[Show abstract][Hide abstract] ABSTRACT: The aim of study was to report different and unusual patterns of preexcitation syndrome (PS) noted in patients referred for studied for poorly-tolerated arrhythmias and their frequency. Electrophysiologic study (EPS) is an easy means to identify a patient with PS at risk of serious events. However the main basis for this diagnosis is the ECG which associates short PR interval and widening of QRS complex with a delta wave.
ECGs of 861 patients in whom PS related to an atrioventricular accessory pathway (AP) was identified at electrophysiological study (EPS), were studied.
The most frequent unusual presentation (9.6%) was the PS presenting with a normal or near normal ECG, noted preferentially for left lateral AP and rarely for posteroseptal or right lateral location. More exceptional (0.1%) was the presence of a long PR interval, which did not exclude a rapid conduction over AP. The association of a complete AV block with symptomatic tachycardias was exceptional (0.3%) and was shown related to a rapid conduction over AP after isoproterenol. Most of the presented patients were at high-risk at EPS.
The diagnosis of PS is not always evident and symptoms should draw attention to minor abnormalities and lead to enlarge indications of EPS, only means to confirm or not PS.
International Journal of Cardiology 04/2014; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The most commonly used drug for the facilitation of supraventricular tachycardia (SVT) induction in the electrophysiological (EP) laboratory is isoprenaline. Despite isoprenaline's apparent indispensability, availability has been problematic in some European countries. Alternative sympatomimethic drugs such as adrenaline have therefore been tried. However, no studies have determined the sensitivity and specificity of adrenaline for the induction of SVT. The objective of this study was to determine the sensitivity and specificity of adrenaline for the induction of SVT.METHODS AND RESULTS: Between February 2010 and July 2013, 336 patients underwent an EP study for prior documented SVT. In 66 patients, adrenaline was infused because tachycardia was not induced under basal conditions. This group was compared with 30 control subjects with no history of SVT. Programmed atrial stimulation was carried out during baseline state and repeated after an infusion of adrenaline (dose ranging from 0.05 mcg/kgc to 0.3 mcg/kgc). The endpoint was the induction of SVT. Among 66 patients with a history of SVT but no induction under basal conditions, adrenaline facilitated induction in 54 patients (82%, P < 0.001). Among the 30 control subjects, SVT was not induced in any patient (0%) after infusion. Adrenaline was generally well tolerated, except for two patients (3.0%), where it had to be discontinued due to headache and high blood pressure or lumbar pain.CONCLUSION: Adrenaline infusion has a high sensitivity (82%) and specificity (100%) for the induction of SVT in patients with prior documented SVT. Therefore, it could serve as an acceptable alternative to isoprenaline, when the latter is not available.
[Show abstract][Hide abstract] ABSTRACT: Patients with well-tolerated sustained monomorphic ventricular tachycardia (SMVT) and left ventricular ejection fraction (LVEF) over 30% may benefit from a primary strategy of VT ablation without immediate need for a 'back-up' implantable cardioverter-defibrillator (ICD).
One hundred and sixty-six patients with structural heart disease (SHD), LVEF over 30%, and well-tolerated SMVT (no syncope) underwent primary radiofrequency ablation without ICD implantation at eight European centres. There were 139 men (84%) with mean age 62 ± 15 years and mean LVEF of 50 ± 10%. Fifty-five percent had ischaemic heart disease, 19% non-ischaemic cardiomyopathy, and 12% arrhythmogenic right ventricular cardiomyopathy. Three hundred seventy-eight similar patients were implanted with an ICD during the same period and serve as a control group. All-cause mortality was 12% (20 patients) over a mean follow-up of 32 ± 27 months. Eight patients (40%) died from non-cardiovascular causes, 8 (40%) died from non-arrhythmic cardiovascular causes, and 4 (20%) died suddenly (SD) (2.4% of the population). All-cause mortality in the control group was 12%. Twenty-seven patients (16%) had a non-fatal recurrence at a median time of 5 months, while 20 patients (12%) required an ICD, of whom 4 died (20%).
Patients with well-tolerated SMVT, SHD, and LVEF > 30% undergoing primary VT ablation without a back-up ICD had a very low rate of arrhythmic death and recurrences were generally non-fatal. These data would support a randomized clinical trial comparing this approach with others incorporating implantation of an ICD as a primary strategy.
European Heart Journal 02/2014; · 14.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Most postinfarct ventricular tachycardias (VTs) are sustained by a reentrant mechanism. The “protected isthmus” of the reentrant circuit is critical for the maintenance of VTs and the target for catheter ablation. Various techniques based on conventional electrophysiology and/or detailed three-dimensional (3D) reconstruction of the VT circuit are used to unmask this isthmus.
The purpose of this study was to assess pace-maps (PMs) to identify postinfarct VT isthmuses. We hypothesized that an abrupt change in paced QRS morphology may be used to identify a VT isthmus and be targeted for successful ablation.
High-density 3D PMs were matched to the subsequent 3D endocardial reentrant VT activation mapping in 10 patients (8 men; age 70.7 ± 10.8 years) who underwent successful postinfarct VT ablation. At each pacing site in a given patient, the 12-lead ECG recorded during pacing was compared to that of VT, with the resulting matching percentage (up to 100% for perfect matches) allocated to this point to generate color-coded PMs.
With respect to VT isthmuses, the best percentages of matching were found in the exit zones and isthmus exit part (89% ± 8% and 84% ± 7%, respectively) and the poorest adjacent to scar border in the outer entrance zones (23% ± 28%), in the entrance zones (39% ± 34%), and in the entrance part of the isthmus (32% ± 26%). The color-coded sequence (from the best to the poorest matching sites) on the PMs revealed figure-of-eight pictures matching the VT activation time maps and identifying VT isthmuses.
Pace-mapping is useful for unmasking VT isthmuses in patients with well-tolerated postinfarct endocardial reentrant VTs.
Heart rhythm: the official journal of the Heart Rhythm Society 02/2014; 11(2):175–181. · 4.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Little is known about the epidemiology of 1:1 atrial flutter (AFL). Our objectives were to determine its prevalence and predisposing conditions. METHODS: 1037 patients aged 16 to 93years (mean 64±12) were consecutively referred for AFL ablation. 791 had heart disease (HD). Patients admitted with 1/1 AFL were collected. Patients were followed 3±3years. RESULTS: 1:1 AFL-related tachycardiomyopathy was found in 85 patients, 59 men (69%) with a mean age of 59±12years. The prevalence was 8%. They were compared to 952 patients, 741 men (78%, 0.04), with a mean age of 65±12years (0.002) without 1:1 AFL. Factors favoring 1:1 AFL was the absence of HD (35 vs 23%, 0.006), the history of AF (42 vs 30.5%)(0.025) and the use of class I antiarrhythmic drugs (34 vs 13%)(p<0.0001), while use of amiodarone or beta blockers was less frequent in patients with 1:1 AFL (5, 3.5%) than in patients without 1:1 AFL (25, 15%) (p<0.0001, 0.03). The failure of ablation (9.4 vs 11%), ablation-related complications (2.3 vs 1.4%), risk of subsequent atrial fibrillation (AF) (20 vs 24%), risk of AFL recurrences (19 vs 13%) and risk of cardiac death (5 vs 6%) were similar in patients with and without 1:1 AFL. CONCLUSIONS: The prevalence of 1:1 AFL in patients admitted for AFL ablation was 8%. These patients were younger, had less frequent HD, had more frequent history of AF and received more frequently class I antiarrhythmic drugs than patients without 1:1 AFL. Their prognosis was similar to patients without 1:1 AFL.
International journal of cardiology 04/2013; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: -The occurrence of ventricular tachycardia (VT) following myocardial infarction (MI) is associated with poorer prognosis. In such patients, implantable cardioverter-defibrillators (ICD) are recommended. Catheter ablation of VT is currently recommended only as an adjunctive therapy. Whether a successful VT ablation alone might be a viable strategy in some of these patients, however, remains unknown. The aim of the present study was to evaluate this strategy. METHODS AND RESULTS: -Between January 2002 and December 2011, 189 patients with cardiomyopathy underwent 259 VT ablations in our centre. 45 patients (mean age 65.2±9.6 years, 91% males) with a history of MI and mean left ventricular ejection fraction of 39.7±9.7% matched the study criteria and were included in this analysis. Acute success was obtained in 40/45 (88.9%). During a follow-up, based on our stepwise algorithm [utilising acute success, repeat electrophysiological study (EPS) and recurrence of VT], 19/45 (42.2%) underwent ICD implantation. During a median follow-up of 4.5 (IQR: 2.1-7.0) years, all-cause mortality occurred in 14/45 (31.1%) of patients. Using multivariate Cox regression analysis, age [hazard ratio (HR)=1.13, 95% confidence interval (CI): 1.03-1.22, p=0.007] was the only independent predictor of mortality while ICD implantation was not [HR=0.54, 95% CI: 0.18-1.64, p=0.28) CONCLUSIONS: -Our results suggest that a stepwise approach to the management of VT with ablation as a first line treatment in post-infarct patients presenting with VT might be a reasonable option. Further studies are required to confirm these results.
Circulation Arrhythmia and Electrophysiology 03/2013; · 5.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Syncope in Wolff-Parkinson-White syndrome (WPW) is without relationship with WPW or reveals a poorly tolerated arrhythmia. Electrophysiologic study (EPS) is recommended. The purpose of the study was to evaluate the influence of the patient's age on the causes and prognosis of syncope. METHODS: A total of 98 patients, mean age 35 ± 18 years, with WPW were admitted for syncope. Note that 29 were aged between 9 and 19 years (mean 15 ± 3) (children and teenagers/group I), 45 between 20 and 49 years (mean 34 ± 8) (adults/group II), and 24 between 50 and 70 years (mean 60 ± 8) (elderly/group III). EPS consisted of atrial pacing and programmed atrial stimulation in control state and after isoproterenol. RESULTS: Potentially malignant form (rapid conduction in accessory pathway >240 beats/min in control state or >300 beats/min after isoproterenol and atrial fibrillation [AF] induction) was more frequent in group I (34%) than in groups II (7%) (P < 0.002) and III (0%) (P < 0.001). Orthodromic atrioventricular reentrant tachycardia (AVRT) and AF were induced as frequently in groups I (59, 34%), II (47, 15.5%), and III (54, 17%). AVRT was induced in all but one patient with malignant form. EPS was as frequently negative in groups I (27.5%), II (44%), and III (37.5%). Natural follow-up (mean 8 ± 6 years) indicated a favorable prognosis, only related to AVRT induction. Induced AF was without significance. CONCLUSIONS: Data in syncope and WPW syndrome depended on age: electrophysiological malignant form was frequent in children/teenagers, rare in adults, and absent in elderly. AVRT, the main cause of syncope, was as frequent in all ranges of age. AF's induction alone had no significance. Final prognosis was favorable.
Pacing and Clinical Electrophysiology 02/2013; · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sex-related differences were not reported for the atrial flutter (AF). The purpose of the study was to look for the influence of gender on indications, clinical data and long-term results of AFl ablation. METHODS: 985 patients, [227 females (23%)] were referred for radiofrequency AFl ablation. Clinical history, echocardiography were collected. Patients were followed from 3months to 10years. RESULTS: Age of women and men was similar (65.5±12 vs 64±11.5years). Underlying heart disease (HD) was as frequent in women as men (77.5 vs 77%), but women had more congenital HD (10 vs 2%;p<0.001), valvular HD (18 vs 10%;p<0.002), hypertensive HD (24 vs 18%;p<0.05), and less chronic lung disease (5 vs 10%;p<0.01), and ischemic HD (5 vs 20%;p<0.001). Atrial fibrillation (AF) history was more frequent in women (36 vs 27%;p<0.001). AFl-related tachycardiomyopathy (4.5 vs 8%;p<0.03) was more frequent, but 1/1 AFl (10 vs 6%;p=NS) as frequent. Failure of ablation (16 vs 10%;p<0.01), ablation-related major complications (3.5 vs 0.9%;p<0.005) were more frequent in women. After 3±3years, AFl recurrences were as frequent in women and men (10 vs 14%), AF occurrence more frequent in women (34 vs 19.5%; p<0.001). After excluding patients with previous AF, AF risk remained higher in women (19 vs 12%; p<0.004). CONCLUSIONS: In patients admitted for ablation, AFL was less common in women than in men, despite similar age and similarly prevalent HD. More than men, women had frequent AF history, a higher risk of failure of ablation and AFl ablation-related major complications and a higher risk of AF after ablation.
International journal of cardiology 01/2013; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AIMS: Orthodromic atrioventricular reentrant tachycardia (ORT) is the most common arrhythmia at electrophysiological study (EPS) in patients with pre-excitation. The purpose of the study was to determine the clinical significance and the electrophysiological characteristics of patients with inducible antidromic tachycardia (ADT).METHODS AND RESULTS: Electrophysiological study was performed in 807 patients with a pre-excitation syndrome in control state and after isoproterenol. Antidromic tachycardia was induced in 63 patients (8%). Clinical and electrophysiological data were compared with those of 744 patients without ADT. Patients with and without ADT were similar in term of age (33 ± 18 vs. 34 ± 17), male gender (68 vs. 61%), clinical presentation with spontaneous atrioventricular reentrant tachycardia (AVRT) (35 vs. 42%), atrial fibrillation (AF) (3 vs. 3%), syncope (16 vs. 12%). In patients with induced ADT, asymptomatic patients were less frequent (24 vs. 37%; <0.04), spontaneous ADT and spontaneous malignant form more frequent (8 vs. 0.5%; <0.001) (16 vs. 6%; <0.002). Left lateral accessory pathway (AP) location was more frequent (51 vs. 36%; P < 0.022), septal location less frequent (40 vs. 56%; P < 0.01). And 1/1 conduction through AP was more rapid. Orthodromic AVRT induction was as frequent (55.5 vs. 55%), but AF induction (41 vs. 24%; P < 0.002) and electrophysiological malignant form were more frequent (22 vs. 12%; P < 0.02). The follow-up was similar; four deaths and three spontaneous malignant forms occurred in patients without ADT. When population was divided based on age (<20/≥20 years), the older group was less likely to have criteria for malignant form.CONCLUSION: Antidromic tachycardia induction is rare in pre-excitation syndrome and generally is associated with spontaneous or electrophysiological malignant form, but clinical outcome does not differ.
[Show abstract][Hide abstract] ABSTRACT: The number of scar-related ventricular tachycardia (VT) ablation procedures is increasing worldwide. This is certainly due to the ever growing number of patients implanted with an implantable cardioverter defibrillator in whom an ablation procedure may be required to better control the ventricular arrhythmia burden, but is also likely related to our better understanding of the arrhythmias mechanisms as well as the improvement of the mapping techniques during the last 15 years. Most VTs, especially those arising after myocardial infarction, depend on a critical isthmus. Defining precisely the critical isthmus of postinfarct VT may be challenging, particularly when the arrhythmia is poorly tolerated. In the literature, there are extensive data concerning the value of conventional electrophysiological techniques, especially entrainment mapping in association with postpacing interval measurements, regarding the identification of postinfarct VT isthmuses. There are, however, other--sometimes emerging--approaches to image critical postinfarct VT channels. We have summarized these, reviewing data from the published literature as well as our own experience.
Pacing and Clinical Electrophysiology 05/2012; 35(7):897-904. · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Radiofrequency ablation has became a validated therapeutic technique for symptomatic drug refractory atrial fibrillation (AF). Cardiac computed tomography (CT) is used to evaluate left atrial (LA) anatomy in order to improve AF ablation. The analysis of noncardiac structures during cardiac CT may identify clinically significant incidental findings (IFs). The objective of this study was to determine the prevalence of IF in patients undergoing AF catheter ablation.
Between February 2008 and March 2010, all patients planned for a first procedure of AF or LA tachycardia (LAT) ablation underwent a cardiac CT scan and were retrospectively included in this study. Extracardiac IFs were considered to be present if an abnormality was identified without previous clinical suspicion or known disease.
Two hundred and fifty patients (55.2 ± 9.6 years of age, 82.4% men) were enrolled (133 paroxysmal, 43 persistent, 58 permanent AF, and 16 LAT). Fifty-eight patients (23.2%) had a total of 76 IFs. Patients with IF were significantly older (59.5 ± 8.2 vs 53.8 ± 9.7 years old, P < 0.001). No relationship existed between the type of arrhythmia and IF existence. The majority of IFs were pulmonary (50%), with 15.8% of pulmonary emphysema. Two cases of lung cancer and of pulmonary fibrosis, 15 mediastinal adenopathies, and three congenital coronary arteries anomalies were found.
Cardiac CT scan is a useful tool to evaluate LA morphology before AF ablation. However, as a considerable prevalence of IF was found in our study, extracardiac structures should be routinely analyzed to detect unknown conditions, which could require specific management.
Pacing and Clinical Electrophysiology 09/2011; 34(12):1665-70. · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Electrocardiographic criteria of preexcitation syndrome are sometimes not visible on ECG in sinus rhythm (SR). The purpose of the study was to evaluate the significance of unapparent preexcitation syndrome in SR, when overt conduction through accessory pathway (AP) was noted at atrial pacing.Methods
Anterograde conduction through atrioventricular AP was identified at electrophysiological study (EPS) in 712 patients, studied for tachycardia (n = 316), syncope (n = 89) or life-threatening arrhythmia (n = 55) or asymptomatic preexcitation syndrome (n = 252). ECG in SR at the time of EPS was analysed.Results78 patients (11%) (group I) had a normal ECG in SR and anterograde conduction over AP at atrial pacing; 634 (group II) had overt preexcitation in SR. Group I was as frequently asymptomatic (35%) as group II (35%), had as frequently tachycardias, syncope or life-threatening arrhythmia as group II (43, 5, 2% vs 43, 13, 8%). AP was more frequently left lateral in group I (57%) than in group II (36%)(p < 0.001). AV re-entrant tachycardia, atrial fibrillation (AF), antidromic tachycardia were induced as frequently in group I (54, 18, 10%) as in group II (54, 27, 7%). Malignant forms (induced AF with RR intervals between preexcited beats < 250 ms in control state or < 200 ms after isoproterenol) were as frequent in group I (11.5%) as II (14%).Conclusions
The frequency of unapparent preexcitation syndrome represents 11% of our population with anterograde conduction through an AP and could be underestimated. The risk to have a malignant form is as high as in patients with overt preexcitation syndrome in SR.Research highlights► 11% of patients with conduction through accessory pathway had unapparent preexcitation syndrome. ► It is recommended repeating the ECG recordings in subjects who practice sports. ► Do not hesitate to indicate electrophysiological study in a patient who complains of tachycardia.
International journal of cardiology 06/2011; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: IntroductionPulmonary vein (PV) isolation is considered the cornerstone of atrial fibrillation (AF) catheter ablation. PV isolation (PVI) by means of cryotherapy has emerged as a promising technique due to both a low thrombogenicity and reduced risk of PV stenosis. The evaluation (need/efficiency/safety) of hybrid therapy (defined as the use of cryotherapy followed by that of radiofrequency energy in a given patient) is the aim of the present study.Methods
Thirty-four consecutive patients (26 men, mean age: 56.7 ± 9.3 years) with symptomatic drug-refractory paroxysmal AF underwent PVI using a balloon-cryotherapy (BCT). A maximum of four cryotherapy applications was applied per PV and disconnection assessed thereafter using a circular LASSO® catheter. When necessary, PV disconnection was then performed using a 4 mm irrigated-tip catheter. All patients underwent CT-scan evaluation before discharge to detect acute PV stenosis.ResultsPVI could be achieved in all patients. Mean procedure duration was 230 ± 42 min and mean fluoroscopy time was 52 ± 13 min. Hybrid therapy was needed to achieve PVI in 26 of 34 (76%). With cryoablation solely, PVI was achieved in 90 of 136 (66%) targeted veins, efficacy being higher in superior as compared to inferior PVs (87% vs. 46%, p < 0.001). Besides one patient with permanent right phrenic nerve injury, no other procedure-related complications were observed. After a mean follow-up period of 8 ± 3 months, 28 patients (82%) did not experience AF recurrence (including six patients on antiarrhythmic drugs).Conclusions
Our study suggests that hybrid ablation therapy is necessary in most patients to achieve PV disconnection after a maximum of four blinded applications of balloon-cryotherapy (especially in inferior PVs), with a significant short-term success rate.
The Egyptian Heart Journal. 06/2011; 63(2):97–101.
[Show abstract][Hide abstract] ABSTRACT: The existence of inter-atrial epicardial connections bridging the two atria at different levels has well been described and their implication in some forms of supraventricular arrhythmias is a known fact. However, up to date, little data exists in the literature showing their role in the mechanisms of focal atrial tachycardias, providing at the same time clear electroanatomical and activation maps using a three-dimensional, non-fluoroscopic mapping system.
We present the case of a 29-year-old woman with a focal atrial tachycardia with the origin in a pulmonary vein, manifested as a right atrial origin due to the conduction of the electrical impulse form the right inferior pulmonary vein (RIPV) to the postero-inferior right atrium (RA) via inter-atrial epicardial connections. Using a three-dimensional, non-fluoroscopic mapping system (CARTO, Biosense Webster), an RA activation map was created during tachycardia.
Radiofrequency (RF) application at the earliest endocardial breakthrough site situated in the postero-inferior RA changed the right atrial depolarization sequence without terminating the arrhythmia. Subsequently, a left atrium activation map was created showing the earliest endocardial breakthrough site at the level of the RIPV ostium and RF application at this level abolished the atrial tachycardia.
Inter-atrial epicardial connections can be part of the substrate of some forms of supraventricular arrhythmias. Awareness of their existence is important to the electrophysiologist, since a better understanding of transseptal activation can avoid, in some cases, unnecessary RF applications at the level of the postero-septal right atrium, with a subsequent increase in procedural risk.
Annales de cardiologie et d'angeiologie 05/2011; 60(4):236-9. · 0.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Atrioventricular reentrant tachycardia (AVRT) is frequent in Wolff-Parkinson-White syndrome (WPW). Atrial fibrillation (AF) is rare. The purpose of the study was to determine the factors of spontaneous AF in WPW according to the initial presentation.
Electrophysiological study (EPS) was performed among 709 patients with a preexcitation syndrome. First event was AF in 44 patients. Remaining patients were studied for AVRT (314), syncope (94), adverse presentation without AF (9) or systematically (248 asymptomatic patients). Patients with AF were older than other patients (44 ± 16 years vs 34.5 ± 17) (0.0003); maximal rate conducted over accessory pathway (AP) was higher in patients with AF than in other patients except in adverse presentation (0.0002); AVRT was induced more frequently in patients with AF than in asymptomatic patients (57% vs 14.5%) but less than in patients with AVRT (89%). AF was induced more frequently in patients with AF than in other patients except in adverse presentation (<0.0001). During follow-up AF occurred more frequently in patients with AF (5; 11%) than in patients with AVRT (7; 2%), with syncope (1%) and asymptomatic patients (4; 1.6%). Older age predicted recurrence (54 ± 16 vs 40 ± 17).
AF was the first event in only 6% of patients with WPW and was a rare event in other patients. They are older but 10% are less than 18 years and have a more rapid conduction over AP than other patients.
International journal of cardiology 01/2011; 157(3):359-63. · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A complete, bidirectional conduction block in the cavotricuspid isthmus (CTI) represents the end-point of the typical atrial flutter ablation. We investigated the correlation between two criteria for successful ablation, one based on the atrial bipolar electrogram morphology before and after complete CTI conduction block, compared to the standard criteria of differential pacing and reversal in the right atrial depolarization sequence during coronary sinus (CS) pacing.
We conducted a retrospective study in 111 patients (81 males, average age 62±10 years) who underwent an atrial flutter ablation during September 2007 - July 2009 in the Cardiology - Rehabilitation Hospital, UMF Cluj-Napoca. We assessed the presence of a bidirectional block at the end of the procedure using the standard criteria. We then analyzed the morphology of the bipolar atrial electrograms adjacent to the ablation line, before and after CTI conduction block.
A change from a qRs morphology to a rSr' morphology when pacing from the coronary sinus and from a rsr' morphology to a QRS morphology when pacing from the low-lateral right atrium was associated with a CTI conduction block. Sensitivity (Se), specificity(Sp), positive predictive value (PPV), negative predictive value (NPV) were 96%, 89%, 99% and 67% respectively.
Our study suggests that the analysis of the atrial bipolar electrogram next to the ablation line before and after CTI ablation may be used as a reliable criterion to validate CTI conduction block due to its high sensitivity, specificity and positive predictive value.
Indian pacing and electrophysiology journal 01/2011; 10(12):536-46.
[Show abstract][Hide abstract] ABSTRACT: Typical atrial flutter (cavo-tricuspid isthmus-dependent) has as an electrophysiological substrate a macro-reentry circuit localized in the right atrium. Depending on the right atrial depolarization sequence, the rotation of the macro-reentry circuit can be counterclockwise (with an inferior to superior activation of the right atrium free wall and superior to inferior activation of the interatrial septum), characterized by negative F waves in inferior leads (DII, DIII, aVF) and V6, and positive in V1 on the surface electrogram (ECG), or clockwise (with a superior to inferior activation of the right atrium free wall and inferior to superior activation of the interatrial septum) characterized by positive F waves in inferior leads (DII, DIII, aVF) and V6, and negative in V1. Nevertheless, it is considered that for the diagnosis of the typical or atypical nature of this arrhythmia, the surface ECG has limited value. The purpose of this study was to compare the relationship between the flutter rotation sequence determined by the intracavitary electrogram and the morphology of the F waves on the surface ECG.
The study included 387 patients admitted to the Cardiology - Rehabilitation Hospital from Cluj-Napoca between January 2007 and May 2010, diagnosed with typical atrial flutter during an electrophysiological study. Using the intracavitary electrograms the flutter rotation sequence was determined (clockwise or counterclockwise). The F waves' aspect on the surface ECG in leads DII, DIII, aVF, aVL, V1 and V6 was then analyzed.
One hundred and fifty two patients (39.3%) were diagnosed with clockwise atrial flutter and 235 patients (60.7%) with counterclockwise atrial flutter. The positive predictive value (PPV) of negative F waves in inferior leads and positive in V1 was, in the case of counterclockwise atrial flutter 98%; the negative predictive value (NPV) was 79%; sensitivity (Se) was 83% and specificity (Sp) was 97%. For typical clockwise atrial flutter, the PPV of the positive F waves in the inferior leads and negative in V1 was 94% (p < 0.001); the NPV was 85%; Se was 73% and Sp was 97%.
The surface ECG has a high value in determining the macroreentry circuit rotation sequence in the case of typical atrial flutter.
Romanian journal of internal medicine = Revue roumaine de médecine interne 01/2011; 49(1):31-6.
[Show abstract][Hide abstract] ABSTRACT: Les vingt dernières années ont été les témoins d’avancées scientifiques significatives dans le domaine de la rythmologie,
et notamment dans la compréhension du mécanisme des arythmies. Ces progrès se sont traduits rapidement au niveau des soins
offerts aux patients par une augmentation, régulière et importante, du nombre des ablations endocavitaires réalisées pour
des troubles du rythme cardiaque. L’exemple de la fibrillation atriale est le plus démonstratif. En effet, en 1990, le traitement
curatif par ablation endocavitaire de la fibrillation atriale n’était que pure chimère alors qu’en 2010 près d’un quart des
patients admis dans un centre de rythmologie interventionnelle en France le sont pour ce motif ! Au cours de ces deux décennies,
des progrès importants dans le domaine de l’imagerie cardiaque ont également favorisé l’essor de l’électrophysiologie interventionnelle.
En effet, en dehors de l’ablation des troubles du rythme les plus « simples », comme le flutter atrial commun dépendant de
l’isthme cavotricuspide ou les tachycardies par réentrée nodale, les besoins des cardiologues interventionnels ne se limitent
plus simplement à l’utilisation de la fluoroscopie et à l’enregistrement des électrogrammes intracardiaques. En effet, avec
l’accroissement de la complexité des arythmies traitées dans les centres de rythmologie interventionnelle, l’imagerie cardiaque
a pris une place de plus en plus importante pour aider les électrophysiologistes.