Home About us Contact
|
Home About us Contact | ||
|
|
||
Slow Conduction (slow + conduction)
Selected AbstractsQuantitative Analysis of the Duration of Slow Conduction in the Reentrant Circuit of Ventricular Tachycardia After Myocardial InfarctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2008YI-GANG LI M.D. Background: Few data are available to define the circuits in ventricular tachycardia (VT) after myocardial infarction and the conduction time (CT) through the zone of slow conduction (SCZ). This study assessed the CT of the SCZ and identified different reentrant circuits. Methods: During VTs, concealed entrainment (CE) was attempted. The SCZ was identified by a difference between postpacing interval (PPI) and VT cycle length (VTcl) ,30 ms. Since the CT in the normally conducting part of the VT circuit is constant during VT and CE, a CE site within the reentrant circuit with (S-QRS)/PPI , 50% was classified as an inner reentry in which the entire circuit was within the scar, and a CE site with (S-QRS)/PPI < 50% as a common reentry in which part of the circuit was within the scar and part out of the scar. Results: CE was achieved in 20 VTs (12 patients). Six VTs (30%) with a (S-QRS)/PPI ,50% were classified as inner reentry and 14 VTs (70%) with a (S-QRS)/PPI <50% during CE mapping as common reentry. The EG-QRS interval (308 ± 73 ms vs 109 ± 59 ms, P < 0.0001) was significantly longer and the incidence of systolic potentials higher (4/6 vs 0/12, P < 0.001) in the inner reentry group. For the 14 VTs with a common reetry, the CT of the SCZ was 348 ± 73 ms, while the CT in the normal area was 135 ± 50 ms. Conclusion: According to the proposed classification, 30% of VTs after myocardial infarction had an entire reentrant circuit within the scar. In VTs with a common reentrant circuit, the CT of the SCZ is approximately four times longer than the CT in the normal area, accounting for more than 70% of VTcl. [source] High-Resolution Mapping of Tachycardia Originating from the Superior Vena Cava: Evidence of Electrical Heterogeneity, Slow Conduction, and Possible Circus Movement ReentryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2002DIPEN C. SHAH M.D. Superior Vena Cava Reentry. High-resolution mapping of a tachycardia originating from the superior vena cava (SVC) in a patient with atrial fibrillation is described. Unidirectional circuitous repetitive activation encompassing the full tachycardia cycle length was documented around a line of block within the myocardial sleeve of the SVC. Intermittent conduction to the right atrium resulted in an irregular atrial tachycardia. Evidence of electrical heterogeneity and slow conduction persisted in sinus rhythm and was exaggerated by premature stimulation but did not reproduce the activation pattern during tachycardia. All the available evidence is best compatible with circus movement reentry within the SVC, with marked slow and anisotropic conduction responsible for the restricted dimensions of the reentrant circuit. These findings may suggest a similar substrate and arrhythmia mechanism in the myocardium of the pulmonary veins. [source] Different Forms of Ventricular Tachycardia Involving the Left Anterior Fascicle in Nonischemic Cardiomyopathy: Critical Sites of the Reentrant Circuit in Low-Voltage AreasJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2009CHRISTOPHER REITHMANN M.D. Introduction: The purpose of this study was to examine the reentrant circuit of ventricular tachycardias (VTs) involving the left anterior fascicle (LAF) in nonischemic cardiomyopathy. Methods and Results: Six patients with nonischemic cardiomyopathy presented with VTs involving the LAF. Potentials in the diastolic or presystolic phase of the VT were identified close to the LAF in 3 patients and in the mid or inferior left ventricular (LV) septum in 3 patients. Superimposed on a CARTO or NavX 3-dimensional voltage map, the diastolic and presystolic potentials were recorded within or at the border of a low-voltage zone in the LV septum in all cases. In 2 patients, both left bundle fascicles participated in the reentrant circuit including a possible interfascicular VT in one case. Ablation targeting the diastolic or presystolic potentials near the LAF or in the midinferior LV septum eliminated the VTs in all patients with the occurrence of a left posterior fascicular block and the delayed occurrence of a complete atrioventricular block in each one patient. During the follow-up of 23 ± 20 months after ablation, 4 patients were free of ventricular tachyarrhythmias. Due to detoriation of heart failure, one patient died after 12 months and one patient underwent heart transplantation after 40 months. Conclusions: Slow conduction in diseased myocardium close to the LAF or in the middle and inferior aspects of the LV septum may represent the diastolic pathway of VT involving the LAF. [source] Quantitative Analysis of the Duration of Slow Conduction in the Reentrant Circuit of Ventricular Tachycardia After Myocardial InfarctionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2008YI-GANG LI M.D. Background: Few data are available to define the circuits in ventricular tachycardia (VT) after myocardial infarction and the conduction time (CT) through the zone of slow conduction (SCZ). This study assessed the CT of the SCZ and identified different reentrant circuits. Methods: During VTs, concealed entrainment (CE) was attempted. The SCZ was identified by a difference between postpacing interval (PPI) and VT cycle length (VTcl) ,30 ms. Since the CT in the normally conducting part of the VT circuit is constant during VT and CE, a CE site within the reentrant circuit with (S-QRS)/PPI , 50% was classified as an inner reentry in which the entire circuit was within the scar, and a CE site with (S-QRS)/PPI < 50% as a common reentry in which part of the circuit was within the scar and part out of the scar. Results: CE was achieved in 20 VTs (12 patients). Six VTs (30%) with a (S-QRS)/PPI ,50% were classified as inner reentry and 14 VTs (70%) with a (S-QRS)/PPI <50% during CE mapping as common reentry. The EG-QRS interval (308 ± 73 ms vs 109 ± 59 ms, P < 0.0001) was significantly longer and the incidence of systolic potentials higher (4/6 vs 0/12, P < 0.001) in the inner reentry group. For the 14 VTs with a common reetry, the CT of the SCZ was 348 ± 73 ms, while the CT in the normal area was 135 ± 50 ms. Conclusion: According to the proposed classification, 30% of VTs after myocardial infarction had an entire reentrant circuit within the scar. In VTs with a common reentrant circuit, the CT of the SCZ is approximately four times longer than the CT in the normal area, accounting for more than 70% of VTcl. [source] Fractionation of Electrograms and Linking of Activation During Pharmacologic Cardioversion of Persistent Atrial Fibrillation in the GoatJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2004ZHAOLIANG SHAN M.D. Introduction: During atrial fibrillation (AF), there is fractionation of extracellular potentials due to head-to-tail interaction and slow conduction of fibrillation waves. We hypothesized that slowing of the rate of AF by infusion of a Class I drug would increase the degree of organization of AF. Methods and Results: Seven goats were instrumented with 83 epicardial electrodes on the left atrium, left atrial appendage, Bachmann's bundle, right atrium, and right atrial appendage. AF was induced and maintained by an automatic atrial fibrillator. After AF had persisted for 4 weeks, the Class IC drug cibenzoline was infused at a rate of 0.1 mg/kg/min. AF cycle length (AFCL), the percentage of fractionated potentials, conduction velocity (CV), and direction of propagation of the fibrillation waves were measured during baseline, after AFCL was increased by 20, 40, 60, and 80 ms, and shortly before cardioversion. Infusion of cibenzoline increased the mean of the median AFCLs from 96 ± 6 ms to 207 ± 43 ms (P < 0.0001). The temporal variation in AFCL in different parts of the atria was 8% to 20% during control and, with the exception of Bachmann's bundle, was not significantly reduced during cibenzoline infusion. CV decreased from 76 ± 14 ms to 52 ± 9 cm/s (P < 0.01). Cibenzoline increased the percentage of single potentials from 81%± 4% to 91%± 4% (P < 0.01) and decreased the incidence of double potentials from 14%± 4% to 7 ± 5% (P < 0.01) and multiple potentials from 5%±% to 1%± 2% (P < 0.001). Whereas during control, linking (consecutive waves propagating in the same direction) during seven or more beats occurred in 9%± 15% of the cycles, after cibenzoline the degree of linking had increased to 40%± 33% (P < 0.05). During the last two beats before cardioversion, there was a sudden prolongation in AFCL from 209 ± 37 ms to 284 ± 92 ms (P < 0.01) and a strong reduction in fractionated potentials (from 22%± 12% to 6%± 5%, P < 0.05). Conclusion: The Class IC drug cibenzoline causes a decrease in fractionation of fibrillation electrograms and an increase in the degree of linking during AF. This supports the observation that Class I drugs widen the excitable gap during AF. (J Cardiovasc Electrophysiol, Vol. 15, pp. 572-580, May 2004) [source] High-Resolution Mapping of Tachycardia Originating from the Superior Vena Cava: Evidence of Electrical Heterogeneity, Slow Conduction, and Possible Circus Movement ReentryJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2002DIPEN C. SHAH M.D. Superior Vena Cava Reentry. High-resolution mapping of a tachycardia originating from the superior vena cava (SVC) in a patient with atrial fibrillation is described. Unidirectional circuitous repetitive activation encompassing the full tachycardia cycle length was documented around a line of block within the myocardial sleeve of the SVC. Intermittent conduction to the right atrium resulted in an irregular atrial tachycardia. Evidence of electrical heterogeneity and slow conduction persisted in sinus rhythm and was exaggerated by premature stimulation but did not reproduce the activation pattern during tachycardia. All the available evidence is best compatible with circus movement reentry within the SVC, with marked slow and anisotropic conduction responsible for the restricted dimensions of the reentrant circuit. These findings may suggest a similar substrate and arrhythmia mechanism in the myocardium of the pulmonary veins. [source] Reentry Within the Cavotricuspid Isthmus: An Isthmus Dependent CircuitPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2005YANFEI YANG Background: We describe a new cavotricuspid isthmus (CTI) circuit. Methods: This study includes 8 patients referred for atrial flutter (AFL) ablation whose tachycardia circuit was confined to the septal CTI and the os of the coronary sinus (CSOS) region. Entrainment mapping was performed within the CTI, CSOS, and other right atrial annular sites (tricuspid annulus (TA)). Electroanatomic mapping was available in 2 patients. Results: Sustained AFL occurred in all patients with mean tachycardia cycle length (TCL) of 318 ± 54 (276 , 420) ms. During tachycardia, fractionated or double potentials were recorded at either the septal CTI and/or the region of CSOS in all, and concealed entrainment with post-pacing interval (PPI) , TCL , 25 ms occurred in this area; but manifest entrainment with PPI > TCL was demonstrated from the anteroinferior CTI and other annular sites in 7/8 patients. In one, tachycardia continued with conduction block at the anteroinferior CTI during ablation. Up to three different right atrial activation patterns (identical TCL) were observed. The tachycardia showed a counterclockwise (CCW) pattern in 6, a clockwise pattern in 2, and simultaneous activation of both low lateral right atrium and septum in 5. Electroanatomic mapping was available in 2, showing an early area arising from the septal CTI in 1, and a CCW activation sequence along the TA in another. Radiofrequency application to the septal CTI terminated tachycardia in 4, and tachycardia no longer inducible in all. Conclusions: We describe a tachycardia circuit confined to the septal CTI/CSOS region, and hypothesize that this circuit involves slow conduction within the CTI and around the CSOS, which acts as a central obstacle. [source] | ||||||||||