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  • 1
    Electronic Resource
    Electronic Resource
    Can Catheter Ablation in Cardiac Arrest Survivors Prevent Ventricular Fibrillation Recurrence? (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: Ventricular tachyarrhythmias are the most common cause for sudden cardiac death. The success of catheter ablation for supraventricular tachycardias led to the supposition that ablation could also be used in the treatment of ventricular tachycardias. Despite the promising results in bundle branch reentry and some forms of idiopathic ventricular tachycardia, the success rate in patients with coronary artery disease is still low. There is hope that new approaches to reliably localize the critical region of the tachycardia and new ablation techniques to create larger areas of injury may lead to a wider application of ablation therapy in the treatment of ventricular tachycardia. Survivors of cardiac arrest typically have more rapid and unstable arrhythmias than patients with sustained ventricular tachycardia, and these rapid arrhythmias frequently degenerate into ventricular fibrillation. The instability of the arrhythmia makes it impossible to localize the arrhythmia origin with current mapping techniques. Experimental and clinical data, however, suggest that these arrhythmias also frequently start from a localized area of electrical activation. With developments in mapping techniques and energy delivery, catheter ablation may soon become a feasible therapeutic approach in some patients with unstable arrhythmias. The article discusses the prerequisites for this approach and suggests the patients who may be appropriate candidates for this technique.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1997.tb03575.x
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  • 2
    Electronic Resource
    Electronic Resource
    Clinical Efficacy of a Wearable Defibrillator in Acutely Terminating Episodes of Ventricular Fibrillation Using Biphasic Shocks (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : 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: The Wearable Cardioverter Defibrillator (WCD) automatically detects and treats ventricular tachyarrhythmias without the need for assistance from a bystander, while at the same time allowing the patient to ambulate freely. It represents an alternative to emergency medical services for outpatient populations with a temporary risk of sudden cardiac death. While the original devices used a monophasic truncated exponential waveform for cardioversion/defibrillation shocks, a new, biphasic shock was developed for the next device generation. In 12 patients undergoing electrophysiological testing for ventricular tachyarrhythmias, termination of electrically induced ventricular fibrillation (VF) was attempted via the WCD. In 22 episodes, induced VF was promptly terminated by the first 70 J (n = 12) or 100 J (n = 10) biphasic shocks. Time between arrhythmia initiation and shock delivery was 22 ± 6 seconds (70 J) and 21 ± 6 seconds (100 J) (P = NS). The measured transthoracic impedance was 71 ± 5 Ω (64–79 Ω) for the 70 J shock and 64 ± 8 Ω (47–72 Ω) for the 100 J shock. The present study demonstrates that a single low energy biphasic shock delivered by the WCD, reliably terminates electrically induced VF (100% of episodes). The results of this study suggest that there is an acceptable safety margin to the maximum output of the device (150 J). Despite our promising data, we recommend that programming all shocks for maximum energy output should be done when using the WCD in ambulatory patients. (PACE 2003; 26:2016–2022)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00311.x
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  • 3
    Electronic Resource
    Electronic Resource
    Inducibility of Sustained Ventricular Tachycardia in a Closed-Chest Ovine Model of Myocardial Infarction (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: The two goals of this study were (1) to develop a closed-chest animal model of monomorphic ventricular tachycardia; and (2) to investigate the effect of dual site pacing on inducibility of ventricular tachycardia. In the first part of the study, 10 of 14 sheep underwent successful induction of myocardial infarction by temporary balloon occlusion of the left anterior descending coronary artery. After a follow-up period of 21–43 days, sustained monomorphic ventricular tachycardia could be induced during programmed electrical stimulation using a “clinical” stimulation protocol in 8 of the 10 sheep. The number of ventricular tachycardia episodes per animal varied between 5 and 70. Ventricular fibrillation was never induced during programmed electrical stimulation. Ventricular tachycardia episodes lasted from 30 seconds up to 15 minutes and were terminated by antitachycardia pacing or DC cardioversion. In the second part of the study, the effect of dual site stimulation on ventricular tachycardia inducibility was investigated. High current stimuli from an area within the infarcted zone were given with the S1 programmed stimulation protocol. This dual site stimulation showed no effect on ventricular tachycardia induction during programmed electrical stimulation. This animal model shows a high induction rate of sustained monomorphic ventricular tachycardia in the chronic phase of myocardial infarction. The high incidence of ventricular tachycardia inducibility provides a reliable tool to study new techniques for the prevention of ventricular tachyarrhythmias.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1999.tb00502.x
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  • 4
    Electronic Resource
    Electronic Resource
    Feasibility of Catheter Cryoablation in Normal Ventricular Myocardium and Healed Myocardial Infarction (2004)
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 27 (2004), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Although novel cryoablation systems have recently been introduced into clinical practice for catheter ablation of supraventricular tachycardia, the feasibility of catheter cryoablation of VT is unknown. Thus, the present study evaluates catheter cryoablation of the ventricular myocardium (1) in healthy sheep and (2) of VT in chronic myocardial infarction (MI). In three healthy sheep, 21 ventricular lesions (12 left and 9 right ventricle) were created with a catheter cryoablation system. Different freeze/thaw characteristics were used for lesion creation. The mean nadir temperature was -84.1°C ± 0.9°C, mean lesion volume was 175.8 ± 170.3 mm3, and 5 of 21 lesions were transmural. Lesion dimensions were 7.5 ± 3.1 mm (width) and 4.2 ± 2.5 mm (depth). Left ventricular lesions were significantly larger than right ventricular lesions (262 ± 166 vs 60.5 ± 91.6 mm3, P = 0.0025). There was no difference in lesion volume with respect to different freeze/thaw characteristics. Anatomically (n = 3) or electrophysiologically (n = 3) guided catheter cryoablation was attempted in six sheep 105 ± 56 days after MI, three of six animals had reproducibly inducible VT with a mean cycle length of 215 ± 34 ms prior to ablation. In these animals, five VTs were targeted for ablation. A mean of 6 ± 3 applications for nine left ventricular lesions were applied, six of nine lesions were transmural. The mean lesion volume was 501 ± 424 mm3. No VT was inducible in two of three animals after cryoablation using an identical stimulation protocol. Therefore, catheter cryoablation of VT in healed MI is feasible, and no acute complications were observed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2004.00672.x
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  • 5
    Electronic Resource
    Electronic Resource
    Noncontact Mapping of Ventricular Tachycardia in a Closed-Chest Animal Model of Chronic Myocardial Infarction (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: Treatment of ventricular tachyarrhythmias in the setting of chronic myocardial infarction requires accurate characterization of the arrhythmia substrate. New mapping technologies have been developed that facilitate identification and ablation of critical areas even in rapid, hemodynamically unstable ventricular tachycardia. A noncontact mapping system was used to analyze induced ventricular tachycardia in a closed-chest sheep model of chronic myocardial infarction. Twelve sheep were studied 96 ± 10 days after experimental myocardial infarction. During programmed stimulation, 15 different ventricular tachycardias were induced in nine animals. Induced ventricular tachycardia had a mean cycle length of 190 ± 30 ms. In 12 ventricular tachycardias, earliest endocardial activity was recorded from virtual electrodes, preceding the surface QRS onset by 30 ± 7 ms. Noncontact mapping identified diastolic activity in ten ventricular tachycardias. Diastolic potentials were recorded over a variable zone, spanning more than 30 mm. Timing of diastolic potentials varied from early to late diastole and could be traced back to the endocardial exit site. Entrainment with overdrive pacing was attempted in nine ventricular tachycardias, with concealed entrainment observed in seven. Abnormal endocardium in the area of chronic myocardial infarction identified by unipolar peak voltage mapping was confirmed by magnetic resonance imaging. These data suggest that induced ventricular tachycardia in the late phase of myocardial infarction in the sheep model is due to macroreentry involving the infarct borderzone. The combination of this animal model with noncontact mapping technology will allow testing of new strategies to cure and prevent ventricular tachycardia in the setting of chronic myocardial infarction. (PACE 2003; 26:2253–2263)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2003.00356.x
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  • 6
    Electronic Resource
    Electronic Resource
    Changes in AV Node Conduction Curves Following Slow Pathway Modification (2000)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: GELLER, J.C., et al.: Changes in AV Node Conduction Curves Following Slow Pathway Modification. Dual AV node physiology often persists after successful slow pathway (SP) ablation, and the mechanism of tachycardia elimination is unresolved. Therefore, AV node conduction curves were analyzed following successful ablation (4 ± 1 energy applications) in 85 consecutive patients (58 women, age 50 ± 2 years) with typical AVNRT. Twenty-seven patients (32%) had complete elimination (group 1) whereas 58 (68%) patients had persistence (group 2) of dual AV node physiology. A significant increase in the AV node Wenckebach cycle length (WB-CL) was observed in both groups (310 ± 9 to 351 ± 15 ms in group 1, and 325 ± 8 to 369 ± 9 ms in group 2, P 〈 0.05). A decrease in the fast pathway (FP) ERP (339 ± 15 to 279 ± 12 ms) and an increase in the maximum FP AH interval (141 ± 5 to 171 ± 7) were observed only in group 1 (P 〈 0.05). In group 2, no change in the SP ERP (267 ± 7 to 280 ± 10 ms) was observed, and the change in the maximum SP-AH following ablation showed a significant inverse relation to the maximum SP-AH at baseline in group 2. In conclusion, (1) an increase in the WB-CL is observed independent of the persistence or elimination of dual physiology after successful ablation; (2) when dual physiology is eliminated, significant changes in the FP ERP and the maximum FP-AH occur; (3) when dual physiology persists, FP physiology and the SP ERP remain unchanged, and a significant inverse relation between the change in the maximum SP-AH following ablation and the maximum baseline SP-AH is observed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2000.01651.x
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  • 7
    Electronic Resource
    Electronic Resource
    A Randomized Prospective Study of Single Coil Versus Dual Coil Defibrillation in Patients with Ventricular Arrhythmias Undergoing Implantable Cardioverter Defibrillator Therapy (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : 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: ICD implantation is standard therapy for malignant ventricular arrhythmias. The advantage of dual and single coil defibrillator leads in the successful conversion of arrhythmias is unclear. This study compared the effectiveness of dual versus single coil defibrillation leads. The study was a prospective, multicenter, randomized study comparing a dual with a single coil defibrillation system as part of an ICD using an active pectoral electrode. Seventy-six patients (64 men, 12 women; age 61 ± 11 years ) were implanted with a dual (group 1, n = 38) or single coil lead system (group 2, n = 38 ). The patients represented a typical ICD cohort: 60% presented with ischemic cardiomyopathy as their primary cardiac disease, the mean left ventricular ejection fraction was 0.406 ± 0.158 . The primary tachyarrhythmia was monomorphic ventricular tachyarrhythmia in 52.6% patients and ventricular fibrillation in 38.4%. There was no significant difference in terms of P and R wave amplitudes, pacing thresholds, and lead impedance at implantation and follow-up in the two groups. There was similarly no difference in terms of defibrillation thresholds (DFT) at implantation. Patients in group 1 had an average DFT of 10.2 ± 5.2 J compared to 10.3 ± 4.1 J in Group 2, P = NS. This study demonstrates no significant advantage of a dual coil lead system over a single coil system in terms of lead values and defibrillation thresholds. This may have important bearing on the choice of lead systems when implanting ICDs. (PACE 2003; 26:1684–1690)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.t01-1-00253.x
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  • 8
    Electronic Resource
    Electronic Resource
    Catheter Ablation of Ventricular Tachycardia by Intramyocardial Injection of Ethanol in an Animal Model of Chronic Myocardial Infarction (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
    Notes: Introduction: Direct injection of ethanol into myocardium has been shown to create large, well-demarcated lesions with transmural necrosis in normal ventricular myocardium and in regions of healed myocardial infarction. The aim of this study was to investigate the effects of direct ethanol injection on the inducibility of ventricular tachycardia (VT) in an animal model of chronic myocardial infarction. Methods and Results: Eight sheep with reproducibly inducible VT underwent an electrophysiologic study 139 ± 65 days after myocardial infarction. Noncontact mapping was used to analyze induced VT. Fifteen different VTs were targeted for catheter ablation. Ablation was achieved by catheter-based intramyocardial injection of a mixture of 96% ethanol, glycerine, and iopromide (ratio 3:1:1). Direct intramyocardial ethanol injection resulted in noninducibility of any VT 20 minutes after ablation in 7 of 8 animals. Four of 5 animals with initially successful ablation remained noninducible for any VT at follow-up study at least 2 days after the ablation procedure. Microscopic examination revealed homogeneous lesions with interstitial edema, intramural hemorrhage, and myofibrillar degeneration at the lesion border. The lesions were well demarcated from the surrounding tissue by a border zone of neutrophilic infiltration. Conclusion: Catheter ablation of VT by direct intramyocardial injection of ethanol during the chronic phase of myocardial infarction is feasible. It may be a useful tool for catheter ablation when the area of interest is located deep intramyocardially or subepicardially or when a more regional approach requires ablation of larger amounts of tissue. (J Cardiovasc Electrophysiol, Vol. 15, pp. 332-341, March 2004)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.03409.x
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  • 9
    Electronic Resource
    Electronic Resource
    Acute Results of Transvenous Cryoablation of Supraventricular Tachycardia (Atrial Fibrillation, Atrial Flutter, Wolff-Parkinson-White Syndrome, Atrioventricular Nodal Reentry Tachycardia) (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: Transvenous Cryoablation for SVT. Introduction: Radiofrequency (RF) catheter ablation currently is used for treatment of cardiac arrhythmias. Although the success rate is high for almost all supraventricular tachycardias (SVT), this technique has some drawbacks, especially when pulmonary veins (PV) are targeted for treatment of atrial fibrillation (AF). Additionally, new techniques for isolation of the PVs have the drawback that they can be used only for PV isolation and not for routine treatment of other SVTs. The aim of this study was to report on the safety and efficacy of a new cryoablation system for treatment of all SVTs. Methods and Results: Forty-nine patients with SVT (38 men; age 48 years, range 23–76) were enrolled in the study. Five patients were withdrawn from the study before they underwent cryoablation. The remaining 44 patients were treated with cryoablation (22 AF, 15 atrial flutter, 3 accessory pathway, 2 AV nodal reentrant tachycardia, 1 AV junction ablation for permanent AF, 1 atrial tachycardia). Cryoablation was performed with the CryoCorTM cryoablation system, which uses a precooling system and N2O as a refrigerant. The number of freezes applied varied according to the index arrhythmia treated. Successful isolation of PVs was performed in 20 of (96%) 21 AF patients and 53 of 55 veins. The overall acute success was 98% (43/44). Fifty-three PVs were isolated (2.5/patient). The success rate was 100% (23/23) for right-sided procedures. The average and nadir temperatures reached in right-sided and left-sided procedures were −77°C and −80°C and −75°C and −78°C, respectively. No acute PV stenosis was seen. Conclusion: This novel cryoablation system appears to be safe and can successfully treat different types of SVTs, including AF. Isolation of PVs is possible without producing stenosis. Despite the high blood flow in the right atrial isthmus and PVs, bidirectional conduction block can be achieved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2002.01082.x
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  • 10
    Electronic Resource
    Electronic Resource
    Spontaneous Episode of Polymorphic Ventricular Tachycardia in a Patient with Intermittent Brugada Syndrome (2001)
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 12 (2001), 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.1540-8167.2001.01094.x
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