Right phrenic injury after radiofrequency catheter ablation of atrial tachycardia at crista terminalis / 中华医学杂志(英文版)

A 62-year-old woman with frequent occurrence of symptomatic atrial tachycardia with a foci located at the root of the upper crista terminalis was found to have right diaphragm paresis after receiving a total of 8 radiofrequency energy deliveries (40-60 W, 50-60ºC) and a total duration of 540 seconds of ablation therapy (7Fr 8 mm deflectable ablation catheter). The right diaphragm paresis remained resolved up to 14 months after the procedure as confirmed by repeated chest X-rays.

Association between abnormal electrocardiographic features and disease severity in patients with arrhythmogenic right ventricular cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the relationship between electrocardiographic (ECG) features and disease severity in patients with the arrhythmogenic right ventricular cardiomyopathy (ARVC).</p><p><b>METHOD</b>The study group consisted of 61 subjects with a definite diagnosis of ARVC on the basis of published guideline criteria and patients were divided into 3 subgroups according to the extent of diseased myocardium defined by cardiac magnetic resonance imaging (MRI): Group A: local involvement (n = 19, 31%), Group B: diffuse involvement of whole right ventricle (n = 28, 46%) and Group C: involvement of both right and left ventricles (n = 14, 23%).</p><p><b>RESULTS</b>Normal electrocardiogram was shown in 1 patient in each group. Epsilon wave was detected in 24 (39%) patients, QRS duration was prolonged [≥ 110 ms (V(1)-V(3))] in 21 (34%) patients, S-wave upstroke was prolonged (≥ 55 ms) in 17 (28%) patients, complete right branch bundle block was evidenced in 10 (16%) patients and pathologic Q waves was found in 9 (15%) patients. The incidence of above abnormal ECG changes was increased in proportion to the degree of disease severity (group A < group B < group C). Incidence of Epsilon wave and prolonged QRS duration [ ≥ 110 ms (V(1)-V(3))] were significantly higher in Group C than in Group A. Incidence of prolonged S-wave upstroke (≥ 55 ms) was significantly higher in Group C than in Group A and Group B. T-wave inversion in V(1) leads was often found in Group A. T-wave inversion in inferior leads (V(1)-V(3) leads or beyond V(3)) was often presented in Group B and Group C.</p><p><b>CONCLUSIONS</b>Normal ECG does not exclude the possibility of diagnosis of ARVC. The extent of T-wave inversion in the precordial leads and incidence of Epsilon wave, prolonged QRS duration [ ≥ 110 ms (V(1)-V(3))] and prolonged S-wave upstroke (≥ 55 ms) were related to degree of disease severity in patients with ARVC.</p>

Association between electrocardiogram characteristics and long-term outcome in patients with idiopathic ventricular fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the association between clinical and ECG characteristics and prognoses in patients with idiopathic ventricular fibrillation (VF).</p><p><b>METHODS</b>We reviewed the data from 21 VF patients [male 47.6%, mean age (38.5 ± 19.0) years] with first event of VF, all patients were resuscitated after cardiac arrest and diagnosed as idiopathic VF. The prevalence of J wave was assessed and patients were divided into J wave positive (J+ group) and negative group (J- group). The end point was death or syncope from arrhythmia, and recorded VF recurrence during the follow-up.</p><p><b>RESULTS</b>J wave was frequent in subjects with idiopathic VF (71.4%). Among patients in the J+ group (15 cases), notch on the QRS wave was found in 7 subjects (46.7%), these patients were more likely to suffer from the sudden cardiac arrest during sleep at early morning than those with J wave but without notch on the QRS wave. Two patients dead suddenly in the J+ group and 1 dead from embolism in the J- group during follow-up [mean (42.4 ± 39.9) months]. The mean year-onset of VF or syncope was significantly higher in the J+ group than in the J-group [(1.3 ± 0.5) episodes/year vs. (0.4 ± 0.3) episodes/year, P < 0.01]. J wave positive was also associated with an increased risk of VF recurrence (RR 1.9, 95%CI 1.1 to 2.9, P = 0.03).</p><p><b>CONCLUSION</b>J wave prevalence is high in patients with history of idiopathic VF, and positive J wave is associated with high risk of recurrence of sudden cardiac death.</p>

Linear ablation of left atrium for the treatment of atrial fibrillation guided by double Lasso catheters and three dimensional electroanatomical mapping / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Linear ablation of left atrium (LA) guided by three dimensional (3-D) electroanatomical mapping (Carto) has been used in many centres worldwide for the treatment of atrial fibrillation (AF) instead of pure anatomical approaches. There were little data about linear ablation of LA guided by Carto and double Lasso catheters in China. We report the results of linear ablation of LA guided by both Carto and double Lasso catheters.</p><p><b>METHODS</b>After the anatomical model of LA and all pulmonary veins (PVs) had been established, circumferential ablations of the left pulmonary vein antrum and the right pulmonary vein antrum were performed with 2 circumferential mapping catheters (Lasso) placed within the ipsilateral superior and inferior PVs. The endpoint of ablation was abolishment or dissociation of the pulmonary vein potentials (PVPs). Oral amiodarone or propafenone was taken for at least 3 months by patients with persistent AF, permanent AF or those whose PVPs had not been isolated completely. The recurrence of atrial tachyarrhythmias was observed 3 months after the procedure.</p><p><b>RESULTS</b>There were 106 patients (mean age, 51.4 +/- 9.9 years). Seventy-eight patients had paroxysmal AF, 12 persistent AF and 16 permanent AF. Onset of atrial fibrillation occurred in 52 patients during ablation procedure. Thirty-two patients restored to sinus rhythm eventually after the procedure. Abolishment or dissociation of PVPs was accomplished during the procedure in 94 patients (88.7%). The duration of procedure and exposure to X-ray were (213 +/- 45) minutes and (32.5 +/- 12.8) minutes, respectively. Among the 87 patients followed up for over 3 months, 62 were free of atrial tachyarrhythmias (including 8 patients who were still taking oral amiodarone). The success rate was 71.3% in the first procedure. Two patients had pericardial effusion treated by pericardial puncture and effusion drainage. No pulmonary vein stenosis, atrioesophageal fistula, stroke or procedural death occurred.</p><p><b>CONCLUSIONS</b>Combination of double Lasso catheters with 3-D electroanatomical mapping to guide the linear ablation of left atrium procedure can confirm the isolation of PVPs.</p>

Left posterior fascicular block: a new endpoint of ablation for verapamil-sensitive idiopathic ventricular tachycardia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Verapamil-sensitive, idiopathic left ventricular tachycardia (ILVT) with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. Radiofrequency (RF) ablation was applied during ventricular tachycardia (VT) and termination of the VT or abolishing the inducibility of the tachycardia was used as an endpoint for successful RF. In this study, the left posterior fascicular block in surface electrocardiogram (ECG) was used as a new endpoint of ablation to cure ILVT.</p><p><b>METHODS</b>Electrophysiological studies and radiofrequency ablation were performed in 39 consecutive patients [30 men, 9 women; age ranging from 10 to 64 years, mean (29 +/- 16) years] with verapamil-sensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous administration of verapamil in all patients. The target site was the midseptum of LV where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential (LDP) during sinus rhythm in 37 patients and during VT in 2 patients to meet the ablation endpoint: the left posterior fascicular block in the surface ECG.</p><p><b>RESULTS</b>Thirty-seven patients with ILVT had been treated by RF ablation during sinus rhythm and two had been treated during VT. All of them met the endpoint of the left posterior fascicular block. Thirty-eight cases were symptom-free without medications during the follow-up period (range from 3 to 95 months, median 17 months). One patient developed a clinical recurrence and the left posterior fascicular block in surface ECG disappeared. The patient received another treatment. The endpoint was met and the procedure was successful.</p><p><b>CONCLUSIONS</b>The left posterior fascicular block in surface ECG used as an endpoint of RF ablation to treat ILVT is effective. It is important especially in those patients whose VT can not be induced or the inducible condition is unstable. The effective endpoint implied that the left posterior fascicle might be a critical part of the re-entrant circuit.</p>