RESUMEN
Intrahepatic interruption of the inferior vena cava (IVC) with continued hemizygous is a very rare abnormality and sometimes it may be accompanied by other cardiovascular abnormalities. Continuation of the hemizygous vein draining into the right atrium through the left superior vena cava (LSVC) is much rarer. In this paper, we have presented a patient who had simultaneous IVC interrupted with persistent LSVC and suffered from Atrioventricular nodal reentrant tachycardia (AVNRT). Finally, radiofrequencies (RF) catheter ablation for AVNRT was successfully performed through a left subclavian vein access.
Asunto(s)
Ablación por Catéter , Vena Cava Superior Izquierda Persistente , Taquicardia por Reentrada en el Nodo Atrioventricular , Vena Cava Inferior , Adulto , Femenino , Humanos , Vena Ácigos/anomalías , Vena Ácigos/cirugía , Ablación por Catéter/métodos , Vena Cava Superior Izquierda Persistente/cirugía , Vena Cava Superior Izquierda Persistente/complicaciones , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Vena Cava Inferior/anomalías , Vena Cava Inferior/cirugía , Vena Cava Superior/anomalías , Vena Cava Superior/cirugíaAsunto(s)
Ablación por Catéter , Técnicas Electrofisiológicas Cardíacas , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Ablación por Catéter/métodos , Nodo Atrioventricular/cirugía , Nodo Atrioventricular/fisiopatología , Resultado del Tratamiento , Potenciales de Acción , MasculinoRESUMEN
INTRODUCTION: Mapping system is useful in ablation of atrioventricular nodal reentry tachycardia (AVNRT) and localization of anatomic variances. Voltage mapping identifies a low voltage area in the Koch triangle called low-voltage-bridge (LVB); propagation mapping identifies the collision point (CP) of atrial wavefront convergence. We conducted a prospective study to evaluate the relationship between LVB and CP with successful site of ablation and identify standard value for LVB. MATERIALS AND METHODS: Three-dimensional (3D) maps of the right atria were constructed from intracardiac recordings using the ablation catheter. Cut-off values on voltage map were adjusted until LVB was observed. On propagation map, atrial wavefronts during sinus rhythm collide in the site representing CP, indicating the area of slow pathway conduction. Ablation site was selected targeting LVB and CP site, confirmed by anatomic position on fluoroscopy and atrioventricular ratio. RESULTS: Twenty-seven consecutive patients were included. LVB and CP were present in all patients. Postprocedural evaluation identified standard cut-off of 0.3-1 mV useful for LVB identification. An overlap between LVB and CP was observed in 23 (85%) patients. Procedure success was achieved in all patient with effective site at first application in 22 (81%) patients. There was a significant correlation between LVB, CP, and the site of effective ablation (p = .001). CONCLUSION: We found correlation between LVB and CP with the site of effective ablation, identifying a voltage range useful for standardized LVB identification. These techniques could be useful to identify ablation site and minimize radiation exposure.
Asunto(s)
Potenciales de Acción , Ablación por Catéter , Técnicas Electrofisiológicas Cardíacas , Frecuencia Cardíaca , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Resultado del Tratamiento , Adulto , Valor Predictivo de las Pruebas , Anciano , Nodo Atrioventricular/fisiopatología , Nodo Atrioventricular/cirugía , Factores de TiempoRESUMEN
INTRODUCTION: The optimal slow pathway (SP) ablation site in cases with an inferiorly located His bundle (HIS) remains unclear. METHODS AND RESULTS: In 45 patients with atrioventricular nodal reentrant tachycardia, the relationship between the HIS location and successful SP ablation site was assessed in electroanatomical maps. We assessed the location of the SP ablation site relative to the bottom of the coronary sinus ostium in the superior-to-inferior (SPSI), anterior-to-posterior (SPAP), and right-to-left (SPRL) directions. The HIS location was assessed in the same manner. The HIS location in the superior-to-inferior direction (HISSI), SPSI, SPAP, and SPRL were 17.7 ± 6.4, 1.7 ± 6.4, 13.6 ± 12.3, and -1.0 ± 13.0 mm, respectively. The HISSI was positively correlated with SPSI (R2 = 0.62; P < .01) and SPAP (R2 = 0.22; P < .01), whereas it was not correlated with SPRL (R2 = 0.01; P = .65). The distance between the HIS and SP ablation site was 17.7 ± 6.4 mm and was not affected by the location of HIS. The ratio of the amplitudes of atrial and ventricular potential recorded at the SP ablation site did not differ between the high HIS group (HISSI ≥ 13 mm) and low HIS group (HISSI < 13 mm) (0.10 ± 0.06 vs. 0.10 ± 0.06; P = .38). CONCLUSION: In cases with an inferiorly located HIS, SP ablation should be performed at a lower and more posterior site than in typical cases.
Asunto(s)
Taquicardia por Reentrada en el Nodo Atrioventricular , Tabique Interventricular , Humanos , Fascículo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Ventrículos Cardíacos , Atrios CardíacosAsunto(s)
Algoritmos , Ablación por Catéter , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Ablación por Catéter/métodos , Electrocardiografía/métodos , Masculino , Femenino , Persona de Mediana Edad , Nodo Atrioventricular/fisiopatología , Nodo Atrioventricular/cirugía , Sistema de Conducción Cardíaco/fisiopatologíaRESUMEN
BACKGROUND: Ablation of accessory pathways (APs) is the cornerstone for treatment of patients with Wolff-Parkinson-White syndrome and manifestation of atrioventricular reentrant tachycardia. Pulsed field ablation (PFA) is a new type of nonthermal energy source delivered to the underlying tissue via the ablation catheter and used for ablation of arrhythmic substrates. OBJECTIVE: The purpose of this study was to determine the efficiency and long-term outcome of ablation of APs of different localizations using a focal pulsed electrical field. METHODS: Electrophysiological study was performed in patients with indication for AP ablation. An ablation catheter was used to map the position of AP insertion. Pulsed electric field was delivered through a standard ablation catheter. In left-sided APs, the first ablation attempt was within the coronary sinus (CS). Patient follow-up was scheduled 1-3 months after the ablation. Additional check-up was performed after 6 and 12 months. RESULTS: Fourteen 14 patients (3 pediatric) were treated. Termination of AP conduction was achieved in all procedures. The cohort consisted of 3 right free wall, 3 posteroseptal, and 8 left-sided APs. Ablation through CS was successfully used in 7 of 8 patients with left-sided APs. No complications were reported. Median follow-up was 5.5 months. Conduction recurrence through AP was documented in 1 patient. CONCLUSION: Focal PFA for AP shows promising results in terms of efficacy and safety. A high rate of successful termination of left-sided APs by ablation within CS may represent a new standard approach. The safety and efficacy profile of PFA seems to be transferable to the pediatric population.
Asunto(s)
Fascículo Atrioventricular Accesorio , Ablación por Catéter , Síndrome de Wolff-Parkinson-White , Humanos , Masculino , Femenino , Ablación por Catéter/métodos , Fascículo Atrioventricular Accesorio/cirugía , Fascículo Atrioventricular Accesorio/fisiopatología , Adulto , Síndrome de Wolff-Parkinson-White/cirugía , Síndrome de Wolff-Parkinson-White/fisiopatología , Resultado del Tratamiento , Adolescente , Persona de Mediana Edad , Niño , Estudios de Seguimiento , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Adulto Joven , Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Técnicas Electrofisiológicas Cardíacas/métodosAsunto(s)
Sistema de Conducción Cardíaco , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia , Electrocardiografía , Estimulación Cardíaca Artificial , Diagnóstico DiferencialRESUMEN
INTRODUCTION: Dual atrioventricular nodal non-reentrant tachycardia (DAVNNT) is a rare and challenging-to-diagnose arrhythmia, without previous reports associating it with a leftward inferior extension (LIE). METHODS: Diagnosis was made using adenosine triphosphate (ATP) injection during atrial pacing in a suspected DAVNNT patient. RESULTS: Ablation of the rightward inferior extension was unsuccessful in eliminating DAVNNT; however, subsequent ablation of the LIE successfully eradicated the arrhythmia. CONCLUSION: This unique case, marked by the first instance of DAVNNT caused by LIE, diagnosed through ATP injection, underscores the utility of this diagnostic approach and broadens the spectrum of our understanding and management of this condition.
Asunto(s)
Ablación por Catéter , Polifosfatos , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Adenosina Trifosfato , Nodo Atrioventricular , Ablación por Catéter/efectos adversos , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Adenosina , Arritmias Cardíacas , ElectrocardiografíaRESUMEN
BACKGROUND: The mechanism of typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known. OBJECTIVE: To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit. METHODS: Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh-density mapping and a modified signal-filtering toolset to record the potentials of the AV nodal structures. RESULTS: Forty-five consecutive cases of successful ablation of typical slow-fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p < .001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p < .001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time-window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow-fast AVNRT. CONCLUSION: Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh-density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right-septal and para-septal arrhythmias.
Asunto(s)
Ablación por Catéter , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Ablación por Catéter/métodos , Atrios Cardíacos , ElectrodosRESUMEN
Ebstein's anomaly of the tricuspid valve (EA) is an uncommon congenital cardiac malformation. It can present with atrioventricular tachycardia (AVRT), atrioventricular nodal re-entrant tachycardia (AVNRT), atrial arrhythmias, and rarely with ventricular tachycardia. The 12-lead electrocardiogram (ECG) is critically important and often diagnostic even prior to an electrophysiology study (EPS). Due to its complex anatomy, it poses particular challenges for mapping and ablation, even for an experienced electrophysiologist. In this review, we aim to provide insight into the electrophysiological perspective of EA and an in-depth analysis of the various arrhythmias encountered in diverse clinical scenarios.
Asunto(s)
Anomalía de Ebstein , Electrocardiografía , Anomalía de Ebstein/cirugía , Anomalía de Ebstein/fisiopatología , Anomalía de Ebstein/diagnóstico por imagen , Humanos , Electrocardiografía/métodos , Técnicas Electrofisiológicas Cardíacas/métodos , Ablación por Catéter/métodos , Femenino , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnósticoRESUMEN
INTRODUCTION: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation. METHOD: A literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8-mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random-effects model of network meta-analysis, along with p-scores, was employed. RESULTS: A total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4-mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202-2.087) when compared to nonirrigated RFA. Similarly, 6-mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307-2.905), 8-mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089-8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058-3.121) compared to nonirrigated RFA. CONCLUSION: Our study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile.
Asunto(s)
Criocirugía , Taquicardia por Reentrada en el Nodo Atrioventricular , Criocirugía/métodos , Humanos , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Ablación por Radiofrecuencia , Metaanálisis en Red , Resultado del Tratamiento , Bloqueo Atrioventricular , Ablación por Catéter/métodos , Diseño de EquipoRESUMEN
BACKGROUND: Recent anatomic and electrophysiologic evidence has provided new insight into the anatomic substrate. Previous reports on electroanatomic mapping (EAM) of the circuit of atrioventricular nodal reentrant tachycardia (AVNRT) have been limited by mapping only the triangle of Koch on the right side of the septum and by the use of conventional mapping tools. The objectives are to obtain comprehensive high-resolution mapping of typical AVNRT and to investigate the role of the atrioventricular ring tissues in the circuit. METHODS: We employed EAM with the use of novel modules and algorithms for studying typical AVNRT from the right and the left sides of the septum. RESULTS: We performed extensive mapping of both the atrial septum and the septal vestibule of the tricuspid valve during typical AVNRT in 9 (6 females) patients, aged 49.6 ± 12.1 years. In two of these, left septal mapping was also obtained through the aorta. The earliest initial activation was variable, emanating from the superior or medial septum. The impulse consistently appeared below the orifice of the coronary sinus, at the site where its inferoanterior margin merged with the septal vestibule of the tricuspid valve at its entrance to the right atrium. It then returned to the initial activation site, presumably through the septal vestibular myocardium. The left septal activation area corresponded to that recorded on the right side. CONCLUSIONS: Typical AVNRT uses a circuit confined within the pyramid of Koch from the AV node to the septal isthmus, involving the myocardial walls of the pyramidal space.
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Tabique Interatrial , Ablación por Catéter , Taquicardia por Reentrada en el Nodo Atrioventricular , Femenino , Humanos , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Nodo Atrioventricular , Atrios Cardíacos , Miocardio , ElectrocardiografíaRESUMEN
BACKGROUND: Slow pathway elimination of the atrioventricular node (AVN) is essential to treat AVN reentrant tachycardia (AVNRT). However, injury to the AVN conduction (IAVN) is one of the serious complications. Cryofreezing energy is expected to reduce the incidence of IAVN. This study aimed to investigate the usefulness of a novel method to avoid IAVN during cryoablation of AVNRT. METHODS: A total of 157 patients (average age, 65.8â¯years; male, 71) suffering from AVNRT were included. Once the AVNRT terminated during cryo-ablation, then rapid atrial constant pacing (RACP) was performed during freezing at a rate lower 10â¯bpm than that inducing Wenchebach AV block in 74 (47.1â¯%) patients (Group A). The RACP rate was decreasingly reduced by 10â¯bpm in case of the occurrence of IAVN. When the RACP reached 100â¯bpm, the cryoablation was prematurely terminated. Group B patients (83â¯=â¯52.9â¯%) underwent cryoablation during sinus rhythm. All patients were allocated in a randomized fashion. We compared the severity of the IAVN between Groups A and B. RESULTS: There were no significant differences at 12â¯months regarding the freedom from the AVNRT between Groups A and B. However, the duration of the IAVN was significantly longer in Group B than A (pâ¯=â¯0.02). There were no significant differences regarding the distance between the His recording sites and successful ablation sites between Groups A and B. No permanent IAVN requiring pacemaker implantation was provoked in either group. CONCLUSION: RACP was useful to avoid sustained and serious IAVN during cryoablation of AVNRT.
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Bloqueo Atrioventricular , Ablación por Catéter , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Masculino , Anciano , Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/etiología , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Frecuencia Cardíaca , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/terapia , Ablación por Catéter/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Several studies have visualized the slow pathway during sinus rhythm using high-density mapping of Koch's triangle (KT) in patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, it is unclear whether the slow pathway can be visualized in all people. Therefore, we evaluated the activation pattern within KT during sinus rhythm in patients with and without AVNRT. METHODS: High-density mapping using the Advisor HD Grid mapping catheter (Abbott) within KT during sinus rhythm was created in 10 patients with slow-fast AVNRT and 30 patients without AVNRT. RESULTS: In 8 (80%) patients with AVNRT, the activation pattern pivoting around a block line (BL) within KT was observed. In 12 (40%) patients without AVNRT, similar activation pattern pivoting around BL was observed, but jump was observed in 11 (92%) of these patients. In all patients, the activation pattern pivoting around BL was observed in 17 (85%) of 20 patients with jump, but only 3 (15%) of 20 patients without jump (p < 0.0001). During jump, there was a long period of no potential from the last atrial potential within KT to the His bundle potential, suggesting the slow pathway conduction through the rightward inferior extension that cannot be visualized. A linear ablation between the pivot point and the septal tricuspid annulus was successful for slow-fast AVNRT. CONCLUSION: Although the slow pathway could not be visualized using high-density mapping during sinus rhythm, the activation pattern pivoting around BL within KT was observed in most patients with the dual pathway physiology, with or without AVNRT.
Asunto(s)
Ablación por Catéter , Taquicardia por Reentrada en el Nodo Atrioventricular , Humanos , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Fascículo Atrioventricular , Frecuencia Cardíaca , ElectrodosRESUMEN
A 62-year-old male was transferred to our hospital complaining of palpitations. His heart rate was 185/min. Electrocardiogram showed a narrow QRS regular tachycardia and the tachycardia changed spontaneously to another narrow QRS tachycardia with two alternating cycle lengths. The arrhythmia was stopped by the administration of adenosine triphosphate. Findings from electrophysiological study suggested that there was an accessory pathway (AP) and dual atrioventricular (AV) nodal pathways. After AP ablation, any other tachyarrythmias were not induced. We supposed that the tachycardia was paroxysmal supraventricular tachycardia involving AP and anterograde conduction alternating between slow and fast AV nodal pathways.