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1.
Am Heart J Plus ; 21: 100195, 2022 Sep.
Article in English | MEDLINE | ID: mdl-38559748

ABSTRACT

Background: Detection of atrial fibrillation (AF) in patients with embolic stroke of undetermined source (ESUS) is challenging due to its paroxysmal nature. We sought to assess AF detection with an insertable cardiac monitor (ICM) and to perform cost analysis for various AF monitoring strategies post-ESUS We applied this cost analysis modeling to recently published Stroke AF and Per Diem trials. Methods: Retrospective chart review was performed in consecutive hospitalized patients with ESUS who had ICM placed prior to discharge. Utilizing rate of ICM-detected AF and Medicare average payments, we modeled 30-day per-patient diagnostic costs of Immediate ICM insertion prior to discharge versus using a wearable monitor followed by ICM in patients with ESUS, from Medicare and patient out-of-pocket perspectives. Similar modeling strategy and cost analysis was applied to the Stroke AF and Per Diem trials. Results: In 192 ESUS patients, AF detection increased with length of monitoring: 7.3 % at 14 days, 9.4 % at 30 days, and 17.2 % after a median ~ 6 months (189 days). Cost modeling predicted that immediate ICM leads to $3683-$4070 lower Medicare payments per-patient and $1425-$1503 lower patient out-of-pocket costs compared to Wearable-to-ICM strategies. Using similar modeling in the PER DIEM and STROKE AF trials, the additive costs of the 30-day ELR to ICM strategy ranged from $3786-$3946 from a payer perspective and $1472-$1503 from a patient out-of-pocket perspective. Conclusions: Use of ICM immediately after ESUS is cost-saving compared to Wearable-to-ICM strategies, due to the cost and low diagnostic yield of short-term wearable cardiac monitoring.

2.
J Atr Fibrillation ; 12(2): 2192, 2019.
Article in English | MEDLINE | ID: mdl-32002112

ABSTRACT

BACKGROUND: Pulmonary vein isolation (PVI) using cryoballoon ablation (PVI-C) is increasingly performed as a first-line strategy for the treatment of patients with persistent atrial fibrillation (PersAF); however, follow-up data and predictors of procedural success are lacking. OBJECTIVE: To study the efficacy of PVI-C in patients with PersAF, focusing on predictors of procedural success. METHODS: By retrospective review, 148 consecutive patients with PersAF who underwent PVI-C were analyzed. The impact of several variables on outcome was evaluated in univariate and multivariate analyses and Cox proportional hazards regression models. RESULTS: After a mean follow-up of 19.2±10.9 months, 75 (50.7%) patients remained arrhythmia-free without the need for antiarrhythmic drug therapy. Patients with a normal left atrial volume index (LAVI) achieved a 71.0% arrhythmia-free survival. LAVI was the most powerful predictor of procedural success. CONCLUSIONS: Arrhythmia-free survival after PVI-C in select patients with PersAF are promising. Moreover, LAVI is a valuable measurement to help guide ablation strategy and predict outcome when using cryoballoon ablation.

3.
Cardiovasc Diagn Ther ; 6(1): 3-9, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26885486

ABSTRACT

BACKGROUND: The optimal strategy of peri-procedural anticoagulation in patients undergoing permanent cardiac device implantation is controversial. Our objective was to compare the major bleeding and thromboembolic complications in patients managed with uninterrupted warfarin (UW) vs. interrupted dabigatran (ID) during permanent pacemaker (PPM) or implantable cardioverter defibrillators (ICD) implantation. METHODS: A retrospective cohort study of all eligible patients from July 2011 through January 2012 was performed. UW was defined as patients who had maintained a therapeutic international normalized ratio (INR) on the day of the procedure. ID was defined as stopping dabigatran ≥12 hours prior to the procedure and then resuming after implantation. Major bleeding events included hemothorax, hemopericardium, intracranial hemorrhage, gastrointestinal bleed, epistaxis, or pocket hematoma requiring surgical intervention. Thromboembolic complications included stroke, transient ischemic attack, deep venous thrombosis, pulmonary embolism, or arterial embolism. RESULTS: Of the 133 patients (73.4±11.0 years; 91 males) in the study, 86 received UW and 47 received ID. One (1.2%) patient in the UW group sustained hemopericardium perioperatively and died. In comparison, the ID patients had no complications. As compared to the ID group, the UW group had a higher median CHADS2 score (2 vs. 3, P=0.04) and incidence of Grade 1 pocket hematoma (0% vs. 7%, P=0.09). Neither group developed any thromboembolic complications. CONCLUSIONS: Major bleeding rates were similar among UW and ID groups. Perioperative ID appears to be a safe anticoagulation strategy for patients undergoing PPM or ICD implantation.

5.
Crit Pathw Cardiol ; 13(2): 43-8, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24827879

ABSTRACT

OBJECTIVE: Published data supporting the best practice for patients with atrial fibrillation (AF) presenting to the emergency department (ED) are limited. Our objective was to evaluate the impact of an AF clinical protocol initiated in the ED with early follow-up in a specialty AF outpatient clinic. METHODS: This was a single-center prospective study of all consented patients with AF who were discharged from the ED through the AF clinical pathway and were then seen in the AF clinic. The primary endpoint was the rate of 90-day hospitalization/ED visits. Secondary endpoints included adherence to established AF anticoagulation guidelines, rate of thromboembolic events, quality of life, and patient satisfaction. RESULTS: One hundred consecutive patients were enrolled in the study. Within 90 days, 15 had ED visits and 4 were hospitalized, whereas none developed thromboembolic complications. There were significant increases in the Atrial Fibrillation Effect on QualiTy of life survey quality of life (67.3 ± 24.8 vs. 89.2 ± 15.7; P < 0.001) and patient satisfaction (66.4 ± 25.3 vs. 77.9 ± 22.8; P < 0.001) scores from baseline to 90 days. Of the 29 patients with CHADS2 score ≥2, 20 (69%) were discharged from the AF clinic with oral anticoagulation. CONCLUSIONS: We describe a novel approach to the care of patients with AF presenting to the ED. Usage of the ED-initiated AF clinical pathway with early follow-up in a protocol-driven AF clinic was associated with low readmission rates, no thromboembolic complications at 90 days, improved quality of life, and high patient satisfaction.


Subject(s)
Atrial Fibrillation/therapy , Clinical Protocols , Disease Management , Emergency Service, Hospital , Stroke/prevention & control , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Prognosis , Prospective Studies , Quality of Life , Stroke/etiology
6.
J Cardiovasc Electrophysiol ; 25(7): 787-92, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24703427

ABSTRACT

Although atrioesophageal fistula (AEF) formation is a well known, albeit rare, catastrophic complication of atrial fibrillation radiofrequency ablation procedures, there are less data regarding this complication using the cryoballoon technique. We report on 3 cases of AEF as a complication of cryoballoon pulmonary vein isolation at 3 different institutions with 2 different generations of cryoballoons.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Cryosurgery/adverse effects , Esophageal Fistula/etiology , Fistula/etiology , Heart Diseases/etiology , Pulmonary Veins/surgery , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Cardiac Catheters , Catheter Ablation/instrumentation , Catheter Ablation/methods , Cryosurgery/instrumentation , Echocardiography, Transesophageal , Equipment Design , Esophageal Fistula/diagnosis , Esophageal Fistula/surgery , Fatal Outcome , Female , Fistula/diagnosis , Fistula/surgery , Heart Diseases/diagnosis , Heart Diseases/surgery , Humans , Male , Middle Aged , Pulmonary Veins/physiopathology
8.
Pacing Clin Electrophysiol ; 37(1): 4-10, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24215291

ABSTRACT

OBJECTIVE: The purpose of our study was to determine if the rate of lead-related complications was increased with the Medtronic CapSureFix MRI™ SureScan™ 5086 MRI pacing lead (5086; Medtronic Inc., Minneapolis, MN, USA) compared to the previous generation of Medtronic CapSureFix Novus™ 5076 pacing lead (5076). BACKGROUND: The 5086 lead is a newly introduced active-fixation pacemaker lead designed to be used conditionally in a magnetic resonance (MR) scanner. This lead has specific design changes compared to the previous generation of 5076 pacing leads. METHODS: This study was a retrospective case control study of 65 consecutive patients implanted with two 5086 leads compared to 92 consecutive control patients implanted with two 5076 leads over a 14-month period at a high-volume tertiary care hospital. RESULTS: Pericarditis, pericardial effusion, cardiac tamponade, or death within 30 days of implant were seen in eight patients from the 5086 cohort and two from the 5076 cohort (odds ratio 6.3, 95% confidence interval 1.3-30.8, P = 0.02). Lead dislodgement occurred in four of the 5086 patients and in none of the 5076 patients (P < 0.03). CONCLUSIONS: In a high-volume center, the incidence of pericarditis, cardiac perforation, tamponade, death, and lead dislodgement was significantly higher with the MR-conditional Medtronic 5086 lead when compared to the previous generation Medtronic 5076 lead.


Subject(s)
Electrodes, Implanted/adverse effects , Foreign-Body Migration/etiology , Heart Injuries/etiology , Magnetic Resonance Imaging/instrumentation , Pacemaker, Artificial/adverse effects , Wounds, Penetrating/etiology , Aged , Equipment Failure , Equipment Safety , Female , Foreign-Body Migration/prevention & control , Heart Injuries/prevention & control , Humans , Magnetic Resonance Imaging/adverse effects , Male , Pericarditis/etiology , Pericarditis/prevention & control , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/prevention & control , Retrospective Studies , Survival Rate , Treatment Outcome , Wounds, Penetrating/prevention & control
9.
Case Rep Pediatr ; 2013: 203241, 2013.
Article in English | MEDLINE | ID: mdl-24369520

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) has been utilized in the pediatric population for cardiogenic shock secondary to medically intractable arrhythmias. There is limited experience with cardiac radiofrequency ablation (RFA) on these patients while on ECMO. A 7-year-old girl presented with a tachycardia-mediated cardiomyopathy secondary to a left atrial appendage tachycardia. She suffered a cardiac arrest due to pulseless electrical activity and was placed on ECMO. Due to elevated left atrial pressures and the refractoriness of her arrhythmia to cardioversion and antiarrhythmic therapy, while on ECMO, blade atrial septostomy and radiofrequency ablation were performed. The patient tolerated the procedure well and was successfully decannulated. Her cardiac function normalized within four weeks of the ablation procedure. Twelve months after the procedure, she remains completely well, with no symptoms or tachycardia.

10.
Pacing Clin Electrophysiol ; 36(1): e15-8, 2013 Jan.
Article in English | MEDLINE | ID: mdl-22486158

ABSTRACT

The right atrial appendage is an uncommon site of origin for ectopic atrial tachycardia. Right atrial appendage tachycardia (RAAT) has been noted to be prevalent in young males and responds well to radiofrequency ablation. We report a case of RAAT resistant to multiple attempts of ablation that responded to ablation using Stereotaxis Niobe™ Magnetic Navigation System (RMN, Stereotaxis, St. Louis, MO, USA).


Subject(s)
Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Body Surface Potential Mapping/instrumentation , Catheter Ablation/instrumentation , Magnetics/instrumentation , Stereotaxic Techniques/instrumentation , Adolescent , Atrial Appendage/surgery , Equipment Design , Equipment Failure Analysis , Female , Humans , Treatment Outcome
11.
ISRN Cardiol ; 2013: 247586, 2013.
Article in English | MEDLINE | ID: mdl-24490084

ABSTRACT

Modern cardiac rhythm management systems have become increasingly complex. The decision on which specific system to implant in a given patient often rests with the implanting physician. We conducted a multiple-choice survey to assess the opinions and preferences of cardiologists and electrophysiologists who implant and follow cardiac rhythm management systems. Reliability and battery longevity were viewed as the most important characteristics in device selection. Patient characteristics which most affected device choice were pacing indication and life expectancy. Remote technology was used in 47% of pacemaker patients, 64% of ICD patients, and 65% of CRT-D patients, with wireless (radiofrequency) remote patient monitoring associated with higher patient compliance rates (74% versus 64%, resp.). Wireless remote patient management with alerts for atrial tachyarrhythmias was felt to be important by 76% of respondents. When choosing an MR-conditional device, physicians deemed patients with prior orthopedic problems, a history of cancer, or neurological disorders to be more likely to require a future MRI. Device longevity and reliability remain the most important factors which influence device selection. Wireless remote patient monitoring with alerts is considered increasingly important when choosing a specific cardiac rhythm management system to implant.

12.
Glob Cardiol Sci Pract ; 2013(3): 261-8, 2013.
Article in English | MEDLINE | ID: mdl-24689027

ABSTRACT

Ventricular arrhythmias in young people most commonly occur due to the presence of hypertrophic cardiomyopathy, long QT syndrome or Wolff-Parkinson-White syndrome. We present a case in which the patient had exercise induced syncopal spells and was found to have ventricular tachycardia (VT) during both exercise stress testing and an electrophysiology study. Further genetic studies showed a previously unseen desmosomal gene mutation confirming the presence of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).

14.
J Am Coll Cardiol ; 48(12): 2500-7, 2006 Dec 19.
Article in English | MEDLINE | ID: mdl-17174189

ABSTRACT

OBJECTIVES: The objective of this study was to assess the role of Purkinje fibers in monomorphic, post-infarction ventricular tachycardia (VT). BACKGROUND: Ventricular fibrillation and polymorphic VT in the setting of acute myocardial infarction (MI) may be triggered by ectopy arising from Purkinje fibers. METHODS: From among a group of 81 consecutive patients with post-infarction monomorphic VT referred for catheter ablation, 9 patients were identified in whom the clinical VT had a QRS duration < or =145 ms. Mapping was performed focusing on areas with Purkinje potentials. RESULTS: A total of 11 VTs with a QRS duration < or =145 ms were induced and mapped in the 9 patients; 9 of the 11 VTs had a right bundle branch block/left-axis morphology that mimicked left posterior fascicular VT. The mean VT cycle length was 402 +/- 82 ms. Eight of 9 patients had a history of inferior MI involving the left ventricular septum. One patient had an anterior wall MI with septal involvement. Mapping during VT demonstrated re-entry involving the inferior left ventricular wall. In each of the VTs, a Purkinje potential was present at the exit site of the VT re-entry circuit. Single radiofrequency catheter ablation lesions were successful in eliminating these VTs in all patients. CONCLUSIONS: The Purkinje system may be part of the re-entry circuit in patients with post-infarction monomorphic VT, resulting in a type of VT with a relatively narrow QRS complex that mimics fascicular VT.


Subject(s)
Myocardial Infarction/complications , Purkinje Fibers/physiopathology , Tachycardia, Ventricular/physiopathology , Aged , Body Surface Potential Mapping , Female , Humans , Male , Middle Aged , Tachycardia, Ventricular/etiology
15.
Circulation ; 114(8): 759-65, 2006 Aug 22.
Article in English | MEDLINE | ID: mdl-16908760

ABSTRACT

BACKGROUND: In patients with atrial fibrillation (AF), the risk of thromboembolic events (TEs) is variable and is influenced by the presence and number of comorbid conditions. The effect of percutaneous left atrial radiofrequency ablation (LARFA) of AF on the risk of TEs is unclear. METHODS AND RESULTS: LARFA was performed in 755 consecutive patients with paroxysmal (n = 490) or chronic (n = 265) AF. Four hundred eleven patients (56%) had > or = 1 risk factor for stroke. All patients were anticoagulated with warfarin for > or = 3 months after LARFA. A TE occurred in 7 patients (0.9%) within 2 weeks of LARFA. A late TE occurred 6 to 10 months after ablation in 2 patients (0.2%), 1 of whom still had AF, despite therapeutic anticoagulation in both. Among 522 patients who remained in sinus rhythm after LARFA, warfarin was discontinued in 79% of 256 patients without risk factors and in 68% of 266 patients with > or = 1 risk factor. Patients older than 65 years or with a history of stroke were more likely to remain anticoagulated despite a successful outcome from LARFA. None of the patients in whom anticoagulation was discontinued had a TE during 25 +/- 8 months of follow-up. CONCLUSIONS: The risk of a TE after LARFA is 1.1%, with most events occurring within 2 weeks after the procedure. Discontinuation of anticoagulant therapy appears to be safe after successful LARFA, both in patients without risk factors for stroke and in patients with risk factors other than age > 65 years and history of stroke. Sufficient safety data are as yet unavailable to support discontinuation of anticoagulation in patients older than 65 years or with a history of stroke.


Subject(s)
Atrial Fibrillation/therapy , Catheter Ablation/adverse effects , Thromboembolism/epidemiology , Aged , Female , Follow-Up Studies , Heparin/pharmacology , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Stroke/epidemiology , Time Factors , Treatment Outcome
16.
J Am Coll Cardiol ; 48(2): 340-8, 2006 Jul 18.
Article in English | MEDLINE | ID: mdl-16843185

ABSTRACT

OBJECTIVES: The aim of this study was to determine the effects of circumferential pulmonary vein ablation (CPVA) and electrogram-guided ablation (EGA) on the spectral characteristics of atrial fibrillation (AF) and the relationship between changes in dominant frequency (DF) and clinical outcome. BACKGROUND: Circumferential pulmonary vein ablation and EGA have been used to eliminate AF. Spectral analysis may identify high-frequency sources. METHODS: In 84 consecutive patients, CPVA (n = 42) or EGA (n = 42) was performed for paroxysmal (n = 49) or persistent (n = 35) AF. During EGA, complex electrograms were targeted. Lead V1 and electrograms from the left atrium and coronary sinus were analyzed to determine the DF of AF before and after ablation. RESULTS: The left atrial DF was higher in persistent (5.83 +/- 0.86 Hz) than paroxysmal AF (5.33 +/- 0.76 Hz, p = 0.03). There was a frequency gradient from the left atrium to the coronary sinus (p = 0.02). Circumferential pulmonary vein ablation and EGA resulted in a similar decrease in DF (18 +/- 17% vs. 17 +/- 15%, p = 0.8). During a mean follow-up of 9 +/- 6 months, the change in DF after CPVA was similar among patients with and without recurrent AF. An acute decrease in DF after EGA was associated with freedom from recurrent AF only in patients with persistent AF (19 +/- 14% vs. 3 +/- 6%, p = 0.02). CONCLUSIONS: Both CPVA and EGA decrease the DF of AF, consistent with elimination of high-frequency sources. Whereas the efficacy of EGA is associated with a decrease in DF in patients with persistent AF, the efficacy of CPVA is independent of changes in DF. This suggests that CPVA and EGA eliminate different mechanisms in the genesis of persistent AF.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/methods , Aged , Electrophysiologic Techniques, Cardiac , Female , Humans , Male , Middle Aged , Pulmonary Veins/surgery , Signal Processing, Computer-Assisted , Spectroscopy, Fourier Transform Infrared
17.
J Am Coll Cardiol ; 47(10): 2013-9, 2006 May 16.
Article in English | MEDLINE | ID: mdl-16697318

ABSTRACT

OBJECTIVES: The purpose of this study was to identify ventricular tachycardia (VT) isthmus sites by pace-mapping within scar tissue and to identify electrogram characteristics that are helpful in identifying VT isthmus sites during sinus rhythm (SR). BACKGROUND: Pace-mapping has been used in the scar border zone to identify the exit site of post-infarction VT. METHODS: In 19 consecutive patients (18 men, mean age 66 +/- 9 years, mean ejection fraction 0.24 +/- 0.12) with post-infarction VT, a left ventricular voltage map was generated during SR. Pace-mapping was performed at sites with abnormal electrograms or isolated potentials. Radiofrequency ablation was performed at isthmus sites as defined by pace-mapping (perfect pace-map = 12/12 matching electrocardiogram leads; good pace-map = 10/12 to 11/12 matching electrocardiogram leads) and/or entrainment mapping. RESULTS: A total of 81 VTs (mean cycle length 396 +/- 124 ms) were inducible. In 16 of the 19 patients, a total of 41 distinct isthmus areas of 41 distinct VTs were identified and successfully ablated. All but one displayed isolated potentials during SR. Furthermore, 22 of the 81 VTs (27%) for which no isthmus was identified became noninducible after ablation of a targeted VT. The 16 patients in whom > or =1 isthmus was identified and ablated were free of arrhythmic events during a mean follow-up of 10 months. CONCLUSIONS: During SR, excellent or good pace-maps at sites of isolated potentials within areas of scar identify areas of fixed block that are protected and part of the critical isthmus of post-infarction VT. Shared common pathways might explain why non-targeted VTs might become noninducible after ablation of other VTs.


Subject(s)
Catheter Ablation , Electrophysiologic Techniques, Cardiac/methods , Myocardial Infarction/physiopathology , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/therapy , Action Potentials , Aged , Cicatrix , Electrocardiography , Female , Heart Conduction System/physiopathology , Heart Rate , Humans , Male , Middle Aged , Myocardial Infarction/complications , Stroke Volume , Tachycardia, Ventricular/etiology
18.
Circulation ; 113(15): 1824-31, 2006 Apr 18.
Article in English | MEDLINE | ID: mdl-16606789

ABSTRACT

BACKGROUND: Because the genesis of atrial fibrillation (AF) is multifactorial and variable, an ablation strategy that involves pulmonary vein isolation and/or a particular set of ablation lines may not be equally effective or efficient in all patients with AF. A tailored strategy that targets initiators and drivers of AF is a possible alternative to a standardized lesion set. METHODS AND RESULTS: Catheter ablation was performed in 153 consecutive patients (mean age, 56+/-11 years) with symptomatic paroxysmal AF with the use of an 8-mm tip radiofrequency ablation catheter. The esophagus was visualized with barium. The pulmonary veins and left atrium were mapped during spontaneous or induced AF. Arrhythmogenic pulmonary veins were isolated or encircled. If AF was still present or inducible, complex electrograms in the left atrium, coronary sinus, and superior vena cava were targeted for ablation. The end point of ablation was absence of frequent atrial ectopy and spontaneous AF during isoproterenol infusion and noninducibility of AF. Routine energy applications near the esophagus were avoided. During follow-up, left atrial flutter developed in 19% of patients and was still present in 10% at >12 weeks of follow-up. A repeat ablation procedure was performed in 18% of patients. During a mean follow-up of 11+/-4 months, 77% of patients were free from AF and/or atrial flutter without antiarrhythmic drug therapy. Pericardial tamponade or transient neurological events occurred in 2% of procedures. CONCLUSIONS: A tailored ablation strategy that only targets triggers and drivers of AF is feasible and eliminates paroxysmal AF in approximately 80% of patients.


Subject(s)
Atrial Fibrillation/therapy , Catheter Ablation/methods , Aged , Atrial Fibrillation/physiopathology , Atrial Flutter/etiology , Atrial Flutter/physiopathology , Catheter Ablation/adverse effects , Female , Humans , Male , Middle Aged , Recurrence , Retreatment , Treatment Outcome
19.
Circulation ; 113(5): 609-15, 2006 Feb 07.
Article in English | MEDLINE | ID: mdl-16461832

ABSTRACT

BACKGROUND: Patients who have previously undergone ablation of atrial fibrillation may experience cavotricuspid isthmus (CTI)-dependent atrial flutter during follow-up. The effects of left atrial (LA) ablation on the characteristics of CTI-dependent flutter have not been described. METHODS AND RESULTS: Fifteen patients underwent ablation of CTI-dependent flutter late after LA ablation of AF. The ECG, biatrial activation patterns, and LA voltage maps during flutter were analyzed. Thirty age- and gender-matched patients who underwent ablation of CTI-dependent flutter without prior LA ablation served as control subjects. Among the patients with prior LA ablation, mapping revealed counterclockwise activation around the tricuspid annulus in 12 of 15 patients (80%) and clockwise activation in 3 of 15 patients (20%). The flutter waves in the inferior leads were upright in 9 of the 15 patients (60%) with prior LA ablation and in none of the control subjects (P<0.001). The upright flutter waves in the inferior leads in patients with counterclockwise flutter corresponded to craniocaudal activation of the right atrial free wall. LA activation contributed little to the genesis of the flutter waves in these patients because of a significant reduction in bipolar LA voltage (0.44+/-0.20 versus 1.54+/-0.19 mV in patients with biphasic/negative flutter waves; P<0.001). CONCLUSIONS: CTI-dependent flutter that occurs after LA ablation of atrial fibrillation often has atypical ECG characteristics because of altered LA activation. In patients presenting with atrial flutter after LA ablation, entrainment mapping should be performed at the CTI even if the ECG is uncharacteristic of CTI-dependent flutter.


Subject(s)
Atrial Fibrillation/therapy , Atrial Flutter/physiopathology , Catheter Ablation/adverse effects , Tricuspid Valve/physiopathology , Atrial Fibrillation/complications , Atrial Flutter/etiology , Body Surface Potential Mapping , Electrocardiography , Female , Heart Atria/physiopathology , Heart Conduction System/physiopathology , Humans , Male , Middle Aged
20.
Heart Rhythm ; 3(1): 20-6, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16399047

ABSTRACT

BACKGROUND: Mapping criteria for hemodynamically tolerated, postinfarction ventricular tachycardia (VT) have been evaluated in only small series of patients. OBJECTIVES: The purpose of this study was to evaluate the utility of various mapping criteria for identifying a critical VT circuit isthmus in a post hoc analysis. METHODS: Ninety VTs (cycle length 491 +/- 84 ms) were mapped in 48 patients with a prior myocardial infarction. The mapping catheter was positioned within a protected area of the reentrant circuit of the targeted VTs at 176 sites. All sites showed concealed entrainment. The predictive values of the following mapping criteria for a successful ablation site were compared: discrete isolated potential during VT, inability to dissociate the isolated potential from the VT, endocardial activation time >70 ms, matching electrogram-QRS and stimulus-QRS intervals, VT termination without global capture during pacing, stimulus-QRS/VT cycle length ratio

Subject(s)
Catheter Ablation/methods , Electrophysiologic Techniques, Cardiac , Tachycardia, Ventricular/surgery , Aged , Electrocardiography , Female , Humans , Male , Myocardial Infarction/physiopathology , Predictive Value of Tests , ROC Curve , Sensitivity and Specificity , Tachycardia, Ventricular/physiopathology
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