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La ablación criotérmica percutánea directa elimina la conducción a través de la vía lenta intranodal sin inducir ritmos ectópicos
Márquez, Manlio F;Colín, Luis;Iturralde, Pedro;Nava, Santiago;González, Eric;Rodríguez, Gerardo;Gómez, Jorge;Salica, Gabriel;Cossío, Jorge;Hermosillo, Antonio G;Cárdenas, Manuel;
Archivos de cardiología de México , 2005,
Abstract: radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia is based on the elimination of conduction of slow or fast intranodal pathway. to avoid potential atrioventricular (av) block, a new technology has been developed, cryothermal ablation. we report a case of av nodal reentrant tachycardia in whom direct cryoablation, without previous ice mapping, was successfully performed. interestingly and as previously described, cryotherapy did not induce ectopic rhythms, the conventional surrogate during radiofrequency ablation.
Multiple Arrhythmogenic Substrate for Tachycardia in a Patient with Frequent Palpitations
Majid Haghjoo,Arash Arya,Mohammadreza Dehghani,Zahra Emkanjoo
Indian Pacing and Electrophysiology Journal , 2005,
Abstract: We report a 26-year-old woman with frequent episodes of palpitation and dizziness. Resting electrocardiography showed no evidence of ventricular preexcitation. During electrophysiologic study, a concealed right posteroseptal accessory pathway was detected and orthodromic atrioventricular reentrant tachycardia incorporating this pathway as a retrograde limb was reproducibly induced. After successful ablation of right posteroseptal accessory pathway, another tachycardia was induced using a concealed right posterolateral accessory pathway in tachycardia circuit. After loss of retrograde conduction of second accessory pathway with radiofrequency ablation, dual atrioventricular nodal physiology was detected and typical atrioventricular nodal reentrant tachycardia was repeatedly induced. Slow pathway ablation was done successfully. Finally sustained self-terminating atrial tachycardia was induced under isoproterenol infusion but no attempt was made for ablation. During 8-month follow-up, no recurrence of symptoms attributable to tachycardia was observed.
Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia: It Is Not Always As It Is Expected
Arash Arya,Majid Haghjoo,Zahra Emkanjoo,Alireza Heydari
Indian Pacing and Electrophysiology Journal , 2004,
Abstract: Observation of Coincident arrhythmias is not uncommon but the co-existence of idiopathic verapamil sensitive left ventricular tachycardia (ILVT) with other arrhythmias is very rare. We hereby presented a 30 year old male patient with a history of frequent episodes of palpitations and sustained narrow complex tachycardia. During electrophysiologic study two arrhythmias, one with narrow complexes which was shown to be typical atrioventricular nodal re-entrant tachycardia and the other with wide QRS complexes and right bundle branch block and left axis morphology, compatible with ILVT, were inducible. Radiofrequency catheter ablation of both arrhythmias was done at two consecutive sessions. The patient has remained asymptomatic without antiarrhythmic therapy for the past six months.
Prediction of Primary Slow-Pathway Ablation Success Rate According to the Characteristics of Junctional Rhythm Developed during the Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia
Ataallah Bagherzadeh,Mohammad Esmaeel Rezaee,Maryam Moshkani Farahani
Journal of Tehran University Heart Center , 2011,
Abstract: Background: Nowadays, developed junctional rhythm (JR) that occurs during slow-pathway radiofrequency (RF) catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) has been focused upon as a highly sensitive surrogate end point for successful radiofrequency ablation. This study was conducted to assess the relationship between the presence and pattern of developed JR during the RF ablation of AVNRT and a successful outcome.Methods: Seventy-five patients aged between 14 and 88 who underwent slow-pathway RF ablation due to symptomatic AVNRT were enrolled into the study and received a total of 162 RF energy applications. Combined anatomic and electrogram mapping approach was used for slow-pathway RF ablation. The ablation procedure consisted of 60-second, 60 °C temperature-controlled energy delivery. After each ablation pulse, successful ablation was assessed according to the loss of AVNRT inducibility via isoproterenol infusion. Four different patterns were considered for the developed JR, namely sparse, intermittent, continuous, and transient block. Success ablation rate was assessed with respect to the position, pattern, and number of junctional beats.Results: Successful RF ablation with a loss of AVNRT inducibility was achieved in 43 (57.3%) patients using 119 RF energy applications (73.5%). JR developed in 133 of the 162 (82.1%) applications with a given sensitivity of 90.8% and low specificity of 41.9% as an end point of successful RF ablation, with a negative predictive value of 62.1%. The mean number of the developed junctional beats was significantly higher in the successful ablations (p value < 0.001), and the ROC analysis revealed that the best cut-off point of the cumulative junctional beats for identifying accurate AVNRT ablation therapy is 14 beats with 90.76 % sensitivity and 90.70% specificity. There were no significant differences in terms of successful ablation rates according to the four different patterns of JR and its positions (p value=0.338, p value=0.105, respectively) in the univariate analyses.Conclusion: JR is a sensitive but non-specific predictor of the successful RF ablation of AVNRT. Nevertheless, according to the results, its specificity could increase with the presence of more than 14 cumulative junctional beats. Although the development of JR during slow-pathway RF ablation seems not to be reliable as a success end point, its absences could be a marker of requiring more energy application to ablate the slow pathway.
Simultaneous Atrial and Ventricular Extrastimulation for Differentiation of Atrioventricular Nodal Reentrant Tachycardia from Orthodromic Atrioventricular Reentrant Tachycardia Using Septal Accessory Pathways
Bernhard Strohmer,Christiana Schernthaner,Maximilian Pichler
The Cardiology , 2005,
Abstract: Determination of tachycardia mechanism by electrophysiological techniques is essential for a definite diagnosis of paroxysmal supraventricular tachycardia and a prerequisite for a safe and efficacious ablation. The purpose of this study was to determine, whether simultaneous atrial and ventricular (AV) extrastimulation is useful for differentiating atrioventricular nodal reentrant tachycardia (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT) using a septal accessory pathway. Forty-eight consecutive patients underwent electrophysiological study with induction of 51 types of tachycardias. Based on standard criteria AVNRT was diagnosed in 40 patients (4 atypical AVNRT) and AVRT through a septal accessory pathway in 11 patients. The diagnostic value of simultaneous AV extrastimulation was tested and the preexcitation index (PI) was compared to that obtained with single and double ventricular extrastimulation. Simultaneous AV extrastimulation was applicable in all patients with AVNRT except in one patient with slow/slow form. This pacing maneuver resulted in atrial and/or ventricular preexcitation in 11% of tested patients (PI 115±35 ms). Simultaneous AV extrastimulation was applicable in 50% of patients with septal AVRT (PI 24±28 ms), whereas in the other half of patients loss of simultaneous capture was observed. Simultaneous AV extrastimulation is a useful and rapid pacing maneuver for differentiation of AVNRT from orthodromic AVRT through a septal accessory pathway. This pacing technique is valid as long as simultaneous capture is achieved during tachycardia and may complete commonly used diagnostic steps in paroxysmal junctional tachycardias.
Radiofrequency Catheter Ablation Of Atrioventricular Nodal Reentry Tachycardia In A Patient With Inferior Vena Cava Anomaly
Murugesan Karthigesan,,Shenthar Jayaprakash
Indian Pacing and Electrophysiology Journal , 2009,
Abstract: Curative radiofrequency catheter modification of the slow pathway is the recommended therapy for patients suffering from recurrent symptomatic atrioventricular nodal reentry tachycardia. This is usually performed via femoral vein and the inferior vena cava (IVC). Presence of venous occlusion or complex venous anomaly involving the IVC may preclude this approach. Here, we report a case with a complex venous anomaly involving the inferior vena cava, who underwent electrophysiological study and successful radiofrequency ablation by an alternative approach.
Cateheter ablation treatment of atrioventricular nodal re-entrant tachycardia
？brahim Halil Tanbo？a,Mustafa Kurt,Turgay I？？k,Ahmet Kaya
Dicle Medical Journal , 2012,
Abstract: Objectives: In this study, we aimed to evaluate our clinicalexperience about the catheter ablation of atrioventricularnodal reentrant tachycardia (AVNRT) includingcomplications and long-term outcomes.Materials and Methods: The study population consistedof 166 patients with AVNRT, 52 of whom from hospital-1and 114 of who from hospital-2. Radio-frequency (RF)ablation therapy was applied after the basic electrophysiologystudy. Complications in RF ablation and long-termrecurrences were noted.Results: More than 90% of the patients had symptomspersisting for more than one year and again more than90% of those were suffering at least 2 episodes per month.The success rate of RF ablation was 98.2% for the entirestudy population. The recurrence rate was observed tobe 3% (n=5) throughout the follow-up period. In the multivariateCox regression analysis; young age, operator`sexperience (Hospital 1 vs. 2), and presence of atypicalAVNRT were the independent predictors of long-term recurrence.Major complications related to AVNRT ablationare not encountered frequently. Death, myocardial infarctionand stroke were not seen in any of the patients, however,two patients developed deep vein thrombosis. Minorcomplications in RF ablation included asymptomatic minimal/mild pericardial effusion (n=5), femoral hematoma requiringno transfusion (n=5) and transient AV block (n=5).Atrio-ventricular block requiring permanent pacemakerimplantation was found only in one patient (0.6%).Conclusion: Radio-frequency catheter ablation in patientswith AVNRT appears to be a safe and effectivemethod. The presence of atypical AVNRT, young age andoperator`s experience were observed to be the independentpredictors of long-term recurrence.
Coexistence of Atrioventricular Nodal Reentrant Tachycardia and Idiopathic Left Ventricular Outflow-Tract Tachycardia
Majid Haghjoo,Arash Arya,Mohammadreza Dehghani,Zahra Emkanjoo
Indian Pacing and Electrophysiology Journal , 2005,
Abstract: Double tachycardia is a relatively rare condition. We describe a 21 year old woman with history of frequent palpitations. In one of these episodes, she had wide complex tachycardia with right bundle branch and inferior axis morphology. A typical atrioventricular nodal tachycardia was induced during electrophysiologic study, aimed at induction of clinically documented tachycardia. Initially no ventricular tachycardia was inducible. After successful ablation of slow pathway, a wide complex tachycardia was induced by programmed stimulation from right ventricular outflow tract. Mapping localized the focus of tachycardia in left ventricular outflow tract and successfully ablated via retrograde aortic approach. During 7 month's follow-up, she has been symptom free with no recurrence. This work describes successful ablation of rare combination of typical atrioventricular nodal tachycardia and left ventricular outflow tract tachycardia in the same patient during one session.
Which parameters describe the electrophysiological properties of successful slow pathway RF ablation in patients with common atrioventricular nodal reentrant tachycardia?
Gerardo Nigro,Vincenzo Russo,Anna Rago,Annabella de Chiara
Anadolu Kardiyoloji Dergisi , 2010,
Abstract: Objective: Atrioventricular nodal reentrant tachycardia (AVNRT) accounts for about 60% of the patients presenting with paroxysmal supraventricular tachycardia. The radiofrequency (RF) catheter ablation of the slow atrioventricular (AV) node pathway is the preferred therapeutic approach in patients with AV node reentrant tachycardia. The aim of our study was describe the electrophysiological properties of successful slow pathway RF ablation in patients with common atrioventricular nodal reentrant tachycardia.Methods: The study design was a retrospective analysis involving fifty consecutive patients (18 males; mean age of 39±22 years) who underwent slow pathway ablation because of AVNRT.Results: Slow junctional beats with a cycle length longer than 550 ms were observed in 39 patients (79%); the presence of rapid junctional beats with a cycle length less than 550 ms was showed in 5 patients (10%). Moreover, in 32 of 50 patients (65%) duration of atrial electrogram more than 40 ms was noticed. Analyzing data reported, we found the statistically significant presence of slow junctional beats (p<0.001) and atrial electrogram >40 ms (p<0.05) in successful RF ablation procedures. Conclusion: In patients with AVNRT undergoing slow pathway ablation, the duration of atrial electrogram >40 ms and slow junctional beats with cycle length >550 ms during the application of RF energy describe the electrophysiological properties of successful slow pathway RF ablation.
The coexistence of Wolff-Parkinson-White syndrome (WPW) and atrioventricular nodal reentrant tachycardia (AVNRT)
Ali Elitok,G？khan Aksan,Mehmet Rasih Sons？z,Mehmet Tezcan,？zgür ？evrim
- , 2018, DOI: 10.1016/j.tjem.2017.12.002
Abstract:
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