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  • 1
    Electronic Resource
    Electronic Resource
    International Consensus on Nomenclature and Classification of Atrial Fibrillation: A Collaborative Project of the Working Group on Arrhythmias and the Working Group of Cardiac Pacing of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (2003)
    350 Main Street , Malden , MA 02148 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 14 (2003), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.00003.x
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  • 2
    Electronic Resource
    Electronic Resource
    Mechanisms of Right Atrial Tachycardia Occurring Late After Surgical Closure of Atrial Septal Defects (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: In patients without structural heart disease, the most frequently occurring AT is the common atrial flutter. In patients with repaired congenital heart disease other mechanisms of AT may occur, due to the presence of an atriotomy that can provide a substrate for reentry. The aim of the present study was to identify the mechanisms of atrial tachycardia (AT) occurring late after atrial septum defect (ASD) repair, with the help of a three-dimensional electroanatomical mapping system. Methods and Results: Twenty-two consecutive patients presenting with AT underwent complete electroanatomic mapping (CARTO®, Biosense Webster, Diamond Bar, CA) of spontaneously occurring and inducible right ATs. Complete maps of 26 ATs were obtained. Three tachycardia mechanisms were identified: single-loop macroreentrant atrial tachycardia (MAT) (n = 7), double-loop MAT (n = 18), and focal AT (n = 1). In all MATs, protected isthmuses were identified as the electrophysiological substrate of the arrhythmia, most frequently the cavotricuspid isthmus (CTI) (n = 24), and a gap between the inferior vena cava and a line of double potentials (n = 11). A mean number of 13.5 ± 2.1 radiofrequency applications were delivered to transect these critical parts of the circuit. During a follow-up of 25 ± 16 months the RF ablation was acutely successful in all patients. Thirteen patients (59%) had an early recurrence of MAT and needed an additional ablation procedure. One of those patients needed two additional ablation procedures. Conclusions: Three-dimensional electroanatomic mapping is useful to identify postsurgical AT mechanisms; the CTI isthmus is involved in 92% MAT, and if the right atrial free wall (RAFW) abnormal tissue related to surgical scar is present this substrate contributes to the MAT circuit
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2005.30605.x
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  • 3
    Electronic Resource
    Electronic Resource
    Prolongation of Tachycardia Cycle Length During Atrial Flutter Ablation: (2004)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.04315.x
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  • 4
    Electronic Resource
    Electronic Resource
    Diagnostic Performance of a Dual-Chamber Cardioverter Defibrillator Programmed with Nominal Settings: A European Prospective Study (2002)
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 13 (2002), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Arrhythmia Discrimination by ICD. Introduction: Despite technologic developments, accurate discrimination of ventricular tachyarrhythmia from rapid rhythms of nonventricular origin remains a challenge. We sought to examine the sensitivity and specificity of a dual-chamber arrhythmia detection algorithm, the PARAD algorithm, incorporated in a dual-chamber implantable cardioverter defibrillator, the Defender (ELA Medical). Methods and Results:All detailed tachycardia episodes (i.e., with stored atrial and ventricular channel markers and electrograms) retrieved from the Holter memory of the device were analyzed from 95 patients (86 men and 9 women; age 62 ± 12 years) implanted with the Defender with the algorithm programmed at nominal settings. Over a follow-up of 15 ± 8 months, 559 detailed sustained tachycardia episodes detected in the tachycardia zone were gathered in 62 patients. Of the 300 ventricular tachycardia (VT) episodes, 298 were appropriately classified as VT by the algorithm. Of the 259 supraventricular tachycardia (SVT) episodes, 231 were appropriately classified as SVT. In 8 patients, 28 episodes of SVT were misclassified as VT: 25 atrial fibrillation episodes (6 patients), 2 sinus tachycardia (1 patient), and 1 atrial tachycardia. Calculated sensitivity and specificity were 99.3% and 89.2% on a per episode basis and 99.8% (95% confidence interval: 97.8 to 100) and 91.6% (95% confidence interval: 86.0 to 97.3) on a per patient basis, respectively. Conclusion: In this selected population of patients, the PARAD algorithm was safe and reliable for detection of a wide spectrum of tachyarrhythmias. Its specificity was high, particularly with respect to sinus tachycardia detection, but it must be improved with respect to detection of atrial fibrillation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2002.00025.x
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  • 5
    Electronic Resource
    Electronic Resource
    Accuracy and Limitations of Published Algorithms Using the Twelve-Lead Electrocardiogram to Localize Overt Atrioventricular Accessory Pathways (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 10 (1999), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Accessory Pathway Localization. Introduction: The purpose of this study was to evaluate the accuracy and limitations of published algorithms using the 12-lead ECG to localize AV accessary pathways (APs). Methods and Results: The 11 relevant algorithms found in the literature (MEDLINE database and major scientific sessions) were tested on a series of 266 consecutive patients who successfully underwent radiofrequency catheter ablation of a single overt AV AP. The positive predictive values (PPV) of the algorithms in applicable patients were significantly lower for algorithms with 〉 6 accessory location sites (40.6%± 10.9% vs 61.2%± 8.0%; P 〈 0.03) and show a tendency for algorithms not relying on delta wave polarity but on QRS polarity only (36.6%± 11.2% vs 52.3%± 13.1%; P = 0.09). The PPV in applicable patients is related to the AP location (P 〈 0.001) and ranked from the highest to the lowest as follows: left lateral (mean PPV = 86.3%), posteroseptal (mean PPV = 65.2%), right anteroseptal (mean PPV = 45.2%), and right posterolateral (mean PPV = 23.4%). Conclusion: Our study suggests that the accuracy of algorithms relying on the 12-lead ECG depends on AP locations as defined in the algorithms and on the number of AP sites. The accuracy tends to be lower when delta wave polarity is not included in the algorithm's architecture. This should be considered when using these algorithms or when building new ones.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1999.tb00189.x
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  • 6
    Electronic Resource
    Electronic Resource
    Atrioventricular Node Ablation for Optimization of Pacemaker Treatment in Hypertrophic Obstructive Cardiomyopathy (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 9 (1996), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Dual chamber pacing is a new indication for the treatment of drug resistant hypertrophic obstructive cardiontyopathy (HOCM) in patients with normal atrioventricular (AV) conduction. In sinus rhythm, the efficacy of the treatment is mainly related to the ability to bypass the normal AV conduction system in order to obtain a complete and permanent right ventricular (RV) capture. This is achieved by programming short AV delays. On the other hand, patients with HOCM frequently have co-existing left ventricular diastolic dysfunction, and the atrial contribution to left ventricular filling is critical. The lack of improvement, rarely encountered, is probably due to incomplete RV capture andlor to the deleterious effect of short AV delay. Instrumental AV node prolongation may he indicated in this situation. This procedure should be undertaken when previous drug-induced AV prolongation has failed. In theory, AV node modulation (i.e., creating a I ± AV block) seems ideal. However, this technique remains difficult, with disappointing chronic results. Most authors hence perform “conventional” AV node ablation. Particular attention is taken in order to perform a proximal node ablation, resulting in a complete AV block with narrow QRS escape rhythm. The reported incidence of AV node prolongation ranges from 7.5%-37.5%. The efficacy of the procedure on symptoms is explained by improved left ventricular filling and/or a further reduction in the systolic gradient evoked by complete RV capture. Another indication for AV node ablation in HOCM is the occurrence of atrial fibrillation, in order to restore adequate and permanent RV capture.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1996.tb00640.x
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  • 7
    Electronic Resource
    Electronic Resource
    History of Pacing in Hypertrophic Cardiomyopathy (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 9 (1996), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The history of pacing in hypertrophic obstructive cardiomyopathy (HOCM) begins in 1964 and ends in the early 1990s when several well-documented articles confirmed that pacing the apex of the right ventricle could be considered as an effective primary therapy of severe, drug resistant HOCM. The first pacemaker implantation was reported in a patient with HOCM who developed a complete AV block. The efficacy of right ventricular (RV) pacing on the gradient was enhanced, but the concept of pacing in the absence of conduction abnormalities was not suggested. In 1967, Hassenstein was the first to demonstrate that right apex ventricular pacing in HOCM with intact AV conduction induced gradient reduction. He subsequently performed the first hemodynamic implantation several years later. The largest series confirming the undoubted efficacy of pacing in HOCM were reported by Jeanrenaud in Switzerland and Fananapazir in the USA in the early 1990s.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1996.tb00636.x
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  • 8
    Electronic Resource
    Electronic Resource
    Philippe Coumel, M.D. (2004)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2004.04452.x
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  • 9
    Electronic Resource
    Electronic Resource
    Safety and Efficacy of a Dual Chamber Implantable Cardioverter Defibrillator Capable of Slow Ventricular Tachycardia Discrimination: (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: New developments in dual chamber implantable cardioverter defibrillators (ICD) have increased the specificity of therapy delivery. This study was performed to examine the performance of an algorithm, focusing on its ability to distinguish slow ventricular tachycardia (VT) from sinus rhythm or supraventricular tachyarrhythmias. The patient population included 77 men and 13 women, 63 ± 11 years old, treated with ICDs after episodes of spontaneous or inducible ventricular tachyarrhythmias. They were randomized to programming of the ICD to a lower limit of VT detection at 128 beats/min (group I, n = 44), versus 153 beats/min II (group II, n = 46). The primary endpoint of the study consisted of comparing the specificity and sensitivity of the algorithm between the two groups of patients. Over a 10.1 ± 3.5 months follow-up, 325 episodes were detected in the Tachy zone in group I, versus 106 in group II. The sensitivity and specificity of the algorithm in group I were 98.8% and 94.4%, respectively, versus 100% and 89% in group II (NS). A single episode of VT at a rate of 132 beats/min was diagnosed as SVT in group I. The sensitivity and specificity of the algorithm for tachycardias 〈153 beats/min were 97.4% and 94.5%, respectively. Overall VT therapy efficacy was 100% in both groups. The performance of this algorithm in the slow VT zone supports the programming of a long Tachy detection interval to document slow events, and allows to treat slow VT, if necessary, without significant risk of inappropriate interventions for sinus tachycardia. (PACE 2003; 26:2275–2282)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2003.00359.x
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  • 10
    Electronic Resource
    Electronic Resource
    Reproducibility of Bipolar Endocavitary Electrogram Measurements at sites of Radiofrequency Energy Delivery in Patients with the Wolff-Parkinson-White Syndrome (1998)
    Springer
    Journal of interventional cardiac electrophysiology 2 (1998), S. 377-381 
    Details
    ISSN: 1572-8595
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Radiofrequency ablation of atrioventricular accessory pathway is widely used to cure patients with the Wolff-Parkinson-White syndrome. The site of successful ablation is determined using electrophysiological parameters, endocavitary bipolar electrogram measurements being the most commonly used. Interobserver reproducibility of these measurements may limit the reliability of ablation criteria based upon bipolar measurements only but, to our knowledge, this reproducibility has not been evaluated so far. Such was the aim of this study. Methods: Three independent observers reviewed the bipolar electrograms recorded at sites were radiofrequency energy was delivered (successfully or not) in 28 consecutive patients with the Wolff-Parkinson-White syndrome. In each tracing, 4 intervals were measured: (1) A0V 0 (onset of the atrial electrogram to onset of the ventricular electrogram), (2) A aV a (activation time of the atrial electrogram to activation time of the ventricular electrogram), (3) V 0-QRS (onset of the ventricular electrogram to onset of delta wave on the surface ECG) and (4) V a-QRS (activation time of the ventricular electrogram to onset of delta wave on the surface ECG). Results: The interobserver reproducibility was low since only 50% of A 0V 0 intervals were measured with an interobserver difference lower than 10ms and up to 43% of V a-QRS intervals were measured with an interobserver difference greater than 30ms. The reproducibility of interval measurement was graded from the highest to the lowest as follows: A 0V 0, A aV a, V 0-QRS and V a-QRS (Chi-square statistic, χ 2 = 71.72, p 〈 0.0001). Kappa values were lower than 0.40, indicating a poor interobserver reproducibility. Conclusions: Our study suggests that interobserver reproducibility of only bipolar electrograms interval measurements at sites of radiofrequency ablation of atrioventricular accessory pathway is poor, which limits the reliability of bipolar criteria to predict a successful ablation site.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009772923689
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