The Experts below are selected from a list of 285 Experts worldwide ranked by ideXlab platform
Fred Morady - One of the best experts on this subject based on the ideXlab platform.
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Paroxysmal Supraventricular Tachycardia
Practical Cardiology, 2020Co-Authors: Hakan Oral, Fred MoradyAbstract:Supraventricular Tachycardias arise in or involve at least some part of the atrium or atrioventricular junction. Supraventricular Tachycardias develop as a result of abnormal automaticity, triggered activity or, most commonly, reentry. Both atrial flutter and atrial fibrillation are supraventricular Tachycardias; however, because of the differences in their mechanisms and clinical manifestations, they are grouped separately from other types of supraventricular Tachycardias, commonly referred to as paroxysmal supraventricular Tachycardia (PSVT).
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diagnosis and ablation of atypical atrial Tachycardia and flutter complicating atrial fibrillation ablation
Heart Rhythm, 2009Co-Authors: Fred Morady, Hakan Oral, Aman ChughAbstract:Depending on the ablation strategy, up to 30% to 50% of patients will develop an atrial Tachycardia after undergoing radiofrequency catheter ablation of atrial fibrillation. This review discusses the mechanisms, mapping techniques, and catheter ablation of atrial Tachycardias that occur after radiofrequency ablation of atrial fibrillation.
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diagnostic value of Tachycardia features and pacing maneuvers during paroxysmal supraventricular Tachycardia
Journal of the American College of Cardiology, 2000Co-Authors: Bradley P Knight, Hakan Oral, Frank Pelosi, Matthew Ebinger, Michael H. Kim, Christian Sticherling, Gregory F. Michaud, Adam S Strickberger, Fred MoradyAbstract:OBJECTIVES The purpose of this prospective study was to quantitate the diagnostic value of several Tachycardia features and pacing maneuvers in patients with paroxysmal supraventricular Tachycardia (PSVT) in the electrophysiology laboratory. BACKGROUND No study has prospectively compared the value of multiple diagnostic tools in a large group of patients with PSVT. METHODS One hundred ninety-six consecutive patients who had 200 inducible sustained PSVTs during an electrophysiology procedure were included. The diagnostic values of four baseline electrophysiologic parameters, nine Tachycardia features and five diagnostic pacing maneuvers were quantified. RESULTS The only Tachycardia characteristic that was diagnostic of atrioventricular (AV) nodal reentry was a septal ventriculoatrial (VA) time of <70 ms, and no pacing maneuver was diagnostic for AV nodal reentry. An increase in the VA interval with the development of a bundle branch block was the only Tachycardia characteristic that was diagnostic for orthodromic Tachycardia, but it occurred in only 7% of all Tachycardias. An atrial-atrial-ventricular response upon cessation of ventricular overdrive pacing was diagnostic of atrial Tachycardia, and this maneuver could be applied to 78% of all Tachycardias. Burst ventricular pacing excluded atrial Tachycardia when the Tachycardia terminated without depolarization of the atrium, but the result could be obtained only in 27% of patients. CONCLUSIONS This prospective study quantitates the diagnostic value of multiple observations and pacing maneuvers that are commonly used during PSVT in the electrophysiology laboratory. The findings demonstrate that diagnostic techniques rarely provide a diagnosis when used individually. Therefore, careful observations and multiple pacing maneuvers are often required for an accurate diagnosis during PSVT. The results of this study provide a useful reference with which new diagnostic techniques can be compared.
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Diagnostic value of Tachycardia features and pacing maneuvers during paroxysmal supraventricular Tachycardia.
Journal of the American College of Cardiology, 2000Co-Authors: Bradley P Knight, Hakan Oral, Frank Pelosi, S. Adam Strickberger, Matthew Ebinger, Michael H. Kim, Christian Sticherling, Gregory F. Michaud, Fred MoradyAbstract:The purpose of this prospective study was to quantitate the diagnostic value of several Tachycardia features and pacing maneuvers in patients with paroxysmal supraventricular Tachycardia (PSVT) in the electrophysiology laboratory. No study has prospectively compared the value of multiple diagnostic tools in a large group of patients with PSVT. One hundred ninety-six consecutive patients who had 200 inducible sustained PSVTs during an electrophysiology procedure were included. The diagnostic values of four baseline electrophysiologic parameters, nine Tachycardia features and five diagnostic pacing maneuvers were quantified. The only Tachycardia characteristic that was diagnostic of atrioventricular (AV) nodal reentry was a septal ventriculoatrial (VA) time of <70 ms, and no pacing maneuver was diagnostic for AV nodal reentry. An increase in the VA interval with the development of a bundle branch block was the only Tachycardia characteristic that was diagnostic for orthodromic Tachycardia, but it occurred in only 7% of all Tachycardias. An atrial-atrial-ventricular response upon cessation of ventricular overdrive pacing was diagnostic of atrial Tachycardia, and this maneuver could be applied to 78% of all Tachycardias. Burst ventricular pacing excluded atrial Tachycardia when the Tachycardia terminated without depolarization of the atrium, but the result could be obtained only in 27% of patients. This prospective study quantitates the diagnostic value of multiple observations and pacing maneuvers that are commonly used during PSVT in the electrophysiology laboratory. The findings demonstrate that diagnostic techniques rarely provide a diagnosis when used individually. Therefore, careful observations and multiple pacing maneuvers are often required for an accurate diagnosis during PSVT. The results of this study provide a useful reference with which new diagnostic techniques can be compared.
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Catheter ablation of ventricular Tachycardia.
Current opinion in cardiology, 1995Co-Authors: Emile G. Daoud, Fred MoradyAbstract:Endocardial lesions created by radiofrequency catheter ablation are relatively small and focal. The application of radiofrequency ablation to patients with structural heart disease and ventricular Tachycardia is quite limited because the substrate for these Tachycardias is often diffuse or difficult
Hakan Oral - One of the best experts on this subject based on the ideXlab platform.
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Paroxysmal Supraventricular Tachycardia
Practical Cardiology, 2020Co-Authors: Hakan Oral, Fred MoradyAbstract:Supraventricular Tachycardias arise in or involve at least some part of the atrium or atrioventricular junction. Supraventricular Tachycardias develop as a result of abnormal automaticity, triggered activity or, most commonly, reentry. Both atrial flutter and atrial fibrillation are supraventricular Tachycardias; however, because of the differences in their mechanisms and clinical manifestations, they are grouped separately from other types of supraventricular Tachycardias, commonly referred to as paroxysmal supraventricular Tachycardia (PSVT).
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diagnosis and ablation of atypical atrial Tachycardia and flutter complicating atrial fibrillation ablation
Heart Rhythm, 2009Co-Authors: Fred Morady, Hakan Oral, Aman ChughAbstract:Depending on the ablation strategy, up to 30% to 50% of patients will develop an atrial Tachycardia after undergoing radiofrequency catheter ablation of atrial fibrillation. This review discusses the mechanisms, mapping techniques, and catheter ablation of atrial Tachycardias that occur after radiofrequency ablation of atrial fibrillation.
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mechanistic significance of intermittent pulmonary vein Tachycardia in patients with atrial fibrillation
Journal of Cardiovascular Electrophysiology, 2002Co-Authors: Hakan Oral, Aman Chugh, Mehmet Ozaydin, Hiroshi Tada, Christoph Scharf, Sohail Hassan, Steve W K Lai, Radmira Greenstein, Frank Pelosi, Bradley P KnightAbstract:Pulmonary Vein Tachycardia. Introduction: The signie cance of intermittent Tachycardia within a pulmonary vein (PV) during an episode of atrial e brillation (AF) is unclear. The aim of this study was to determine the role that intermittent PV Tachycardias play in AF. Methods and Results: In 56 patients with AF, segmental ostial ablation guided by PV potentials was performed to isolate the PVs. The characteristics of intermittent PV Tachycardias and the inducibility of AF before and after PV isolation were analyzed prospectively. During AF, a PV Tachycardia (mean cycle length 130 6 30 msec) with exit block to the left atrium was present in 93% of left superior, 80% of left inferior, 73% of right superior, and 7% of right inferior PVs. The site of shortest cycle length during AF alternated between the PVs and left atrium 1 to 13 times per minute. Complete isolation was achieved in 168 (94%) of 178 targeted PVs. In 99% of PVs, Tachycardia resolved upon isolation. AF was persistent before and after PV isolation in 100% and 27% of patients, respectively (P < 0.001). Conclusion: Intermittent bursts of Tachycardia are observed within multiple PVs during persistent AF in a majority of patients. After PV isolation, PV Tachycardias almost always resolve, and AF is less likely to be inducible or persistent. These observations suggest a dynamic interplay between the atria and PVs, with intermittent bursts of PV Tachycardia being dependent on left atrial input and with the probability of persistent AF diminishing when PV Tachycardias are eliminated by PV isolation. (J Cardiovasc
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diagnostic value of Tachycardia features and pacing maneuvers during paroxysmal supraventricular Tachycardia
Journal of the American College of Cardiology, 2000Co-Authors: Bradley P Knight, Hakan Oral, Frank Pelosi, Matthew Ebinger, Michael H. Kim, Christian Sticherling, Gregory F. Michaud, Adam S Strickberger, Fred MoradyAbstract:OBJECTIVES The purpose of this prospective study was to quantitate the diagnostic value of several Tachycardia features and pacing maneuvers in patients with paroxysmal supraventricular Tachycardia (PSVT) in the electrophysiology laboratory. BACKGROUND No study has prospectively compared the value of multiple diagnostic tools in a large group of patients with PSVT. METHODS One hundred ninety-six consecutive patients who had 200 inducible sustained PSVTs during an electrophysiology procedure were included. The diagnostic values of four baseline electrophysiologic parameters, nine Tachycardia features and five diagnostic pacing maneuvers were quantified. RESULTS The only Tachycardia characteristic that was diagnostic of atrioventricular (AV) nodal reentry was a septal ventriculoatrial (VA) time of <70 ms, and no pacing maneuver was diagnostic for AV nodal reentry. An increase in the VA interval with the development of a bundle branch block was the only Tachycardia characteristic that was diagnostic for orthodromic Tachycardia, but it occurred in only 7% of all Tachycardias. An atrial-atrial-ventricular response upon cessation of ventricular overdrive pacing was diagnostic of atrial Tachycardia, and this maneuver could be applied to 78% of all Tachycardias. Burst ventricular pacing excluded atrial Tachycardia when the Tachycardia terminated without depolarization of the atrium, but the result could be obtained only in 27% of patients. CONCLUSIONS This prospective study quantitates the diagnostic value of multiple observations and pacing maneuvers that are commonly used during PSVT in the electrophysiology laboratory. The findings demonstrate that diagnostic techniques rarely provide a diagnosis when used individually. Therefore, careful observations and multiple pacing maneuvers are often required for an accurate diagnosis during PSVT. The results of this study provide a useful reference with which new diagnostic techniques can be compared.
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Diagnostic value of Tachycardia features and pacing maneuvers during paroxysmal supraventricular Tachycardia.
Journal of the American College of Cardiology, 2000Co-Authors: Bradley P Knight, Hakan Oral, Frank Pelosi, S. Adam Strickberger, Matthew Ebinger, Michael H. Kim, Christian Sticherling, Gregory F. Michaud, Fred MoradyAbstract:The purpose of this prospective study was to quantitate the diagnostic value of several Tachycardia features and pacing maneuvers in patients with paroxysmal supraventricular Tachycardia (PSVT) in the electrophysiology laboratory. No study has prospectively compared the value of multiple diagnostic tools in a large group of patients with PSVT. One hundred ninety-six consecutive patients who had 200 inducible sustained PSVTs during an electrophysiology procedure were included. The diagnostic values of four baseline electrophysiologic parameters, nine Tachycardia features and five diagnostic pacing maneuvers were quantified. The only Tachycardia characteristic that was diagnostic of atrioventricular (AV) nodal reentry was a septal ventriculoatrial (VA) time of <70 ms, and no pacing maneuver was diagnostic for AV nodal reentry. An increase in the VA interval with the development of a bundle branch block was the only Tachycardia characteristic that was diagnostic for orthodromic Tachycardia, but it occurred in only 7% of all Tachycardias. An atrial-atrial-ventricular response upon cessation of ventricular overdrive pacing was diagnostic of atrial Tachycardia, and this maneuver could be applied to 78% of all Tachycardias. Burst ventricular pacing excluded atrial Tachycardia when the Tachycardia terminated without depolarization of the atrium, but the result could be obtained only in 27% of patients. This prospective study quantitates the diagnostic value of multiple observations and pacing maneuvers that are commonly used during PSVT in the electrophysiology laboratory. The findings demonstrate that diagnostic techniques rarely provide a diagnosis when used individually. Therefore, careful observations and multiple pacing maneuvers are often required for an accurate diagnosis during PSVT. The results of this study provide a useful reference with which new diagnostic techniques can be compared.
Bradley P Knight - One of the best experts on this subject based on the ideXlab platform.
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mechanistic significance of intermittent pulmonary vein Tachycardia in patients with atrial fibrillation
Journal of Cardiovascular Electrophysiology, 2002Co-Authors: Hakan Oral, Aman Chugh, Mehmet Ozaydin, Hiroshi Tada, Christoph Scharf, Sohail Hassan, Steve W K Lai, Radmira Greenstein, Frank Pelosi, Bradley P KnightAbstract:Pulmonary Vein Tachycardia. Introduction: The signie cance of intermittent Tachycardia within a pulmonary vein (PV) during an episode of atrial e brillation (AF) is unclear. The aim of this study was to determine the role that intermittent PV Tachycardias play in AF. Methods and Results: In 56 patients with AF, segmental ostial ablation guided by PV potentials was performed to isolate the PVs. The characteristics of intermittent PV Tachycardias and the inducibility of AF before and after PV isolation were analyzed prospectively. During AF, a PV Tachycardia (mean cycle length 130 6 30 msec) with exit block to the left atrium was present in 93% of left superior, 80% of left inferior, 73% of right superior, and 7% of right inferior PVs. The site of shortest cycle length during AF alternated between the PVs and left atrium 1 to 13 times per minute. Complete isolation was achieved in 168 (94%) of 178 targeted PVs. In 99% of PVs, Tachycardia resolved upon isolation. AF was persistent before and after PV isolation in 100% and 27% of patients, respectively (P < 0.001). Conclusion: Intermittent bursts of Tachycardia are observed within multiple PVs during persistent AF in a majority of patients. After PV isolation, PV Tachycardias almost always resolve, and AF is less likely to be inducible or persistent. These observations suggest a dynamic interplay between the atria and PVs, with intermittent bursts of PV Tachycardia being dependent on left atrial input and with the probability of persistent AF diminishing when PV Tachycardias are eliminated by PV isolation. (J Cardiovasc
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diagnostic value of Tachycardia features and pacing maneuvers during paroxysmal supraventricular Tachycardia
Journal of the American College of Cardiology, 2000Co-Authors: Bradley P Knight, Hakan Oral, Frank Pelosi, Matthew Ebinger, Michael H. Kim, Christian Sticherling, Gregory F. Michaud, Adam S Strickberger, Fred MoradyAbstract:OBJECTIVES The purpose of this prospective study was to quantitate the diagnostic value of several Tachycardia features and pacing maneuvers in patients with paroxysmal supraventricular Tachycardia (PSVT) in the electrophysiology laboratory. BACKGROUND No study has prospectively compared the value of multiple diagnostic tools in a large group of patients with PSVT. METHODS One hundred ninety-six consecutive patients who had 200 inducible sustained PSVTs during an electrophysiology procedure were included. The diagnostic values of four baseline electrophysiologic parameters, nine Tachycardia features and five diagnostic pacing maneuvers were quantified. RESULTS The only Tachycardia characteristic that was diagnostic of atrioventricular (AV) nodal reentry was a septal ventriculoatrial (VA) time of <70 ms, and no pacing maneuver was diagnostic for AV nodal reentry. An increase in the VA interval with the development of a bundle branch block was the only Tachycardia characteristic that was diagnostic for orthodromic Tachycardia, but it occurred in only 7% of all Tachycardias. An atrial-atrial-ventricular response upon cessation of ventricular overdrive pacing was diagnostic of atrial Tachycardia, and this maneuver could be applied to 78% of all Tachycardias. Burst ventricular pacing excluded atrial Tachycardia when the Tachycardia terminated without depolarization of the atrium, but the result could be obtained only in 27% of patients. CONCLUSIONS This prospective study quantitates the diagnostic value of multiple observations and pacing maneuvers that are commonly used during PSVT in the electrophysiology laboratory. The findings demonstrate that diagnostic techniques rarely provide a diagnosis when used individually. Therefore, careful observations and multiple pacing maneuvers are often required for an accurate diagnosis during PSVT. The results of this study provide a useful reference with which new diagnostic techniques can be compared.
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Diagnostic value of Tachycardia features and pacing maneuvers during paroxysmal supraventricular Tachycardia.
Journal of the American College of Cardiology, 2000Co-Authors: Bradley P Knight, Hakan Oral, Frank Pelosi, S. Adam Strickberger, Matthew Ebinger, Michael H. Kim, Christian Sticherling, Gregory F. Michaud, Fred MoradyAbstract:The purpose of this prospective study was to quantitate the diagnostic value of several Tachycardia features and pacing maneuvers in patients with paroxysmal supraventricular Tachycardia (PSVT) in the electrophysiology laboratory. No study has prospectively compared the value of multiple diagnostic tools in a large group of patients with PSVT. One hundred ninety-six consecutive patients who had 200 inducible sustained PSVTs during an electrophysiology procedure were included. The diagnostic values of four baseline electrophysiologic parameters, nine Tachycardia features and five diagnostic pacing maneuvers were quantified. The only Tachycardia characteristic that was diagnostic of atrioventricular (AV) nodal reentry was a septal ventriculoatrial (VA) time of <70 ms, and no pacing maneuver was diagnostic for AV nodal reentry. An increase in the VA interval with the development of a bundle branch block was the only Tachycardia characteristic that was diagnostic for orthodromic Tachycardia, but it occurred in only 7% of all Tachycardias. An atrial-atrial-ventricular response upon cessation of ventricular overdrive pacing was diagnostic of atrial Tachycardia, and this maneuver could be applied to 78% of all Tachycardias. Burst ventricular pacing excluded atrial Tachycardia when the Tachycardia terminated without depolarization of the atrium, but the result could be obtained only in 27% of patients. This prospective study quantitates the diagnostic value of multiple observations and pacing maneuvers that are commonly used during PSVT in the electrophysiology laboratory. The findings demonstrate that diagnostic techniques rarely provide a diagnosis when used individually. Therefore, careful observations and multiple pacing maneuvers are often required for an accurate diagnosis during PSVT. The results of this study provide a useful reference with which new diagnostic techniques can be compared.
A. John Camm - One of the best experts on this subject based on the ideXlab platform.
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The sinus Tachycardias.
Nature clinical practice. Cardiovascular medicine, 2005Co-Authors: Shamil Yusuf, A. John CammAbstract:Sinus Tachycardia, in the forms of four distinct rhythm disturbances, is frequently encountered in clinical practice but is often overlooked. The most common rhythm, normal sinus Tachycardia, whether physiologic, pathologic or iatrogenic, is predominantly catecholamine driven, is virtually asymptomatic and is managed by identifying and treating the underlying cause. The other so-called primary sinus Tachycardias, which include inappropriate sinus Tachycardia, postural orthostatic Tachycardia syndrome and sinus node re-entry Tachycardia, have fundamentally different clinical features, basic underlying etiologic mechanisms and treatment strategies. Differentiation of these types from normal sinus Tachycardia and from other atrial arrhythmias is crucial for successful management. Accurate diagnosis and appropriate therapy of the sinus Tachycardias not only prevents multiple consultations but might also have important long-term prognostic implications.
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Deciphering the sinus Tachycardias.
Clinical cardiology, 2005Co-Authors: Shamil Yusuf, A. John CammAbstract:Sinus Tachycardia is the most common rhythm disturbance encountered in clinical practice. Primary sinus Tachycardia without an underlying secondary cause, despite often being associated with troublesome symptoms, is often neglected leading to multiple consultations and frustration on part of both the practitioner and the patient. The fact that primary sinus Tachycardias are a heterogeneous group of disorders is seldom appreciated; hence, a firm diagnosis is rarely reached and management is haphazard. Furthermore, there may be prognostic implications for prolonged or recurrent sinus Tachycardia, making it imperative that this group of arrhythmias receive adequate and appropriate attention. Normal sinus Tachycardia (i.e., secondary), inappropriate sinus Tachycardia, postural orthostatic Tachycardia syndrome (POTS) and sinus node reentry Tachycardia make up this group of arrhythmias. Their definitions, clinical features, diagnostic criteria, pathophysiologic mechanisms, and optimum management are discussed in this review.
Jeffrey J. Goldberger - One of the best experts on this subject based on the ideXlab platform.
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Catheter ablation for supraventricular Tachycardias: contemporary issues
Future cardiology, 2013Co-Authors: Evaldas Giedrimas, Jeffrey J. GoldbergerAbstract:The treatment of cardiac arrhythmias has evolved significantly over the last 30 years. Understanding of arrhythmia mechanisms has led to pharmacologic therapies, surgical interventions and the widely used percutaneous catheter ablation techniques. The focus of this review is centered on the current catheter ablation therapies available for supraventricular Tachycardia. We will discuss current management strategies including challenges when considering catheter ablation therapy for management of supraventricular Tachycardias: atrioventricular nodal reentrant Tachycardia, atrioventricular reentrant Tachycardia utilizing an accessory pathway, atrial Tachycardia and atrial flutter. Selected contemporary issues related to supraventricular Tachycardia physiology, ablation approaches and ablation outcomes and complications will be discussed. Future goals for electrophysiologists are to continue to improve procedural safety and efficiency, while maintaining the impressive success rates that have been achieved.
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Effectiveness of radiofrequency catheter ablation for treatment of atrial Tachycardia.
The American journal of cardiology, 1993Co-Authors: Jeffrey J. Goldberger, John G. Kall, Brian Olshansky, Frederick A. Ehlert, Barbara J. Deal, D. Woodrow Benson, Jeffrey M. Baerman, D.e. Kopp, Alan H. Kadish, David I. WilberAbstract:Abstract Catheter ablation has been used to treat atrioventricular node reentrant and atrioventricular reentrant Tachycardias with extremely high success rates. The suitability of catheter ablation for treatment of atrial Tachycardia, a much less common type of supraventricular Tachycardia, has not been well addressed. Fifteen patients (8 females) ranging from 10 to 83 years (mean 38 ± 22) were referred for catheter ablation of supraventricular Tachycardia. The diagnosis of atrial Tachycardia was established by standard electrophysiologic techniques. A combination of activation and pace mapping was used to identify a suitable site for radiofrequency current catheter ablation. Medical therapy was unsuccessful in all but 1 patient. Two patients had surgically corrected congenital heart disease, 2 had coronary artery disease and 1 had dilated cardiomyopathy. Seven patients had depressed left ventricular function. Six patients had incessant Tachycardias. Presumed Tachycardia mechanism was automatic in 11 patients and reentrant in 4. Mean Tachycardia cycle length was 372 ± 74 ms. Catheter ablation was acutely successful in 12 patients (80%) with application of 11.1 ± 6.6 lesions at a mean voltage of 60 ± 9 V. In the other 3 patients, 16 to 38 lesions were applied. At a mean follow-up of 18.5 ± 6.5 months, 2 patients have had recurrences with different P-wave morphologies and underwent a second successful catheter ablation procedure. An additional 2 patients had recurrences with the same P-wave morphology and 1 underwent a second successful catheter ablation procedure. Thus, radiofrequency ablation can be used in a diverse population of patients with atrial Tachycardia with an acute success rate of 80% and a long-term success rate of 73%.
