38 results on '"Tai, Ching-Tai"'
Search Results
2. Electrocardiographic and electrophysiologic characteristics of midseptal accessory pathways.
- Author
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Chang SL, Lee SH, Tai CT, Chiang CE, Cheng JJ, Lin YJ, Hsieh MH, Lee KT, Tsao HM, Kuo JY, Chen YJ, and Chen SA
- Subjects
- Adolescent, Adult, Aged, Algorithms, Catheter Ablation, Electrocardiography, Electrophysiologic Techniques, Cardiac, Female, Humans, Male, Middle Aged, Prospective Studies, Coronary Vessels physiopathology, Heart Conduction System physiopathology, Heart Septum physiopathology, Tachycardia physiopathology
- Abstract
Background: The purpose of the present study was to investigate the electrocardiographic and electrophysiologic characteristics of right midseptal (RMS) and left midseptal (LMS) accessory pathways (APs), and to develop a stepwise algorithm to differentiate RMS from LMS APs., Methods and Results: From May 1989 to February 2004, 1591 patients with AP-mediated tachyarrhythmia underwent RF catheter ablation in this institution, and 38 (2.4%) patients had MS APs. The delta wave and precordial QRS transition during sinus rhythm, retrograde P wave during orthodromic tachycardia, and electrophysiologic characteristic and catheter ablation in 30 patients with RMS APs and 8 patients with LMS APs were analyzed. There was no significant difference in electrophysiologic characteristics and catheter ablation between RMS and LMS APs. The polarity of retrograde P wave during orthodromic tachycardia also showed no statistical difference between patients with RMS and LMS APs. The delta wave polarity was positive in leads I, aVL, and V3 to V6 in patients with RMS and LMS APs. Patients with LMS APs had a higher incidence of biphasic delta wave in lead V1 than patients with RMS APs (80% vs. 15%, P=0.012). The distributions of precordial QRS transition were different between RMS APs (leads V2; n = 10, V3; n = 7 and V4; n = 3) and LMS APs (leads V1; n = 1 and V2; n = 4) (P = 0.03). The combination of a delta negative wave in lead V1 or precordial QRS transition in lead V3 or V4 had a sensitivity of 90%, specificity of 80%, positive predictive value of 95%, and negative predictive value of 66% in predicting an RMS AP., Conclusions: Delta wave polarity in lead V1 and precordial QRS transition may differentiate RMS and LMS APs.
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- 2005
- Full Text
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3. Effects of isoproterenol in facilitating induction of slow-fast atrioventricular nodal reentrant tachycardia
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Chen Shih-Ann, Yu Wen-Chung, Chang Mau-Song, Chiou Chuen-Wang, Wen Zu-Chin, Chen Yi-Jen, Chiang Chern-En, Tai Ching-Tai, Huang Jin-Long, Lee Shih-Huang, and Ueng Kwo-Chang
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Adult ,Atropine ,Male ,Tachycardia ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Catheter ablation ,Heart Conduction System ,Isoprenaline ,Internal medicine ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,cardiovascular diseases ,Sympathomimetics ,Child ,Aged ,Aged, 80 and over ,Chi-Square Distribution ,business.industry ,Isoproterenol ,Reentry ,Middle Aged ,Electrophysiology ,Logistic Models ,Anesthesia ,Catheter Ablation ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Electrical conduction system of the heart ,Cardiology and Cardiovascular Medicine ,NODAL ,business ,medicine.drug - Abstract
This study demonstrates that patients with poorer conduction properties of the anterograde slow and retrograde fast pathways usually need isoproterenol to facilitate induction of atrioventricular nodal reentrant tachycardia. Isoproterenol infusion usually facilitates induction of tachycardia by enhancing the retrograde ventriculoatrial conduction.
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- 1996
4. Transient complete atrioventricular block during radiofrequency ablation of slow pathway for atrioventricular nodal reentrant tachycardia
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Tai Ching-Tai, Lee Shih-Huang, Chang Mau-Song, Chiang Chern-En, Chiou Chuen-Wang, Chen Shih-Ann, Wen Zu-Chi, and Ueng Kwo-Chang
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Male ,Tachycardia ,medicine.medical_specialty ,Time Factors ,Radiofrequency ablation ,medicine.medical_treatment ,law.invention ,Electrocardiography ,law ,Internal medicine ,Block (telecommunications) ,medicine ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,Transient (computer programming) ,cardiovascular diseases ,business.industry ,Cardiac Pacing, Artificial ,Reentry ,Middle Aged ,Prognosis ,medicine.disease ,Ablation ,Heart Block ,Treatment Outcome ,Atrioventricular Node ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,NODAL ,business ,Atrioventricular block ,Follow-Up Studies - Abstract
We conclude that most patients with transient AV block are clinically and electrocardiographically stable over a long follow-up time; thus, whether such patients will eventually have complete AV block is as yet unknown.
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- 1996
5. Complications of diagnostic electrophysiologic studies and radiofrequency catheter ablation in patients with tachyarrhythmias: an eight-year survey of 3,966 consecutive procedures in a tertiary referral center
- Author
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Wen Zu-Chi, Ueng Kwo-Chang, Chang Mau-Song, Chiou Chuen-Wang, Cheng Chen-Chuen, Chiang Chern-En, Lee Shih-Huang, Tai Ching-Tai, and Chen Shih-Ann
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Adult ,Male ,medicine.medical_specialty ,Heart disease ,Radiofrequency ablation ,medicine.medical_treatment ,law.invention ,law ,Risk Factors ,Tachycardia ,Medicine ,Humans ,In patient ,Prospective Studies ,Referral and Consultation ,business.industry ,Electrodiagnosis ,Incidence ,Middle Aged ,Ablation ,medicine.disease ,Surgery ,Logistic Models ,Radiofrequency catheter ablation ,Logistic analysis ,Catheter Ablation ,Referral center ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Predictors and comparisons of complications in patients with electrophysiologic study or radiofrequency ablation have not been assessed in previous published reports. The purpose of this study was to prospectively evaluate the procedure-specific complications and investigate the possible causes and predictors of complications in electrophysiologic study and radiofrequency ablation. Data of diagnostic electrophysiologic studies and radiofrequency ablation were prospective, and represented a consecutive series of 2,593 patients with 3,966 procedures. The present study showed that a significantly higher complication rate occurred in radiofrequency ablation than in electrophysiologic study (3.1% vs. 1.1%, respectively, p = 0.00002) and a significantly higher complication rate occurred in elderly than in young patients with electrophysiologic study (2.2% vs 0.5%, p = 0.0002) or radiofrequency ablation (6.1% vs 2.0%, p = 0.00015). Multiple logistic analysis found that older age (p0.01) and systemic disease in elderly patients (p0.01) were the independent predictors of complications in both procedures. Furthermore, there was no temporal trend in the incidence of complication. We conclude that the incidence of complication was higher in radiofrequency ablation, and elderly patients had a higher incidence of complications in both electrophysiologic study and radiofrequency ablation; these procedures, when performed by experienced personnel in an appropriately staffed and equipped laboratory, can be undertaken with an acceptable risk.
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- 1996
6. Electrophysiologic characteristics and radiofrequency catheter ablation in patients with multiple atrioventricular nodal reentry tachycardias
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Cheng Chen-Chuen, Wen Zu-Chi, Chen Shih-Ann, Tai Ching-Tai, Chiou Chuen-Wang, Lee Shih-Huang, Chang Mau-Song, Ueng Kwo-Chang, and Chiang Chern-En
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Tachycardia ,Adult ,Male ,medicine.medical_specialty ,Radiofrequency ablation ,medicine.medical_treatment ,Tachycardia, Sinoatrial Nodal Reentry ,law.invention ,Electrocardiography ,law ,Internal medicine ,medicine ,Humans ,Retrograde direction ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Reentry ,Middle Aged ,Ablation ,Atrioventricular node ,Electrophysiology ,medicine.anatomical_structure ,Cardiology ,Catheter Ablation ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,NODAL ,business - Abstract
Information about the mechanism and radiofrequency catheter ablation of multiple atrioventricular (AV) nodal reentry tachycardias is limited. Among the 550 consecutive patients with AV nodal reentry tachycardia, 36 with multiple forms of, AV nodal reentry tachycardia were included in this study. Electrophysiologic characteristics, as well as the efficacy and safety of radiofrequency ablation, were evaluated. Results showed that anterograde dual pathways were seen in 32 patients and triple pathways in 2, and retrograde dual pathways were seen in 23 patients and triple pathways in 11. Twenty-two patients had 2 types, 7 had 3 types, 5 had 4 types, and 2 had 5 types of AV nodal reentry tachycardia and echoes. After delivering radiofrequency energy to the target sites, 32 patients had no induction of AV nodal reentry tachycardia and only 4 had induction of 1 echo. Furthermore, 22 patients (61%) had simultaneous elimination or modification of the slow and/or intermediate pathways in the anterograde and retrograde direction. During the follow-up period of 19 ±14 months, 2 patients had recurrence of tachycardia. Thus, multiple anterograde and retrograde AV nodal pathways were present in the human AV node and they constituted the substrates of reentry circuits. Radiofrequency catheter ablation was safe and effective in eliminating the slow and intermediate pathways for maintenance of multiple AV nodal reentry tachycardias.
- Published
- 1996
7. Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia
- Author
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Chiou Chuen-Wang, Wu Tsu-Juey, Lee Shih-Huang, Tai Ching-Tai, Cheng Chen-Chuen, Ueng Kwo-Chang, Chen Shih-Ann, Chiang Chern-En, and Chang Mau-Song
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Tachycardia ,Adult ,medicine.medical_specialty ,Exacerbation ,Adolescent ,medicine.medical_treatment ,Pregnancy Complications, Cardiovascular ,Catheter ablation ,Blurred vision ,Pregnancy ,Risk Factors ,Internal medicine ,Tachycardia, Supraventricular ,Medicine ,Humans ,Age of Onset ,Tachycardia, Paroxysmal ,Aged ,Chi-Square Distribution ,business.industry ,Middle Aged ,medicine.disease ,Electrophysiology ,Relative risk ,Cardiology ,Catheter Ablation ,Gestation ,Female ,Age of onset ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
It is important for women to understand the risk of first onset and symptomatic exacerbation of paroxysmal supraventricular tachycardia (SVT) during pregnancy. Reports regarding the effects of pregnancy on first onset and symptomatic exacerbation of paroxysmal SVT have been controversial, and have not been conducted in a systematic fashion. Two hundred seven consecutive female patients diagnosed with symptomatic paroxysmal SVT were requested to respond to multiple questionnaires before electrophysiologic study and catheter ablation. A person-years data method was used to estimate risk of first onset of paroxysmal SVT during pregnancy. Exacerbation of paroxysmal SVT was assessed by a score scale including each of the following symptoms: palpitation, fatigue, rest dyspnea, effort dyspnea, dizziness, chest oppression, blurred vision, and syncope (total score change > 2 points). In the 107 patients with accessory pathway-mediated tachycardia, 7 patients had had a first onset of tachycardia during pregnancy (relative risk ratio 0.86, confidence interval 0.4 to 1.9, p = 0.35). In the 100 patients with atrioventricular nodal reentrant tachycardia, 1 patient had had the first onset of tachycardia during pregnancy (relative risk ratio 0.11, confidence interval 0.02 to 0.56, p = 0.004). Otherwise, 14 of the 63 patients (22%) with tachycardia in the pregnant and nonpregnant periods had exacerbation of symptoms during pregnancy. Thus, first onset of paroxysmal SVT during pregnancy was rare (3.9%), and pregnancy was associated with a low risk of first onset of paroxysmal SVT. However, symptoms of paroxysmal SVT were exacerbated during pregnancy in some patients.
- Published
- 1995
8. Mitral valve prolapse in patients with paroxysmal supraventricular tachycardia
- Author
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Chang Mau-Song, Wu Tsu-Juey, Tsai Der-Shang, Chiou Chuen-Wang, Chen Shih-Ann, Tai Ching-Tai, Hsu Tsuei-Lieh, Chiang Chern-En, Cheng Chen-Chuen, Chen Chung-Yin, N. Chiang Benjamm, Wang Shih-Pu, and Lee Shih-Huang
- Subjects
Tachycardia ,Adult ,Male ,medicine.medical_specialty ,Heart disease ,Population ,Paroxysmal supraventricular tachycardia ,Sex Factors ,Mitral valve ,Internal medicine ,medicine ,Prevalence ,Tachycardia, Supraventricular ,Mitral valve prolapse ,Humans ,Tachycardia, Atrioventricular Nodal Reentry ,In patient ,education ,Tachycardia, Paroxysmal ,Aged ,education.field_of_study ,Mitral Valve Prolapse ,business.industry ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Female ,Wolff-Parkinson-White Syndrome ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,AV nodal reentrant tachycardia - Abstract
This study showed that (1) the prevalence of MVP in patients with Wolff-Parkinson-White syndrome and AV nodal reentrant tachycardia was similar to that of the general population; (2) the location of accessory pathways was not related to the presence of MVP; and (3) MVP was persistently present after elimination of preexcitation. These findings suggest that MVP may have an independent association with PSVT. The study limitations are: (1) Acquisition bias should be noted because the prevalence of PSVT in patients found to have MVP was not obtained. (2) Comparison between patients with PSVT and an ageand sex-matched population sample in whom MVP was assessed by identical methods was not performed; thus, the association between MVP and this family of arrhythmias was not obtained. Furthermore, the higher prevalence of MVP in patients with both accessory pathway-mediated and AV nodal reentrant tachycardia must be reassessed.
- Published
- 1995
9. Differentiating Macroreentrant from Focal Atrial Tachycardias Occurred After Circumferential Pulmonary Vein Isolation.
- Author
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CHANG, SHIH‐LIN, TSAO, HSUAN‐MING, LIN, YENN‐JIANG, LO, LI‐WEI, HU, YU‐FENG, TUAN, TA‐CHUAN, TSAI, WEN‐CHIN, CHANG, CHIEN‐JUN, SUENARI, KAZUYOSHI, HUANG, SHIH‐YU, TAI, CHING‐TAI, LI, CHENG‐HUNG, CHAO, TZE‐FAN, WU, TSU‐JUEY, and CHEN, SHIH‐ANN
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CARDIAC surgery ,ATRIAL fibrillation ,PULMONARY veins ,ALGORITHMS ,ANALYSIS of variance ,BODY surface mapping ,CATHETER ablation ,CHI-squared test ,ELECTROCARDIOGRAPHY ,FISHER exact test ,HEART atrium ,MATHEMATICAL statistics ,RESEARCH funding ,STATISTICS ,T-test (Statistics) ,TACHYCARDIA ,PARAMETERS (Statistics) ,RETROSPECTIVE studies ,SURGERY - Abstract
Macroreentrant and Focal Atrial Tachycardias. Background: Atrial tachycardias (ATs) are commonly observed following catheter ablation of atrial fibrillation (AF). The aim of this study was to identify ECG characteristics that differentiate focal from macroreentrant ATs after circumferential pulmonary vein isolation (CPVI). Methods and Results: One hundred and twenty ATs that occurred after CPVI were mapped using a 3-dimensional mapping system in 87 patients with AF. Further ablation was performed to eliminate the ATs. The surface ECGs of 68 ATs in 41 consecutive patients (Group 1) were analyzed retrospectively to create diagnostic algorithms. The algorithms were tested in the second 46 consecutive patients (Group 2). Patients with macroreentrant AT had lower left atrial (LA) voltage than those with focal AT (1.3 ± 0.3 vs 1.5 ± 0.2 mV, P = 0.01). Focal AT had a higher incidence of a positive polarity in V6 compared with macroreentrant AT (88% vs 55%, P = 0.03). The positive amplitude of the flutter/P waves in V6 was higher for focal AT than macroreentrant AT. The cycle lengths of the focal ATs were longer than those for macroreentrant AT (296 ± 107 vs 244 ± 25 ms, P < 0.001). Right atrial macroreentrant AT had a higher incidence of a negative polarity in at least 1 precordial lead compared with LA macroreentry. The positive flutter waves in V1 could differentiate roof/mitral isthmus dependent from non-roof/mitral isthmus dependent macroreentry. This algorithm correctly differentiated the focal from macroreentrant ATs with a sensitivity of 94%, specificity of 91%, and predictive accuracy of 92% in Group 2. Conclusion: Different electrophysiological properties may facilitate the differentiation between macroreentrant and focal ATs after CPVI. (J Cardiovasc Electrophysiol, Vol. 22, pp. 748-755, July 2011) [ABSTRACT FROM AUTHOR]
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- 2011
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10. Gender Differences in the Clinical Characteristics and Atrioventricular Nodal Conduction Properties in Patients With Atrioventricular Nodal Reentrant Tachycardia.
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SUENARI, KAZUYOSHI, HU, YU‐FENG, TSAO, HSUAN‐MING, TAI, CHING‐TAI, CHIANG, CHERN‐EN, LIN, YENN‐JIANG, CHANG, SHIH‐LIN, LO, LI‐WEI, TA‐CHUAN, TUAN, LEE, PI‐CHANG, TUNG, NGUYEN HUU, HUANG, SHIH‐YU, WU, TSU‐JUEY, and CHEN, SHIH‐ANN
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AGE distribution ,AUTONOMIC nervous system ,CATHETER ablation ,COMPUTER software ,ELECTROPHYSIOLOGY ,FISHER exact test ,HORMONES ,REGRESSION analysis ,SEX distribution ,STATISTICS ,T-test (Statistics) ,TACHYCARDIA ,U-statistics ,DATA analysis ,EQUIPMENT & supplies ,RETROSPECTIVE studies ,PATHOLOGICAL physiology - Abstract
Gender Differences in Patients With AVNRT. Introduction: The detailed electrophysiological characteristics of the gender differences associated with atrioventricular nodal reentrant tachycardia (AVNRT) have not been clarified. This study investigated the gender-related electrophysiological differences in a large series of patients undergoing radiofrequency catheter ablation. Methods and Results: A total of 2,088 consecutive AVNRT patients (men/women 869/1,219) who underwent catheter ablation were enrolled in this study. We evaluated the gender differences in their electrophysiological characteristics. Women had a significantly younger age of onset, higher incidence of multiple jumps, shorter AH interval, atrial effective refractory period (ERP), anterograde fast pathway ERP, anterograde slow pathway ERP, and retrograde slow pathway ERP, and longer ventricular ERP than men. The incidence of baseline ventriculoatrial dissociation was lower in women than in men. Women needed less isoproterenol/atropine to induce AVNRT. No gender differences in the radiation exposure time, procedure time, complication rate, acute success rate, or second procedure rate were noted. Both typical and atypical AVNRT were more predominant in women. In the patients with atypical AVNRT, there was no significant gender difference in incidence of baseline ventriculoatrial dissociation; however, the retrograde slow pathway ERP was significantly shorter in women than in men. Women of premenopausal age (≤50 years old) had a significantly higher incidence of anterograde multiple jumps and a retrograde jump phenomenon, and a shorter anterograde slow pathway ERP and retrograde slow pathway ERP than those of women over 50 years old. Conclusion: Gender differences in the anterograde and retrograde AV nodal electrophysiology were noted in the patients with AVNRT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1114-1119) [ABSTRACT FROM AUTHOR]
- Published
- 2010
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11. Characteristics of Complex Fractionated Electrograms in Nonpulmonary Vein Ectopy Initiating Atrial Fibrillation/Atrial Tachycardia.
- Author
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LO, LI‐WEI, LIN, YENN‐JIANG, TSAO, HSUAN‐MING, CHANG, SHIH‐LIN, HU, YU‐FENG, TSAI, WEN‐CHIN, TUAN, DA‐CHUN, CHANG, CHIEN‐JUNG, LEE, PI‐CHANG, TAI, CHING‐TAI, TANG, WEI‐HUA, SUENARI, KAZUYOSHI, HUANG, SHIH‐YU, HIGA, SATOSHI, and CHEN, SHIH‐ANN
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PULMONARY vein abnormalities ,ATRIAL fibrillation ,TACHYCARDIA ,DISEASE relapse ,HEART diseases ,THERAPEUTICS ,REAL-time control ,CARDIAC magnetic resonance imaging - Abstract
Background: Nonpulmonary vein (PV) ectopy initiating atrial fibrillation (AF)/atrial tachycardia (AT) is not uncommon in patients with AF. The relationship of complex fractionated atrial electrograms (CFAEs) and non-PV ectopy initiating AF/AT has not been assessed. We aimed to characterize the CFAEs in the non-PV ectopy initiating AF/AT. Methods: Twenty-three patients (age 53 ± 11 y/o, 19 males) who underwent a stepwise AF ablation with coexisting PV and non-PV ectopy initiating AF or AT were included. CFAE mapping was applied before and after the PV isolation in both atria by using a real-time NavX electroanatomic mapping system. A CFAE was defined as a fractionation interval (FI) of less than 120 ms over 8-second duration. A continuous CFAE (mostly, an FI < 50 ms) was defined as electrogram fractionation or repetitive rapid activity lasting for more than 8 seconds. Results: All patients (100%) with non-PV ectopy initiating AF or AT demonstrated corresponding continuous CFAEs at the firing foci. There was no significant difference in the FI among the PV ostial or non-PV atrial ectopy or other atrial CFAEs (54.1 ± 5.6, 58.3 ± 11.3, 52.8 ± 5.8 ms, P = 0.12). Ablation targeting those continuous CFAEs terminated the AF and AT and eliminated the non-PV ectopy in all patients (100%). During a follow-up of 7 months, 22% of the patients had an AF recurrence with PV reconnections. There was no recurrence of any ablated non-PV ectopy during the follow-up. Conclusion: The sites of the origin of the non-PV ectopies were at the same location as those of the atrial continuous CFAEs. Those non-PV foci were able to initiate and sustain AF/AT. By limited ablation targeting all atrial continuous CFAEs, the AF could be effectively eliminated. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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12. Comparison of Cooled-Tip Versus 4-mm-Tip Catheter in the Efficacy of Acute Ablative Tissue Injury During Circumferential Pulmonary Vein Isolation.
- Author
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CHANG, SHIH‐LIN, TAI, CHING‐TAI, LIN, YENN‐JIANG, LO, LI‐WEI, TUAN, TA‐CHUAN, UDYAVAR, AMEYA R., HU, YU‐FENG, TSAO, HSUAN‐MING, CHANG, CHIEN‐JUN, TSAI, WEN‐CHIN, and CHEN, SHIH‐ANN
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PULMONARY vein abnormalities , *CATHETERIZATION , *ATRIAL fibrillation , *PATIENTS , *TACHYCARDIA - Abstract
Introduction: Although several studies have reported the benefits of cooled-tip ablation for circumferential pulmonary veins isolation (CPVI), the acute change of substrate property and acute PV reconnection have not been well demonstrated. The aim of this study was to compare the cooled-tip with regular 4-mm-tip catheter in acute substrate change after CPVI and long-term efficacy. Methods and Results: One hundred and fifty-six patients (115 males, age 53 ± 12 years) who underwent CPVI for treatment of atrial fibrillation (AF) were included. Group A consisted of 52 patients with cooled-tip ablation, and group B consisted of 104 patients with 4-mm-tip catheter ablation. The bipolar voltage of circumferential lesions was obtained using a 3-dimensional (3D) mapping system (NavX) before and after CPVI. The electrical reconnections of 4 PVs were evaluated 30 minutes after CPVI using a circular catheter. Cooled-tip catheter caused more reduction of the electrical voltage in PV antrum, lower incidence of acute PV reconnection, inducibility of AF, and gap-related atrial tachyarrhythmia (AT). Less number of left atrial (LA) ablation line and ablation applications and less procedure time were found in cooled-tip group compared to 4-mm-tip group. No significant difference in the incidence of pain sensation and complication was observed between the 2 groups. At a 14-month follow-up, the recurrence rate in the cooled-tip group was lower than in the 4-mm group (13.5% vs 33.7%, P = 0.009). Conclusion: Cooled-tip catheter has a superior long-term outcome than the 4-mm-tip catheter in CPVI, which may be associated with the efficacy of transmural block and electrical isolation in PV antrum. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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13. Induced Atrial Tachycardia After Circumferential Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation: Electrophysiological Characteristics and Impact of Catheter Ablation on the Follow-Up Results.
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CHANG, SHIH‐LIN, LIN, YENN‐JIANG, TAI, CHING‐TAI, LO, LI‐WEI, TUAN, TA‐CHUAN, UDYAVAR, AMEYA R., HU, YU‐FENG, CHIANG, SHUO‐JU, WONGCHAROEN, WANWARANG, TSAO, HSUAN‐MING, UENG, KWO‐CHANG, HIGA, SATOSHI, LEE, PI‐CHANG, and CHEN, SHIH‐ANN
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TACHYCARDIA ,CATHETER ablation ,ATRIAL fibrillation ,PULMONARY veins ,ELECTROPHYSIOLOGY ,TOMOGRAPHY - Abstract
Introduction: Atrial tachycardia (AT), including focal and reentrant AT, can occur after circumferential pulmonary vein isolation (CPVI). The aim of this study was to investigate the electrophysiological characteristics of induced AT and its clinical outcome. Methods and Results: In our series of 160 patients with paroxysmal atrial fibrillation (AF), 45 ATs were induced by high-current burst pacing after CPVI in 26 patients. All induced ATs were mapped using a three-dimensional (3D) mapping system. Noninducibility was the endpoint of the ablation of the AT. Gap-related AT was considered if the AT was related to the CPVI lesions. A 16-slice multidetector computed tomography scan was performed in all patients to correlate the anatomical structure with electroanatomical mapping. Thirty-five (78%) reentrant ATs and 10 (22%) focal ATs were identified. Of those, 34 were gap-related ATs (24 reentrant and 10 focal ATs). Reentrant AT had more gaps in the left atrial appendage ridge than did focal AT (39.6% vs 0%, P = 0.02). Focal AT had a higher incidence of gap in the PV carina compared with reentrant AT (80% vs 10%, P < 0.001). Reentrant ATs were mostly terminated during the ablation creating the mitral and roof lines with crossing of the gaps. During a mean follow-up of 21 ± 8 months, only one patient (0.6%) with induced mitral reentry had a recurrent AT. Conclusion: The location of the AT gap may be related with the complex anatomy of the LA. The induced ATs after CPVI can be eliminated by catheter ablation. [ABSTRACT FROM AUTHOR]
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- 2009
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14. Noncontact Mapping of the Heart: How and When to Use.
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TAI, CHING‐TAI and CHEN, SHIH‐ANN
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BODY surface mapping , *ELECTROPHYSIOLOGY , *RADIO frequency , *CATHETER ablation , *ARRHYTHMIA , *TACHYCARDIA treatment - Abstract
Noncontact Mapping of the Heart. The noncontact mapping system is a new tool for electrophysiologic study and radiofrequency ablation. The mode of operation includes single beat, three-dimensional, high-density mapping. Careful analysis of unipolar electrograms and isopotential maps are essential to understand the mechanism of the arrhythmia. Radiofrequency catheter ablation guided by this system is effective in curing patients of their tachycardias. [ABSTRACT FROM AUTHOR]
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- 2009
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15. Electrophysiological Characteristics and Catheter Ablation in Patients with Paroxysmal Supraventricular Tachycardia and Paroxysmal Atrial Fibrillation.
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CHANG, SHIH‐LIN, TAI, CHING‐TAI, LIN, YENN‐JIANG, LO, LI‐WEI, TUAN, TA‐CHUAN, UDYAVAR, AMEYA R., TSAO, HSUAN‐MING, HSIEH, MING‐ HSIUNG, HU, YU‐FENG, CHIANG, SHUO‐JU, CHEN, YI‐JEN, WONGCHAROEN, WANWARANG, UENG, KWO‐CHANG, and CHEN, SHIH‐ANN
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ELECTROPHYSIOLOGY , *CATHETER ablation , *ELECTROSURGERY , *TACHYCARDIA , *ATRIAL fibrillation , *ARRHYTHMIA , *HEART diseases - Abstract
Introduction: Paroxysmal supraventricular tachycardia (PSVT) is often associated with paroxysmal atrial fibrillation (AF). However, the relationship between PSVT and AF is still unclear. The aim of this study was to investigate the clinical and electrophysiological characteristics in patients with PSVT and AF, and to demonstrate the origin of the AF before the radiofrequency (RF) ablation of AF. Methods and Results: Four hundred and two consecutive patients with paroxysmal AF (338 had a pure PV foci and 64 had a non-PV foci) that underwent RF ablation were included. Twenty-one patients (10 females; mean age 47 ± 18 years) with both PSVT and AF were divided into two groups. Group 1 consisted of 14 patients with inducible atrioventricular nodal reentrant tachycardia (AVNRT) and AF. Group 2 consisted of seven patients with Wolff-Parkinson-White (WPW) syndrome and AF. Patients with non-PV foci of AF had a higher incidence of AVNRT than those with PV foci (11% vs. 2%, P = 0.003). Patients with AF and atypical AVNRT had a higher incidence of AF ectopy from the superior vena cava (SVC) than those with AF and typical AVNRT (86% vs. 14%, P = 0.03). Group 1 patients had smaller left atrial (LA) diameter (36 ± 3 vs. 41 ± 3 mm, P = 0.004) and higher incidence of an SVC origin of AF (50% vs. 0%, P = 0.047) than did those in Group 2. Conclusion: The SVC AF has a close relationship with AVNRT. The effect of atrial vulnerability and remodeling may differ between AVNRT and WPW syndrome. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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16. Electrophysiologic Characteristics of the Sinus Venosa in Patients with Typical Atrial Flutter.
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TAI, CHING‐TAI, GERTRUDE ONG, MARY, and CHEN, SHIH‐ANN
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HEART blood-vessels , *HEART diseases , *ATRIAL arrhythmias , *TACHYCARDIA , *HEART conduction system - Abstract
Background: The sinus venosa is a posterior barrier of typical atrial flutter. However, its electrophysiology has not been studied. Methods and Results: The study population included 20 patients with typical atrial flutter (Group 1) and 20 patients with paroxysmal supraventricular tachycardia (Group 2). The noncontact mapping system was used to evaluate the electrophysiology of the sinus venosa (SV) during coronary sinus (CS) and low right atrial (LRA) pacing and atrial activation during typical atrial flutter. The results showed 12 of Group 1 patients (60%) had two lines of block, one in the CT and the other in the SV. The virtual electrograms in the CT and SV showed double potentials. Eight patients (40%) had only one line of block in the CT. During atrial pacing at the cycle length of 500 ms, nine of Group 1 patients had a line of block on the SV. None of the Group 2 patients had a line of block. During atrial pacing at the CL of 300 ms, 12 of Group 1 patients had a line of block on the SV. Eight of Group 1 patients had transverse conduction through the SV during atrial pacing. None of the Group 2 had a line of block. Conclusions: This study showed that the SV formed the posterior line of block in 60% of the patients with typical atrial flutter. Fixed conduction block and rate-dependent conduction block in the SV may be involved in the pathogenesis of typical AFL. [ABSTRACT FROM AUTHOR]
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- 2008
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17. Does the Age Affect the Fluoroscopy-Guided Transseptal Puncture in Catheter Ablation of Atrial Fibrillation?
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HU, YU‐FENG, TAI, CHING‐TAI, LIN, YENN‐JIANG, CHANG, SHIH‐LIN, LO, LI‐WEI, WONGCHAROEN, WANWARANG, UDYAVAR, AMEYA R., TUAN, TA‐CHUAN, and CHEN, SHIH‐ANN
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CATHETERIZATION , *FLUOROSCOPY , *VENA cava superior , *PAROXYSMAL tachycardia , *TACHYCARDIA - Abstract
Background: The anatomical differences with age may raise difficulty in determining the proper positioning of the transseptal puncture site in the therapeutic left heart catheterization. This study investigated whether age affects the fluoroscopy-guided transseptal puncture in the catheter ablation of atrial fibrillation. Methods and Results: Fifty patients (52 ± 12 years, 35 men) who underwent ablation for paroxysmal/persistent atrial fibrillation were included. The patients were divided into two groups according to their age (cut-point 50 y/o): young group (n = 20) and old group (n = 30). In the 30° right anterior oblique view (RAO), the width between the transseptal puncture site and coronary sinus ostium (H N-CSO) was longer in old-age group (14.4 ± 9.4 vs 10.9 ± 10.4 mm, P = 0.034). In the 60° left anterior oblique view (LAO) view, the angle of the direction of the transseptal needle (N-angle) was less in the old-age group (56.0 ± 10.0° vs 58.4 ± 9.8°, P = 0.041). The ratio of the transseptal puncture site-coronary sinus ostium (CSO) distance over the distance between the superior vena cava-right atrial junction and CSO (VN-CSO/VJ-CSO) was significantly higher in the old-age group (0.73 ± 0.12 vs 0.63 ± 0.2, P = 0.009). Conclusion: The transseptal puncture site in the RAO view moved higher and more posterior and the transseptal puncture angle in the LAO view decreased with age. These findings highlight the influence of age on the atrial anatomy and transseptal puncture site. [ABSTRACT FROM AUTHOR]
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- 2007
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18. Noncontact three-dimensional mapping guides catheter ablation of difficult atrioventricular nodal reentrant tachycardia
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Lee, Pi-Chang, Tai, Ching-Tai, Lin, Yenn-Jiang, Liu, Tu-Ying, Huang, Bien-Hsien, Higa, Satoshi, Yuniadi, Yoga, Lee, Kun-Tai, Hwang, Betau, and Chen, Shih-Ann
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TACHYCARDIA , *CATHETER ablation , *HEART diseases , *HEART beat - Abstract
Abstract: Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia in adulthood. Although selective ablation of the slow AV nodal pathway can cure AVNRT, accidental AV block may occur. The details on the electrophysiologic characteristics, quantitative data on the voltage inside Koch''s triangle, and the use of three-dimensional noncontact mapping to facilitate the catheter ablation of AVNRT associated with a high-risk for AV block or other arrhythmias have been limited. Methods and results: Nine patients (M/F =5/4, 34±23 years, range 17–76) with clinically documented AVNRT were included. All patients had undergone previous sessions for slow AV nodal pathway ablation but they had failed, because of repetitive episodes of complete AV block during the RF energy applications. Further, one patient had a complex anatomy and 4 patients were associated with other tachycardias, respectively. The electrophysiologic studies revealed that 4 patients had the slow–fast, 4 the slow–intermediate and one the fast–intermediate form of AVNRT. Noncontact mapping demonstrated two types of antegrade AV nodal conduction, markedly differing sites of the earliest atrial activation during retrograde VA conduction, and a lower range of voltage within Koch''s triangle. The lowest border of the retrograde conduction region was defined on the map, and the application of the RF energy was delivered below that border to prevent the occurrence of AV block. The distance between the successful ablation lesions and the lowest border of the retrograde conduction region was significantly shorter in the patients with the slow–intermediate form of AVNRT than in those with the slow–fast form (5.5±3.4 vs. 15±7.6 mm; p <0.05). After the ablation procedure, either rapid pacing or extrastimulation could not induce any tachycardia, and there was no recurrence during the follow-up (10.3±5.4, 2 to 22 months). Conclusions: Noncontact mapping could effectively demonstrate the antegrade and retrograde atrionodal conduction patterns, electrophysiologic characteristics of Koch''s triangle, and guide the successful catheter ablation in difficult AVNRT cases. [Copyright &y& Elsevier]
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- 2007
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19. High-Resolution Mapping Around the Eustachian Ridge During Typical Atrial Flutter.
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HUANG, JIN‐LONG, TAI, CHING‐TAI, LIU, TU‐YING, LIN, YENN‐JIANG, LEE, PI‐CHANG, TING, CHIH‐TAI, and CHEN, SHIH‐ANN
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ATRIAL flutter , *EUSTACHIAN tube , *ELECTRONOGRAPHY , *TACHYCARDIA , *ATRIAL arrhythmias , *PATIENTS - Abstract
Background: Although the reentrant circuit of typical atrial flutter (AFL) has been well recognized, the activation around the Eustachian ridge (ER) has not been fully characterized. The aim of this study was to delineate the activation patterns around the ER during typical AFL using high-resolution noncontact mapping. Methods: Fifty-three patients (M/F = 43/10, 62 ± 14 years) with typical AFL were included. The high-resolution mapping of the right atrium using a noncontact mapping system during AFL and pacing from the coronary sinus (CS) was performed to evaluate the conduction through the ER. Results: Three types of activation patterns around the ER could be classified according to the ER conduction during AFL and CS pacing. Type I (n = 21, M/F = 16/5, 61 ± 13 years) exhibited conduction block at the ER during AFL and CS pacing. The local unipolar electrograms at the ER exhibited long double potentials (DPs) (109 ± 12 ms, range 77–153 ms) during AFL and CS pacing (84 ± 18 ms, range 48–129 ms). Type II (n = 8, M/F = 7/1, 61 ± 15 years) exhibited conduction block at the ER during AFL, but conduction through the ER during CS pacing. The unipolar electrograms exhibited long DPs (119 ± 12 ms, range 97–141 ms) at the ER during the tachycardia and an rS pattern during CS pacing. Type III (n = 24, M/F = 20/4, 61 ± 16 years) exhibited an activation wavefront that passed along the ER, with the sinus venosa as the posterior barrier during AFL. During CS pacing, all cases exhibited conduction through the ER with an rS pattern. Conclusions: This study is the first to demonstrate the three patterns of activation along the ER during AFL and CS pacing. This finding suggested that the ER is an anatomic and functional barrier during typical AFL. [ABSTRACT FROM AUTHOR]
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- 2006
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20. The Electrophysiological Characteristics in Patients with Ventricular Stimulation Inducible Fast-Slow Form Atrioventricular Nodal Reentrant Tachycardia.
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LEE, PI‐CHANG, HWANG, BETAU, TAI, CHING‐TAI, HSIEH, MING‐HSIUNG, CHEN, YI‐JEN, CHIANG, CHERN‐EN, and CHEN, SHIH‐ANN
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ATRIOVENTRICULAR node physiology ,TACHYCARDIA ,ELECTROPHYSIOLOGY ,CARDIAC pacing ,NEURAL stimulation ,ARRHYTHMIA - Abstract
Background: Atrioventricular nodal reentrant tachycardia (AVNRT) can usually be induced by atrial stimulation. However, it seldom may be induced with only ventricular stimulation, especially the fast-slow form of AVNRT. The purpose of this retrospective study was to investigate the specific electrophysiological characteristics in patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation. Methods: The total population consisted of 1,497 patients associated with AVNRT, and 106 (8.4%) of them had the fast-slow form of AVNRT and 1,373 (91.7%) the slow-fast form of AVNRT. In patients with the fast-slow form of AVNRT, the AVNRT could be induced with only ventricular stimulation in 16 patients, Group 1; with only atrial stimulation or both atrial and ventricular stimulation in 90 patients, Group 2; and with only atrial stimulation in 13 patients, Group 3. We also divided these patients with slow-fast form AVNRT (n = 1,373) into two groups: those that could be induced only by ventricular stimulation (Group 4; n = 45, 3%) and those that could be induced by atrial stimulation only or by both atrial and ventricular stimulation (n = 1.328, 97%). Results: Patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation had a lower incidence of an antegrade dual AVN physiology (0% vs 71.1% and 92%, P < 0.001), a lower incidence of multiple form AVNRT (31% vs 69% and 85%, P = 0.009), and a more significant retrograde functional refractory period (FRP) difference (99 ± 102 vs 30 ± 57 ms, P < 0.001) than those that could be induced with only atrial stimulation or both atrial and ventricular stimulation. The occurrence of tachycardia stimulated with only ventricular stimulation was more frequently demonstrated in patients with the fast-slow form of AVNRT than in those with the slow-fast form of AVNRT (15% vs 3%, P < 0.001). Patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation had a higher incidence of retrograde dual AVN physiology (75% vs 4%, P < 0.001), a longer pacing cycle length of retrograde 1:1 fast and slow pathway conduction (475 ± 63 ms vs 366 ± 64 ms, P < 0.001; 449 ± 138 ms vs 370 ± 85 ms, P = 0.009), a longer retrograde effective refractory period of the fast pathway (360 ± 124 ms vs 285 ± 62 ms, P = 0.003), and a longer retrograde FRP of the fast and slow pathway (428 ± 85 ms vs 362 ± 47 ms, P < 0.001 and 522 ± 106 vs 456 ± 97 ms, P = 0.026) than those with the slow-fast form of AVNRT that could be induced with only ventricular stimulation. Conclusion: This study demonstrated that patients with the fast-slow form of AVNRT that could be induced with only ventricular stimulation had a different incidence of the antegrade and retrograde dual AVN physiology and the specific electrophysiological characteristics. The mechanism of the AVNRT stimulated only with ventricular stimulation was supposed to be different in patients with the slow-fast and fast-slow forms of AVNRT. [ABSTRACT FROM AUTHOR]
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- 2006
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21. The Different Ablation Effects on Atrioventricular Nodal Reentrant Tachycardia in Children with and without Dual Nodal Pathways.
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LEE, PI‐CHANG, HWANG, BETAU, TAI, CHING‐TAI, CHIANG, CHERN‐EN, and CHEN, SHIH‐ANN
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TACHYCARDIA ,CATHETER ablation ,CATHETERIZATION ,ELECTROSURGERY ,ELECTROPHYSIOLOGY - Abstract
Background: Previous studies in adults have shown a significant shortening of the fast pathway effective refractory period (ERP) after successful slow pathway ablation. However, information on atrioventricular nodal reentrant tachycardia (AVNRT) in children is limited. The purpose of this retrospective study was to investigate the different effects of radiofrequency (RF) catheter ablation in pediatric AVNRT patients between those with and without dual atrioventricular (AV) nodal pathways. Methods: From January 1992 to August 2004, a total 67 pediatric patients with AVNRT underwent an electrophysiologic study and RF catheter ablation at our institution. We compared the electrophysiologic characteristics between those obtained before and after ablation in the children with AVNRT with and without dual AV nodal pathways. Results: Dual AV nodal pathways were found in 37 (55%) of 67 children, including 36 (54%) with antegrade and 10 (15%) with retrograde dual AV nodal pathways. The antegrade and retrograde fast pathway ERPs in children with dual AV nodal pathways were both longer than the antegrade and retrograde ERPs in children without dual AV nodal pathways (300 ± 68 vs 264 ± 58 ms, P = 0.004; 415 ± 70 vs 250 ± 45 ms, P < 0.001) before ablation. In children with antegrade dual AV nodal pathways, the antegrade fast pathway ERP decreased from 300 ± 68 ms to 258 ± 62 ms (P = 0.008). The retrograde fast pathway ERP also decreased after successful ablation in the children with retrograde dual AV nodal pathways (415 ± 70 vs. 358 ± 72 ms, P = 0.026). Conclusion: The dual AV nodal physiology could not be commonly demonstrated in pediatric patients with inducible AVNRT. After a successful slow pathway ablation, the fast pathway ERP shortened significantly in the children with dual AV nodal pathways. [ABSTRACT FROM AUTHOR]
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- 2006
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22. Electrophysiological Characteristics of Junctional Rhythm During Ablation of the Slow Pathway in Different Types of Atrioventricular Nodal Reentrant Tachycardia.
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LEE, SHIH‐HUANG, TAI, CHING‐TAI, LEE, PI‐CHANG, CHIANG, CHERN‐EN, CHENG, JUN‐JACK, UENG, KOW‐CHANG, CHEN, YI‐JEN, HSIEH, MING‐HSIUNG, TSAI, CHIN‐FENG, CHIOU, CHUEN‐WANG, YU, WEN‐CHUNG, KUO, JEN‐YUAN, TSAO, HSUAN‐MING, LEE, KUN‐TAI, and CHEN, SHIH‐ANN
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ATRIOVENTRICULAR node , *HEART conduction system , *TACHYCARDIA , *CATHETER ablation , *ELECTROPHYSIOLOGY techniques - Abstract
LEE, S-H.,et al.: Electrophysiological Characteristics of Junctional Rhythm During Ablation of the Slow Pathway in Different Types of Atrioventricular Nodal Reentrant Tachycardia. Background:Junctional rhythm (JR) is commonly observed during radiofrequency (RF) ablation of the slow pathway for atrioventricular (AV) nodal reentrant tachycardia. However, the atrial activation pattern and conduction time from the His-bundle region to the atria recorded during JR in different types of AV nodal reentrant tachycardia have not been fully defined.Methods:Forty-five patients who underwent RF ablation of the slow pathway for AV nodal reentrant tachycardia were included; 27 patients with slow-fast, 11 patients with slow-intermediate, and 7 patients with fast-slow AV nodal reentrant tachycardia. The atrial activation pattern and HA interval (from the His-bundle potential to the atrial recording of the high right atrial catheter) during AV nodal reentrant tachycardia (HASVT) and JR (HAJR) were analyzed.Results:In all patients with slow-fast AV nodal reentrant tachycardia, the atrial activation sequence recorded during JR was similar to that of the retrograde fast pathway, and transient retrograde conduction block during JR was found in 1 (4%) patient. The HAJR was significantly shorter than the HASVT (57± 24 vs 68± 21 ms, P<0.01). In patients with slow-intermediate AV nodal reentrant tachycardia, the atrial activation sequence of the JR was similar to that of the retrograde fast pathway in 5 (45%), and to that of the retrograde intermediate pathway in 6 (55%) patients. Transient retrograde conduction block during JR was noted in 1 (9%) patient. The HAJR was also significantly shorter than the HASVT (145± 27 vs 168± 29 ms, P= 0.014). In patients with fast-slow AV nodal reentrant tachycardia, retrograde conduction with block during JR was noted in 7 (100%) patients. The incidence of retrograde conduction block during JR was higher in fast-slow AV nodal reentrant tachycardia than slow-fast (7/7 vs 1/11, P<0.01) and slow-intermediate AV nodal reentrant tachycardia (7/7 vs 1/27, P<0.01).Conclusions:In patients with slow-fast and slow-intermediate AV nodal reentrant tachycardia, the JR during ablation of the slow pathway conducted to the atria through the fast or intermediate pathway. In patients with fast-slow AV nodal reentrant tachycardia, there was no retrograde conduction during JR. These findings suggested there were different characteristics of the JR during slow-pathway ablation of different types of AV nodal reentrant tachycardia.(PACE 2005; 28:111–118) [ABSTRACT FROM AUTHOR]
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- 2005
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23. Mechanism of Adenosine-Induced Termination of Focal Atrial Tachycardia.
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HIGA, SATOSHI, TAI, CHING‐TAI, LIN, YENN‐JIANG, LIU, TU‐YING, LEE, PI‐CHANG, HUANG, JIN‐LONG, YUNIADI, YOGA, HUANG, BIEN‐HSIEN, HSIEH, MING‐HSIUNG, LEE, SHIH‐HUANG, KUO, JEN‐YUAN, LEE, KUN‐TAI, and CHEN, SHIH‐ANN
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TACHYCARDIA , *ADENOSINES , *ADENINE , *ARRHYTHMIA , *CATHETER ablation , *ELECTROSURGERY - Abstract
Focal Atrial Tachycardia. Introduction:Adenosine can terminate most focal atrial tachycardias (ATs). However, information about the termination mechanism is limited. This study investigated the effects and mechanism of adenosine on terminating focal AT using a three-dimensional noncontact mapping system.Methods and Results:The study consisted of 7 patients (4 men and 3 women; age 44± 29 years) with focal AT. Cycle length variation and atrial activation pattern at baseline and just before AT termination by adenosine (3–12mg) were analyzed. Noncontact mapping demonstrated focal AT propagated from the origin (O) with preferential conduction and spread away from the breakout sites to the whole atrium. Compared to baseline AT, termination episodes revealed higher mean beat-to-beat variation of AT cycle length (11.7± 11.7 msec vs 4.7± 4.5 msec, P<0.001) and standard deviation of normalized AT cycle length (0.033± 0.014 vs 0.011± 0.005, P<0.001). In termination episodes, adenosine significantly decreased the peak negative voltage of AT-O (–27.2± 15.3%, P<0.01), preferential conduction (proximal:–32.1± 18.7, mid:–28.4± 22.8, distal portion:–29.6± 21.4%, P<0.01), and breakout (–31.4± 12.5%, P<0.01). However, adenosine did not affect voltage in nontermination episodes. Adenosine shifted the locations of AT-O in 5 of 10 AT episodes with termination. Mean number of shifting AT-O was 2.4± 1.5 (range 1–4), with maximum shifting distance of 15.0± 3.1 (range 10–19) mm. Focal activation at AT-O simply disappeared in all termination episodes and therefore was not due to conduction block within preferential conduction or breakout site. Catheter ablation lesions covered 50% of total shifting origins, without late recurrence.Conclusion:Adenosine-induced AT termination was associated with significantly decreased electrogram voltage, shifting AT-O locations, and disappearance of focal activation.(J Cardiovasc Electrophysiol, Vol. 15, pp. 1-7, December 2004) [ABSTRACT FROM AUTHOR]
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- 2004
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24. The Different Electrophysiological Characteristics in Children with Wolff-Parkinson-White Syndrome Between Those with and Without Atrial Fibrillation.
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LEE, PI‐CHANG, HWANG, BETAU, TAI, CHING‐TAI, CHIANG, CHERN‐EN, YU, WEN‐CHUNG, and CHEN, SHIH‐ANN
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TACHYCARDIA ,JUVENILE diseases ,WOLFF-Parkinson-White syndrome ,ATRIAL fibrillation ,ELECTROPHYSIOLOGY - Abstract
LEE, P.-C., et al.: The Different Electrophysiological Characteristics in Children with Wolff-Parkinson-White Syndrome Between Those with and Without Atrial Fibrillation. Atrioventricular reciprocating tachycardia (AVRT) is known to be the most common supraventricular tachycardias in childhood. Because AF with rapid ventricular response may degenerate to ventricular fibrillation through conduction of accessory pathways (APs), it can be potentially life-threatening in some pediatric patients with WPW syndrome. However, information about WPW syndrome children associated with AF is limited. The purpose of this study was to investigate the specific electrophysiological characteristics in pediatric patients with WPW syndrome and AF. From July 1992 to February 2002, 51 pediatric patients with manifest WPW syndrome and documented AVRT underwent electrophysiological study and radiofrequency catheter ablation. In these patients, two (4%) were found to have several spontaneous episodes of AF recognized on 12-lead standard ECG or 24-hour Holter monitoring. Eleven (22%) patients had AF induced by rapid atrial pacing during the baseline procedure of electrophysiological study. The children with manifest WPW syndrome were divided into two groups: those with AF (group 1; n = 11) consisted of seven male and four female children (mean age 15 ± 3 years, range 10–18), and those without AF (group 2; n = 40) consisted of 22 boys and 18 girls (mean age 16 ± 3 years, range 7–18). The study excluded a patient who had Ebstein's anomaly associated with moderate tricuspid regurgitation and right atrial enlargement. The onset and duration of symptoms were not significantly different between the two groups. Comparing the electrophysiological characteristics, the atrial effective refractory period (ERP) was shorter in WPW syndrome children with AF (170 ± 36 vs 190 ± 38 ms, P = 0.041). This study demonstrated that the pediatric WPW syndrome patients with AF had different electrophysiological characteristics from those without AF. (PACE 2004; 27:235–239) [ABSTRACT FROM AUTHOR]
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- 2004
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25. Spontaneous Transition of 2:1 Atrioventricular Block to 1:1 Atrioventricular Conduction During Atrioventricular Nodal Reentrant Tachycardia: Evidence Supporting the Intra-Hisian or Infra-Hisian Area as the Site of Block.
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LEE, SHIH‐HUANG, TAI, CHING‐TAI, CHIANG, CHERN‐EN, YU, WEN‐CHUNG, CHENG, JUN‐JACK, DING, YU‐AN, CHANG, MAU‐SONG, and CHEN, SHIH‐ANN
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ATRIOVENTRICULAR node , *HEART conduction system , *TACHYCARDIA , *ELECTROPHYSIOLOGY , *HEART physiology , *HIS bundle - Abstract
Spontaneous Transition of 2:1 AV Block to 1:1 AV Conduction. Introduction: The incidence of spontaneous transition of 2:1 AV block to 1:1 AV conduction during AV nodal reentrant tachycardia has not been well reported. Among previous studies, controversy also existed about the site of the 2:1 AV block during AV nodal reentrant tachycardia. Methods and Results: In patients with 2:1 AV block during AV nodal reentrant tachycardia, the incidence of spontaneous transition of 2:1 AV block to 1:1 AV conduction and change of electrophysiologic properties during spontaneous transition were analyzed. Among the 20 patients with 2:1 AV block during AV nodal reentrant tachycardia, a His-bundle potential was absent in blocked beats during 2:1 AV block in 8 patients, and the maximal amplitude of the His-bundle potential in the blocked beats was the same as that in the conducted beats in 4 patients and was significantly smaller than that in the conducted beats in 8 patients (0.49 ± 0.25 mV vs 0.16 ± 0.07 mV, P = 0.007). Spontaneous transition of 2:1 AV block to 1:1 AV conduction occurred in 15 (75%) of 20 patients with 2:1 AV block during AV nodal reentrant tachycardia. Spontaneous transition of 2:1 AV block to 1:1 AV conduction was associated with transient right and/or left bundle branch block. The 1:1 AV conduction with transient bundle branch block was associated with significant His-ventricular (HV) interval prolongation (66 ± 19 ms) compared with 2:1 AV block (44 ± 6 ms, P < 0.01) and 1:1 AV conduction without bundle branch block (43 ± 6 ms, P < 0.01). Conclusion: The 2:1 AV block during AV nodal reentrant tachycardia is functional; the level of block is demonstrated to be within or below the His bundle in a majority of patients with 2:1 AV block during AV nodal reentrant tachycardia, and a minority are possibly high in the junction between the AV node and His bundle. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1337-1341, December 2003) [ABSTRACT FROM AUTHOR]
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- 2003
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26. Is the Fascicle of Left Bundle Branch Involved in the Reentrant Circuit of Verapamil-Sensitive Idiopathic Left Ventricular Tachycardia?
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KUO, JEN‐YUAN, TAI, CHING‐TAI, CHIANG, CHERN‐EN, YU, WEN‐CHUNG, HUANG, JIN‐LONG, HSIEH, MING‐HSIUNG, JIA‐YIN HOU, CHARLES, TSAI, CHENG‐HO, DING, YU‐AN, and CHEN, SHIH‐ANN
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VERAPAMIL , *TACHYCARDIA , *ELECTROPHYSIOLOGY , *CATHETER ablation , *RADIO frequency - Abstract
The exact reentrant circuit of the verapamil-sensitive idiopathic left VT with a RBBB configuration remains unclear. Furthermore, if the fascicle of left bundle branch is involved in the reentrant circuit has not been well studied. Forty-nine patients with verapamil-sensitive idiopathic left VT underwent electrophysiological study and RF catheter ablation. Group I included 11 patients (10 men, 1 woman; mean age 25 ± 8 years) with left anterior fascicular block (4 patients), or left posterior fascicular block (7 patients) during sinus rhythm. Group II included 38 patients (29 men, 9 women; mean age 35 ± 16 years) without fascicular block during sinus rhythm. Duration of QRS complex during sinus rhythm before RF catheter ablation in group I patients was significant longer than that of group II patients (104 ± 12 vs 95 ± 11 ms, respectively, P = 0.02). Duration of QRS complex during VT was similar between group I and group II patients (141 ± 13 vs 140 ± 14 ms, respectively, P = 0.78). Transitional zones of QRS complexes in the precordial leads during VT were similar between group I and group II patients. After ablation, the QRS duration did not prolong in group I or group II patients (104 ± 11 vs 95 ± 10 ms, P = 0.02); fascicular block did not occur in group II patients. Duration and transitional zone of QRS complex during VT were similar between the two groups, and new fascicular block did not occur after ablation. These findings suggest the fascicle of left bundle branch may be not involved in the antegrade limb of reentry circuit in idiopathic left VT. (PACE 2003; 26:1986–1992) [ABSTRACT FROM AUTHOR]
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- 2003
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27. Novel Concept of Atrial Tachyarrhythmias Originating from the Superior Vena Cava: Insight from Noncontact Mapping.
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Liu, Tu‐Ying, Tai, Ching‐Tai, Lee, Pi‐Chang, Hsieh, Ming‐Hsiung, Higa, Satoshi, Ding, Yu‐An, and Chen, Shih‐Ann
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VENA cava superior , *TACHYARRHYTHMIAS , *MEDICAL literature - Abstract
Noncontact Mapping of SVC Tachycardia. Introduction: Information about the activation patterns inside the superior vena cava (SVC) and entry and exit sites at the SVC-right atrial (RA) junction during SVC tachyarrhythmia is limited. Methods and Results: A detailed characterization of electrophysiologic mechanisms and ablation strategies was performed using a noncontact three-dimensional mapping system in two cases of SVC tachycardia. The first case demonstrated SVC tachycardia originating from an ectopic focus inside the SVC, with sustained depolarization and conduction to the atrium. Entry and exit sites across the SVC-RA junction were located very close to each other. The second case demonstrated two different reentrant circuits, one inside the SVC and the other into and out of the SVC-RA junction. The entry and exit sites were located far away from each other. Conclusion: Noncontact mapping may help to reveal the mechanism of SVC tachyarrhythmias and to locate entry and exit sites at the SVC-RA junction as a guide for catheter ablation.(J Cardiovasc Electrophysiol, Vol. 14, pp. 533-539, May 2003). [ABSTRACT FROM AUTHOR]
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- 2003
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28. Superior Vena Cava Rhythm Masquerading as Normal Sinus Rhythm.
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YUNIADI, YOGA, TAI, CHING‐TAI, LIN, YENN‐JANG, and CHEN, SHIH‐ANN
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TACHYCARDIA , *ELECTROCARDIOGRAPHY , *PATIENTS , *ELECTRODIAGNOSIS , *HEART disease diagnosis , *ELECTRIC properties of hearts - Abstract
SVC Rhythm Masquerading as NSR . We report the case of a patient with persistent cardiac rhythm originating from the superior vena cava (3 cm above the vena cava-atrial junction). It was detected by noncontact balloon mapping before induction of tachycardia and confirmed by conventional contact mapping with image studies. Thus, a 12-lead ECG showing normal morphologies of P waves may not indicate that the P waves are of sinus node origin. (J Cardiovasc Electrophysiol, Vol. 15, pp. 950-952, August 2004) [ABSTRACT FROM AUTHOR]
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- 2004
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29. EP ROUNDS A Narrow Complex Tachycardia with Ventriculoatrial Dissociation After Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia: What is the Mechanism?
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HUANG, BIEN‐HSIEN, TAI, CHING‐TAI, LIU, TU‐YING, and CHEN, SHIH‐ANN
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DIAGNOSIS , *ATRIOVENTRICULAR node , *HEART conduction system , *TACHYCARDIA , *CATHETER ablation , *DIFFERENTIAL diagnosis - Abstract
Discusses a case of a woman with a narrow complex tachycardia with ventriculoatrial dissociation after catheter ablation of atrioventricular nodal reentrant tachycardia. Factors that favor nodofascicular tachycardia; Observation on the junctional tachycardia related to injury to the atrioventricular node; Differential diagnosis.
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- 2004
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30. Long RP Tachycardia After Injury of Accessory Atrioventricular Pathway Conduction by Radiofrequency Catheter Ablation.
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CHEN, HUNG‐YI, TAI, CHING‐TAI, and CHEN, SHIH‐ANN
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TACHYCARDIA , *ATRIOVENTRICULAR node , *CATHETER ablation , *CARDIOVASCULAR diseases , *DISEASES - Abstract
CHEN, H.-Y., et al.: Long RP Tachycardia After Injury of Accessory Atrioventricular Pathway Conduction by Radiofrequency Catheter Ablation. (PACE 2003; 26:765–767). [ABSTRACT FROM AUTHOR]
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- 2003
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31. Incessant Wide QRS Tachycardia After Pulmonary Vein Isolation and Pacemaker Implantation in a Patient with Tachycardia-Bradycardia Syndrome.
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LO, LI‐WEI, TUAN, TA‐CHUAN, TAI, CHING‐TAI, LIN, YENN‐JIANG, CHANG, SHIH‐LIN, and CHEN, SHIH‐ANN
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ARTIFICIAL implant complications ,CARDIAC pacemakers ,PULMONARY veins ,TACHYCARDIA ,HEART beat ,IMPLANTED cardiovascular instruments ,HEART disease diagnosis ,ELECTROCARDIOGRAPHY ,PATIENTS - Abstract
The article presents a medical case of a 51-year-old patient who developed incessant wide QRS tachycardia after pulmonary vein isolation and pacemaker implantation for the treatment of tachycardia-bradycardia syndrome. Five months after the surgery, he presented with palpitations and exertional dyspnea. A 12-lead electrocardiography revealed a wide QRS tachycardia, with a rapid regular ventricular paced rhythm and irregular P waves.
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- 2007
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32. “Pseudosinus Rhythm”: What Is the Mechanism?
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WONGCHAROEN, WANWARANG, TAI, CHING‐TAI, LIN, YENN‐JIANG, CHANG, SHIH‐LIN, and CHEN, SHIH‐ANN
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ATRIAL fibrillation , *VENA cava superior , *PULMONARY veins , *ELECTROCARDIOGRAPHY , *PULMONARY blood vessels , *TACHYCARDIA - Abstract
The article comments on the mechanism of pseudosinus rhythm. According to the author the potential mechanisms of the dissociated sinus rhythm were postulated as the origin of the arrhythmogenic foci that were from the superior vena cava (SVC) and right superior pulmonary vein (RSPV), with exit block from both sites, resulting in the dissociated right and left atrial activities. Another is the arrhythmogenic focus originated in the SVC with exit block, and far-field potentials from the SVC were recorded in the RSPV. Recent evidence indicates that focal electric firing originating from the SVC can initiate paroxysmal atrial fibrillation.
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- 2005
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33. Mechanism of Transition from Wide to Narrow Orthodromic Atrioventricular Reciprocating Tachycardia.
- Author
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YUNIADI, YOGA, TAI, CHING‐TAI, LIN, YENN‐JIANG, HUANG, BIEN‐HSIEN, and CHEN, SHIH‐ANN
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TACHYCARDIA , *SINOATRIAL node , *ARRHYTHMIA , *CARDIAC pacing , *HEART conduction system , *CARDIAC contraction - Abstract
Presents a case of a 34-year-old man with clinical diagnosis of Wolff-Parkinson-White syndrome. Mechanism of transition from wide to narrow orthodromic atrioventricular reciprocating tachycardia; Frequency of the episodes of tachycardia; Presentation of a right bundle branch block pattern at the QRS morphology during tachycardia.
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- 2004
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34. Variation of HA Intervals in Atrioventricular Nodal Reentrant Tachycardia with Atrioventricular Block:.
- Author
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LEE, KUN‐TAI, TAI, CHING‐TAI, LIN, YENN‐JIANG, LAI, WEN‐TER, and CHEN, SHIH‐ANN
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PALPITATION , *TACHYCARDIA , *ELECTROPHYSIOLOGY , *ARRHYTHMIA , *CARDIAC contraction , *ELECTRIC properties of hearts , *PHYSIOLOGICAL effects of electricity - Abstract
Presents a case of a 32-year-old man who was referred for electrophysiologic study because of frequent episodes of palpitation. Absence of any organic heart disease on the patient; Confirmation of the AV nodal reentrant tachycardia by the appearance of dual AV nodal pathway physiology; Mechanism for variation of His-atrial intervals.
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- 2004
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35. Alternating Wide and Narrow QRS Complex Tachycardias:.
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HUANG, BIEN‐HSIEN, TAI, CHING‐TAI, LIN, YENN‐JIANG, and CHEN, SHIH‐ANN
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TACHYCARDIA , *ARRHYTHMIA , *DIASTOLE (Cardiac cycle) , *HEART beat , *HEART diseases , *ELECTROCARDIOGRAPHY - Abstract
Describes a case involving a patient suffering from alternating wide and narrow QRS complex tachycardias. Symptoms exhibited by the patient; Characteristics of tachycardias; Diastolic potential shown by endocardial mapping.
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- 2004
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36. Supraventricular Tachycardias with Progressive Change of QRS Complex Morphology.
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KUO, JEN‐YUAN, TAI, CHING‐TAI, YU, WEN‐CHUNG, LEE, PI‐CHANG, and CHEN, SHIH‐ANN
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VENTRICULAR tachycardia , *CARDIAC pacing , *MORPHOLOGY , *DISEASES in teenagers , *TACHYCARDIA , *ARRHYTHMIA - Abstract
Presents the case of a 15-year-old man with a supraventricular tachycardia with changing morphology of QRS complex and tachycardia cycle length induced by ventricular burst pacing. Medical history of the patient; Possible mechanism explaining supraventricular tachycardias with progressive change of QRS complex morphology; Reason for the progressive preexcitation of the QRS complex.
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- 2004
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37. The electrophysiologic characteristics of atrioventricular nodal reentry tachycardia with eccentric retrograde activation
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Ong, Mary Gertrude Y., Lee, Pi-Chang, Tai, Ching-Tai, Lin, Yenn-Jiang, Hsieh, Ming-Hsiung, Chen, Yi-Jen, Lee, Kun-Tai, Tsao, Hsuan-Ming, Kuo, Jen-Yuan, Chang, Shih-Lin, and Chen, Shih-Ann
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TACHYCARDIA , *ARRHYTHMIA , *CATHETER ablation , *PAROXYSMAL tachycardia - Abstract
Abstract: Background: The occurrence of eccentric retrograde atrial activation has been demonstrated to be from 6 to 8% in patients with atrioventricular nodal reentrant tachycardia (AVNRT) by several previous reports. However, most of those reports were limited by the absence of coronary sinus venography to confirm if the retrograde activation was truly left sided. The purposes of this study were to 1) determine the incidence of left sided retrograde atrial activation in our center, 2) determine the specific electrophysiologic characteristics of eccentric and concentric atrial activation and 3) determine the outcome of radiofrequency catheter ablation for AVNRT with eccentric retrograde atrial activation. Methods: From November 2001 to July 2004, 290 consecutive patients with AVNRT who underwent an electrophysiologic study and radiofrequency ablation were included. Group 1 consisted of AVNRT patients with eccentric retrograde atrial activation; group 2 consisted of AVNRT patients with concentric retrograde atrial activation. The electrophysiologic characteristics of the group 1 and group 2 patients were then compared. Results: The incidence of AVNRT with eccentric retrograde activation confirmed by CS venography was 6.5%. There were more females and atypical AVNRT in patients with retrograde eccentric conduction. There was more VA block after ablation and tachycardia induction by right ventricular pacing/extrastimuli in eccentric rather than concentric retrograde atrial activation. A shorter antegrade fast functional refractory period of the AV node was demonstrated in the atypical eccentric group as compared to the atypical concentric group. Conclusion: This study demonstrated the different electrophysiologic characteristics between the AVNRT patients with eccentric and concentric retrograde atrial activation. Successful ablation sites were similar to the standard RA ablation sites in patients with retrograde eccentric conduction. [Copyright &y& Elsevier]
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- 2007
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38. Effects of right bundle branch block during atrioventricular nodal reentrant tachycardia
- Author
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Lee, Kun-Tai, Lee, Shih-Huang, Tai, Ching-Tai, Lee, Pi-Chang, Chiang, Chern-En, Lin, Yenn-Jiang, Huang, Bien-Hsien, Yuniadi, Yoga, Lai, Wen-Ter, and Chen, Shih-Ann
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ARRHYTHMIA , *TACHYCARDIA , *CATHETER ablation , *CATHETERIZATION - Abstract
Abstract: Background: The significant role of bundle branch block during atrioventricular nodal reentrant tachycardia (AVNRT) is not clear. The purposes of this study were to study the effects of complete right bundle branch block (RBBB) on electrophysiological parameters during AVNRT and to define the significance of complete RBBB during AVNRT. Methods and results: According to characteristics of electrocardiogram during sinus rhythm and AVNRT, 50 patients who underwent catheter ablation for slow¿fast AVNRT were divided into three groups. Group I included 20 patients who had narrow QRS (¿110 ms) during sinus rhythm and AVNRT. Group II included 18 patients who had persistent RBBB (¿120 ms) during sinus rhythm and AVNRT. Group III included 12 patients who had narrow QRS during sinus rhythm, but they had narrow QRS and transient RBBB during AVNRT. The atrio-His (AH) interval (296±60 vs. 288±75 ms), His-ventricular (HV) interval (36±11 vs. 35±11 ms), His-atrial (HA) interval (72±24 vs. 71±28 ms), VAHRA interval (defined as the interval between the onset of ventricular depolarization and the onset of atrial activity of right high atrium; 34±24 vs. 37±25 ms), VACSO interval (defined as the interval between the onset of ventricular depolarization and the onset of atrial activity of coronary sinus ostium; 13±28 vs. 26±23 ms) and tachycardia cycle length (TCL; 368±67 vs. 359±73 ms) during AVNRT were similar between group I and group II (all P>0.05). In group III, the AH interval (255±81 vs. 246±83 ms), HV interval (44±5 vs. 42±11 ms), HA interval (66±19 vs. 70±15 ms), VAHRA interval (27±15 vs. 29±16 ms), VACSO interval (23±25 vs. 21±25 ms) and TCL (322±76 vs. 316±77 ms) were not significantly different between AVNRT with narrow QRS and those with transient RBBB (all P>0.05). Conclusions: Persistent RBBB and transient RBBB have no significant effects on the electrophysiological parameters during AVNRT. These findings suggest that RBBB might not influence the conduction of lower common pathway or the circuit of AVNRT. [Copyright &y& Elsevier]
- Published
- 2005
- Full Text
- View/download PDF
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