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Nodal Ablation (nodal + ablation)
Selected AbstractsBiventricular Pacing for Severe Mitral Reguritation Following Atrioventrgicular Nodal AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2p1 2003PATRICK J.S. DISNEY DISNEY, P.J.S., et al.: Biventricular Pacing for Severe Mitral Regurgitation Following Atrioventricular Nodal Ablation. A 69-year-old woman developed acute pulmonary edema and severe mitral regurgitation (MR) 2 days following an uncomplicated AV nodal (AVN) ablation and insertion of VVI pacemaker for chronic atrial fibrillation. There was no history of significant mitral valve disease. Left ventricular function was normal and there was no evidence of an acute cardiac ischemic event. Transthoracic echo and right heart catheterization studies showed reduction in the severity of MR with biventricular pacing as opposed to RV pacing alone. A permanent pacemaker configured for biventricular pacing was implanted with complete resolution of symptoms and significant reduction in degree of MR. (PACE 2003; 26[Pt. I]:643,644) [source] Electroanatomic Versus Fluoroscopic Mapping for Catheter Ablation Procedures:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2004A Prospective Randomized Study Introduction: The aim of this prospective randomized study was to compare the routine use of electroanatomic imaging (CARTO) with that of conventional fluoroscopically guided activation mapping (conventional) in an unselected population referred for catheter ablation. We sought to compare the two approaches with respect to procedure outcome and duration, radiation exposure, and cost. Methods and Results: All patients undergoing catheter ablation (with the exception of complete AV nodal ablation) were prospectively randomized to either a CARTO or conventional procedure for mapping and ablation. One hundred two patients were randomized. Acute procedural success was similar with either strategy (CARTO vs conventional 43/47 vs 51/55, P > 0.5), as was procedure duration (144 [58] vs 125 [48] min, P = 0.07 (mean [SD]). CARTO was associated with a substantial reduction in fluoroscopy time (9.3 [7.6] vs 28.8 [19.5] min, P < 0.001) and radiation dose (6.2 [6.1] vs 20.8 [32.7] Gray, P = 0.003). CARTO cases used fewer catheters (2.5 [0.7] vs 4.4 [1.1], P < 0.001), but catheter costs were higher (13.8 vs 9.3 units, P < 0.001, where one unit is equivalent to the cost of a nonsteerable quadripolar catheter). Conclusion: For all catheter ablation procedures, even when a center's "learning curve" for CARTO is included, procedure duration and outcome are similar for CARTO and conventional procedures. CARTO is associated with drastically reduced fluoroscopy time and radiation dose. Although fewer catheters are used with CARTO, catheter costs remain higher. (J Cardiovasc Electrophysiol, Vol. 15, pp. 310-315, March 2004) [source] Bimodal RR Interval Distribution in Chronic Atrial Fibrillation:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2000Impact of Dual Atrioventricular Nodal Physiology on Long-Term Rate Control after Catheter Ablation of the Posterior Atrionodal Input Bimodal RR Interval Distribution, Introduction: Radiofrequency (RF) catheter modification of the AV node hi patients with atrial fibrillation (AF) is limited by an unpredictable decrease of the ventricular rate and a wish incidence of permanent AV block, A bimodal RR histogram has been suggested to serve as a predictor for successful outcome but the corresponding AV node properties have never been characterized, We hypothesized that a bimodal histogram indicates dual AV nodal physiology and predicts a better outcome after AV node modification in chronic AF. Methods and Results: Thirty-seven patients were prospectively subdivided into two groups according to the RR histogram of 24-hour ECC monitoring, Before to RF ablation, internal cardioversion and programmed stimulation were performed, Among the 22 patients (group I) with a bimodal RR histogram, dual AV nodal physiology was found in 17 (779f) patients, Ablation significantly decreased ventricular rate with loss of the peak of short RR cycles after ablation (mean and maximal ventricular rates: 32% and 35% rate reduction, respectively; P < 0,01), In 15 patients with a unimodal RR histogram (group II), dual AV nodal physiology was found in 2 (13%), and rate reductions were 16% and 17%, respectively, At 6 months, 3 (14%) patients in group 1 and 6 (40%) in group II underwent elective AV nodal ablation with pacemaker implantation due to intolerable rapid ventricular response to AF. Conclusion: Bimodal RR interval distribution during chronic AF suggests the presence of dual AV nodal physiology and predicts a better outcome of RF ablation of the posterior atrionocdal input. [source] Radiofrequency Energy Modification of the Atrioventricular Junction in Patients with Atrial Fibrillation: Modes of Ventricular Response Under Autonomic Blockade and Long-Term EffectPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2001HARALAMPOS D. KRIATSELIS KRIATSELIS, H.D., et al.: Radiofrequency Energy Modification of the Atrioventricular Junction in Patients with Atrial Fibrillation: Modes of Ventricular Response Under Autonomic Blockade and Long-Term Effect. The short- and long-term effect of radiofrequency (RF) modification of the AV junction on ventricular rate and left ventricular function and the different types of ventricular response during energy application under autonomic nervous blockade were assessed in 28 patients with medically refractory atrial fibrillation. During the successful RF application, ventricular rate slowed progressively (type I response, ten patients) or accelerated at first and then slowed (type II response, 11 patients). Type II response was associated with a more anterior ablation site compared to Type I response. A primary successful outcome was achieved in 21 patients. Inadvertent complete AV block developed in three patients, while in four patients AV nodal ablation was performed after an unsuccessful modification attempt. During 6-month follow-up, the ventricular rate was adequately controlled in only four patients. Among the 16 patients with a recurrence of uncontrolled AF were all 10 patients with type I response and 6 of 11 patients with type II response. One patient died suddenly 10 weeks after the procedure. [source] | ||||||||||