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  • 1
    Electronic Resource
    Electronic Resource
    Left Mitral Isthmus Ablation Associated with PV Isolation: Long-Term Results of a Prospective Randomized Study (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: Background: The deployment of an ablation line connecting the left inferior PV to the mitral annulus (mitral isthmus line [MIL]) enhances the efficacy of pulmonary vein disconnection (PVD) in preventing atrial fibrillation (AF) recurrences. Objectives: To investigate the long-term effect of the additional linear lesion in a prospective randomized study. Methods: One hundred and eighty-seven patients (37 females, mean age: 55 ± 11 years) with paroxysmal (126) or persistent (61 patients) AF, were prospectively randomized into two groups: PVD (group A, 92 patients) or PVD combined with MIL (group B, 95 patients), performed by means of an irrigated-tip ablation catheter. Results: Successful disconnection of all PVs was achieved in all patients. A bidirectional block (BB) along the left atrial isthmus was obtained in 72 of 95 (76%) patients in group B, most of whom required additional RF pulses from within the distal CS. A transient ischemic attack occurred in 1 patient of group A, and a cardiac tamponade occurred in 1 patient of group B. At 1 year, 53 ± 5% (group A) and 71 ± 5% (group B) remained arrhythmia free (P = 0.01); subgroup analysis highlights a higher improvement among patients with persistent AF (74 ± 9% vs 36 ± 9%; P 〈 0.01) than what was observed in paroxysmal AF (76 ± 6% vs 62 ± 6%; P 〈 0.05); antiarrhythmic drugs were continued in 56% and 50%, respectively, in groups A and B (P = ns). Conclusions: The addition of mitral isthmus line to the PV disconnection allows a significant improvement of sinus rhythm maintenance rate, particularly in patients with persistent AF, without the risk for major complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.50192.x
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  • 2
    Electronic Resource
    Electronic Resource
    Catheter Ablation of Ventricular Tachycardia in Remote Myocardial Infarction: (2003)
    350 Main Street , Malden , MA 02148-5018 , 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
    Notes: Introduction: The aim of this study was to describe the arrhythmogenic substrate in postinfarction patients with ventricular tachycardia (VT) guiding the placement of individual strategic linear lesions transecting all potential isthmuses using target area maps with limited mapping points to allow short procedure times. Methods and Results: In 28 patients with pleomorphic, unstable, and/or incessant VT, electroanatomic voltage mapping was performed in conjunction with limited sinus rhythm mapping, pace mapping, and activation mapping. Radiofrequency (RF) energy was applied directly within the low-voltage areas of the chronically infarcted areas or in the border zone. Ablation lines typically were perpendicular to the course of the presumed central common pathways. The maps consisted of 63 ± 30 mapping points. An average lesion line length of 46 ± 21 mm was placed with 17 ± 7 RF pulses. Twenty-two (79%) of the 28 patients were rendered completely noninducible at the end of the procedure. Procedure time measured 134 ± 41 minutes. No major complications were observed. Six (27%) of 22 patients who were rendered completely noninducible experienced VT recurrence during follow-up versus 4 (67%) of 6 patients who were still inducible after ablation (P = 0.06). Conclusion: Individually tailored substrate description guiding the placement of linear lesion lines transecting potential isthmuses rendered 80% of the patients completely noninducible. The construction of regional target area maps allowed short procedure times, with a resulting low incidence of complications in these critically ill patients. (J Cardiovasc Electrophysiol, Vol. 14, pp. 675-681, July 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.02541.x
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  • 3
    Electronic Resource
    Electronic Resource
    Spatial and Temporal Heterogeneity of Depolarization and Repolarization May Complicate Implantable Cardioverter Defibrillator Therapy in Brugada Syndrome (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 11 (2000), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: ICD Therapy in Brugada Syndrome. Introduction: Dynamic variations in electrophysiologic phenomena inherent to the Brugada syndrome may complicate therapy with implantable cardioverter defibrillators (ICDs). Methods and Results: Between 1997 and 1999, 3 of 7 patients with Brugada syndrome (1 man and 2 women, mean age 42 years) received an ICD. During follow-up, 2 patients experienced multiple inappropriate shocks. Simultaneously with dynamic changes in the surface ECG, endocardial ECGs revealed a dynamic decrease in the right ventricular R wave and an increase in the corresponding T wave, resulting in T wave oversensing. With ajmaline administration, these dynamic changes in endocardial signals were reproducible at different right ventricular sites, whereas left ventricular epicardial signals remained stable. Incremental AAI pacing and exercise stress testing resulted in similar changes in right ventricular endocardial signals, but normalization of the surface ECG apart from progressively increasing S waves in leads II, V5, and V6. Orciprenaline administration had no effect on ECG phenomena. After implantation of a left ventricular epicardial lead for sensing and pacing, no inappropriate tachycardia detection recurred. Conclusion: These findings demonstrate that, in Brugada syndrome, spontaneous or ajmaline-induced changes in the surface ECG may be paralleled by significant variations in the right ventricular endocardial electrogram that may result in ICD malfunction. Implantation of a left ventricular epicardial lead for sensing and pacing may be the ultimate successful approach in certain patients. To assure proper ICD function, ajmaline testing during ICD implantation appears to be helpful.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2000.tb00004.x
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  • 4
    Electronic Resource
    Electronic Resource
    Persistence of Single Echo Beat Inducibility After Selective Ablation of the Slow Pathway in Patients with Atrioventricular Nodal Reentrant Tachycardia: (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: Residual Slow Pathway Conduction Effects on AVN Function. Introduction: Residual slow pathway conduction with or without reentrant echo beats has been reported in 25% to 30% of patients undergoing ablation for AV nodal reentrant tachycardia (AVNRT). Methods and Results: Fifty-eight consecutive patients (aged 45 ± 12 years) with slow-fast AVNRT underwent radiofrequency catheter ablation of the slow AV nodal pathway (SP). Residual slow-fast echo beat was documented in 21 (36%) of 58 patients (group A). The pre-and postablation AH intervals triggering the echo beats were similar (346 ± 8 msec vs 352 ± 6 msec, P = NS), as were the pre-and postablation echo zones (55 ± 6 msec vs 52 ± 5 msec, P = NS) and functional refractory period of the SP. A consistent prolongation of the AV nodal effective refractory period (AVN-ERP; from 265 ± 28 msec to 340 ± 50 msec, P 〈 0.001) and the Wenckebach cycle length (WBCL; from 298 ± 41 msec to 438 ± 43 msec, P 〈 0.001) was observed in all patients with abolition of SP conduction (group B). In group A patients, the prolongation of WBCL was less (285 ± 33 msec preablation, and 334 ± 41 msec postablation, P 〈 0.001). Additional pulses abolished the residual echo in 16 of 21 patients, and further prolongation of the AVN-ERP and WBCL comparable to those found in patients without a residual echo beat was observed. During 19 ± 8 months follow-up, no patient had clinical recurrence of AVNRT. Conclusion: Residual single echo beat after SP ablation for AVNRT reflects the persistence of some portion of the SP with unchanged functional conduction properties whose prognostic significance is uncertain. A consistent increase of WBCL can be a reliable marker of complete abolition of slow pathway conduction and termination of AVNRT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1996.tb00576.x
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  • 5
    Electronic Resource
    Electronic Resource
    Modulation of the Atrioventricular Node Conduction to Achieve Rate Control in Patients with Atrial Fibrillation: Long-Term Results (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 22 (1999), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Modulation of the AV node reduces the ventricular rate during AF, without affecting AV conduction during sinus rhythm. Acute and long-term results of AV node modulation in 75 patients with AF and severe related symptoms of heart failure are presented in this study. The procedure involved, in all cases, the selective ablation of the posterior inputs to the AV node; in a subgroup of 15 patients with poor modification of AV conduction properties, a sequential approach involving subsequent anterior input ablation was performed. The procedure caused acutely a prolongation of the Wenckebach cycle length (38 patients in sinus rhythm) from 334 ± 88 to 470 ± 80 ms (P 〈 0.01), and a reduction of the average ventricular rate (37 patients in AF) from 154 ± 31 to 88 ± 40 beats/min (P 〈 0.01); permanent complete AV block was induced in 9 of 75 patients (12%). Considering the “sequential” approach, an increase of the Wenckebach cycle length from 362 ± 50 to 530 ± 45 ms (P 〈 0.01) and a reduction of the average heart rate in patients with AF from 158 ± 16 to 81 ± 20 beats/min (P 〈 0.01) was obtained in this subgroup of patients, in whom the AH interval prolonged from 93 ± 12 to 175 ± 27 ms, and no complete AV block was observed. At a mean follow-up of 23 ± 9 months (range 2–48), the mean number of hospital admissions per patient per year decreased from 4.2 to 0.2. Five of 49 patients with paroxysmal AF and 3 of 26 patients with chronic AF had high rate recurrences (1 〉 120 beats/min) that caused severe palpitations; these patients were considered as late clinical failures (8/75; 11%). All patients reported a substantial subjective improvement and an increased exercise tolerance, as documented by a semiquantitative questionnaire. There were no episodes of late AV block or sudden cardiac deaths. In conclusion, modulation of the AV node—either by slow pathway ablation, or by a “sequential” posterior and anterior approach in refractory patients—allows a long-term control of the ventricular rate and prevents the recurrence of severe clinical symptoms in more than 75% of patients with drug refractory AF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1999.tb00472.x
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