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  • 1
    Electronic Resource
    Electronic Resource
    Cryoablation: (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: The use of cryoablation in the electrophysiology lab provides some distinct advantages not seen with conventional radiofrequency ablation. Ice mapping allows a functional assessment of a putative ablation site prior to the formation of a permanent lesion. This provides a distinct advantage adjacent to the AV node for para-hisian pathways and difficult cases of AVNRT. Cryoablation also produces minimal endothelial disruption and thrombus formation and causes no collagen shrinkage. This is likely advantageous when ablation is required within venous structures. There is also mounting experimental evidence that cryoablation is safe adjacent to the arterial system, especially within the middle cardiac vein or distal coronary sinus. As the technology evolves and further iterations of the catheter proceed, the role for this new but well-established technology is likely to grow.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.15106.x
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  • 2
    Electronic Resource
    Electronic Resource
    Esophageal Temperature Monitoring During Radiofrequency Ablation of 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: Introduction: Ablative strategies for atrial fibrillation have centered on the left atrium, in particular the pulmonary veins. An emphasis on ablating outside the ostia of the pulmonary veins appears to have reduced the risk of pulmonary vein stenosis. Unfortunately, ablation in the posterior left atrium has been reported to result in fatal atrio-esophageal fistula. Methods and Results: We monitored esophageal temperatures in 16 consecutive patients undergoing atrial fibrillation ablation. There were 14 men and 2 women; average age 54.7 ± 10.6 years. Eight patients had a lasso-guided pulmonary isolation procedure, eight an electroanatomically guided left-atrial circumferential approach. A commercially available esophageal temperature probe (Mallinckrodt Mon-a-therm 12F Esophageal Stethoscope with Temperature Sensor, Thermistor 400 Series) was positioned under general anesthesia. Temperature changes were noted and related to the relative location of the ablation catheter and the temperature probe during the temperature change. The esophagus was midline in three, right sided in three, and left sided in the remaining patients. Temperature rises could be recorded at the posterior aspect of any pulmonary vein. Detailed analysis of six patient maps revealed heating occurred with lesions created within 1 cm of the esophagus. Conclusion: The location of the esophagus relative to the back of the left atrium displays considerable variability. It is rarely midline and most often lies in close proximity to the left-sided veins. Ablation in close radiographic proximity (approximately 1 cm) to the esophagus as defined by a radio-opaque temperature probe can result in heating at the esophageal lumen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.40825.x
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  • 3
    Electronic Resource
    Electronic Resource
    Tachycardia with VA Dissociation: An Unusual Tachycardia Mechanism (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.1540-8167.2005.50069.x
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  • 4
    Electronic Resource
    Electronic Resource
    An Unusual Accessory Pathway: Anteroseptal to Ventricular Outflow Region Connection (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: Accessory pathways are typically located along the left or right atrioventricular junction. Distinct ventricular pre-excitation patterns determined by surface electrocardiography can provide reasonable pathway localization prior to invasive mapping and catheter ablation. We report an accessory pathway producing an unusual electrocardiographic appearance suggestive of ventricular outflow region pre-excitation. Pacing maneuvers and standard intracardiac recordings confirmed an atrial insertion immediately adjacent to the atrioventricular (AV) node and supported a ventricular insertion at the outflow tract region well away from the AV junction. The elimination of pathway conduction was achieved with radiofrequency (RF) energy at the atrial insertion after successful ice mapping excluded AV block at the target site. This is the second such pathway observed at our institution over a 20-year period.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2005.40522.x
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  • 5
    Electronic Resource
    Electronic Resource
    Isolation of Pulmonary Veins Using a Transvenous Curvilinear Cryoablation Catheter: Feasibility, Initial Experience, and Analysis of Recurrences (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: Pulmonary vein isolation (PVI) using focal cryothermal catheters is safe and moderately effective, but associated with long procedure times. We hypothesized that a linear freezing segment could shorten fluoroscopic and procedure times. We report our initial experience with a novel circular cryothermal catheter. Methods and Results: Complete PV isolation (PVI) was achieved in 41 of 45 PVs by cryoablation (91%) in 18 patients who underwent Lasso-guided cryothermal using a novel 7 F circular catheter (2.5 ± 0.7 veins per patient). A mean of 27.2 ± 11 applications per patient (9.2 ± 4.7 per vein) with a mean temperature −79.8 ± 4°C were delivered. Recorded temperatures did not predict complete or incomplete isolation. Focal cryothermal ablation using a 7 F 4-mm tip was required in the remainder for isolation. During 14.8 ± 6.2 month follow-up, 4 (22%) had no recurrence of AF, and 7/18 (39%) had 〉90% reduction in symptoms without antiarrhythmic agents (AAA). Computed tomography scans at 3 months showed no stenosis (14.1 ± 2.5 mm, 13.9 ± 2.4 mm; P = 0.2). Eight patients underwent repeat ablation. Mapping demonstrated 13 of 14 (93%) previously isolated veins had recovery of over 64 ± 24% of the ostium. All were successfully isolated with RF and 7 of 8 were arrhythmia free 6.0 ± 2.9 months after ablation. Overall, 14 of 18 (78%) patients had their arrhythmia clinically controlled without drugs after one or two procedures. Conclusions: Our initial experience demonstrates safety and feasibility of circular cryothermal ablation with less fluoroscopic and procedure times as compared to focal cryothermy. As with RF, complete and permanent isolation of the PVs is not easily achieved. Reducing heat load due to PV flow may improve results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.00287.x
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  • 6
    Electronic Resource
    Electronic Resource
    A Wide QRS Tachycardia: (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.1540-8167.2004.04060.x
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  • 7
    Electronic Resource
    Electronic Resource
    Atrial Fibrillation in Patients with Wolff-Parkinson-White Syndrome (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.1540-8167.2002.00230.x
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  • 8
    Electronic Resource
    Electronic Resource
    Unipolar Electrogram Characteristics Predictive of Successful Radiofrequency Catheter Ablation of Accessory Pathways (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: Unipolar Electrogram in Ablation. Introduction: The purpose of this study was to determine the characteristics of the unipolar electrogram that are most helpful in predicting successful radiofrequency ablation of accessory pathways. Methods and Results: The unipolar electrogram was analyzed at 185 ablation sites in 53 patients; 94 attempts were directed at the site of earliest atrial activation (“atrial gronp”) and 91 at the site of earliest ventricular activation (“ventricular group”). The electrogram was analyzed for several features, including pattern (“QS” or “initial R”). Unipolar pattern: Overall, a “QS” pattern was seen at 55% of unsuccessful, 75% of temporarily successful, and 90% of permanently successful sites. For the atrial group, the respective frequencies were 53%, 77%, and 92%, and for the ventricular group, 57%, 73%, and 86%. The difference in pattern distribution between unsuccessful and permanently successful sites was significant for all groups: overall, P 〈 0.0001; atrial group, P = 0.0005; ventricular group, P = 0.02. Absence of a “QS” pattern (i.e., “initial R”) predicted a 92% chance of unsuccessful ablation. Additional features: Activation times were significantly shorter at permanently successful than at unsuccessful (P 〈 0.0001) or temporarily successful sites (P = 0.0002). No significant differences were found in atrial or ventricular amplitudes or in A/V ratios. Intrinsic deflection slew was lower at temporarily successful sites (P = 0.03 vs all other sites). Conclusion: Ablation at sites revealing an “initial R” pattern (i.e., absent “QS”) is very unlikely to be successful. Activation time is shorter at successful sites. These features are equally applicable when mapping the atrial potential as when mapping the ventricular potential.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2000.tb00313.x
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  • 9
    Electronic Resource
    Electronic Resource
    The Utility of Holter Monitoring Compared to Loop Recorders in the Evaluation of Syncope and Presyncope (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of noninvasive electrocardiology 5 (2000), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Holter monitoring is frequently used to assess patients with syncope, but rarely provides a diagnosis. Newer loop recorders provide the opportunity for prolonged electrocardiographic monitoring to enhance diagnostic yield.Methods: The results of 232 Holter monitors and 81 loop recordings performed for the investigation of syncope or presyncope were reviewed for indication, patient demographics, and presence and type of symptoms and/or arrhythmias. The results were classified as (1) symptom-arrhythmia correlation, (2) clinically useful information (group 1 plus those excluding arrhythmic syncope, and those demonstrating asymptomatic serious arrhythmias) and (3) unhelpful (asymptomatic and no serious arrhythmias).Results: Loop recorders provided a symptom-arrhythmia correlation in 11.1% of patients compared to only 0.4% in the Holter group (P 〈 0.0001). Clinically useful information was obtained in 54.3% of loop patients compared to 27.6% in the Holter group (P 〈 0.0001). Technical problems occurred in 0.4% of the Holter patients and in 3.7% of loop patients (P = 0.05). Classification was difficult in seven patients in the Holter group; two experienced symptoms during sinus rhythm but also had a serious asymptomatic arrhythmia, and five patients had 6–10 beats of asymptomatic ventricular tachycardia at a rate 〈 160 beats/min.Conclusion: Loop recording was well tolerated and superior to Holter monitoring in providing a symptom-arrhythmia correlation or clinically useful information in patients with syncope and presyncope. An initial approach with a loop-recording device should be employed in these patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.2000.tb00400.x
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  • 10
    Electronic Resource
    Electronic Resource
    Atrial Response to Ventricular Antitachycardia Pacing Discriminates Mechanism of 1:1 Atrioventricular Tachycardia (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: Inappropriate shocks from implantable cardioverter defibrillators (ICD) remain a significant clinical problem despite device discrimination algorithms. The atrial response to antitachycardia pacing (ATP) may determine the mechanism of 1:1 A:V tachycardia. Methods: For this study we refer to sinus tachycardia, atrial tachycardia (AT), atrial fibrillation, and flutter as atrial tachycardia (AT), and all other tachycardia as “non-AT.” Three atrial response patterns during the burst of ATP were determined. The atrial cycle length (ACL) may be unchanged (type 1) indicating AT. The ACL may show variation during ATP (type 2) indicating variable VA block and does not discriminate between an AT and a non-AT mechanism, in which case a default diagnosis of non-AT is made. The ACL may accelerate to the ATP cycle length (type 3) indicating entrainment. A VAAV response at the end of ATP was considered diagnostic of AT (type 3A) whereas a VAV or VVA response was considered a non-AT mechanism (type 3B). This algorithm was applied to ICD tracings from 68 episodes of spontaneous 1:1 A:V tachycardia that had 136 sequences of ATP administered. The rhythm “truth” was determined by consensus of two experienced clinicians. Results: The algorithm correctly identified AT with a sensitivity of 71.9% (95% CI: 67.1–73.6), and specificity of 95% (83.5–99.1). The PPV was 97.2% (90.9–99.5), and NPV 58.5% (51.4–61.0). Kappa was 0.57 (0.43–0.62). If used clinically the algorithm would have aborted 53.3% (8/15) of inappropriate shocks delivered into an AT-mechanism tachycardia and would not have withheld a shock for any episode of VT. Conclusion: Analysis of atrial response patterns during and after ventricular ATP can successfully discriminate tachycardia mechanism and may reduce inappropriate ICD shocks.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2005.40474.x
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