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  • 1
    Electronic Resource
    Electronic Resource
    Effect of Coronary Sinus Electrode on the Optimal Atrial Defibrillation Pathway for an Atrioventricular Defibrillator (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
    Notes: Atrial Defibrillation Pathway. Introduction: Previous studies have demonstrated significant failure in converting atrial fibrillation (AF) using a conventional ventricular pathway. The aim of this study was to assess the benefit of incorporating a coronary sinus (CS) lead into the atrial defibrillation pathway in atrial defibrillation threshold (ADFT) reduction in patients with persistent AF. Methods and Results: This study was a prospective, randomized assessment of shock configuration on ADFT in 18 patients undergoing elective internal cardioversion for persistent AF (mean AF duration: 8 ± 9 months). The lead system included a dual-coil defibrillation lead (Endotak DSP, Guidant) with a distal right ventricular (RV) electrode and a proximal superior vena cava (SVC) electrode, a CS lead (Perimeter, Guidant), and a left pectoral cutaneous electrode (Can). In each patient, dual step-up ADFTs were determined for each of three vectors: (1) RV → SVC+Can; (2) CS → SVC+Can; and (3) RV → CS+SVC+Can (group 1, n = 8) or RV+CS → SVC+Can (group 2, n = 10), using R wave-synchronized biphasic shocks. Successful defibrillation was achieved in all patients without any ventricular proarrhythmia. ADFT of CS → SVC+Can (11.8 ± 5.6 J) was significantly lower than ADFT of RV → SVC+Can (16.5 ± 7.8 J, P = 0.021) . ADFT of CS → SVC+Can was similar to RV → CS+SVC+Can (group 1:12.0 ± 6.5J vs17.4 ± 4.8 J, P = 0.16), but it was significantly higher than RV+CS → SVC+Can (group2: 9.0 ± 3.9J vs11.6 ± 5.0 J, P = 0.049). Conclusion: Patients with persistent AF of substantial duration can be reliably cardioverted using a conventional implantable cardioverter defibrillator (ICD) lead set; however, the incorporation of a CS lead to the conventional ICD lead configuration significantly lowered ADFT. The optimal shock vector that incorporates a CS lead for atrial defibrillation requires future studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.02354.x
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  • 2
    Electronic Resource
    Electronic Resource
    Catheter Ablation for Persistent Atrial Fibrillation: Are We Ready for “Prime Time”? (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
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.50573.x
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  • 3
    Electronic Resource
    Electronic Resource
    Adenosine Triphosphate Enhanced Contrast Pulmonary Venogram to Facilitate Pulmonary Vein Ablation (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
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2002.00300.x
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  • 4
    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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  • 5
    Electronic Resource
    Electronic Resource
    Effect of Gender on Atrial Electrophysiologic Changes Induced by Rapid Atrial Pacing and Elevation of Atrial Pressure (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
    Notes: Atrial Electrical Remodeling. Introduction: The incidence of atrial fibrillation is greater in men than in women, but the reasons for this gender difference are unclear. The purpose of this study was to evaluate the effects of gender on the atrial electrophysiologic effects of rapid atrial pacing and an increase in atrial pressure. Methods and Results: Right atrial pressure and effective refractory period (ERP) were measured during sinus rhythm and during atrial and simultaneous AV pacing at a cycle length of 300 msec in 10 premenopausal women, 11 postmenopausal women, and 24 men. The postmenopausal women were significantly older than the premenopausal women (61 ± 8 years vs 34 ± 10 years; P 〈 0.01). During sinus rhythm, mean atrial ERP in premenopausal women was shorter (211 ± 19 msec) than in postmenopausal women and age-matched men (242 ± 18 msec and 246 ± 34 msec, respectively; P 〈 0.05). Atrial ERPs in all patients shortened significantly during atrial and simultaneous AV pacing. However, the degree of shortening during atrial pacing (43 ± 8 msec vs 70 ± 20 msec and 74 ± 21 msec; P 〈 0.05) and during simultaneous AV pacing (48 ± 16 msec vs 91 ± 27 msec and 84 ± 26 msec; P 〈 0.05) was significantly less in premenopausal women than in postmenopausal women or age-matched men. Conclusion: The results of this study demonstrate a significant gender difference in atrial electrophysiologic changes in response to rapid atrial pacing and an increase in atrial pressure. The effect of menopause on the observed changes suggests that the gender differences may be mediated by the effects of estrogen on atrial electrophysiologic properties.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2001.00986.x
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  • 6
    Electronic Resource
    Electronic Resource
    Atrial Tachycardia Arising from an Epicardial Site with Venous Connection Between the Left Superior Pulmonary Vein and Superior Vena Cava (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
    Notes: We describe a case of atrial tachycardia originating from an epicardial site with a venous connection between the left superior pulmonary vein (LSPV) and superior vena cava (SVC). Initial endocardial mapping with multiple electrodes catheters demonstrated early endocardial activation at both the SVC and LSPV. However, radiofrequency applications at the SVC failed to terminate the atrial tachycardia. With three-dimensional electroanatomic mapping, the earliest endocardial activation was found to be in the left atrial appendage (LAA). However, radiofrequency energy applications at multiple sites in the LAA resulted in only transient termination of the tachycardia. A left atrial angiogram demonstrated a venous connection between the LSPV and SVC, overlying the LAA. An application of radiofrequency energy with a saline-irrigated ablation catheter delivered at the earliest activation site in the LAA terminated the tachycardia. The tachycardia did not recur during 18-month follow-up. (J Cardiovasc Electrophysiol, Vol. 14, pp. 540-543, May 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.02403.x
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  • 7
    Electronic Resource
    Electronic Resource
    Reply to the Editor: (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
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.t01-1-03242.x
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  • 8
    Electronic Resource
    Electronic Resource
    Area of Left Ventricular Regional Conduction Delay and Preserved Myocardium Predict Responses to Cardiac Resynchronization Therapy (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: A significant proportion of patients with dilated cardiomyopathy and left bundle branch block (LBBB) do not respond to cardiac resynchronization therapy (CRT). The purpose of this study was to investigate whether the electromechanical properties of the myocardium would predict acute hemodynamic improvement during left ventricular (LV) pacing. Methods and Results: We studied 10 patients with idiopathic dilated cardiomyopathy and LBBB (ejection fraction (EF): 27%± 7%; QRS duration: 166 ± 16 msec) using three-dimensional electromechanical endocardial mapping technique to assess endocardial activation time (Endo-AT), unipolar voltage, and local linear shortening during sinus rhythm. LV stimulation was performed in VDD mode at five different sites and three atrioventricular delays within the coronary sinus. LV + dP/dtmax changes from baseline were measured during LV stimulation at each site (%ΔdP/dtmax). There was no significant relationship between maximum %ΔdP/dtmax during LV stimulation at the best coronary sinus site and LV EF, baseline LV + dP/dtmax, total LV Endo-AT, baseline QRS duration nor changes in QRS duration during LV pacing. However, the maximum %ΔdP/dtmax was significantly positively correlated with percentage area of late Endo-AT (r = 0.97, P 〈 0.001) and preserved LV myocardium (r = 0.81, P = 0.005), respectively. Patients with 〉20% of LV area with late Endo-AT and 〉30% of preserved LV myocardium had five times better acute hemodynamic response with LV stimulation. Multivariate analysis showed that only percentage area of late Endo-AT was independently correlated with %ΔdP/dtmax (P 〈 0.05). Conclusion: The presence of a larger amount of LV area with late Endo-AT and preserved LV myocardium measured by electromechanical mapping could identify patients who have better acute improvement in systolic performance during LV stimulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2005.40568.x
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  • 9
    Electronic Resource
    Electronic Resource
    Effects of Temporal Application Parameters on Lesion Dimensions During Transvenous Catheter Cryoablation (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: Transvenous catheter cryoablation is a novel technique for treating cardiac arrhythmias. However, the relative importance of temporal application parameters on lesion dimension and clinical efficacy has not been studied. Methods and Results: We investigated the effects of (1) application duration: single 2.5 (2.5 × 1) versus single 5 versus double 2.5 (2.5 × 2) versus double 5 (5 × 2) minutes, (2) number of freeze–thaw cycles: single versus double, and (3) electrode contact area: horizontal versus vertical orientation, on the lesion diameter and depth during catheter cryoablation (10F, 6.5-mm tip-electrode, CryoCor™, San Diego) in a thigh muscle preparation. A total of 175 lesions (horizontal = 90, vertical = 85) were created in thigh muscle preparations on 10 swine. The lesion diameter and depth were significantly greater using 2.5 × 2 and 5 × 2 application modes as compared with 2.5 × 1 applications (P 〈 0.05). Horizontal tip-electrode orientation produced larger lesion diameter (P 〈 0.05), but not lesion depth as compared with vertical orientation. Multivariate analysis demonstrated that both tip-electrode orientation and duration of freeze 〉2.5 minutes were independent predictors for lesion diameter (P 〈 0.001). However, only duration of freeze 〉2.5 minutes was an independent predictor for lesion depth (P 〈 0.001). Conclusions: The dimensions of lesions created by catheter cryoablation are affected by mode of cryoablation application and electrode orientation. Increasing the duration of application, employing multiple freeze–thaw cycles at shorter cycle durations, and orienting the catheter to enhance/increase tissue contact can create a larger lesion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2005.40559.x
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  • 10
    Electronic Resource
    Electronic Resource
    Transvenous Cryoablation Reduces Platelet Activation During Pulmonary Vein Ablation Compared with Radiofrequency Energy in Patients with Atrial Fibrillation (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: Radiofrequency (RF) ablation procedures for atrial fibrillation (AF) are associated with potential risks of thromboembolism, which may be minimized by the use of cryoablation that preserves the integrity of endocardium. The objective of this study was to compare the thrombogenic potential of transvenous cryoablation versus RF ablation during pulmonary vein (PV) isolation. Methods and Results: Thirty consecutive patients with paroxysmal AF were randomized to undergo segmental PV isolation procedure using 4-mm tip RF ablation (n = 15) or cryoablation (CryoCor, San Diego, CA, USA) (n = 15). Blood samples were drawn after sheath insertion (baseline), after transseptal puncture, before ablation (after heparin administration), and after isolation of a superior PV. Activation of coagulation was measured with plasma levels of prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III complex (TAT), and platelets by plasma level of β-thromboglobulin (β-TG) and flow cytometric enumerating of P-selectin (CD62)-positive platelets. In both groups, the plasma level of β-TG, F1 + 2, and TAT were elevated after sheath insertion. The percentage changes in plasma level of β-TG, F1 + 2, and TAT and CD41/62-positive platelets from baseline after transseptal puncture and before ablation were similar (P 〉 0.05). However, the percentage changes in CD62-positive platelets from baseline were significantly higher in patients treated with RF ablation (82 ± 20%) than with cryoablation (22 ± 14%, P = 0.02), although their plasma levels of β-TG, F1 + 2, and TAT were not different (P 〉 0.05). Conclusions: Significant platelet and coagulation activations were observed during PV ablation procedures, and heparin administration only prevented activation of coagulation but not platelets. Persistent platelets activation was observed during RF energy application, but not during cryoablation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.50103.x
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