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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]

Introduction: Early restoration of sinus rhythm following ablation of atrial fibrillation (AF) facilitates reverse atrial remodeling and improves the long-term outcome. The purpose of this study was to determine the predictors and outcome in patients with very early AF recurrences (< 2 days)., Methods and Results: Ablation was performed in 339 consecutive AF patients (paroxysmal AF = 262). Biatrial voltage was mapped during sinus rhythm. If recurrent AF occurred within 2 days following the ablation, electrical cardioversion was performed to restore sinus rhythm. Very early recurrences of AF occurred in 39 (15%) patients with paroxysmal AF and 26 (34%) with nonparoxysmal AF. Patients with very early recurrence had a higher incidence of nonparoxysmal AF (40% vs 18.6%, P< 0.001), requirement of electrical cardioversion during procedure, larger left atrial (LA) diameter (43 ± 7 vs 39 ± 6 mm, P< 0.001), lower left ventricular ejection fraction (54 ± 10% vs 59 ± 7, P< 0.001), longer procedural time, and lower LA voltage (1.5 ± 0.7 vs 1.9 ± 0.8 mV, P< 0.001). A multivariate analysis revealed that the independent predictors of a very early recurrence were a longer procedural time and lower LA voltage. During a follow-up of 13 ± 5 months, a very early recurrence did not predict the long-term outcome of a single procedure recurrence in the patients with paroxysmal AF, but was associated with a late recurrence in the nonparoxysmal AF patients., Conclusion: Very early recurrence occurred in patients with paroxysmal AF is not associated with long-term recurrence. Nonparoxysmal AF is an independent predictor of late recurrence of AF in patients with very early recurrence., (© 2011 Wiley Periodicals, Inc.)

Background: Alteration in ventricular repolarization has been reported in patients with spinal cord injuries (SCIs). However, its clinical impact remains unclear., Objective: The purpose of this study was to investigate the correlation between SCIs and ventricular repolarization and the associated clinical impact., Methods: One hundred forty-four patients with an SCI were retrospectively reviewed and were divided into two groups (SCI level ≤ T6, n = 110; SCI level >T6, n = 34). The electrocardiograms were reviewed during acute phase (at emergency room) and chronic phase (>1 year)., Results: There were no differences in the underlying diseases or in ASIA score between the two groups, except there were more patients with tetraplegia among those with an SCI level ≤ T6. For the electrophysiological parameters from the electrocardiograms, the patients with an SCI level ≤ T6 had longer QTc and PR interval than those with an SCI level >T6 during acute phase. In the chronic phase, there were no differences in the electrophysiological parameters between the two groups. Only in patients with an SCI level ≤ T6 did a Kaplan-Meier analysis show that QTc prolongation could predict 30-day mortality after the acute injury. After multivariate Cox regression analysis, only tetraplegia and QTc prolongation were independent predictors of 30-day mortality (odds ratios 7.85 and 34.62, respectively). In patients with an SCI level ≤ T6, the QTc intervals were shorter in the chronic phase than those during the acute phase., Conclusion: QTc interval was associated with the level of acute SCI and predicted the 30-day mortality., (Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background: Few epidemiologic data on the gender differences among patients with accessory atrioventricular pathways have been reported., Objective: The purpose of this study was to investigate the explicit gender differences in electrophysiologic characteristics among patients with accessory atrioventricular pathways., Methods: A total of 1,821 consecutive patients with accessory atrioventricular pathways were referred to our institution for electrophysiologic study and radiofrequency catheter ablation. A detailed electrophysiologic study was performed in all patients., Results: Patient age at onset of atrioventricular reentrant tachycardia was 43 ± 17 years. There were 1,117 males (61.3%) with accessory atrioventricular pathways. Men had more manifest and left-sided but fewer multiple accessory pathways. Men had more antidromic atrioventricular reentrant tachycardia. Men had a shorter anterograde accessory pathway effective refractory period (ERP) and a higher prevalence of an anterograde accessory pathway ERP (<250 ms). Men with accessory atrioventricular pathways had a longer atrioventricular nodal ERP and atrial ERP and a shorter ventricular ERP., Conclusion: Gender differences in the clinical and electrophysiologic characteristics of patients with accessory atrioventricular pathways could be closely linked and may imply a different pathogenesis., (Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.)

Introduction: Information about the impact of age on the electrophysiological characteristics of accessory pathways (APs) in patients with Wolff-Parkinson-White (WPW) syndrome remains limited., Methods and Results: A total of 1,885 consecutive patients (mean age 43 ± 17 years, male 61.5%) with WPW syndrome who were referred to the tertiary center for an electrophysiological study and radiofrequency catheter ablation were investigated. The patients were divided into 4 groups based on their age (Group 1: <20; Group 2: 20-39; Group 3: 40-59; Group 4: ≧60 years old). With age, more left-sided APs (53.2%, 67.7%, 71.7%, 75.7%, P < 0.001) and a longer duration of the arrhythmia (4.3 ± 2.8 years, 10.1 ± 7.0 years, 12.4 ± 10.9 years, 14.0 ± 12.4 years, P < 0.001) were noted. The incidence of concealed APs (53.5%, 53.0%, 57.8%, 60.9%, P = 0.01), and orthodromic atrioventricular (AV) reentrant tachycardia (92.4%, 94.2%, 96.5%, 96.3%, P = 0.023) increased with age. The tachycardia cycle length, antegrade (275.5 ± 42.2 ms, 286.7 ± 62.7 ms, 302.5 ± 66.5 ms, 315.2 ± 80.2 ms, P < 0.001) and retrograde AP effective refractory periods (APERPs) (254.0 ± 42.5 ms, 263.3 ± 51.8 ms, 274.5 ± 100.5 ms, 292.7 ± 57.0 ms, P < 0.001), atrial ERP, antegrade AV node effective refractory period (AVNERP), and ventricular effective refractory period (VERP) lengthened as the age increased. The incidence of decremental APs, multiple APs, and a catecholamine response were similar. The duration of the catheter ablation, total fluoroscopy time, acute success rate, complication rate, and incidence of a secondary procedure were similar between the different age groups., Conclusion: The electrophysiological characteristics and pattern of the arrhythmic attack associated with the AP changed with age., (© 2010 Wiley Periodicals, Inc.)

Background: Previous studies have indicated that atrial fibrillation (AF) in patients over the age of 60 at diagnosis is a risk factor for a substantial increase in cardiovascular events. However, information about the impact of age on the atrial substrate and clinical outcome after catheter ablation of AF is limited., Methods: This study included 350 patients (53 ± 12 years, 254 males) who underwent circumferential pulmonary vein isolation (CPVI) of AF, guided by a NavX mapping system. The subjects were divided into three groups according to their age, as follows: Group I: age ≤50 (n = 141), Group II: age = 51-64 (n = 149) and Group III: age ≥65 years old (n = 60). The mean voltage and total activation time of the individual atria were obtained by using a NavX mapping system before ablation. Several parameters, including the gender, AF duration, and left atrial (LA) diameter were analyzed., Results: The younger age group had a significantly smaller LA diameter (Group I vs Group II vs Group III, 36.89 ± 7.11 vs 39.16 ± 5.65 vs 40.77 ± 4.95 mm, P = 0.002) and higher LA bipolar voltage (2.09 ± 0.83 vs 1.73 ± 0.73 vs 1.86 ± 0.67 mV, respectively, P = 0.024), compared with the older AF patients. The LA bipolar voltage exhibited a significant reduction when the patients became older, however, that did not occur in the right atrium. The incidence of an AF recurrence was higher in the older age group than in the younger age groups. A subgroup of patients with lone AF was analyzed and age was found to be an independent predictor of the AF recurrence after receiving the first CPVI in the multivariable model (P < 0.05)., Conclusions: Age has a significant impact on the LA substrate properties and outcome of the catheter ablation of AF., (© 2010 Wiley Periodicals, Inc.)

Gender differences of supraventricular tachycardias such as atrioventricular nodal re-entry, atrioventricular re-entry, and atrial fibrillation have been reported. There is little evidence of the effect of gender on focal atrial tachycardia (FAT). The study consisted of 298 patients who were referred to this institution for radiofrequency catheter ablation of FAT from October 1992 to April 2008 and included 156 men (52%) and 142 women (48%). Men were significantly older than women (57.9 +/- 18.2 vs 47.2 +/- 19.0 years old, p <0.001). Women had more associated arrhythmias (17.0% vs 28.9%, p = 0.01), mostly due to an increased incidence of atrioventricular nodal re-entrant tachycardia. Men had more cardiovascular co-morbidities (19.9% vs 9.9%, p = 0.02), a mechanism of increased automaticity (19.1% vs 8.1%, p = 0.01), and nonparoxysmal tachycardia (14.7% vs 4.4%, p = 0.01). No gender differences were noted among FAT number, left atrial involvement, shortest tachycardia cycle, success rate of catheter ablation, or recurrence rate of FAT. Mean duration of follow-up was 63.2 +/- 47.5 months. Premenopausal women had a lesser cardiovascular co-morbidity (15.3% vs 4.3%, p = 0.04) and a greater incidence of a mechanism of increased automaticity (13.4% vs 2.9%, p = 0.03). In conclusion, gender differences in electrophysiologic characteristics were noted in FAT.

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.