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Radiofrequency Catheter Ablation (radiofrequency + catheter_ablation)
Kinds of Radiofrequency Catheter Ablation Selected AbstractsCapsule Endoscopy in Examination of Esophagus for Lesions After Radiofrequency Catheter Ablation: A Potential Tool to Select Patients With Increased Risk of ComplicationsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2010LUIGI DI BIASE M.D. Capsule Endoscopy in Examination of Esophagus.,Background: Esophageal injury can result from left atrial radiofrequency ablation (RFA) therapy, with added concern because of its possible relationship to the development of atrial-esophageal (A-E) fistulas. Objective: Evaluate utility of esophageal capsule endoscopy to detect esophageal lesions as a complication of RFA therapy in the treatment of atrial fibrillation (AF). Methods: Consecutive patients with AF who underwent left atrial RFA therapy and received capsule endoscopy within 48 hours postablation. Video was reviewed by a single gastroenterologist. The medical records were also reviewed for symptoms immediately postablation and at the 3-month follow-up. Results: A total of 93 consecutive patients were included and 88 completed the study and were analyzed. The prevalence of esophageal lesions was 17% (15/88 patients). Nine percent (8/88) of these patients had lesions anatomically consistent with the location of the ablation catheter. Six patients with positive capsule findings had symptoms of chest pain (3/6, 50%), throat pain (2/6, 33%), nausea (1/6, 17%), and abdominal pain (1/6, 17%). An additional 24 patients were symptomatic postablation, but with normal capsule findings. All patients with identified lesions by capsule endoscopy received oral proton pump inhibitor therapy, and were instructed to contact the Cleveland Clinic in the event of worsening symptoms. No delayed complications were reported at the 3-month follow-up. Conclusion: This study supports the use of capsule endoscopy as a tool for the detection of esophageal injury post-RFA therapy. PillCam ESO is well tolerated and provides satisfactory images of the areas of interest in the esophagus without potential risk related to insufflation with regular esophagogastroduodenoscopy. (J Cardiovasc Electrophysiol, Vol. 21, pp. 839-844, August 2010) [source] Hybrid Therapy of Radiofrequency Catheter Ablation and Percutaneous Transvenous Mitral Commissurotomy in Patients With Atrial Fibrillation and Mitral StenosisJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2010TAKESHI MACHINO M.D. AF Ablation and PTMC.,Background: The rhythm control of atrial fibrillation (AF) associated with mitral stenosis (MS) is often difficult using antiarrhythmic drugs (AADs), even after a percutaneous transvenous mitral commissurotomy (PTMC). Few studies have examined the efficacy and safety of simultaneously performing radiofrequency catheter ablation (RFCA) and a PTMC in patients with MS and AF. Methods: Twenty consecutive patients with drug-resistant AF and rheumatic MS underwent RFCA combined with a PTMC (n = 10; persistent AF-8, long-lasting [>1 year] persistent AF-2; RFCA group) or transthoracic direct cardioversion (DC) following a PTMC (n = 10; persistent AF-7, long-lasting persistent AF-3; DC group). In all patients, the mitral valve morphology was amenable to a PTMC, and more than 2 AADs had been ineffective in maintaining sinus rhythm (SR). In the RFCA group, a segmental pulmonary vein isolation (PVI) was performed in the initial 5 patients, and an extensive PVI was performed in the remaining 5. Results: During a mean follow-up period of 4.0 ± 2.7 years, 8 patients (80%) in the RFCA group were maintained in SR, as compared to 1 (10%) in the DC group (hazard ratio, 0.16; 95% confidence interval, 0.03 to 0.75; P = 0.008 by the log-rank test). The prevalence of the concomitant use of class I and/or class III AADs was comparable between the 2 groups (P = 0.70). No complications occurred during the procedure or follow-up period in either group. Conclusions: The hybrid therapy using RFCA and a PTMC was safe and feasible, and significantly improved the AF free survival rate compared to DC following a PTMC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 284,289, March 2010) [source] Acute Pulmonary Vein Stenosis after Radiofrequency Catheter AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2009NICOLAS COMBES M.D. No abstract is available for this article. [source] Temporary Occlusion of the Great Cardiac Vein and Coronary Sinus to Facilitate Radiofrequency Catheter Ablation of the Mitral IsthmusJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2008ANDRE D'AVILA M.D. Introduction: Ablation of the mitral isthmus to achieve bidirectional conduction block is technically challenging, and incomplete block slows isthmus conduction and is often proarrhythmic. The presence of the blood pool in the coronary venous system may act as a heat-sink, thereby attenuating transmural RF lesion formation. This porcine study tested the hypothesis that elimination of this heat-sink effect by complete air occlusion of the coronary sinus (CS) would facilitate transmural endocardial ablation at the mitral isthmus. Methods: This study was performed in nine pigs using a 30 mm-long prototype linear CS balloon catheter able to occlude and displace the blood within the CS (the balloon was inflated with ,5 cc of air). Using a 3.5 mm irrigated catheter (35 W, 30 cc/min, 1 minute lesions), two sets of mitral isthmus ablation lines were placed per animal: one with the balloon deflated (CS open) and one inflated (CS Occluded). After ablation, gross pathological analysis of the linear lesions was performed. Results: A total of 17 ablation lines were placed: 7 with CS Occlusion, and 10 without occlusion. Despite similar biophysical characteristics of the individual lesions, lesion transmurality was consistently noted only when using the air-filled CS balloon. Conclusions: Temporary displacement of the venous blood pool using an air-filled CS balloon permits transmurality of mitral isthmus ablation; this may obviate the need for ablation within the CS to achieve bidirectional mitral isthmus conduction. [source] Radiofrequency Catheter Ablation of Atrial Fibrillation in Athletes Referred for Disabling Symptoms Preventing Usual Training Schedule and Sport CompetitionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2008FRANCESCO FURLANELLO M.D. Introduction: Atrial fibrillation (AF) may occasionally affect athletes by impairing their ability to compete, and leading to noneligibility at prequalification screening. The impact of catheter ablation (CA) in restoring full competitive activity of athletes affected by AF is not known. The aim of our study was to investigate the effectiveness of CA of idiopathic AF in athletes with palpitations impairing physical performance and compromising eligibility for competitive activities. Methods and Results: Twenty consecutive competitive athletes (all males; 44.4 ± 13.0 years) with disabling palpitations on the basis of idiopathic drug-refractory AF underwent 46 procedures (2.3 ± 0.4 per patient) according to a prospectively designed multiprocedural CA approach that consolidates pulmonary veins (PV) isolation through subsequent steps. Preablation, effort-induced AF could be documented in 13 patients (65%) during stress ECG and significantly reduced maximal effort capacity (176 ± 21 W), as compared with patients with no AF during effort (207 ± 43 W, P < 0.05). At the end of CA protocol, which also included ablation of atrial flutter (AFL) in 7 patients, 18 (90.0%) patients were free of AF and two (10.0%) reported short-lasting (minutes) episodes of palpitations during 36.1 ± 12.7 months follow-up. Compared with preablation, postablation maximal exercise capacity significantly improved (from 183 ± 32 to 218 ± 20 W, P < 0.02). All baseline quality of life (QoL) parameters pertinent to physical activity significantly improved (P < 0.05) at the end of CA protocol. All athletes obtained reeligibility and could effectively reinitiate sport activity. Conclusions: AF, alone or in combination with AFL, may significantly impair maximal effort capacity thereby limiting competitive performance. Multiple PV isolation proved very effective in these patients to restore full competitive activity and allow reeligibility. [source] Real-Time Monitoring of Luminal Esophageal Temperature During Left Atrial Radiofrequency Catheter Ablation for Atrial Fibrillation: Observations About Esophageal Heating During Ablation at the Pulmonary Vein Ostia and Posterior Left AtriumJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2006CHRISTIAN PERZANOWSKI M.D. Introduction: Left atrial radiofrequency catheter ablation (RFA) is gaining acceptance as treatment for drug-refractory atrial fibrillation (AF). This therapy has been associated with esophageal injury and atrioesophageal fistula formation causing death. Methods: We describe 3 patients undergoing catheter ablation for AF during real-time monitoring of luminal esophageal temperature. Results: We observed heating of the esophagus during short duration low power RFA, at either the left or right pulmonary vein ostia. Cryoablation at the pulmonary vein ostium in one patient resulted in esophageal cooling. Furthermore, we observed that fluoroscopic localization of the ablation catheter at a site apparently distant from the esophagus is not adequate to assure avoidance of ablation-induced esophageal heating. Conclusions: Real-time monitoring of luminal esophageal position and temperature is feasible, enhances recognition of esophageal heating, and may add useful information beyond that provided by fluoroscopic assessment of esophageal position. There is a potential role for esophageal monitoring to help avoid thermal injury to the esophagus during catheter ablation for atrial fibrillation. [source] Successful Radiofrequency Catheter Ablation of Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary VeinJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005YASUHIRO HIRASAWA M.D. We report a case of idiopathic left ventricular outflow tract (LVOT) tachycardia that was eliminated by a radiofrequency application from the anterior interventricular coronary vein (AIV). The ECG exhibited QRS complexes with an inferior axis and atypical left bundle branch block pattern with an early transition of the precordial R waves at V3. Several radiofrequency applications from the coronary cusps and endocardial LVOT were not effective. Radiofrequency applications in the AIV, where the activation preceded the onset of the QRS by 30 msec, successfully eliminated the tachycardia. The AIV may be an optional site for radiofrequency ablation of idiopathic epicardial LVOT tachycardia. [source] Detection of Inadvertent Catheter Movement into a Pulmonary Vein During Radiofrequency Catheter Ablation by Real-Time Impedance MonitoringJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2004PETER CHEUNG M.D. Introduction: During radiofrequency ablation to encircle or isolate the pulmonary veins (PVs), applications of radiofrequency energy within a PV may result in stenosis. The aim of this study was to determine whether monitoring of real-time impedance facilitates detection of inadvertent catheter movement into a PV. Methods and Results: In 30 consecutive patients (mean age 53 ± 11 years) who underwent a left atrial ablation procedure, the three-dimensional geometry of the left atrium, the PVs, and their ostia were reconstructed using an electroanatomic mapping system. The PV ostia were identified based on venography, changes in electrogram morphology, and manual and fluoroscopic feedback as the catheter was withdrawn from the PV into the left atrium. Real-time impedance was measured at the ostium, inside the PV at approximately 1 and 3 cm from the ostium, in the left atrial appendage, and at the posterior left atrial wall. There was an impedance gradient from the distal PV (127 ± 30 ,) to the proximal PV (108 ± 15 ,) to the ostium (98 ± 11 ,) in each PV (P < 0.01). There was no significant impedance difference between the ostial and left atrial sites. During applications of radiofrequency energy, movement of the ablation catheter into a PV was accurately detected in 80% of the cases (20) when there was an abrupt increase of ,4 , in real-time impedance. Conclusion: There is a significant impedance gradient from the distal PV to the left atrium. Continuous monitoring of the real-time impedance facilitates detection of inadvertent catheter movement into a PV during applications of radiofrequency energy. (J Cardiovasc Electrophysiol, Vol. 15, pp. 1-5, June 2004) [source] Left Atrial Flutter After Radiofrequency Catheter Ablation of Focal Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2003JULIÁN VILLACASTÍN M.D. We report an arrhythmic complication in two patients in whom a procedure directed at isolating one or two pulmonary veins had been performed. The complication was related to pulmonary vein disconnection scars after ablation. Both patients developed new clinical tachycardia (atypical atrial flutter) secondary to a reentrant phenomena in the vicinity of a previously ablated pulmonary vein.(J Cardiovasc Electrophysiol, Vol. 14, pp. 417-421, April 2003) [source] Long-Term Follow-Up After Radiofrequency Catheter Ablation of Ventricular Tachycardia: A Successful Approach?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2002ALIDA E. BORGER VAN DER BURG M.D. RF Catheter Ablation of VT.Introduction: Radiofrequency ablation (RFCA) of ventricular tachycardia (VT) is a potential curative treatment modality. We evaluated the results of RFCA in patients with VT. Methods and Results: One hundred fifty-one consecutive patients (122 men and 29 women; age 57 ± 16 years) with drug-refractory VT were treated. Underlying heart disease was ischemic heart disease in 89 (59%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 32 (21%), and idiopathic VT in 30 (20%; left ventricle in 9 [30%]; right ventricle in 21 [70%]). Ablation was performed using standard ablation techniques. Three hundred six different VTs were treated (cycle length 334 ± 87 msec, 2.0 ± 1.4 VTs per patient). Procedural success (noninducibility of VT after RFCA) was achieved in 126 (83%) patients (70 ischemic heart disease [79%]; 28 ARVC [88%]; 27 idiopathic VT [93%]). Procedure-related complications (< 48 hours) occurred in 11 (7%) patients: death 3 (2.0%), cerebrovascular accident 2 (1.3%), complete heart block 4 (2.6%), and pericardial effusion 3 (2.0%). Thirty-three (22%) patients received an implantable cardioverter defibrillator (because of hemodynamic unstable VT, failure of the procedure, or aborted sudden death). During follow-up (34 ± 11 months), VT recurrences occurred in 38 (26%) patients (recurrence rate: 19% in successfully ablated patients and 64% in nonsuccessfully ablated patients; P < 0.001). During follow-up, 12 (8%) patients died (heart failure 8, unknown cause 1, noncardiac cause 3). Conclusion: RFCA of VT can be performed with a high degree of success (83%). The long-term outcome of successfully ablated patients is promising, with a 75% relative risk reduction compared with nonsuccessfully ablated patients. During follow-up, only one patient died suddenly, supporting a selective ICD placement approach in patients with hemodynamically stable VT. [source] Radiofrequency Catheter Ablation of Idiopathic Ventricular Tachycardia Originating in the Main Stem of the Pulmonary ArteryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2002CARL TIMMERMANS M.D. Idiopathic Pulmonary Artery Ventricular Tachycardia. We report the case of a patient in whom successful radiofrequency catheter ablation of an idiopathic ventricular tachycardia (VT) originating in the main stem of the pulmonary artery was performed. After successful ablation of the index arrhythmia, which was an idiopathic right ventricular outflow tract VT, a second VT with a different QRS morphology was reproducibly induced. Mapping of the second VT revealed the presence of myocardium approximately 2 cm above the pulmonary valve. Application of radiofrequency energy at this site resulted in termination and noninducibility of this VT. After 6-month follow-up, the patient remained free from VT recurrences. [source] Radiofrequency Catheter Ablation of Postinfarction Ventricular Tachycardia from the Proximal Coronary SinusJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2001JOSEF KAUTZNER M.D., Ph.D. VT Ablation from the Coronary Sinus. Optimum strategy for radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) after inferior wall myocardial infarction (MI) that originates from the posteroseptal process of the left ventricle is not known. We describe a case report of a 57,year-old man who developed recurrent post-MI VT with ECG morphology consistent with this type of VT (i.e., left bundle branch block pattern with predominant R waves from V2 to V6 and left-axis deviation). Endocardial mapping and entrainment during VT demonstrated a critical isthmus of the reentrant circuit in the proximal coronary sinus. RF application terminated VT and rendered it noninducible. [source] Topographic Anatomy of the Inferior Pyramidal Space: Relevance to Radiofrequency Catheter AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2001DAMIÁN SÁNCHEZ-QUINTANA M.D. Inferior Pyramidal Space and Ablation.Introduction: Radiofrequency catheter ablation carried out in the vicinity of the triangle of Koch risks damaging not only the AV conduction tissues but also their arterial supply. The aim of this study was to examine the relationship of the AV nodal artery to the inferior pyramidal space, the triangle of Koch, and the right atrial endocardial surface. Methods and Results: We studied 41 heart specimens, 24 by gross dissections and 17 by histologic sections. The proximity of the AV nodal artery to the surface landmarks of the triangle of Koch was variable, but it was notable that in 75% of specimens the artery passed close to the endocardial surface of the right atrium and within 0.5 to 5 mm of the mouth of the coronary sinus. In all specimens, the mean distance of the artery to the endocardial surface was 3.5 ± 1.5 mm at the base of Koch's triangle. The location of the compact AV node and its inferior extensions varied within the landmarks of the triangle. At the mid-level of Koch's triangle, the compact node was medially situated in 82% of specimens, but it was closer to the hinge of the tricuspid valve in the remaining 18% of specimens. In 12% of specimens, the inferior parts of the node extended to the level of the mouth of the coronary sinus. Conclusion: The nodal artery runs close to the orifice of the coronary sinus, the endocardial surface of the right atrium, the middle cardiac vein, and the specialized conduction tissues in most hearts. The nodal artery and/or the AV conduction tissues can be at risk of damage when ablative procedures are carried out at the base of the triangle of Koch. [source] Predictive Capability of Left Atrial Size Measured by CT, TEE, and TTE for Recurrence of Atrial Fibrillation Following Radiofrequency Catheter AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2010SACHIN S. PARIKH M.D. Background: Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) has been well established and is in part related to left atrial (LA) size. The purpose of this study was to assess the predictive capability of LA diameter (LAD) and LA volume (LAV) by echocardiography and computed tomography (CT) to determine success in patients undergoing RFCA of AF. Methods: Eighty-eight patients with paroxysmal or persistent AF who had undergone RFCA and had a prior transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and CT were enrolled in the study. TTE LADs and LV ejection fraction as well as TEE LADs and LAVs in three views were recorded. CT LAVs were also recorded. Clinical parameters prior to ablation as well as at 1-year follow-up were assessed. Results: A total of 40 (45%) patients with paroxysmal AF and 48 (55%) patients with persistent AF were analyzed. Paroxysmal AF patients had a RFCA success rate of 88% at 1 year with persistent AF patients having a 52% success rate (P < 0.001). A CT-derived LAV , 117 cc was associated with an odds ratio (OR) for recurrence of 4.8 (95% confidence interval [CI]=[1.4,16.4], P = 0.01) while a LAV ,130 cc was associated with an OR for recurrence of 22.0 (95% CI =[2.5,191.0], P = 0.005) after adjustment for persistent AF. Conclusions: LA dimensions and AF type are highly predictive of AF recurrence following RFCA. LAV by CT has significant predictive benefit over standard LADs in severely enlarged atria even after adjustment for AF type. (PACE 2010; 532,540) [source] The Most Common Site of Success and Its Predictors in Radiofrequency Catheter Ablation of the Slow Atrioventricular Nodal Pathway in ChildrenPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2008HAW-KWEI HWANG M.D. Background:Locating ablation targets on the slow pathway in children as one would in adults may not accommodate the dimensional changes of Koch's triangle that occur with heart growth. We investigated the most common site of success and the effect of a variety of variables on the outcome of slow pathway ablation in children. Methods:A total of 116 patients (ages 4,16 years) with structurally normal hearts underwent radiofrequency ablation of either the antegrade or the retrograde slow pathway. Ablation sites were divided into eight regions (A1, A2, M1, M2, P1, P2, CS1, and CS2) at the septal tricuspid annulus. Results:Ablation was successful in 112 (97%) children. The most common successful ablation sites were at the P1 region. The less the patient weighed, the more posteriorly the successful site was located (P = 0.023, OR 0.970, 95% CI 0.946,0.996), and the more likely the slow pathway was eliminated rather than modified: median weight was 46.7 kg (range, 14.5,94.3 kg) in the eliminated group and 56.5 kg (range, 20,82.6 kg) in the modified group (P = 0.021, OR 1.039, 95% CI 1.006,1.073). Conclusions:The most common site of success for slow pathway ablation in children is at the P1 region of the tricuspid annulus. The successful sites in lighter children are more posteriorly located. Weight is also a predictor of whether the slow pathway is eliminated or only modified. [source] Successful Radiofrequency Catheter Ablation of Ventricular Tachycardia Originating from Underneath the Mechanical Prosthetic Aortic ValvePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2008TAKUMI YAMADA M.D. A 67-year-old man who developed sustained ventricular tachycardia (VT) 4 years after a prosthetic aortic valve replacement, underwent electrophysiologic testing and catheter ablation. The mechanism of the VT was suggested to be triggered activity because the VT could be induced by programmed ventricular stimulation, and burst ventricular pacing demonstrated overdrive suppression without a transient entrainment. Successful catheter ablation using a transseptal approach was achieved underneath the mechanical prosthetic aortic valve on the blind side for that approach. This case demonstrated that catheter mapping and ablation of the entire LV using a transseptal approach might be possible. [source] Electrophysiologic Characteristics and Radiofrequency Catheter Ablation in Children with Wolff-Parkinson-White SyndromePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2006PI-CHANG LEE Background: The majority of cardiac arrhythmias in children are supraventricular tachycardia, which is mainly related to an accessory pathway (AP)-mediated reentry mechanism. The investigation for Wolff-Parkinson-White (WPW) syndrome in adults is numerous, but there is only limited information for children. This study was designed to evaluate the specific electrophysiologic characteristics and the outcome of radiofrequency (RF) catheter ablation in children with WPW syndrome. Methods: From December 1989 to August 2005, a total of 142 children and 1,219 adults with atrioventricular reentrant tachycardia (AVRT) who underwent ablation at our institution were included. We compared the clinical and electrophysiologic characteristics between children and adults with WPW syndrome. Results: The incidence of intermittent WPW syndrome was higher in children (7% vs 3%, P=0.025). There was a higher occurrence of rapid atrial pacing needed to induce tachycardia in children (67% vs 53%, P=0.02). However, atrial fibrillation (AF) occurred more commonly in adult patients (28% vs 16%, P = 0.003). The pediatric patients had a higher incidence of multiple pathways (5% vs 1%, P < 0.001). Both the onset and duration of symptoms were significantly shorter in the pediatric patients. The antegrade 1:1 AP conduction pacing cycle length (CL) and antegrade AP effective refractory period (ERP) in children were much shorter than those in adults with manifest WPW syndrome. Furthermore, the retrograde 1:1 AP conduction pacing CL and retrograde AP ERP in children were also shorter than those in adults. The antegrade 1:1 atrioventricular (AV) node conduction pacing CL, AV nodal ERP, and the CL of the tachycardia were all shorter in the pediatric patients. Conclusion: This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome. [source] Quality of Life and Cost for Patients with Premature Ventricular Contractions by Radiofrequency Catheter AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2006CONG-XIN HUANG Objective: To evaluate the quality of life (QoL), health-care resource utilization, and cost for the patients with premature ventricular contractions (PVCs) by radiofrequency catheter ablation (RFCA). Methods: RFCA was performed in 58 patients with symptomatic PVCs that were refractory/easy to medication. A 24-hour ambulatory electrocardiographic monitoring, QoL, health-care resources utilization, and cost were assessed at a screening visit and 3 and 12 months after RFCA. Results: RFCA was successfully performed in 56 patients (96.6%). This resulted in a significant improvement in the QoL at 3 and 12 months after the procedure. There were no major complications related to the procedure. Nine patients (15.5%) had residual arrhythmia. Seven of them underwent repeated ablation with successful results. It also improved the QoL and reduced health-care resource utilization and cost. Conclusions: RFCA is a safe and effective treatment for PVCs, and it is a viable alternative to drugs in the presence of disabling symptoms. [source] Use of Intracardiac Echocardiography in Guiding Radiofrequency Catheter Ablation of Atrial Tachycardia in a Patient After the Senning OperationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2003ANITA KEDIA A patient with D-transposition of the great arteries developed drug refractory atrial tachycardia 12 years after a Senning operation. Electrophysiological study confirmed the presence of atrial baffle-tricuspid valve isthmus dependent reentrant intraatrial tachycardia. Intracardiac echocardiography facilitated initial identification of structures, catheter positioning, and identification of the atrial baffle-tricuspid valve isthmus. (PACE 2003; 26:2178,2180) [source] Left Atrial Flutter After Segmental Ostial Radiofrequency Catheter Ablation for Pulmonary Vein IsolationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2003HAKAN ORAL Segmental ostial ablation to electrically isolate pulmonary veins has been performed for atrial fibrillation. Left atrial flutter that utilized a critical isthmus adjacent to the ostium of the left superior pulmonary vein was diagnosed and successfully ablated in a patient 3 months after a successful pulmonary vein isolation procedure. Documenting the cause of symptoms after pulmonary vein isolation in patients with atrial fibrillation is critical in guiding therapy. (PACE 2003; 26:1417,1419) [source] Radiation Exposure During Radiofrequency Catheter Ablation for Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p2 2003LAURENT MACLE MACLE, L., et al.: Radiation Exposure During Radiofrequency Catheter Ablation for Atrial Fibrillation.RF catheter ablation of paroxysmal atrial fibrillation (PAF) is associated with prolonged fluoroscopy. The procedural duration and fluoroscopic exposure to patients and medical staff were recorded and compared among 43 ablation procedures for PAF, 20 for common atrial flutter, and 16 for accessory pathways. Patient radiation exposure was measured by dosimeters placed over the xyphoid, while that of physicians and nurses was measured by dosimeters placed outside and inside the lead apron. The mean fluoroscopy time was57 ± 30minutes for PAF,20 ± 10minutes for common flutter, and22 ± 21minutes for accessory pathway ablation. The patient median radiation exposure was 1110,Sv for PAF, compared with 500 ,Sv for common flutter and 560 ,Sv for accessory pathway ablation (P < 0.01). The median radiation exposure to physician and nurse inside the lead apron were, respectively, 2 ,Sv and 3 ,Sv for PAF, 1 ,Sv and 2 ,Sv for common flutter, and <0.5 ,Sv and 3 ,Sv for accessory pathway ablations. RF catheter ablation for PAF was associated with prolonged fluoroscopy times and a twofold higher radiation exposure to the patient and physician compared with other ablation procedures. Assuming 300 procedures/year, radiation exposure to the medical staff was below the upper recommended annual dose limit. (PACE 2003; 26[Pt. II]:288,291) [source] Radiofrequency Catheter Ablation of an Incessant Ventricular Tachycardia Following Valve SurgeryPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2002THORSTEN LEWALTER LEWALTER, T., et al.: Radiofrequency Catheter Ablation of an Incessant Ventricular Tachycardia Following Valve Surgery. Sustained monomorphic ventricular tachycardia (VT) after valve surgery represents a clinical entity with different tachycardia mechanisms. This case report describes an incessant VT after tricuspid and aortic valve replacement that did not respond to antiarrhythmic drug treatment. The tachycardia exhibited VA block and a right bundle branch block pattern with left-axis deviation, suggesting ventricular excitation via the left posterior fascicle. The electrophysiological study was limited by the prosthetic tricuspid and aortic valve replacement, therefore a transseptal approach was necessary to obtain access to the ventricular myocardium. Radiofrequency catheter ablation was performed in the proximal left bundle or distal His region with termination of the incessant VT followed by complete AV block. After pacemaker implantation using a transvenous right atrial and an epicardial ventricular lead, no VT reoccurrence could be documented. [source] Change in Morphology of Reentrant Atrial Arrhythmias Without Termination Following Radiofrequency Catheter AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2002MASAHIKO TAKAGI TAKAGI, M., et al.: Change in Morphology of Reentrant Atrial Arrhythmias Without Termination Following Radiofrequency Catheter Ablation. A 60-year-old woman who had previously undergone an atrial septal defect repair and had type I atrial flutter underwent electrophysiological study. After radiofrequency (RF) ablation to the isthmus between the inferior vena cava and the tricuspid annulus, type I atrial flutter was changed to atrial tachycardia following atriotomy without termination. This atrial tachycardia was eliminated by single-site RF ablation of a small lesion below the caudal end of the atriotomy scar, where continuous and fragmented potentials were recorded during tachycardia. We experienced a rare case in which RF energy changed tachycardia circuits. [source] Successful Pediatric Stenting of a Nonthrombotic Coronary Occlusion as a Complication of Radiofrequency Catheter AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2001GUNNAR G. STROBEL STROBEL, G.G., et al.: Successful Pediatric Stenting of a Nonthrombotic Coronary Occlusion as a Complication of Radiofrequency Catheter Ablation. This is a case of a right coronary artery occlusion complicating a RF catheter ablation of a posteroseptal accessory connection in an 8-year-old boy. After multiple balloon angioplasty attempts in the occluded vessel, only transient patency was achieved. The occlusion was successfully treated with placement of an intracoronary stent. [source] When Should Heparin Preferably Be Administered During Radiofrequency Catheter Ablation?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2001OLE-GUNNAR ANFINSEN ANFINSEN, O.-G., et al.: When Should Heparin Preferably be Administered During Radiofrequency Catheter Ablation? RF catheter ablation is complicated by thromboembolism in about 1% of patients. Limited knowledge exists concerning when and how to use anticoagulation or antithrombotic treatment. We studied the activation of coagulation (prothrombin fragment 1 + 2 [PF1 + 2] and D-dimer), platelets (,-thromboglobulin [,-TG]) and fibrinolysis (plasmin-antiplasmin complexes [PAP]) during RF ablation of accessory pathways in 30 patients. They were randomized to receive heparin (100 IU/kg, intravenously) (1) immediately after introduction of the femoral venous sheaths (group I) or (2) after the initial electrophysiological study, prior to the delivery of RF current (groups II and III). Group II additionally received saline irrigation of all femoral sheaths. After the initial bolus, 1,000 IU of heparin was supplied hourly in all groups. Within groups II and III, median plasma values of PF1 + 2 and ,-TG more than tripled (P , 0.007) during the diagnostic study and gradually declined during heparin administration despite RF current delivery. Median D-dimer tripled (P = 0.005) and PAP doubled (NS) before heparin administration; then both remained around the upper reference values. In the early heparin group, however, PF1 + 2, Ddimer, and PAP did not rise at all, and ,-TG showed only a slight increase towards the end of the procedure. The differences between group I versus groups II and III were statistically significant prior to the first RF current delivery (PF1 + 2, D-dimer, and ,-TG) and by the end of the procedure (PF1 + 2, D-dimer, and PAP). In conclusion, "late" heparin administration allows hemostatic activation during the initial catheterization and diagnostic study. By administering intravenous heparin immediately after introduction of the venous sheaths, hemostatic activation is significantly decreased. Saline irrigation of the venous sheaths added nothing to late heparin administration. [source] Radiofrequency Catheter Ablation from the Left Sinus of Valsalva in a Patient with Idiopathic Ventricular TachycardiaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 7 2000NAOHIKO TAKAHASHI We report the case of a 54-year-old woman with idiopathic VT originating in the left ventricular outflow tract. She initially presented with palpitations and light-head-edness. The morphology of the PVCs exhibited an inferior axis and tall R waves were noted in all the precordial leads. Spontaneous PVCs were transiently terminated by an intravenous injection of adenosine triphosphate. Radiofrequency catheter ablation from the left sinus of Valsalva successfully abolished the PVCs and the VT. [source] P Wave Dispersion Predicts Recurrence of Paroxysmal Atrial Fibrillation in Patients with Atrioventricular Nodal Reentrant Tachycardia Treated with Radiofrequency Catheter AblationANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2006Basri Amasyali M.D. Background: Paroxysmal atrial fibrillation (AF) recurs in up to one-third of patients with atrioventricular nodal reentrant tachycardia (AVNRT) treated with slow pathway ablation. Therefore, identification of patients at risk for recurrence of AF after slow pathway ablation is important because of the necessity for additional therapies. The purpose of this study was to determine whether successful slow pathway ablation influences P wave parameters and whether these parameters predict the recurrence of paroxysmal AF in patients with both AVNRT and paroxysmal AF after ablation. Methods: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) were compared to 36 age-matched controls with AVNRT only (Group 2). P wave durations and P dispersion were measured before and after ablation. Results: No significant differences were observed between P wave parameters observed before and after ablation. Maximum P wave durations (Pmax) and P dispersion (Pdisp) were significantly higher in Group 1 than in Group 2 (P < 0.001 for both) whereas minimum P wave durations did not differ between groups, both before and after ablation. Ten patients (28%) in Group-1 had recurrence of AF during a mean follow-up of 34 ± 11 months. Univariate predictors of AF recurrence were Pdisp ,35.5 ms (P < 0.010), left atrial diameter >40 mm (P < 0.010), mitral or aortic calcification (P < 0.010), Pmax ,112 ms (P < 0.050), valvular heart disease (P < 0.050), and atrial vulnerability (induction of AF lasting >30 second) after ablation (P < 0.050). However, only Pdisp ,35.5 ms (P < 0.050) and left atrial diameter >40 mm (P < 0.010) were independent predictors of AF recurrences. Conclusion: This study suggests that P wave dispersion could identify patients with AVNRT susceptible to recurrence of AF after slow pathway ablation. [source] Tako-tsubo Cardiomyopathy Complicating Left Atrial Radiofrequency AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2007MICHAEL DERNTL M.D. Two female patients undergoing left atrial radiofrequency catheter ablation developed Tako-tsubo cardiomyopathy. This reversible form of left ventricular dysfunction is known to occur under conditions associated with marked sympathetic nervous activation. Radiofrequency catheter ablation in the left atrium can damage autonomic ganglionated plexi, leading to vagal withdrawal, thus resulting in enhanced sympathetic tone. Tako-tsubo cardiomyopathy has not been previously described following radiofrequency catheter ablation. [source] Successful Catheter Ablation of Two Types of Ventricular Tachycardias Triggered by Cardiac Resynchronization Therapy: A Case ReportJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2007PETR PEICHL M.D., Ph.D. We report a case of a patient with nonischemic dilated cardiomyopathy and implantable cardioverter-defibrillator, in whom an upgrade to biventricular pacing triggered multiple episodes of ventricular tachycardias (VTs) of two morphologies. First VT presented as repetitive nonsustained arrhythmia of the same morphology as isolated ectopic beats, suggesting its focal origin. Second VT was reentrant and was triggered by the former ectopy, leading to a therapy from the device. Electroanatomical mapping of the left ventricle revealed relatively small low voltage area in the left ventricular outflow tract and identified both an arrhythmogenic focus as well as critical isthmus for reentrant VT. Radiofrequency catheter ablation successfully abolished both VTs. After the procedure, biventricular pacing was continued without any recurrences during a period of 24 months. The report emphasizes the role of catheter ablation in management of VTs triggered by cardiac resynchronization therapy. [source] Idiopathic Left Ventricular Tachycardia Originating from the Mitral AnnulusJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2005KOJI KUMAGAI M.D. Background: Radiofrequency catheter ablation (RFCA) can eliminate most idiopathic repetitive monomorphic ventricular tachycardias (RMVTs) originating from the right and left ventricular outflow tracts (RVOT, LVOT). Here, we describe the electrophysiological (EP) findings of a new variant of RMVT originating from the mitral annulus (MAVT). Methods and Results: MAVT was identified in 35 patients out of 72 consecutive left ventricular RMVTs from May 2000 to June 2004. All patients underwent an EP study and RFCA. The sites of origin of the MAVT were grouped into four groups according to the successful ablation sites around the mitral annulus. Group I included the anterior sites (n = 11), group II the anterolateral sites (n = 9), group III the lateral sites (n = 6), and group IV the posterior sites (n = 9). The MAVTs were a wide QRS tachycardia with a delta wave-like beginning of the QRS complex. The transitional zone of the R wave occurred between V1-V2 in all cases. The 12-lead electrocardiogram (ECG) pattern might reflect the site of the origin of MAVTs around the mitral annulus. We proposed an algorithm for predicting the site of the focus and the tactics needed for successful RFCA of the MAVT. Conclusions: We described the EP findings of the new variant of RMVT, MAVT. Most MAVTs could be eliminated by RF applications to the endocardial mitral annulus using our proposed tactics. [source] | ||||||||||