Clinical, electrocardiographic and electrophysiological characteristics, and catheter ablation results of left upper septal premature ventricular complexes.

BACKGROUND: To investigate the clinical, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of left upper septal (LUS) premature ventricular complexes (PVCs) arising from the proximal left fascicular system. METHODS: Thirty-one patients who had undergone radiofrequency catheter ablation (RFCA) for idiopathic PVCs were enrolled in the study. All PVCs presented with narrow QRS complexes (<110 ms) with precordial QRS morphology of incomplete right bundle branch block type or identical to the sinus rhythm (SR) QRS morphology. RFCA was applied to the LUS area where the earliest fascicular potential (FP) was recorded during mapping. RESULTS: The mean QRS duration during SR and PVCs were 92.3 ± 7.9 and 103.2 ± 7.3 ms, respectively. The mean fascicular potential-ventricular interval during PVC at the target site was 32.7 ± 2.7 ms. The mean His-ventricular (H-V) interval during SR and PVCs were 45.1 ± 2.7 and 21.3 ± 3.6 ms, respectively. Left anterior hemiblock/left posterior hemiblock and left bundle branch block (LBBB) were observed in 16 (53.3%) and 4 (12.9%) patients after RFCA, respectively. The His to FP interval in SR and H-V interval during PVC were found as significant markers for predicting the postablation LBBB. RFCA was acutely successful in 29 of 31 patients (93.5%) in the first procedure. Two patients had a recurrence of PVCs during follow-up and one of them underwent a second successful ablation. The overall success rate was 90.3% (28/31) in a mean follow-up duration of 24.3 ± 15.4 months. CONCLUSIONS: LUS-PVCs have distinctive electrocardiographic and electrophysiologic characteristics and can be managed successfully by focal RFCA with detailed FP mapping of the left upper septum with a mild risk of left bundle branch injury.

Coexistence of atrioventricular accessory pathways and drug-induced type 1 Brugada pattern.

BACKGROUND: Atrial arrhythmias, particularly atrioventricular nodal reentrant tachycardia, can coexist with drug-induced type 1 Brugada electrocardiogram (ECG) pattern (DI-Type1-BrP). The present study was designed to determine the prevalence of DI-Type1-BrP in patients with atrioventricular accessory pathways (AV-APs) and to investigate the clinical, electrocardiographic, electrophysiologic, and genetic characteristics of these patients. METHODS: One-hundred twenty-four consecutive cases of AV-APs and 84 controls underwent an ajmaline challenge test to unmask DI-Type1-BrP. Genetic screening and analysis was performed in 55 of the cases (19 with and 36 without DI-Type1-BrP). RESULTS: Patients with AV-APs were significantly more likely than controls to have a Type1-BrP unmasked (16.1 vs 4.8%, P = 0.012). At baseline, patients with DI-Type1-BrP had higher prevalence of chest pain, QR/rSr' pattern in V1 and QRS notching/slurring in V2 and aVL during preexcitation, rSr' pattern in V1 -V2 , and QRS notching/slurring in aVL during orthodromic atrioventricular reentrant tachycardia (AVRT) compared to patients without DI-Type1-BrP. Abnormal QRS configuration (QRS notching/slurring and/or fragmentation) in V2 during preexcitation was present in all patients with DI-Type1 BrP. The prevalence of spontaneous preexcited atrial fibrillation (AF) and history of AF were similar (15% vs 18.3%, P = 0.726) in patients with and without DI-Type1-BrP, respectively. The prevalence of mutations in Brugada-susceptibility genes was higher (36.8% vs 8.3%, P = 0.02) in patients with DI-Type1-BrP compared to patients without DI-Type1-BrP. CONCLUSIONS: DI-Type1-BrP is relatively common in patients with AV-APs. We identify 12-lead ECG characteristics during preexcitation and orthodromic AVRT that point to an underlying type1-BrP, portending an increased probability for development of malignant arrhythmias.

Electrocardiographic estimation of successful ablation site in patients with manifest inferior paraseptal accessory pathway.

Inferior paraseptal accessory pathways (APs) have a wide distribution and prediction of AP location before radiofrequency ablation is very important in such pathways. We aimed to estimate successful ablation site based on electrocardiogram in 137 patients (mean age: 25.8±9.0; 126 males) with single manifest inferior paraseptal AP. Right endocardial inferior paraseptal APs were discriminated from left endocardial APs with an R/S ratio <1 (p<0.001) and negative delta wave in lead V1 (p<0.001). Epicardial inferior paraseptal APs were differentiated from endocardial APs by a negative delta wave in lead II (p=0.001), positive delta waves in AVR (p<0.001) and V1 (p=0.012), R/S ratio <1 in lead II (p=0.03), and R/S ratio ≥1 in V1 (p=0.04). Delta wave polarity and R/S ratio in lead V1 differentiate right endocardial inferior paraseptal APs from left endocardial APs. Delta wave polarities in leads II, AVR and V1, and R/S ratios in leads II and V1 estimate epicardial inferior paraseptal APs.

Clinical and electrophysiological characteristics of typical atrioventricular nodal reentrant tachycardia in the elderly - changing of slow pathway location with aging.

BACKGROUND: The aim of this study was to retrospectively evaluate the clinical and electrophysiological characteristics of elderly patients with typical atrioventricular nodal reentrant tachycardia (AVNRT), and to assess the acute safety and efficacy of slow-pathway radiofrequency (RF) ablation in this specific group of patients. METHODS AND RESULTS: The present study retrospectively included a total of 1,290 patients receiving successful slow-pathway RF ablation for typical slow-fast AVNRT. Patients were divided into 2 groups: group I included 1,148 patients aged <65 years and group II included 142 patients aged >65 years. The required total procedure duration and total fluoroscopy exposure time were significantly higher in group II vs. group I (P=0.005 and P=0.0001, respectively). The number of RF pulses needed for a successful procedural end-point was significantly higher in group II than in group I (4.4 vs. 7.2, P=0.005). While the ratio of the anterior location near to the His-bundle region was significantly higher in group II, the ratio of posterior and midseptal locations were significantly higher in group I (P=0.0001). The overall procedure success rates were similar. There was no significant difference between the 2 groups in respect of the complications rates. CONCLUSIONS: This experience demonstrates that RF catheter ablation, targeting the slow pathway, could be considered as first-line therapy for typical AVNRT patients older than 65 years as well as younger patients, as it is very safe and effective in the acute period of treatment.

Simultaneous Ablation of Ventricular Tachycardia and Hemodynamic Improvement of Mid-ventricular Obstructive Hypertrophic Cardiomyopathy by Coronary Venous Ethanol Ablation.

Transvenous coronary ethanol ablation may be successfully applied to simultaneously treat ventricular arrhythmia superimposed within a segment of hypertrophic cardiomyopathy. This presentation nicely describes this emerging technique for ventricular tachycardia ablation and identifies potential additional benefits of venous ethanol administration in patients with left ventricular obstructive physiology.

Evaluation of an education and follow-up programme for implantable cardioverter defibrillator-implanted patients.

AIMS AND OBJECTIVES: To determine the experiences, problems and the need for care and education of implantable cardioverter defibrillator-implanted patients and to assess the effects of an education and nurse follow-up programme on their quality of life, anxiety, depression and knowledge level. BACKGROUND: Although implantable cardioverter defibrillator has become a well-established therapy for people experiencing potentially lethal dysrhythmias, implantable cardioverter defibrillator patients may have physical and psychosocial problems due to the implantation. Applying a planning education and follow-up programme to implantable cardioverter defibrillator-implanted patients may prevent the need for more intensive treatment during the postimplantation period. DESIGN: A mixed methods design that used both qualitative and quantitative data collections and analysis was used for this study. METHODS: The study was performed in the cardiology department in Turkey between 2009-2010. The data were collected using the 'Semi-Structured Interview Form', 'Form for Assessment of Patients' Knowledge Level about implantable cardioverter defibrillator', 'Spielberger's State-Trait Anxiety Inventory', 'Beck Depression Inventory II' and 'The Short-Form 36 Health Survey'. All forms were completed at the beginning of the study and at six months. The study included 27 patients in the experimental group and 27 patients in the control group. RESULTS: The results showed that the patients were living with various physical and psychosocial problems and insufficient knowledge regarding the implantable cardioverter defibrillator. Education and follow-up programme increased knowledge levels, decreased anxiety and depression scores and improved several subscales of quality of life in the experimental group patients. CONCLUSION: It was recommended that education and follow-up programme be used for patients scheduled to undergo implantable cardioverter defibrillator implantation, starting before implantation and continuing thereafter, to help patients adapt to a life with implantable cardioverter defibrillator. RELEVANCE TO CLINICAL PRACTICE: Planned education and follow-up programme conducted by nurses may improve the knowledge levels and quality of life, anxiety and depression scores of the implantable cardioverter defibrillator-implanted patients.

Radiofrequency catheter ablation of patients with permanent junctional reciprocating tachycardia and long-term follow-up results.

BACKGROUND: Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of atrioventricular re-entrant tachycardia. We report the clinical and electrophysiological properties of PJRT and outcomes of radiofrequency catheter ablation (RCA) in a large group of patients. METHODS: We included 62 patients with the diagnosis of PJRT. Radiofrequency catheter ablation was performed in all. RESULTS: Location of accessory pathway was right posteroseptal in 37 (59,7%) cases, right midseptal in 3 (4,8%), left posterior in 7 (11,3%), left lateral in 5 (8,1%), left posterolateral in 3 (4,8%), left anterolateral in 2 (3,2%), left posteroseptal in 2 (3,2%), middle cardiac vein in 2 (3,2%), and left coronary cusp in 1 (1,6%). Single procedure success rate was 90.3%. None of patients had recurrence during follow-up after repeat ablations. Overall long-term success rate was 98.4%. Left ventricular systolic function recovered in all patients with tachycardia-induced cardiomyopathy (TIC). CONCLUSION: Retrograde decremental accessory pathways are mainly located in posteroseptal region. Radiofrequency catheter ablation is a safe and effective approach in patients with PJRT.

Comprehensive assessment of Mahaim accessory pathways' anatomic distribution.

OBJECTIVE: To present the authors' experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations. METHODS: Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed. RESULTS: Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12-66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients). CONCLUSION: MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.

[Degeneration of atrioventricular nodal reentrant tachycardia into polymorphic ventricular tachycardia: a case report]. / Polimorfik ventrikül tasikardisine dönüsen atriyoventriküler nodal yeniden girisli tasikardi: Olgu sunumu.

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia and is usually treated successfully by radiofrequency catheter ablation. We report on a 38-year-old woman whose AVNRT attacks occasionally degenerated into polymorphic ventricular tachycardia (VT). The patient presented with a complaint of palpitations. The electrocardiogram was in sinus rhythm with a normal corrected QT interval. During Holter monitoring, narrow QRS complex tachycardia with a heart rate of 220 beats/min was noted at nighttime, that lasted for 90 minutes, during which two episodes of polymorphic VT were also seen. The diagnosis of AVNRT was confirmed on an electrophysiologic study and AVNRT was successfully treated by radiofrequency catheter ablation. The patient had no complaint during a follow-up of eight months, with no signs of arrhythmia on repeat Holter monitoring.

Simultaneous conduction over the fast and slow pathways during induction of atrioventricular nodal reentrant arrhythmia with a rate of less than 100 bpm and infra-His block after radiofrequency ablation of the slow pathway.

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal regular supraventricular tachycardia in adults. It is typically induced with an anterograde block over the fast pathway (FP) and conduction over the slow pathway (SP), with subsequent retrograde conduction over the FP. Rarely, a simultaneous conduction of a premature atrial complex occurs over the FP and SP to induce AVNRT and is called "one for two phenomenon". We present a 46-year-old woman with atrioventricular nodal rhythm with a rate of 95 beats per minute with distinct electrophysiological characteristics showing simultaneous conduction over the FP and SP during induction of tachycardia and an infra-His block after radiofrequency ablation of the SP.

Successful percutaneous epicardial ablation of an accessory pathway located at the right atrial appendage.

In patients with Wolff-Parkinson-White syndrome, difficulty in ablation of accessory pathways is associated with failures and recurrences. Epicardially located accessory pathways may require different management strategies when conventional ablation attempts fail. In particular, an epicardial accessory pathway communicating the right atrial appendage to the right ventricle is an extraordinary situation resulting in difficulties in ablation. Hereby, we report on a challenging case of percutaneous epicardial ablation of an epicardial accessory pathway located at right atrial appendage in a 28-year-old man with Wolff-Parkinson-White syndrome, who had a prior history of unsuccessful endocardial ablation. Percutaneous epicardial ablation may be a viable option obviating the necessity of surgical ablation procedures for difficult ablation cases with epicardial accessory pathways.

Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience.

OBJECTIVE: Catheter ablation following electrophysiologic study (EPS) is the mainstay of diagnosis and treatment for patients with atrioventricular reentrant tachycardia (AVRT), demonstrating excellent long-term outcome and a low rate of complications. In this study, our aim was to assess our experience in patients with accessory pathway (AP) and to compare our data with the literature. METHODS: We included 1,437 patients who were diagnosed and treated for AP in our hospital between 1998 and 2020. The demographic data of all the patients, AP location, and periprocedural results were recorded. RESULTS: Of the 1,437 patients, 1,299 (90.4%) were men; and the mean age of the population was 26.67 years. The location of 1,418 APs were along the left free wall (647 [45.6%] patients), in the posteroseptal region (366 [25.3%] patients), in the anteroseptal region (290 [20.4%] patients), and along the right free wall (115 [8.1%] patients). The ratio of the second AP existence was 3.0% and AVNRT co-existence was 2.0%. A total of 55 (3.8%) patients had recurrent sessions for relapse. Our center's total success rate was 95.5%, and total complication rate was 0.26%. CONCLUSION: According to our retrospective analysis, EPS is a highly functional tool in the diagnosis and management of arrhythmias such as AVRT for high-risk patient groups like military personnel with the aim of risk stratification and medical management.

Hiccup as a result of late lead perforation: report of two cases and review of the literature.

Pacemaker (PM) lead perforation is a rare complication with an incidence of <1%. Late lead perforation is defined as the perforation of a device lead through the myocardium more than 1 month after implantation. It is a subcategory of overall lead perforation and it has been described in several case reports. In the current paper, we present two cases with late partial lead perforation developing after the PM implantation.

Intra-left atrial mechanical delay detected by tissue Doppler echocardiography can be a useful marker for paroxysmal atrial fibrillation.

OBJECTIVES: There are some clinical and echocardiographic parameters to predict paroxysmal atrial fibrillation (PAF), but more sensitive predictors are needed. Tissue Doppler imaging may be a sensitive method for this purpose. METHODS: Thirty-four patients with PAF and 31 control subjects were studied. Time intervals from the beginning of P-wave to beginning of A-wave from lateral and septal mitral and right ventricular tricuspid annuli in tissue Doppler imaging were recorded. The differences between these intervals gave the mechanical delays between/within the corresponding atria. RESULTS: There were no differences between groups with regard to age. PAF patients were found to have increased left atrial dimension and intra-left atrial mechanical delay. Twenty-five milliseconds was calculated as cutoff value to predict PAF. P-wave dispersion was found to be increased in PAF. CONCLUSIONS: This study shows an increase in intra-left atrial mechanical delay in PAF patients. This method can be used as an early marker to detect PAF.

Atrial myocardial deformation properties are temporarily reduced after cardioversion for atrial fibrillation and correlate well with left atrial appendage function.

AIM: This study was conducted to evaluate whether left atrial strain and strain rate correlate well with transesophageal parameters of stunning after atrial fibrillation. METHODS AND RESULTS: Twenty-two consecutive patients with chronic atrial fibrillation >/=3 months and <1 year were enrolled in the study. Transthoracic (TTE) and transesophageal (TEE) echocardiography with color Doppler myocardial imaging were performed before, 1 day after and 10 days after successful cardioversion. Left atrial transthoracic strain (S) and strain rate (SR) from lateral, inferior and anterior atrial walls, left atrial appendage tissue velocities, strain and strain rate values were measured with offline analysis. Left atrial appendage emptying (LAAEV) and filling (LAAFV) velocities were obtained from transesophageal echocardiography. Left atrial transthoracic, and left atrial appendage strain and strain rates were significantly lower following 1 day after cardioversion (TTE S/SR, 5.0 +/- 2.8%/2.3 +/- 1.0; TEE (septal) S/SR, 7.6 +/- 3.6%/1.6 +/- 0.7). There was a good correlation between these parameters and LAAEV (LA systolic strain and LAAEV, r = 0.73, P = 0.007). Left atrial and LAA strain and strain rate values improved over time, and correlated well with LAAEV, measured 10 days after cardioversion. CONCLUSIONS: Transthoracic atrial and TEE LAA strain and strain rate, which are quantitative measures of atrial function, are reduced after cardioversion, and recover subsequently. The good correlation between LAA function and TTE strain and strain rate suggests that TTE atrial parameters may help determine duration of anticoagulation.

Does gender modify the detrimental coronary effects of metabolic syndrome?

The association between metabolic syndrome and coronary artery disease, either clinical or subclinical, has been well established. There is also a consensus regarding the higher prevalence of metabolic syndrome in females compared with males with coronary artery disease. However, the impact of gender on the coronary artery disease severity has not been investigated in patients with metabolic syndrome. The available data have suggested no significant association between gender and the extent and severity of coronary artery disease.

Intracavitary left ventricular hydatid cysts ruptured during cardiopulmonary resuscitation in a patient with acute myocardial infarction.

Cardiac hydatid cyst is a rare complication of parasitic infection caused by Echinococcus granulosus. Cardiac involvement occurs in only 0.2-2% of hydatidosis cases. Rupture of hydatid cysts into cardiac chambers is very rare. In this report, we present a case of intracavitary left ventricular hydatid cysts ruptured during cardiopulmonary resuscitation in a patient with acute myocardial infarction.

Precordial ST-segment elevation in acute occlusion of the proximal right coronary artery.

Isolated right ventricular myocardial infarction (RVMI) rarely occurs and accounts for only 3% of all myocardial infarction cases. In the literature, there are several reported isolated RVMI cases with precordial ST-segment elevation. We describe a 45-year-old man with marked ST-segment elevations in leads V1 through V4 accompanied by slight ST-segment elevations in the inferior leads (III, aVF) caused by acute occlusion of a nondominant small right coronary artery proximal to the conus branch causing isolated RVMI.

Admission plasma leptin level strongly correlates with the success of thrombolytic therapy in patients with acute myocardial infarction.

Obesity-associated alterations in coagulation and fibrinolytic factors in favor of thrombosis are well known. Observations suggest that leptin, a recently discovered obesity gene product, in addition to being a satiety factor, induces platelet aggregation, accelerates formation of firm thrombi, and is associated with abnormal fibrinolysis. The authors studied the influence of plasma leptin concentrations on admission within 6 hours of acute myocardial infarction (MI) on the outcome of thrombolytic therapy (TT). Forty-one patients with acute MI who underwent TT were enrolled into the study. Levels of plasma leptin were determined with radioimmunoassay method in samples obtained just before initiation of TT. Patients were initially classified according to the admission plasma leptin concentrations, and it was observed that failure of reperfusion therapy with streptokinase was significantly higher in patients with admission plasma leptin concentrations > or =14 ng/mL (group 2) as compared to patients with admission plasma leptin concentrations <14 ng/mL (group 1). Final failure of TT, identified both by reinfarction and absence of early reperfusion as assessed noninvasively, was observed in 11 patients (39%) in group 1 and in 10 patients (77%) in group 2 (p=0.025). Left ventricular ejection fraction was slightly but significantly higher in group 1 than in group 2 (p=0.031). High plasma leptin concentrations on admission in patients within 6 hours after the onset of acute MI are associated with less TT efficacy. The authors suggest that admission leptin levels may play a role in the management of patients with acute MI.