The impact of high-density atrioventricular dual-chamber mapping in a patient with a left epicardial accessory pathway.
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ABSTRACT:
SUBMITTER: Mori H
PROVIDER: S-EPMC7653477 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC10030295 | biostudies-literature
Project description:A 42-year-old man was admitted for recurrent atrioventricular reciprocating tachycardia. We performed a total activation mapping, which included a range from the ventricular to atrial waves during right ventricular pacing. The mapping revealed a delayed ventriculoatrial conduction on the left lateral wall. We performed ablation within the coronary sinus, and the ventriculoatrial conduction was lost. By widening the range, we could easily visualize the ventriculoatrial conduction through the accessory pathway. This mapping showed that the conduction in the area of the accessory pathway was delayed, and it was easy to estimate that the conduction pathway included the coronary sinus.
| S-EPMC9484014 | biostudies-literature
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| S-EPMC8441193 | biostudies-literature
Project description:Radiofrequency catheter ablation (RFCA) is the primary choice for treating patients with an accessory pathway and atrioventricular re-entrant tachycardia. However, using RFCA to treat a right-sided accessory pathway in a patient with Ebstein anomaly can be difficult owing to challenges in locating the electrophysiological atrioventricular groove. We report a case of atrioventricular re-entrant tachycardia in a patient with Ebstein anomaly and a right-sided accessory pathway that was successfully treated using RFCA and 3-dimensional (3D) high-density mapping. RFCA and 3D mapping may be useful in the management of such cases and may aid in improving prognoses of patients.
| S-EPMC8209408 | biostudies-literature
Project description:BackgroundA dual-chamber leadless pacemaker system has been designed for atrioventricular synchronous pacing using wireless, beat-to-beat, implant-to-implant (i2i) communication between distinct atrial and ventricular leadless pacemakers. The atrioventricular synchrony achieved across various ambulatory scenarios has yet to be systematically evaluated.MethodsA prospective, single-arm, unblinded, multicenter, international clinical trial of the leadless pacemaker system was conducted in patients with a conventional dual-chamber pacing indication enrolled from February 2022 to March 2023. Leadless pacemaker systems were implanted, and 12-lead Holter electrocardiographic recordings were collected 3 months after implantation over various postures/activities: sitting, supine, left lateral recumbent, right lateral recumbent, standing, normal walk, and fast walk. An independent Holter core laboratory performed a manual adjudication of the percent of atrioventricular synchronous beats using the standard 300-millisecond PR interval limit. Atrium-to-ventricle and ventricle-to-atrium i2i communication success rates were also assessed. Post hoc summary statistics describing the relationships between atrioventricular synchrony and i2i success, posture/activity, implantation indication, atrioventricular event, and heart rate were calculated.ResultsIn the evaluable population (n=384 of 464 enrolled [83%]; 61% male; age, 70 years; weight, 82 kg; 60% ejection fraction; 95% of beats evaluable), the mean atrioventricular synchrony of 98% of beats observed across all postures using the standard 300-millisecond limit was greater than both atrial-to-ventricular i2i (94%) and ventricular-to-atrial i2i (94%; P<0.001), exceeding both i2i values in 95% of patients. Atrioventricular synchrony was achieved in >95% of evaluable beats across all postures/activities, implantation indications, atrioventricular paced/sensed event combinations, and heart rate ranges (including >100 bpm).ConclusionsThis dual-chamber leadless pacemaker system demonstrated atrioventricular synchrony in 98% of evaluable beats at 3 months after implantation. Atrioventricular synchrony was maintained across postures/activities and remained robust for heart rates >100 bpm.
| S-EPMC11305627 | biostudies-literature
Project description:Proper localization of the anatomical target during ablation of the accessory pathways (AP) and the ability to detect clear AP potentials on the ablation catheter are crucial for successful AP ablation. We report a case of recurring AP conduction that was finally eliminated using a novel ablation catheter equipped with high-resolution mini-electrodes. Smaller and closer electrodes result in high mapping resolution with less signal averaging and cancellation effects. Owing to improved sensitivity, the new catheter seems effective in detecting fragmented and high frequency signals, thus allowing more effective radiofrequency application and improving ablation success.
| S-EPMC5529322 | biostudies-literature
Project description:BackgroundImplantable cardioverter defibrillators (ICDs) are most effective in treating sudden cardiac death. However, accurate diagnostic workup of broad complex tachycardia is crucial to ensure correct indication for ICD treatment and to avoid unnecessary invasive treatment and device-associated morbidity.Case summaryWe present a case of atypical atrial flutter with 2:1 atrioventricular (AV) conduction via a left-posterior accessory pathway (AP), leading to the diagnosis of Wolff-Parkinson-White (WPW) syndrome. Upon admission, the 72-year-old patient showed a regular broad complex tachycardia with superior axis and positive concordance in precordial leads, suggestive of either ventricular tachycardia (VT), antidromic AV re-entrant tachycardia (AVRT), or supraventricular tachycardia with antegrade conduction via a left-posterior AP. Interrogation of the two-chamber ICD, which was very likely implanted unjustified in a peripheral clinic before, revealed atrial flutter with 2:1 AV conduction. Remarkably, after the restoration of sinus rhythm, no classic echocardiogram (ECG) criteria for preexcitation syndrome were detected. An invasive electrophysiological study proved the diagnosis of a bidirectionally conducting, left-posterior AP, which was successfully ablated.DiscussionDifferential diagnosis of broad complex tachycardia with superior axis and positive concordance of chest leads consists of i) VT with a left ventricular exit at the posterior mitral annulus, ii) antidromic AVRT involving a left-posterior AP, and iii) supraventricular tachycardia predominantly conducted via a left-posterior AP. The absence of classic ECG criteria for preexcitation syndrome does not rule out AP sufficiently, highlighting the importance of minimal surface-ECG preexcitation criteria. In the case of detection of minimal surface-ECG preexcitation criteria, administration of adenosine rules out or proves the existence of an AP noninvasively and cost-effectively.
| S-EPMC9272436 | biostudies-literature
Project description:BackgroundDespite substantial technical improvements in long-term mechanical circulatory support, ventricular tachycardia (VT) remains a major challenge in left ventricular assist device (LVAD) patients. Recurrent VTs in LVAD patients are not only associated with limited quality of life, but also increased mortality. Although LVAD therapy improves VT tolerance of the left ventricle, haemodynamical deterioration of the right ventricle is the limiting factor in these patients.Case summaryWe present a case report of a hybrid epicardial VT ablation of incessant VTs in a 53-year-old man with advanced heart failure and St.p. LVAD implantation. With this unique clinical case report, we describe an epicardial VT ablation using secondary surgical open-heart access in a patient with therapy-refractory VTs combing left-sided minithoracotomy with high-density (HD) mapping and catheter ablation.DiscussionTo the best of our knowledge, the presented approach is the first interdisciplinary case of epicardial VT ablation using secondary surgical open-heart access in an LVAD patient with therapy-refractory VTs. By combing left-sided minithoracotomy with HD mapping and catheter ablation, we could to demonstrate that even in these complex patients epicardial VT ablations can be performed safely and improve quality of life of LVAD patients with recurrent implantable cardioverter-defibrillator shock therapies.
| S-EPMC8233488 | biostudies-literature
Project description:The association of situs inversus totalis and left ventricular noncompaction is very rare and poses several and unique challenges if endo-epicardial ablation has to be performed, both for anatomical access to the target area and for arrhythmia complexity. We report a case of incessant ventricular tachycardia with endo-epicardial involvement that required ablation in both surfaces to obtain final noninducibility.
| S-EPMC8022008 | biostudies-literature
Project description:Background:Catheter ablation (CA) of epicardial accessory pathways (APs) can be performed via the coronary sinus (CS) system. Variable CS anatomy with complications of former CA procedures inside the CS venous system may require using alternative CA approach and technology. Case summary:We report the case of a 23-year-old man with Wolff-Parkinson-White syndrome and history of aborted sudden cardiac death (SCD) and unsuccessful previous AP radiofrequency ablation (RFA). CS venography during the redo procedure revealed an early CS trifurcation with cardiac veins stenosis, thus with difficulties in maintaining cardiac veins' access and catheter manoeuvring inside CS venous system. The last office visit with electrocardiogram (ECG) performance was in 3?months after the CA. Neither delta wave on the ECG nor any complaints/adverse health effects was detected at that time. Discussion:Successful CA of epicardial AP in patients with a high risk of SCD is essential. However, CS complex anatomy and changes after former RFA inside it may lead to CS venous system access limitations. Alternative CA approach and technology should be considered to ensure CS venous system cannulation and epicardial AP CA performance.
| S-EPMC7319811 | biostudies-literature