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  • 1
    Electronic Resource
    Electronic Resource
    Conduction Properties of the Crista Terminalis in Patients with Typical Atrial Flutter: Basis for a Line of Block in the Reentrant Circuit (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 9 (1998), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Conduction Properties of the Crista Terminalis. Introduction: Previous mapping studies in patients with typical atrial flutter have demonstrated the crista terminalis to he a posterior harrier of the reentrant circuit forming a line of block. However, the functional role of the crista terminalis in patients with or without a history of atrial flutter is not well known. The aim of this study was to determine whether the conduction properties of the crista terminalis are different between patients with and those without a history of atrial flutter. Methods and Results: The study population consisted of 12 patients with clinically documented atrial flutter (group 1) and 12 patients with paroxysmal supraventricular tachycardia as well as induced atrial flutter (group 2). A 7-French, 20-pole, deflectable Halo catheter was positioned around the tricuspid annulus. A 7-French, 20-pole Crista catheter was placed along the crista terminalis identified by the recording of double potentials with opposite activation sequences during typical atrial flutter. After sinus rhythm was restored, pacing from the low posterior right atrium near the crista terminalis was performed at multiple cycle length to 2:1 atrial capture. No double potentials were recorded along the crista terminalis during sinus rhythm in both groups. In group 1, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 638 ± 119 msec. After infusion of propranolol, it was prolonged to 832 ± 93 msec without change of the interdeflection intervals of double potentials. In group 2, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 214 ± 23 msec. After infusion of procainamide, it was prolonged to 306 ± 36 msec with increase of interdeflection interval of double potentials. Conclusion: The crista terminalis forms a line of transverse conduction block during typical atrial flutter. Poor transverse conduction property in the crista terminalis may be the requisite substrate for clinical occurrence of typical atrial flutter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1998.tb00120.x
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  • 2
    Electronic Resource
    Electronic Resource
    Electrophysiologic Characteristics and Anatomical Complexities of Accessory Atrioventricular Pathways with Successful Ablation of Anterograde and Retrograde Conduction at Different Sites (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 7 (1996), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: RF Ablation of Accessory Pathways. Introduction: Catheter ablation may eliminate anterograde and retrograde accessory pathway conduction at closely adjacent but anatomically discrete sites. However, the mechanisms of this discrepancy, the electrophysiologic and anatomical characteristics, and information about systematic study from a large patient population are not available. The purpose of this study was to investigate the electrophysiologic characteristics and anatomical complexities of the accessory pathway in which anterograde and retrograde conduction was successfully ablated at different sites. Methods and Results: Thirty-eight (10.9%) patients (19 men and 19 women; mean age 37 ± 2.4 years) fulfilling the criteria of having separate ablation sites for anterograde and retrograde conduction were designated as group I, and the other 310 patients (215 men and 95 women; mean age 47 ± 0.6 years) were designated as group II. The patients with right-sided free-wall pathways had the highest incidence (18.6%) of separate ablation sites. The anatomical distance between anterograde and retrograde directions (left anterior oblique view. 13 ± 0.6 vs 8 ± 0.9 mm, P 〈 0.01; right anterior oblique view, 17 ± 0.6 vs 5 ± 0.7 mm, P 〈 0.01), and incidence of conduction impairment in one direction after successful ablation of another direction (15% vs 78%, P 〈 0.05) differed significantly between left and right free-wall pathways. The mean distances obtained from left (7 ±0.4 vs 14 ± 0.4 mm, P 〈 0.05) and right (7 ± 1.1 vs 15 ± 0.9 mm, P 〈 0.05) anterior oblique views were shorter in patients who had impairment of conduction properties than those in patients without impaired conduction after successful ablation of one direction. Conclusions: This study showed that anatomical and functional dissociation of the accessory pathway into anterograde and retrograde components was possible. Further study on the relation between electropbysiologic and pathologic characteristics would be helpful to confirm these findings.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1996.tb00465.x
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  • 3
    Electronic Resource
    Electronic Resource
    Future Ablation Concepts of Tachyarrhythmias (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 6 (1995), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Catheter Ablation. Application of radiofrequency energy to arrhythmogenic substrates after careful cardiac mapping could ensure a high success rate in eliminating certain types of tachyarrhythmias. Future studies of catheter ablation will focus on how to improve ablation efficacy and achieve a better result in various types of tachyarrhythmias. More information about the arrhythmogenic mechanisms will be provided to improve the knowledge of diagnostic and interventional electrophysiology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1995.tb00360.x
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  • 4
    Electronic Resource
    Electronic Resource
    Conduction Properties of the Crista Terminalis in Patients with Atrial Flutter Due to Amiodarone Therapy for Atrial Fibrillation (2003)
    350 Main Street , Malden , MA 02148-5018 , U.S.A . : Blackwell Publishing
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Some patients with atrial fibrillation (AF) treated by antiarrhythmic drugs (AAD) can develop typical atrial flutter, but the mechanism is not clear. This study included 21 patients with AF. Group I (n = 7) had typical atrial flutter due to amiodarone therapy. Group II (n = 7) did not develop atrial flutter after amiodarone treatment. Group III (n = 7) did not receive AAD treatment. A 7 Fr, 20-pole electrode catheter was placed along the CT identified by fluoroscopy and intracardiac echocardiography. After restoration of the sinus rhythm, decremental pacing near the CT was performed until 2 to 1 atrial capture. Complete transverse conduction block was defined as the appearance of double potentials with opposite activation sequence along the CT. Focal transverse conduction delay was defined as the appearance of double potentials at ≥ 2 recording sites. Focal transverse conduction delay was observed during pacing at the cycle length of 693 ± 110 ms in group I, 360 ± 97 ms in group II and 343 ± 109 ms in group III (P = 0.001). Complete transverse conduction block was observed during pacing at the cycle length of 391 ± 118 ms in group I and 231 ± 23 ms in group II (P = 0.001), but not in group III. In conclusion, focal transverse conduction delay in the CT was common in patients with AF. A predisposition to the line of the conduction block in the CT might contribute to the conversion of AF to typical atrial flutter due to amiodarone therapy. (PACE 2003; 26:2241–2246)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2003.00354.x
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  • 5
    Electronic Resource
    Electronic Resource
    Spectral Analysis of Chronic Atrial Fibrillation and Its Relation to Minimal Defibrillation Energy (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: TAI, C-T., et al.: Spectral Analysis of Chronic Atrial Fibrillation and Its Relation to Minimal Defibrillation Energy. The average rate of fibrillatory activity may reflect the global activation pattern of AF. Electrical cardioversion is the most effective method of converting chronic AF to sinus rhythm. The aim of this study was to investigate the relation between the minimal defibrillation energy requirement and the dominant frequency of chronic AF. Twenty-nine patients with chronic AF (mean duration 57.9 ± 7.7 months) underwent external electrical cardioversion. Before cardioversion, the frequency content of the 60-second AF in ECG lead V1 was quantified using digital signal processing. After band-pass filtering, QRST complexes were cancelled using a recursive least squares algorithm. The resulting fibrillatory baseline signal was subjected to fast Fourier transform and was displayed as a power spectrum. The dominant AF frequency was found to range from 4.9 to 8.7 Hz (mean 6.7 ± 0.9 Hz). Twenty-six patients had successful conversion of AF to sinus rhythm without immediate recurrence. There was a positive correlation between the minimal defibrillation energy and the dominant frequency of chronic AF (ρ= 0.414, P = 0.035). Thus, power spectral analysis of AF using the surface ECG is feasible and may be useful in predicting the minimal shock energy required for successful cardioversion of chronic AF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.01747.x
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  • 6
    Electronic Resource
    Electronic Resource
    Ventricular Tachycardia in a Patient with Primary Hyperparathyroidism (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We present a case of primary hyperparathyroidism with hypercalcemia in a patient who had spontaneous attacks of ventricular tachycardia. Right ventricular burst pacing reproducibly induced ventricular tachycardia in the electrophysiological laboratory after intravenous administration of calcium-gluconate, and verapamil could terminate the tachycardia. After resection of the parathyroid adenoma, the calcium level was restored to normal, and ventricular tachycardia did not occur again during the follow-up period,
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00842.x
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  • 7
    Electronic Resource
    Electronic Resource
    Mechanism of Spontaneous Transition from Typical Atrial Flutter to Atrial Fibrillation: Role of Ectopic Atrial Fibrillation Foci (2001)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 24 (2001), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: HSIEH, M.-H., et al.: Mechanism of Spontaneous Transition from Typical Atrial Flutter to Atrial Fibrillation: Role of Ectopic Atrial Fibrillation Foci. Paroxysmal AF has been known to be initiated by ectopic beats, especially in the pulmonary veins (PVs), and radiofrequency catheter ablation could cure it. We considered that the spontaneous transition from typical atrial flutter to AF also could be initiated by ectopic beats. Twenty patients (18 men, mean age 66 ± 14 years) with episodes of spontaneous transition from typical atrial flutter to AF were included in this study. They underwent detailed mapping of both atria. All the patients had spontaneous AF initiated by ectopic beats, and all of them had typical atrial flutter and spontaneous transition from typical atrial flutter (12 patients with counterclockwise atrial flutter and 8 patients with clockwise atrial flutter) to AF. The transition was initiated by ectopic beats from the PVs (17 foci, 85%), crista terminalis (2 foci, 10%), and superior vena cava (1 focus, 5%). After successful ablation of AF foci, typical atrial flutter was induced again, but no spontaneous transition was found after at least 10 minutes of observation. We concluded that paroxysmal AF and spontaneous transition from typical atrial flutter to AF were initiated by ectopic beats, and successful catheter ablation of the ectopic foci can eliminate paroxysmal AF and spontaneous transition from typical atrial flutter to AF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.00046.x
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  • 8
    Electronic Resource
    Electronic Resource
    Effects of Procainamide and dl-Sotalol on the Changes of Atrial Electrophysiology Induced by High Current Stimulation (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The relation between high current atrial stimulation and antiar-rhythmic drugs was not clear. We evaluated the effects of procainamide and dl-sotalol on the electrophysiological changes induced by high current stimulation. Effects of high current atrial stimulation on effective refractory period, dispersion of refractoriness, conduction velocity, and wavelength of the earliest atrial premature beat were evaluated at baseline and after infusion of procainamide (10 patients) and dl-sotalol (10 patients). High current atrial stimulation shortened effective refractory period locally (−12%± 4.0%, −7.0%± 3.0%, −5.1 ± 3.3%, and −3.0 ± 2.0%, at 0, 7, 14, and 21 mm from the S1 stimulation site, respectively; P 〈 0.001); increased the dispersion of refractoriness (from 17.8 ± 8.5 to 27.4 ± 12.5 ms, P 〈 0.001); decreased conduction velocity of the earliest premature beat (from 0.58 ± 0.10 to 0.52 ± 0.09 ms, P = 0.01); and decreased wavelength of the earliest atrial premature beat (from 10.9 ± 2.4 to 8.8 ± 2.1 cm, P 〈 0.001). These effects of high current stimulation persisted after procainamide infusion. However, after dl-sotalol infusion, high current atrial stimuli did not change the dispersion of refractoriness (23.1 ± 10 ms vs 26.4 ± 10.4 ms; P 〉 0.05, twice diastolic threshold vs 10 mA); conduction velocity of the earliest premature beat (0.54 ± 0.06 ms vs 0.50 ± 0.06 ms, P 〉 0.05); or wavelength of the earliest premature atrial beat (11.5 ± 1.6 m/s vs 10.1 ± 1.7 cm; P 〉 0.05). Although high current atrial stimulation shortened effective refractory period locally, increased dispersion of refractoriness, and decreased the wavelength of the earliest premature atrial impulse, these effects were abolished by dl-sotalol but not procainamide.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb01124.x
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  • 9
    Electronic Resource
    Electronic Resource
    Impairment of Coronary Microvascular Function in Patients with Neurally Mediated Syncope (2003)
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: CHEN, J.-W., et al.: Impairment of Coronary Microvascular Function in Patients with Neurally Mediated Syncope. Recent evidence suggests that myocardial ischemia may occur in patients with neurally mediated syncope and normal coronary angiograms. This study was conducted to evaluate if coronary microvascular function is impaired in such patients. Coronary hemodynamic studies and head-up tilt table tests (HUTs) were performed on 30 consecutive patients with normal coronary angiograms and recurrent syncope. Another ten subjects with atypical chest pain and no evidence of myocardial ischemia or syncope served as a control. Great cardiac vein flow (GCVF) and coronary sinus flow (CSF) were measured by the thermodilution method at baseline and after dipyridamole infusion (0.56 mg/kg IV for 4 minutes). Coronary flow reserve (CFR), derived from CSF and GCVF, was significantly lower in the 15 patients with positive HUT than in the other 15 patients with negative HUT (1.75 ± 0.48vs2.64 ± 0.8, P 〈 0.01and2.29 ± 0.45vs3.07 ± 0.63, P 〈 0.01, respectively). Ischemic-like ECG was noted during treadmill exercise test in 40% of the former and in 7% of the latter group(P = 0.01). There was no significant difference in CFR between patients with negative HUT and control subjects. Coronary microvascular function was impaired in syncopal patients with positive HUT and relatively preserved in those with negative HUT, suggesting the possible linkage between coronary microvascular dysfunction and the development of neurally mediated syncope. (PACE 2003; 26[Pt. I]:605–612)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00101.x
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  • 10
    Electronic Resource
    Electronic Resource
    Prevention of the Initiation of Atrial Fibrillation: Mechanism and Efficacy of Different Atrial Pacing Modes (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Several atrial pacing modes have been reported to be effective in the prevention of atrial fibrillation (AF); they included biatrial pacing, dual site right atrial pacing, Bachmann's bundle (BB) pacing, and coronary sinus pacing. However, the relative efficacy and electrophysiological mechanisms of these pacing modes in the prevention of AF are not clear. In 15 patients (age 54 ± 14 years) with paroxysmal AF, P wave duration, effective refractory period, and atrial conduction time were determined with six different atrial drive pacings, that were right atrial appendage (RAA), BB, right posterior interatrial septum (RPS), distal coronary sinus (DCS), RAA plus RPS simultaneously (DSA), and RAA plus DCS simultaneously (BiA). All these patients consistently had AF induced with early RAA extrastimulation coupling to RAA drive pacing. No patient had AF induced with RAA extrastimulation coupled to BB, RPS, or DCS drive pacing, but seven and eight patients had AF induced with RAA extrastimulation coupled to DSA and BiA drive pacing, respectively. The P wave duration was longest during RAA pacing, and became shorter during other atrial pacing modes. Analysis of electrophysiological change showed that early RAA extrastimulation coupled to RAA drive pacing caused the longest atrial conduction delay among these atrial pacing modes; BB, RPS, and DCS drive pacing caused a greater reduction of this conduction delay than DSA and BiA drive pacing. In addition, the effective refractory periods of RAA determined with BB, RPS, and DCS drive pacing were similar and longer than that determined with DSA and BiA drive pacing. In patients with paroxysmal AF, this arrhythmia was readily induced with RAA extrastimuli coupled to RAA drive pacing. BB, RPS, and DCS pacing were similar and more effective than DSA and BiA pacing in preventing AF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb06764.x
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