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  • 1
    Electronic Resource
    Electronic Resource
    Entrainment of Typical AV Nodal Reentrant Tachycardia Using Para-Hisian Pacing: (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: Lower Common Pathway Within the AV Node. Introduction: Despite the ability to cure atrioventricular nodal reentrant tachycardia (AVNRT) by radiofrequency catheter ablation with a high success rate, the exact localization of the tachycardia circuit is still not well established. The presence of AV nodal tissue between the typical AVNRT circuit and the His bundle, constituting a lower common pathway (LCP), remains controversial. Methods and Results: Entrainment of AVNRT during para-Hisian stimulation allows accurate measurement of the His- to- atrial (HA) interval which is part of the same circuit as that of the tachycardia. With an LCP, during tachycardia, there is simultaneous conduction from the low turnaround of the circuit to the atrium (via the fast pathway) and to the His bundle (via the LCP). However, during entrainment by para-Hisian pacing, the impulse bas to retrogradely depolarize sequentially the LCP and the fast pathway. Therefore, in the presence of an LCP, the HA interval duration during tachycardia (HAt) should be shorter than that of during entrainment by para-Hisian stimulation (HAe). We considered an LCP present when Hae - HAt was ≥ 10 msec. Entrainment of typical AVNRT with para-Hisian stimulation was performed in 23 consecutive patients (21 females) with a mean age of 45 ± 17 years. LCP was considered to be present in 18 of 23 patients (78%). In addition, transient His-bundle dissociation from the ongoing tachycardia occurred in seven patients (30%). Conclusion: These results support the presence of a LCP during typical AVNRT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1999.tb00242.x
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  • 2
    Electronic Resource
    Electronic Resource
    Catheter Ablation for the Common Type of Atrial Flutter: Where Do We Stand? (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: Atrial flutter is a reentrant tachycardia that originates in the right atrium. The wave front of atrial flutter travels craniocaudally along the anterolateral wall of the right atrium, surrounds the inferior vena cava, and crosses the region between this structure and the tricuspid ring before closing the. circuit after upward septal propagation. The area located between the tricuspid annulus and the inferior vena cava has been proposed as an ideal target for ablation because it appears to be an isthmus that is an obligatory route for closing the inferior part of the arrhythmia circuit. Various publications dealing with radiofrequency ablation of this tachycardia have dealt with different approaches, and a wide range of acute and chronic success rates have been reported. The main difficulty in interpreting the results of this series is the lack of a carefully defined patient selection, technique description, and follow-up protocol. In almost all of these series it clearly appears that a significant number of late flutter recurrences occur in these patients, in addition to the emergence of previously unknown atrial fibrillation. Many recent reports, where ablation has been targeted at the inferior vena cava-tricuspid annulus isthmus, have shown a high rate of acute, success. In our experience, the procedure seems to be facilitated by the use of extra large tip (8-mm) ablation catheters that allow the use of higher power outputs. Careful mapping of the ablation site has shown that creation of complete bidirectional block at the isthmus is important for prevention of late recurrences. Further technological improvements should aim at developing energy delivery systems that allow controlled destruction of wide areas of the atrial myocardium. (J Interven Cardiol 1996;9:35–44)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1996.tb00593.x
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  • 3
    Electronic Resource
    Electronic Resource
    Value of Automatic Processing and Reliability of Stored Data in an Implanted Pacemaker: Initial Results in 59 Patients (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 20 (1997), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Stored data in implantable pacemakers have rarely been used as a diagnostic tool because of the complexity. Our group bas developed software called AIDA, providing an automatic interpretation of data stored in memories of the Chorus (ELA medical) pacemaker. We com pared the results of AIDA analysis to surface ECG Holter interpretation in 59 patients (age 75 ± 9 years). In 33 cases, neither AIDA nor the Holter found any anomaly. Eleven patients demonstrated episodes of supraventricular tachycardia (SVT), confirmed by AIDA in ten patients; AIDA failure was due to nonsustained episodes of SVT not inducing mode switch. Loss of atrial sensing, pacemaker-mediated tachycar dia, and ventricular extrasystoles were detected by AIDA in ten patients. Traditional Holter missed three cases. This initial study confirms that stored pacemaker data, automatically interpreted can provide reli able information over a 24-hour period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1997.tb05457.x
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  • 4
    Electronic Resource
    Electronic Resource
    Electrocardiographic Patterns and Results of Radiofrequency Catheter Ablation of Clockwise Type I Atrial Flutter (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: Clockwise Rotation of Atrial Flutter. Introduction: Counterclockwise right atrial propagation is usually observed in common atrial flutter, but little is known regarding flutter with clockwise right atrial rotation. The aim of this study is to describe the ECG characteristics and results of catheter ablation of atrial flutter with clockwise right atrial rotation. Methods and Results: Among the 38 patients with type I atrial flutter in this study population, right atrial impulse propagation was counterclockwise in 20 and clockwise in 8. In the remaining 10 patients, both clockwise and counterclockwise patterns were seen. Clinical and ECG parameters associated with clockwise flutter were compared to those of 28 cases of counterclockwise atrial flutter. Ablation was performed in 11 of 18 cases using a technique identical to that used for counterclockwise flutter. A classical “sawtooth” pattern of the flutter wave was observed in 28 of 28 counterclockwise and 14 of 18 clockwise flutter. A shorter plateau phase, a widening of the negative component of the F wave in the inferior leads, and a negative F wave in V1 were the most consistent findings in clockwise flutter. Coronary sinus recording always showed septal to lateral left atrial impulse propagation. Ablation was successful in 11 of 11 cases of clockwise flutter in whom this procedure was performed, with 9.5 ± 11.6 radiofrequency pulses delivered between the tricuspid valve and the coronary sinus ostium (n = 5) or the inferior vena cava (n = 5), and in the proximal coronary sinus (n = 1). After a follow-up of 46.6 weeks, two recurrences of clockwise flutter were encountered, which were successfully treated with a second session. Conclusion: Contrary to commonly accepted concepts, clockwise rotation of atrial flutter Ls not an infrequent phenomenon and can mimic counterclockwise rotation. It can also be successfully ablated by radiofrequency pulses.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1996.tb00467.x
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  • 5
    Electronic Resource
    Electronic Resource
    Electrophysiology of the Atrio-AV Nodal Inputs and Exits in the Normal Dog Heart (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 8 (1997), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ablation of Atrionodal Connections. Introduction: We studied the effects of selective and combined ablation of the fast (FP) and slow pathway (SP) on AV and VA conduction in the normal dog heart using a novel epicardial ablation technique. Methods and Results: For FP ablation, radiofrequency current (RFC) was applied to a catheter tip that was held epicardially against the base of the right atrial wall. SP ablation was performed epicardially at the crux of the heart. Twenty-three dogs were assigned to two ablation protocols: FP/SP ablation group (n = 17) and SP/FP ablation group (n = 6). In 12 of 17 dogs, FP ablation prolonged the PR interval (97 ± 10 to 149 ± 22 msec. P 〈 0.005) with no significant change in anterograde Wenckebach cycle length (WBCL), Subsequent SP ablation performed in 8 dogs further prolonged tbe PR interval and the anterograde WBCL (117 ± 22 to 193 ± 27, P 〈 O.(M)5). Complete AV block was seen in I of 8 dogs, whereas complete or high-grade VA block was seen in 6 of 8 dogs. In the SP/FP ablation group, SP ablation significantly increased WBCL with no PR changes. Combined SP/FP ablation in A dogs prolonged the PR interval significantly, but no instance of complete AV block was seen. VA block was found in 50% of these cases. Histologic studies revealed that RFC ablation affected the anterior and posterior atrium adjacent to the undamaged AV node and His bundle. Conclusion: Using an epicardial approach, combined ablation of tbe FP and SP AV nodal inputs can be achieved with an unexpectedly low incidence of complete A V block, although retrograde VA conduction was significantly compromised.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1997.tb00852.x
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  • 6
    Electronic Resource
    Electronic Resource
    Entrainment of Supraventricular Tachycardias: A Review (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
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb01131.x
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  • 7
    Electronic Resource
    Electronic Resource
    Inferior Vena Cava-Tricuspid Annulus Isthmus is a Critical Site of Unidirectional Block During the Induction of Common Atrial Flutter (1997)
    Springer
    Journal of interventional cardiac electrophysiology 2 (1997), S. 57-69 
    Details
    ISSN: 1572-8595
    Keywords: atrial flutter ; electrophysiology ; catheter ablation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Until recently no clinical studies had reported precise right atrium (RA) mapping when performing induction of atrial flutter (AFI). We studied the mode of tachycardia initiation in 16 patients (pts) referred for radiofrequency (RF) AFl ablation. AFl induction was performed at the beginning of the procedure (n = 10), or after previous AFl termination during RF delivery (n = 6). Detailed analysis of AFl initiation was provided by duodecapolar (Halo) and multipolar catheters positioned in the peritricuspidian region at the lateral right atrial wall (LRA), the inferior vena cavatricuspid annulus (IVC-TA) isthmus and the interatrial septum. Induction was obtained during incremental pacing (IAP) (15 pts) or programmed stimulation (1 pt) from the proximal coronary sinus (PCS). Results: Atrial flutter with counterclockwise (CCW) RA rotation was induced in all pts by PCS pacing. During PCS IAP, at long pacing cycle lengths, impulse propagated in a clockwise (CW) direction through the IVC-TA isthmus and then upward at low (L) LRA. This led to a collision at the mid LRA with another wave front propagating in a CCW direction at the septum. IAP from PCS induced a progressive delay of propagation at the IVC-TA isthmus resulting in a prolongation of the PCS-Mid Isthmus interval from 85±29 to 151±42 msec. At same pacing cycle lengths (CL), the PCS-HLRA interval was comparatively less prolonged, from 75±12 to 105±18 msec, p = 0.0007. This preferential slowing of conduction between PCS and mid isthmus, during IAP from PCS, was associated with a displacement of the zone of collision to the Low LRA. Finally a CW functional block occurred at the IVC-TA isthmus and CCW AFl was induced through a period of transient concealed entrainment. The paced CL required to initiate flutter ranged from 290 to 180 msec and the mean CL of induced atrial flutter was 254±27 msec. Conclusions: The IVC-TA isthmus has decremental properties and exhibits wenckebach phenomenon during incremental PCS pacing. Initiation of a counterclockwise flutter by PCS pacing is associated with appearance of a functional unidirectional block at the IVC-TA isthmus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009768924691
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