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  • 1
    Electronic Resource
    Electronic Resource
    Protected Circumferential Conduction in the Posterior Atrioventricular Vestibule of the Left Atrium: Electrophysiologic and Anatomic Correlates (2005)
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 28 (2005), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: The anatomic substrate for protected isthmus conduction in the right atrium has been well defined. Little is known of similar substrates in the left atrium (LA). Methods: Patients (pts) with reentrant tachycardia (AVRT) supported by a single left-sided accessory pathway were studied retrospectively (n = 64) and prospectively (n = 31). Intracardiac electrograms were recorded from the His bundle position and coronary sinus (CS). The LA was mapped with a steerable catheter using the transseptal approach. LA anatomy was examined grossly and histologically in six cadaver hearts after removal of endocardium. Results: A distal-to-proximal CS activation sequence during AVRT was seen in all patients with a left lateral accessory pathway before ablation. After one to three radiofrequency (RF) energy deliveries that did not interrupt accessory pathway conduction, the CS activation sequence was reversed in three patients in the retrospective group and bidirectional conduction block in the posterior atrioventricular vestibule of the LA (PAVV) was demonstrated in nine patients in the prospective group. Four of the six cadaver hearts showed a distinct circumferential inferoposterior myocardial bundle that coursed parallel to the CS in the PAVV. Conclusions: We described evidence of bidirectional intraatrial block in the PAVV after application of RF energy during accessory pathway ablation. Such conduction block may mimic the presence of a second accessory pathway. Our data suggest that circumferential conduction in the PAVV may be poorly coupled to the rest of the LA and may be involved in the macro-reentrant circuit around the mitral annulus. The circumferential inferoposterior myocardial bundle may serve as the underlying anatomic substrate
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2005.00148.x
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  • 2
    Electronic Resource
    Electronic Resource
    BOOK REVIEW (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: Book reviewed in this article: Current Concepts in Diagnosis and Management of Arrhythmias in Infants and Children. Edited by Barbara J. Deal, Grace S. Wolff, and Henry Gelband
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1999.tb00321.x
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  • 3
    Electronic Resource
    Electronic Resource
    Narrow Complex Tachycardia with VA Block: Diagnostic and Therapeutic Implications (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
    Notes: To review our experience with cases of narrow complex tachycardia with VA block, highlighting the difficulties in the differential diagnosis, and the therapeutic implications. Prior reports of patients with narrow complex tachycardia with VA block consist of isolated case reports. The differential diagnosis of this disorder includes: automatic junctional tachycardia, AV nodal reentry with final upper common pathway block, concealed nodofascicular (ventricular) pathway, and intra-Hissian reentry. Between June 1994 and January 1996, six patients with narrow complex tachycardia with episodes of ventriculoatrial block were referred for evaluation. All six patients underwent attempted radiofrequency ablation of the putative arrhythmic site. Three of six patients had evidence suggestive of a nodofascicular tract. Intermittent antegrade conduction over a left-sided nodofascicular tract was present in two patients and the diagnosis of a concealed nodofascicular was made in the third patient after ruling out other tachycardia mechanisms. Two patients had automatic junctional tachycardia, and one patient had atroventricular nodal reentry with proximal common pathway block. Attempted ablation in the posterior and mid-septum was unsuccessful in patients with nodofascicular tachycardia. In contrast, those with atrioventricular nodal reentry and automatic junctional tachycardia readily responded to ablation. The presence of a nodofascicular tachycardia should be suspected if: (1) intermittent antegrade preexcitation is recorded, (2) the tachycardia can be initiated with a single atrial premature producing two ventricular complexes, and (3) a single ventricular extrastimulus initiates SVT without a retrograde His deflection. The presence of a nodofascicular pathway is common in patients with narrow complex tachycardia and VA block. Unlike AV nodal reentry and automatic junctional tachycardia, the response to ablation is poor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb00178.x
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  • 4
    Electronic Resource
    Electronic Resource
    Can Current Minute Ventilation Rate Adaptive Pacemakers Provide Appropriate Chronotropic Response in Pediatric Patients? (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: CABRERA, M.E., et al.: Can Current Minute Ventilation Rate Adaptive Pacemakers Provide Appropriate Chronotropic Response in Pediatric Patients? Since children have different activity patterns and exercise responses, uncertainty exists as to whether minute ventilation (MV) sensors designed for adults provide adequate chronotropic response in pediatrics. In particular, high respiratory rates (RR 〉 48 breaths/min), which are characteristic of the ventilatory response to exercise in children, cannot be sensed by MV rate responsive pacemakers. The purpose of this study was to evaluate the MV sensor rate response of the Medtronic Kappa 400 using exercise data from healthy children in a computer simulation of its rate response algorithm. Thirty-eight healthy children, ages 6–14, underwent a treadmill maximal exercise test. Subjects were divided based on body surface area (BSA) and MV rate response parameters were selected. Respiratory rates and tidal volumes were entered into the Kappa 400 rate response algorithm to calculate sensor-driven rates. Intrinsic heart rate (HR), oxygen uptake, and sensor-driven rates were normalized to HR reserve (HRR), metabolic reserve (MR), and sensor-driven reserve to compare across groups. Linear regression analysis among sensor-driven rate reserve, HRR, and MR was performed as described by Wilkoff. The mean slopes (± SD) of the relationships between the sensor-driven rate reserve and HRR were 1.06 ± 0.34, 1.07 ± 0.28, and 1.01 ± 0.19 for children with BSA 〈 1.10 m2, 1.10 〈 BSA 〈 1.40 m2, and BSA 〉 1.40 m2, respectively. High correlations were found between sensor-drive rates and HR responses and between sensor-drive rates and MV throughout exercise. No significant differences were noted between sensor-drive rates and HR using the Wilkoff model. From this study the authors conclude that: (1) MV is a good physiological parameter to control heart rate and (2) simulated sensor-driven rates closely match intrinsic HRs during exercise in healthy children, which supports the appropriateness of clinical validation in pediatric pacemaker patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.00907.x
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  • 5
    Electronic Resource
    Electronic Resource
    Electroanatomical Mapping and Ablation of the Substrate Supporting Intraatrial Reentrant Tachycardia after Palliation for Complex Congenital Heart Disease (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
    Notes: In patients with congenital heart disease who have undergone palliative surgical interventions postoperative arrhythmias frequently complicate tbe clinical course. Intraatrial reentrant tachycardias(LAHTs) are one of the most common forms of postoperative arrhythmias in these patients and can lead to significant morbidity and even mortality. Drug therapy and/or antitachycardia pacing have been disappointing. Ablative therapy with radiofrequency energy offers a potential for cure for these patients but the conventional approach using multielectrode recordings and fluoroscopic guidance is technically difficult and provides limited success. Recent development of a novel nonfluoroscopic technology with electroanatomical mapping using the CARTO mapping/ablation system has shown promising results in defining the arrhythmia circuit, facilitating diagnosis, and guiding ablative therapy. Rased on our preliminary experience, a systematic approach to postoperative IART using electroanatomical mapping is described. Further studies are needed to fully evahiate the impact of this new technology on the management and therapy of IART.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb00283.x
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  • 6
    Electronic Resource
    Electronic Resource
    Automatic atrial tachycardia in an infant following general anesthesia (2005)
    Oxford, UK : Blackwell Publishing Ltd
    Pediatric anesthesia 15 (2005), S. 0 
    Details
    ISSN: 1460-9592
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Automatic atrial tachycardia (AAT) is a rare supraventricular tachyarrhythmia (〈10% of all supraventricular tachycardias), which can present in infants or young children. There are no published reports of AAT occurring in an infant or child following noncardiac surgery and general anesthesia. This report describes the management of a previously healthy 5-month-old infant, who developed AAT in the postanesthesia care unit following an uneventful circumcision under general anesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1460-9592.2004.01400.x
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  • 7
    Electronic Resource
    Electronic Resource
    Electrophysiology of “Incisional” Reentrant Atrial Tachycardia Complicating Surgery for Congenital Heart Disease (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: Intraatrial reentrant tachycardia, which occurs frequently in patients who have undergone corrective surgery for congenital heart disease, presents a challenge to successful management. Because the surgical repair sites are invariably critical to the development and maintenance of reentrant atrial tachycardia, we use the term “incisional reentry” to describe these arrhythmias. An understanding of the electrophysiology of such “incisional reentry,” and techniques to identify a critical isthmus, are essential for successful ablation of these circuits. A critical isthmus may be identified by the presence of entrainment with concealed fusion. Confirmation that the site is critical to the tachycardia circuit is obtained by an analysis of the relationship between the postpacing interval and the tachycardia cycle length. Advances in mapping from multiple simultaneous sites, along with the ability to create larger, deeper lesions will be needed in order to cure a larger number of these patients. Ultimately, in some cases one must consider each procedure palliative rather than curative, as the disease progresses and substrate evolves and more tachycardia circuits become active.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1997.tb03638.x
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  • 8
    Electronic Resource
    Electronic Resource
    The Use of Radiofrequency Energy in Pediatric Cardiology (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 8 (1995), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The use of radiofrequency energy for the treatment of supraventricular tachycardia in pediatric patients has gained widespread acceptance, especially for tachyarrhythmias associated with palpitations, dizziness, presyncope or syncope, cardiomyopathy, and cardiac arrest. Ablation of the substrate supporting atrioventricular reentry, atrioventricular node reentry, and automatic atrial tachycardia yields a 90%–98% success rate with low incidence (〈 1%) of complications and adverse side-effects. Ablation of intra-atrial reentry, including atrial flutter and fibrillation, appears to be promising and would be a significant advance in the management of patients following extensive atrial surgery for congenital heart disease. Radiofrequency energy is also used to treat various forms of idiopathic ventricular tachycardia. Finally, radiofrequency energy has been extended to control the ventricular rate associated with malignant atrial tachycardia by either modification or ablation of the atrioventricular node, and subsequent pacemaker implant. Long-term outcome of radiofrequency ablation is unknown, but the short-to-intermediate (1–5 yrs) outcome is excellent, with low recurrence rate of the tachycardia, no proarrhythmic effect, and excellent clinical state. (J Interven Cardiol 1995;8:557–568)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1995.tb00583.x
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