Search

Background: Open‐window mapping (OWM) is a novel automated mapping method for catheter ablation of an accessory pathway (AP), in which the local signal is annotated with window‐of‐interest parameters to analyze both atrial and ventricular signals. This study aimed to determine the utility of OWM in visualizing the location and width of APs in patients with Wolff‐Parkinson‐White syndrome. Methods: This two‐center study enrolled 30 patients (20 males; mean age: 56 years, interquartile range [IQR]: 22–69 years) who underwent high‐density OWM with the extended early‐meets‐late (EEML) algorithm using a 20‐electrode, 5‐spline catheter (PENTARAY, Biosense Webster). The lower threshold of the EEML was set to adjust the EEML gap to match the propagation mapping, and broad APs were defined as an EEML gap > 1 cm. Results: The median mapping points, mapping time, and lower threshold of the EEML were 2482 (IQR: 1755–4000) points, 23 (IQR: 15–30) min, and 23 (IQR: 18–25), respectively. All 30 APs (24 in the mitral annulus and 6 in the tricuspid annulus) were successfully eliminated. Of these APs, 21 (70%) were eliminated by the first radio frequency (RF) application. OWM revealed broad APs in 11 patients (37%), in four of whom (36%) the first RF application achieved a loss of AP conduction (vs. 90% of patients without broad APs; p =.004). Conclusion: OWM facilitates the visualization of the location and width of APs, which may be particularly useful for predicting whether multiple RF applications are required for broad APs. [ABSTRACT FROM AUTHOR]

Introduction: Gastric hypomotility (GH) is a major complication of atrial fibrillation (AF) ablation. We aimed to clarify whether additional cryoballoon ablation (CBA) of the left atrial (LA) roof is associated with GH. Methods and Results: This study included 54 patients with non‐paroxysmal AF who underwent CBA for pulmonary vein isolation and of the LA roof line. GH was defined according to the results of esophagogastroscopy performed 2 days after ablation. GH was observed in 10 patients. There were significant differences in LA diameter (LAD), right inferior pulmonary vein (RIPV) diameter, and the height of the LA roof from the point where the LA posterior wall and esophagus make contact between patients with (GH+) and without GH (GH–) (LAD: 41.0 [36.3–41.8] mm vs. 46.5 [42.8–50.0] mm, p <.01; RIPV diameter: 19.7 [19.0–20.5] mm vs. 23.2 [21.2–24.9] mm, p <.01; height of LA roof: 5.7 [5.1–6.1] mm vs. 8.8 [7.1–11.2] mm for, p <.01, respectively). Multivariate analysis revealed that LA roof height was a predictor of GH. Moreover, Patient Assessment of Upper Gastrointestinal Disorders‐Symptom Severity Index (PAGI‐SYM) scores increased significantly 1 week after ablation (from 1.0 [0.0–2.8] to 5.0 [3.0–11.0], p =.03) in patients with GH. Conclusion: The height of the LA roof may be a predictor of GH after CBA of the LA roof line. Additionally, GH‐related symptoms may still appear 1 week after ablation. [ABSTRACT FROM AUTHOR]

This case report describes frequent ventricular premature contractions (VPCs) originating from an epicardial site of the basal posteroseptal ventricle. Detailed pace-mapping using a high output pacing stimulator was utilized to successfully ablate VPCs within the coronary sinus. [ABSTRACT FROM AUTHOR]

Backgrounds: Catheter ablation for non‐paroxysmal atrial fibrillation (non‐PAF) remains challenging and more effective strategy has been required to reduce postoperative arrhythmia recurrences. This study aims to investigate the efficacy and safety of a novel extensive ablation strategy for non‐PAF, that is based on a combination of cryoballoon (CBA), radiofrequency (RFA), and Marshall‐vein ethanol ablations (EA‐VOM). Methods: The study was a single‐center, retrospective observational study. We enrolled 171 consecutive patients who underwent de‐novo catheter ablation for non‐PAF under conscious sedation with a novel extensive ablation strategy that included CBA for pulmonary vein isolation (PVI) and left atrial roof ablation (LARA), RFA for mitral isthmus (MI) ablation, superior vena cava isolation, and other linear ablations and EA‐VOM. Recurrence of atrial arrhythmias over 1 year, procedure outcomes, and procedure‐related complications were investigated. Results: A total of 139 (81.3%) patients remained in sinus rhythm during 1‐year follow‐up. Of the 139 patients, 51 patients (29.8%) received antiarrhythmic drugs. The mean procedure time was 204 ± 45 min. PVI and LARA ablation by CBA and MI block by RFA and EA‐VOM were completed in 171 (100%) and 166 (97.1%) patients, respectively. No serious procedure‐related complications were observed except for one case of delayed pericardial effusion. Conclusion: Approximately 80% of the study patients were AF‐free during 1‐year follow‐up period after a single procedure based on the novel extensive ablation strategy combining CBA, RFA, and EA‐VOM. This strategy for non‐PAF may be preferred in terms of maintenance of sinus rhythm, safety even in high‐risk patients, and relatively short procedure time. [ABSTRACT FROM AUTHOR]

HACHIYA, H.,et al.: Edrophonium-Induced Right Ventricular Outflow Tract Tachycardia. Idiopathic right ventricular outflow tract-ventricular tachycardia (RVOT-VT) generally occurs when sympathetic nervous system activity is increased, though, in a few patients, it develops when parasympathetic nervous activity (PNA) is increased. Among 101 consecutive patients with RVOT-VT confirmed by endocardial catheter mapping, 5 (4.9%) presented with nocturnal RVOT-VT. Autonomic nervous balance was studied by heart rate variability (HRV) analysis from 24-hour ambulatory electrocardiogram (ECG). Standard programmed ventricular stimulation (PVS), ventricular burst pacing, and drug provocation were performed to induce RVOT-VT. In the studied five patients, the average number of mostly nocturnal ventricular premature contractions (VPCs) was 6649± 4472/day. Two patients had nocturnal nonsustained RVOT-VT on 24-hour ambulatory ECG recordings. The HRV analysis revealed that a progressive increase in high-frequency power coincided with an increase in VPCs or development of RVOT-VT at night, whereas low/high frequency ratio did not change significantly during the 24-hour period. RVOT-VT could not be induced by PVS, ventricular burst pacing, or isoproterenol or adenosine triphosphate i.v. However, RVOT-VT could only be induced by edrophonium, 5 mg i.v., in all patients. An increase in PNA was observed in a few patients before the development of RVOT-VT. Edrophonium facilitated induction of RVOT-VT in such patients.(PACE 2005; 28:S158–S162) [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to test regional pharmacological effects of an antiarrhythmic agents to predict ablative effects. Background: The vein of Marshall (VOM) providing vascular access to myocardial tissue has been used for ablative purposes using ethanol. Methods: A total of 35 patients (male 21, 63.2 ± 7.8 years old) were included. A balloon‐tipped infusion catheter was inserted into the VOM. Endocardial ultrahigh‐resolution mapping was performed along the VOM region to record the change in atrial electrograms (AEs) after VOM injection of cibenzoline of 3.5 mg during sustained atrial fibrillation (AF). Subsequently, ethanol was infused into the VOM and ablative region was mapped. Results: In 17 patients (49 %), cibenzoline reduced AEs amplitude by >50%, all of which had also complete elimination of AEs following ethanol (Group A). In 18 patients (Group B), cibenzoline failed to eliminate AEs; yet, in 13 of 18 AEs were eliminated by ethanol. In the remaining five patients, ethanol did not eliminate AE. Conclusions: Cibenzoline into the VOM could reliably predicts the results of subsequent ethanol infusion into the VOM using ultrahigh‐resolution mapping system, which leads to avoid unnecessary permanent lesion creation by ethanol infusion. [ABSTRACT FROM AUTHOR]

Background: The cryoballoon (CB) can be utilized for extra pulmonary vein (PV) ablation such as for a left atrial (LA) posterior wall (LAPW) isolation. However, scrutiny of the esophageal injuries during the LAPW isolation has never been performed. We sought to thoroughly investigate the esophageal lesions (ELs) and gastric hypomotility (GH) caused by an LAPW isolation using a CB. Methods: A total of 101 persistent atrial fibrillation patients who underwent an LAPW isolation using a CB were enrolled. The CB was applied on the roof and bottom area of the LAPW after a PV isolation. The luminal esophageal temperature (LET) was monitored by a thermistor probe during the CB applications. When the LET reached 15°C, the freezing application was prematurely interrupted. Esophagogastroscopy was performed on the next day following the ablation. Results: All PVs were successfully isolated in all patients. A successful LAPW isolation solely with CB ablation was performed in 72 (71.3%) patients. Cryofreezing applications were prematurely interrupted due to low LETs in 49 (48.5%) patients predominantly during the LA bottom line ablation. ELs and GH were observed in 11 (10.9%) and 16 patients (15.8%), respectively. The nadir LET tended to be lower in patients with ELs and GH than in those without (ELs: 14.8 ± 4.5°C vs 17.4 ± 6.0°C, P = 0.17; GH: 15.5 ± 4.5°C vs 17.5 ± 6.1°C, P = 0.23, respectively). Conclusions: Esophageal complications such as ELs and GH occur during the LAPW isolation with a CB. There was no reliable predictor of those adverse events. [ABSTRACT FROM AUTHOR]

Background Phrenic nerve (PN) palsy (PNP) is the most frequent complication of cryoballoon ablation (CBA) of atrial fibrillation (AF). The major complication of this technique seems to be right-sided PN injury (PNI) following ablation of the right pulmonary veins (PVs). We sought to assess the incidence and prognosis of left-sided PNI during CBA. Methods CBA was performed in 448 patients with AF. During the ablation of the left-sided PVs, the PN was paced from the left subclavian vein with a pacing output just exceeding the threshold by 10 ∼ 20%. The right and left arm 12-lead electrocardiogram electrodes were positioned 5 cm above the xiphoid process and 16 cm along the left costal margin. The amplitude of the compound motor action potentials was recorded during the CBA. Results Two thousand one hundred seventy-eight CBA applications were delivered in 1,094 left-sided PVs. PNI occurred in 29 patients (6.5%); the PN could be captured by an increasing pacing output in 21 patients (4.7%), and premature termination of the freezing was required to avoid PNP in eight patients (1.8%). The PN function recovered before discharge; however, it took 7 months for one patient to completely recovery from the PNP. Conclusions Left-sided PNP could be provoked during a left-sided CBA procedure. Assessment of the left PN during the CBA was necessary to prevent left-sided PNP. [ABSTRACT FROM AUTHOR]

Presents a study which evaluated the effects of glucose and insulin on J-ST-segment elevation in men with Brugada syndrome. Patients and methods; Results and discussion; Clinical implications.