undergoing catheter ablation, entrainment of ORT or AVNRT was performed from the right ventricular apex. The atrial-His (AH) interval was measured on the return cycle (post-AH) and during Tachycardia just prior to pacing (pre-AH). The cPPI-TCL was calculated as (PPI-TCL) − (post-AH − pre-AH). In the first 50 children, the best cutoff was identified and then validated in the next 50 children. Results: In the first 50 children, cPPI-TCL was longer in AVNRT compared with ORT (122 ± 19 ms vs 63 ± 23 ms, P 95 ms was 95% specific for AVNRT. There was even greater separation of cPPI-TCL values comparing AVNRT with ORT utilizing a septal accessory pathway. Conclusions: The cPPI-TCL is a useful technique to distinguish AVNRT from ORT in children. Our data suggest that in children a cPPI-TCL 95 ms is rarely observed in ORT. This technique is particularly useful to distinguish AVNRT from ORT utilizing a septal accessory pathway. (PACE 2010; 469–474)
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catheter ablation for atrioventricular nodal Reentry Tachycardia in children a time to freeze and a time to burn
Heart Rhythm, 2006Co-Authors: Prince J KannankerilAbstract:Radiofrequency (RF) catheter ablation is a well-established therapy for most supraventricular Tachycardias in children, including atrioventricular nodal Reentry Tachycardia (AVNRT). The excellent results of RF ablation have been verified in large cohorts of children in both the retrospective Pediatric Radiofrequency Ablation Registry and the multicenter Prospective Assessment after Pediatric Cardiac Ablation. 1,2 However, RF ablation for AVNRT carries a small risk of inadvertent injury to the AV node, with resulting permanent heart block. This is a dreaded complication, particularly as the targeted arrhythmia is troublesome but not life threatening. With the emergence of catheter-based cryoablation systems, many have adopted this approach for children with AVNRT because of its potential advantages. The ability to “cryomap” or assess the result of a lesion while the effects are still reversible represents perhaps the most desirous aspect for interventional electrophysiologists. Initial reports of cryoablation for treatment of AVNRT in children demonstrated the safety of the technique, but they also revealed lower acute success rates and higher recurrence rates compared with the results of RF ablation reported in the large multicenter trials. 3‐5 In a study in this issue of Heart Rhythm, Collins et al 6 directly compare radiofrequency energy and cryothermal energy for catheter ablation of AVNRT in 117 children at a single high-volume center. This group has been a leader in our efforts to better understand the aspects of AVNRT unique to children. In the present study, they confirm that both RF ablation and cryoablation can successfully and safely treat AVNRT in children. The 95% success rate of cryoablation in this study was high, with only one true failure requiring crossover to RF ablation for procedural success. The two other failures were aborted procedures because of malfunction of the cryoablation console and first-degree heart block induced with catheter manipulation. The latter may be due to the size and stiffness of the current generation of cryoablation catheters. With continued use and refinement, cryoablation of AVNRT in children likely will attain the high success rate currently enjoyed by RF ablation (100% in the present study). The recurrence rates were 2% for RF ablation and 8% for cryoablation, but this study was too small to detect a significant difference between groups. Nonetheless, the results are consistent with the higher recurrence rates reported in previous studies evaluating cryoablation. 4,7
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sustained slow pathway conduction superior to dual atrioventricular node physiology in young patients with atrioventricular nodal Reentry Tachycardia
Pacing and Clinical Electrophysiology, 2006Co-Authors: Prince J Kannankeril, Frank A. FishAbstract:Background: Young patients with atrioventricular nodal Reentry Tachycardia (AVNRT) frequently do not display discrete dual AV node physiology (DAVNP) as classically defined. The purpose of the study was to investigate the prevalence of sustained slow pathway conduction (SSPC; PR > RR during atrial pacing) in young patients with AVNRT and compare it to dual atrioventricular node physiology. Methods: The presence of SSPC and DAVNP was prospectively assessed before and after radiofrequency catheter ablation in 61 young patients (age 4–23 years) with typical AVNRT. Results: Prior to ablation, 32 (52%) displayed DAVNP, while 46 (75%) displayed SSPC; 7 patients (11%) had neither marker. Patients with DAVNP were older than those without (15 ± 3 vs 13 ± 4, P = 0.027) and the prevalence increased with age (38% 15, P = 0.041), while SSPC showed no age predilection. Patients under 13 years displayed SSPC more commonly than DAVNP (81% vs 38%, P = 0.004). DAVNP persisted after ablation in 10/32 (31%) patients, compared to 6/46 (13%) with persistent SSPC after ablation. The ability to use loss of the marker (present before, absent after ablation) as a surrogate for successful ablation was greater for SSPC than for DAVNP (66% vs 36%, P = 0.001). Conclusion: SSPC is more common than DAVNP in young patients with AVNRT. SSPC is eliminated more frequently than DAVNP after acutely successful ablation, and appears to be a better indicator of the substrate for AVNRT. Elimination of SSPC may serve as a useful surrogate endpoint for slow pathway ablation.
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frequency of late recurrence of intra atrial Reentry Tachycardia after radiofrequency catheter ablation in patients with congenital heart disease
American Journal of Cardiology, 2003Co-Authors: Prince J Kannankeril, Mark E Anderson, Jeffrey N Rottman, Mark S Wathen, Frank A. FishAbstract:Forty-seven catheter ablation procedures for intra-atrial Reentry Tachycardia were performed in 40 patients with palliated congenital heart disease. The acute success rate was 87% and the recurrence rate was 34% during an average follow-up of 36 months. Of those patients who had recurrence, 88% did so within 1 year of ablation. Of the 23 patients who were free of recurrence 1 year after ablation, 21 (91%) remain free from recurrence at an average of 45 months (median 39; range 15 to 88) after ablation.
Yasuhiro Taniguchi - One of the best experts on this subject based on the ideXlab platform.
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variation of p qrs relation during atrioventricular node Reentry Tachycardia
Journal of the American College of Cardiology, 1999Co-Authors: Yasuhiro Taniguchi, Chunchieh Wang, Delon WuAbstract:Abstract Objectives The main objective of this study was to characterize the phenomenon of variation in the P-QRS relation during atrioventricular node Reentry Tachycardia. Background Variation of P-QRS relation during Tachycardia has been observed occasionally in atrioventricular node Reentry Tachycardia. However, the incidence, the characteristics and the mechanisms of this phenomenon have not been investigated previously. Methods Retrospective analysis was performed in 311 consecutive patients with slow-fast form and 108 patients with atypical or multiple form of atrioventricular node Reentry Tachycardia to examine whether variation of P-QRS relation with changes in AH, HA and AH/HA (A = atria; H = His bundle) ratio occurred during Tachycardia. Results A total of 28 patients, 8 with slow-fast and 20 with atypical or multiple Tachycardias, were found to manifest this phenomenon. There were 6 males and 22 females, with an average age of 38 ± 16 years. In 10 patients, this phenomenon occurred transiently following electrical induction of the Tachycardia. In 15 patients, changes in AH, HA and AH/HA ratio were associated with the occurrence of Wenckebach or 2:1 block proximal to the His bundle (H) recording site without interruption of the Tachycardia. In nine patients, three with nonsustained Tachycardia and six after administration of adenosine triphosphate, this phenomenon was observed at the termination of the Tachycardia. This phenomenon was usually accompanied by a mild lengthening of the Tachycardia cycle length. Conclusions Variation of P-QRS relation with or without block may occur during atrioventricular node Reentry Tachycardia, especially in atypical or multiple-form Tachycardias. It was postulated that decremental conduction in the distal common pathway, which exists between the distal link of the Reentry circuit and the H, is primarily responsible for this phenomenon.
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atypical atrioventricular nodal Reentry Tachycardia with atrioventricular block mimicking atrial Tachycardia electrophysiologic properties and radiofrequency ablation therapy
Journal of Cardiovascular Electrophysiology, 1997Co-Authors: Yasuhiro Taniguchi, Chunchieh Wang, W U DelonAbstract:AVNRT Mimicking Atrial Tachycardia, Introduction: Fast-intermediate form AV nodal Reentry Tachycardia (AVNRT) sometimes may mimic atrial Tachycardia or atrial flutter and render the diagnosis difficult when the Tachycardia rate is fast and AV block occurs during Tachycardia. Methods and Results: A 45-year-old woman with paroxysmal supraventricular Tachycardia was referred to this institution. Initially, the Tachycardia was thought to be an atrial Tachycardia because of: (1) a short cycle length of the Tachycardia with 2:1 and Wenckebach AV block; (2) a difference in the atrial activation sequence during Tachycardia and during ventricular pacing; and (3) failure of burst ventricular pacing to affect the atrial rate and the atrial activation sequence during Tachycardia. An accurate diagnosis of fast-intermediate form AVNRT was subsequently made based on the finding that the Tachycardia was induced following delivery of a third ventricular extrastimulus, which showed a sequence of V-A-H and a change on atrial activation sequence of the induced beat. Successful radiofrequency ablation was achieved only after accurate diagnosis of the Tachycardia was made. Conclusion: Fast-intermediate form AVNRT sometimes may masquerade as atrial Tachycardia. Accurate diagnosis is mandatory for successful ablation therapy.
Chunchieh Wang - One of the best experts on this subject based on the ideXlab platform.
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variation of p qrs relation during atrioventricular node Reentry Tachycardia
Journal of the American College of Cardiology, 1999Co-Authors: Yasuhiro Taniguchi, Chunchieh Wang, Delon WuAbstract:Abstract Objectives The main objective of this study was to characterize the phenomenon of variation in the P-QRS relation during atrioventricular node Reentry Tachycardia. Background Variation of P-QRS relation during Tachycardia has been observed occasionally in atrioventricular node Reentry Tachycardia. However, the incidence, the characteristics and the mechanisms of this phenomenon have not been investigated previously. Methods Retrospective analysis was performed in 311 consecutive patients with slow-fast form and 108 patients with atypical or multiple form of atrioventricular node Reentry Tachycardia to examine whether variation of P-QRS relation with changes in AH, HA and AH/HA (A = atria; H = His bundle) ratio occurred during Tachycardia. Results A total of 28 patients, 8 with slow-fast and 20 with atypical or multiple Tachycardias, were found to manifest this phenomenon. There were 6 males and 22 females, with an average age of 38 ± 16 years. In 10 patients, this phenomenon occurred transiently following electrical induction of the Tachycardia. In 15 patients, changes in AH, HA and AH/HA ratio were associated with the occurrence of Wenckebach or 2:1 block proximal to the His bundle (H) recording site without interruption of the Tachycardia. In nine patients, three with nonsustained Tachycardia and six after administration of adenosine triphosphate, this phenomenon was observed at the termination of the Tachycardia. This phenomenon was usually accompanied by a mild lengthening of the Tachycardia cycle length. Conclusions Variation of P-QRS relation with or without block may occur during atrioventricular node Reentry Tachycardia, especially in atypical or multiple-form Tachycardias. It was postulated that decremental conduction in the distal common pathway, which exists between the distal link of the Reentry circuit and the H, is primarily responsible for this phenomenon.
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atypical atrioventricular nodal Reentry Tachycardia with atrioventricular block mimicking atrial Tachycardia electrophysiologic properties and radiofrequency ablation therapy
Journal of Cardiovascular Electrophysiology, 1997Co-Authors: Yasuhiro Taniguchi, Chunchieh Wang, W U DelonAbstract:AVNRT Mimicking Atrial Tachycardia, Introduction: Fast-intermediate form AV nodal Reentry Tachycardia (AVNRT) sometimes may mimic atrial Tachycardia or atrial flutter and render the diagnosis difficult when the Tachycardia rate is fast and AV block occurs during Tachycardia. Methods and Results: A 45-year-old woman with paroxysmal supraventricular Tachycardia was referred to this institution. Initially, the Tachycardia was thought to be an atrial Tachycardia because of: (1) a short cycle length of the Tachycardia with 2:1 and Wenckebach AV block; (2) a difference in the atrial activation sequence during Tachycardia and during ventricular pacing; and (3) failure of burst ventricular pacing to affect the atrial rate and the atrial activation sequence during Tachycardia. An accurate diagnosis of fast-intermediate form AVNRT was subsequently made based on the finding that the Tachycardia was induced following delivery of a third ventricular extrastimulus, which showed a sequence of V-A-H and a change on atrial activation sequence of the induced beat. Successful radiofrequency ablation was achieved only after accurate diagnosis of the Tachycardia was made. Conclusion: Fast-intermediate form AVNRT sometimes may masquerade as atrial Tachycardia. Accurate diagnosis is mandatory for successful ablation therapy.
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Late clinical and electrophysiologic outcome of radiofrequency ablation therapy by the inferior approach in atrioventricular node Reentry Tachycardia
American Heart Journal, 1994Co-Authors: Chunchieh Wang, I-chang Hsieh, Delon WuAbstract:Abstract A late electrophysiologic study was conducted in 182 of 289 patients with slow-fast atrioventricular node Reentry Tachycardia 81 ± 36 days after radiofrequency ablation therapy by the inferior approach. Of these 182 patients, electrophysiologic study immediately after ablation revealed a selective modification of the slow pathway in 159, a modification of both the slow and fast pathways in 15, a modification of the fast pathway alone in 3, and failure of ablation in 5. One hundred two patients had no induction of echoes; 75 had induction of fewer than four echoes; and 5 had induction of sustained Tachycardia with or without isoproterenol infusion. The late electrophysiologic study in these 182 patients revealed a persistent effect without changes in conduction properties in 161 (88%) patients. A change in conduction properties was noted in 21 patients, including 5 with resumption of slow- or fast-pathway conduction with induction of sustained Tachycardia, 8 with improved fast- or slow-pathway conduction, and 8 with an additional depression of fast- or slow-pathway conduction. Of the 102 patients with no induction of echoes and the 75 patients with induction of fewer than four echoes during the immediate postablation electrophysiologic study, 5 (3 and 2, respectively) patients had induction of Tachycardia. Of the 5 patients with induction of sustained Tachycardia in the immediate postablation electrophysiologic study, 3 continued to have induction of sustained Tachycardia; 1 had induction of echoes only; and 1 had no induction of echoes. The predictability of late success by using a combination of induction of no and fewer than four echoes in the immediate postablation electrophysiologic study had a sensitivity of 99%, a specificity of 38%, a positive predictive value of 97%, a negative predictive value of 60%, and a total predictive accuracy of 96%. Thus the effects of radiofrequency ablation persist in the majority of patients during follow-up, and elimination of all echoes is unnecessary for achieving a late success.
Delon Wu - One of the best experts on this subject based on the ideXlab platform.
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variation of p qrs relation during atrioventricular node Reentry Tachycardia
Journal of the American College of Cardiology, 1999Co-Authors: Yasuhiro Taniguchi, Chunchieh Wang, Delon WuAbstract:Abstract Objectives The main objective of this study was to characterize the phenomenon of variation in the P-QRS relation during atrioventricular node Reentry Tachycardia. Background Variation of P-QRS relation during Tachycardia has been observed occasionally in atrioventricular node Reentry Tachycardia. However, the incidence, the characteristics and the mechanisms of this phenomenon have not been investigated previously. Methods Retrospective analysis was performed in 311 consecutive patients with slow-fast form and 108 patients with atypical or multiple form of atrioventricular node Reentry Tachycardia to examine whether variation of P-QRS relation with changes in AH, HA and AH/HA (A = atria; H = His bundle) ratio occurred during Tachycardia. Results A total of 28 patients, 8 with slow-fast and 20 with atypical or multiple Tachycardias, were found to manifest this phenomenon. There were 6 males and 22 females, with an average age of 38 ± 16 years. In 10 patients, this phenomenon occurred transiently following electrical induction of the Tachycardia. In 15 patients, changes in AH, HA and AH/HA ratio were associated with the occurrence of Wenckebach or 2:1 block proximal to the His bundle (H) recording site without interruption of the Tachycardia. In nine patients, three with nonsustained Tachycardia and six after administration of adenosine triphosphate, this phenomenon was observed at the termination of the Tachycardia. This phenomenon was usually accompanied by a mild lengthening of the Tachycardia cycle length. Conclusions Variation of P-QRS relation with or without block may occur during atrioventricular node Reentry Tachycardia, especially in atypical or multiple-form Tachycardias. It was postulated that decremental conduction in the distal common pathway, which exists between the distal link of the Reentry circuit and the H, is primarily responsible for this phenomenon.
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Late clinical and electrophysiologic outcome of radiofrequency ablation therapy by the inferior approach in atrioventricular node Reentry Tachycardia
American Heart Journal, 1994Co-Authors: Chunchieh Wang, I-chang Hsieh, Delon WuAbstract:Abstract A late electrophysiologic study was conducted in 182 of 289 patients with slow-fast atrioventricular node Reentry Tachycardia 81 ± 36 days after radiofrequency ablation therapy by the inferior approach. Of these 182 patients, electrophysiologic study immediately after ablation revealed a selective modification of the slow pathway in 159, a modification of both the slow and fast pathways in 15, a modification of the fast pathway alone in 3, and failure of ablation in 5. One hundred two patients had no induction of echoes; 75 had induction of fewer than four echoes; and 5 had induction of sustained Tachycardia with or without isoproterenol infusion. The late electrophysiologic study in these 182 patients revealed a persistent effect without changes in conduction properties in 161 (88%) patients. A change in conduction properties was noted in 21 patients, including 5 with resumption of slow- or fast-pathway conduction with induction of sustained Tachycardia, 8 with improved fast- or slow-pathway conduction, and 8 with an additional depression of fast- or slow-pathway conduction. Of the 102 patients with no induction of echoes and the 75 patients with induction of fewer than four echoes during the immediate postablation electrophysiologic study, 5 (3 and 2, respectively) patients had induction of Tachycardia. Of the 5 patients with induction of sustained Tachycardia in the immediate postablation electrophysiologic study, 3 continued to have induction of sustained Tachycardia; 1 had induction of echoes only; and 1 had no induction of echoes. The predictability of late success by using a combination of induction of no and fewer than four echoes in the immediate postablation electrophysiologic study had a sensitivity of 99%, a specificity of 38%, a positive predictive value of 97%, a negative predictive value of 60%, and a total predictive accuracy of 96%. Thus the effects of radiofrequency ablation persist in the majority of patients during follow-up, and elimination of all echoes is unnecessary for achieving a late success.