Ablation of Posteroseptal APs - Tips/Tricks
|
|
|
- Patricia Glenn
- 5 years ago
- Views:
Transcription
1 blation of Posteroseptal Ps - Tips/Tricks California eart Rhythm Symposium San Francisco September 7,202 Warren (Sonny) Jackman eart Rhythm nstitute University of Oklahoma ealth Sciences Center Oklahoma City, OK Disclosure Consulting: Lecture onoraria: - Biosense Webster - St Jude Medical - Endosense - Biosense Webster - Rhythmia Medical - Boston Scientific - CT - Biotronik - ytronus - Medtronic - Boston Scientific Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal ccessory Pathways Posteroseptal Region Based on Original Duke Surgical blation Experience nnulus Right Midseptal and Posteroseptal P nnulus Tricuspid nnulus Tricuspid nnulus LO Projection LO Projection
2 Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal P Right Midseptal and Posteroseptal P - Earliest ntegrade nnulus - Earliest ntegrade - Earliest Retro (±) nnulus Tricuspid nnulus Tricuspid nnulus LO Projection LO Projection Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal P Right Midseptal and Posteroseptal P - Earliest ntegrade - Earliest Retro (±) - P Potential nnulus - Earliest ntegrade - Earliest Retro (±) - P Potential nnulus Tricuspid nnulus Oblique Course LO Projection LO Projection 2
3 Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal P Right Midseptal and Posteroseptal P - Earliest ntegrade - Earliest ntegrade - Earliest Retro (±) - Earliest Retro (±) Not Usually at Same Location Pacing R Not Usually at Same Location Pacing R Oblique Course Oblique Course LO Projection Short Local - at the Site of Earliest entricular ctivation Pacing R Short Local - at Site of Earliest entricular ctivation Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal P 25 (25 ms) - Earliest ntegrade - Earliest Retro (±) Not Usually at Same Location Pacing Oblique Course Reverse Direction of trial ctivation 3
4 Right Midseptal and Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal P - Earliest ntegrade - Earliest Retro (±) Not Usually at Same Location Oblique Course Long Local - at the Site of Earliest Pacing entricular ctivation Pacing R Short Local - (25 ms) Pacing Marked ncrease in Local nterval at Long Site of Local Earliest - entricular (45 ms) ctivation (45 ms) Reverse Direction of trial ctivation Oblique Course Pacing R Pacing Pacing R Pacing P Oblique Course llows dentification of the P Potential Short Local - (25 ms) P Long Local - (45 ms) P Potential P Potential P Potential Obscured by Local trial Potential P Potential Obscured by Local trial Potential 4
5 Safety in Septal ccessory Pathway blation Midseptal Ps Prevent Block - Keep ablation electrode on ventricular side of tricuspid annulus Safety in Septal ccessory Pathway blation Midseptal Ps Prevent Block - Keep ablation electrode on ventricular side of tricuspid annulus - Unipolar tip electrogram (Uni ) records P potential but no atrial potential blation of igh Midseptal P R -PS MS MS T R Bip -2 Uni 2 Targeting a igh Midseptal P P P RO Projection Uni p d P No P 00 ms 5
6 Targeting a igh Midseptal P Targeting a igh Midseptal P R Bip -2 R Bip -2 MS T Uni 2 P P MS T Uni 2 P P Uni p P No P Uni p P No P Sharp P No d d 00 ms 00 ms MS T R Bip -2 Uni 2 Uni p d Targeting a igh Midseptal P P P P No P Sharp P No RF # Success Reduce Risk of Block blation Catheter Beneath Septal Leflet of Tricuspid alve blation of Midseptal P R MS T RO Projection 00 ms 6
7 Posteroseptal ccessory Pathways Posteroseptal ccessory Pathways Left Midseptal P Left Midseptal P Tricuspid nnulus nnulus Tricuspid nnulus nnulus LO Projection LO Projection Left Midseptal ccessory Pathways Left Midseptal ccessory Pathways Major Clue to Left Midseptal Location Major Clue to Left Midseptal Location P Tricuspid nnulus nnulus Tricuspid nnulus nnulus During Retrograde P Conduction: Similar Timing of trial ctivation in and Proximal Electrograms During Retrograde P Conduction: Similar Timing of trial ctivation in and Proximal Electrograms 7
8 R LO Projection 9 TS Same - nterval Similar Timing of Retrograde trial ctivation in and Prox Electrograms R p d RT Posteroseptal P Left Midseptal ccessory Pathways Similar Timing of Retrograde trial ctivation in and Proximal Tricuspid nnulus Push Mapping Catheter gainst Roof of the Ostium P nnulus Left Midseptal ccessory Pathways Similar Timing of Retrograde trial ctivation in and Proximal Roof of Os (Record Farfield Left Midseptum) R R Tricuspid nnulus P nnulus Roof Os Roof Os Push Mapping Catheter gainst Roof of the Ostium Records Farfield ctivation From Left Midseptal Region RO LO 8
9 Far-Field P Potential Recorded from Roof of Os Far-Field P Potential Recorded from Roof of Os R p R p d Roof p Ostium d p Far-Field P Potential d Roof p Ostium d p Far-Field P Potential void blation at this Site d d. Only Transient P Block (Late Recurrence) 2. Risk of Fast Pathway Block Midseptal nnulus R R R p Roof Os MS-M MS-M Roof Os d MS-M p MS-M d P RO LO d L (PC) S S 00 ms 9
10 R p d MS-M p MS-M d Onset of Farfield R p d MS-M p MS-M d Onset of Farfield Local 5 ms fter Onset of Farfield ctivation d P d P L (PC) S S 00 ms L (PC) S S 00 ms R p d MS-M p MS-M d Onset of Farfield Local 5 ms fter Onset of Farfield ctivation R p d MS-M p MS-M d Onset of Farfield Local 5 ms fter Onset of Farfield ctivation d Oblique Course P d Oblique Course Target the P Potential with a Small on the Unipolar Electrogram P L (PC) S S 00 ms L (PC) S S 00 ms 0
11 Midseptal nnulus ccessory Pathways Midseptal nnulus ccessory Pathways LO orta LO orta Central Fibrous Body Midseptal nnulus 2 Patients Central Fibrous Body Midseptal nnulus 2 Patients /2 Prior Failed blation Posteroseptal ccessory Pathways Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal P nnulus Left Midseptal P Right Midseptal and Posteroseptal P nnulus Left Midseptal P Tricuspid nnulus Left Posteroseptal P Tricuspid nnulus Left Posteroseptal P - Earliest ntegrade - Earliest Retrograde LO Projection LO Projection
12 Posteroseptal ccessory Pathways Posteroseptal ccessory Pathways Right Midseptal and Posteroseptal P nnulus Left Midseptal P Right Midseptal and Posteroseptal P nnulus Left Midseptal and Posteroseptal P Tricuspid nnulus Left Posteroseptal P - Earliest ntegrade - Earliest Retrograde - Usually Oblique: P Potential nterior-superior Edge of Ostium LO Projection LO Projection 4 yo Male -PJRT Prior Failed RF R p d -S Bip -2 Os Uni 2 Uni p nterior-superior Ostium P P R p d Bip -2 -S Uni 2 Os Uni p RF # at nterior-superior Ostium P d d 2
13 L- Connections C C Myocardial Coat Myocardial Coat Courtesy of nton Becker Courtesy of nton Becker 240 uman earts Myocardial Coat Myocardial Extensions solated Myocardial Belts (9%) C (PC) Myo Extension Over PC (2% earts) Myo Extension Over (3% earts) () Myocardial Coat Michael v Ludinghausen et al, Clinical natomy 992 Courtesy of nton Becker 3
14 ypothesis -entricular Connection L- Connections Myocardial Coat Epicardial Posteroseptal ccessory Pathways Result from Myocardial - entricular Connections ypothesis Sinus Ostium Myocardial Coat L Marshall -L Connection C Sun, Jackman, et al, Circulation 2002 Small Sun, Jackman, et al, Circulation 2002 L Sinus Myocardial Extensions - Connect to L Sinus-entricular Connections Sinus-entricular Connections Retrograde Conduction Sinus Ostium L ctiv Retrograde Conduction Sinus Ostium Earliest L ctiv L ctiv Small Sun, Jackman, et al, Circulation 2002 E L ctiv LO Projection Small Sun, Jackman, et al, Circulation 2002 E L ctiv LO Projection 4
15 Sinus-entricular Connections Sinus-entricular Connections Retrograde Conduction Sinus Ostium L Small Sun, Jackman, et al, Circulation 2002 Delay in Reversing Direction of ctivation E L ctiv Earliest L ctiv LO Projection L ctiv Retrograde Conduction 3 Potentials in /. Retrograde E (P) L Sun, Jackman, et al, Circulation 2002 E L ctiv LO Projection L ctiv Sinus-entricular Connections Sinus-entricular Connections Retrograde Conduction L ctiv Retrograde Conduction Delay in Reversing Direction of ctivation L ctiv 3 Potentials in /. Retrograde E (P) 2. Myocardium 3. L Sun, Jackman, et al, Circulation E L ctiv LO Projection 3 Potentials in /. Retrograde E (P) 2. Myocardium 3. Left trium L Sun, Jackman, et al, Circulation E L ctiv LO Projection 5
16 LO Projection P R R 4 Retrograde P Conduction (RT) RB LO Projection P R R 4 Retrograde P Conduction (RT) RB RO Projection 8 # Extn RO Projection 8 #2 Myo # Extn R R 5 5 # Extn st Retrograde Potential - ctivation of Extension 8 5 #2 Myo 2 nd Retrograde Potential - ctivation of Myocardium R LO Projection P RO Projection R R 4 8 Retrograde P Conduction (RT) RB #2 Myo # Extn #3 L #3 L LO Projection Retrograde P: 2 Potentials in P R Potential First: L- Connection (Epi R PS P) 4 L Potential First: Conventional - Connection RO Projection 8 R RB 5 5 #3 L 3 rd Retrograde Potential - ctivation of Left trium 6
17 LO Projection Retrograde P: 2 Potentials in P R Potential First: L- Connection (Epi R PS P) 4 L Potential First: Conventional - Connection RB R dentify Origin of the Potentials Use a Late trial Extrastimulus 8 R L will be dvanced Before Myocardium 5 Floor 8 LO Projection R R Roof 0 Floor 8 deal entricular Pacing Wavefront Floor 8 L Pacing Site Roof 4 LO Projection LO Projection 7
18 Late trial Extrastimulus R 0 S 2 R 0 S 2 Roof Roof 4 8 S S 4 8 S S Floor Floor Late trial Extrastimulus Late trial Extrastimulus R S 2 R S 2 Roof Roof Floor 4 8 S S Floor 4 8 S S
19 Late trial Extrastimulus Late trial Extrastimulus R S 2 R S 2 Roof Roof Floor 4 8 S S Floor 4 8 S S dvanced - Unchanged Potential Precedes trial Potential - dvanced - Unchanged R 0 Late trial Extrastimulus 0 80 S Transition: Sinus-entricular Connection (Epicardial Posteroseptal ccessory Pathway) Septal Roof Floor 4 8 S S Potential Precedes trial Potential - dvanced - Unchanged 9
20 Sinus-entricular Connection (Epicardial Posteroseptal ccessory Pathway) Sinus-entricular Connection (Epicardial Posteroseptal ccessory Pathway). - 2 Transition: Septal. - 2 Transition: Septal 2. Delta in af : Negative Level at or below Os 2. Delta in af : Negative Level at or below Os 3. Delta in Lead : Steep Negative Epicard PSP Sinus-entricular Connection (Epicardial Posteroseptal ccessory Pathway) Sinus-entricular Connection (Epicardial Posteroseptal ccessory Pathway). - 2 Transition: Septal. - 2 Transition: Septal 2. Delta in af : Negative Level at or below Os 2. Delta in af : Negative Level at or below Os 3. Delta in Lead : Steep Negative Epicard PSP 3. Delta in Lead : Steep Negative Epicard PSP Steep Negative Delta Wave in Lead Steep Negative Delta Wave in Lead ery Specific, Less Sensitive (70%) 20
21 Delta Wave in Lead Targeting Earliest Retrograde ctivation Negative soelectric Retrograde Conduction RF Sinus Ostium L L ctiv Earliest L ctiv Epicardial PS P (-L Connection) Right Posterolateral P (Not Epicardial P) Small E L ctiv LO Projection Targeting Earliest Retrograde ctivation Targeting Earliest Retrograde ctivation Retrograde Conduction Sinus Ostium Local Block with Shift in Site of Earliest L ctiv L RF L ctiv Earliest L ctiv Retrograde Conduction Sinus Ostium L RF L ctiv Earliest L ctiv Small E L ctiv LO Projection Small E L ctiv LO Projection 2
22 Targeting Earliest Retrograde ctivation Targeting Earliest Retrograde ctivation Retrograde Conduction Sinus Ostium Local Block with Further Shift in Site of Earliest L ctiv L RF L ctiv Earliest L ctiv Retrograde Conduction Sinus Ostium L RF L ctiv Earliest L ctiv Small E L ctiv LO Projection Small E L ctiv LO Projection Targeting Earliest Retrograde ctivation No Further Shift in Site of Earliest L ctiv Sinus Ostium L RF L ctiv Earliest L ctiv blation at Site of Earliest Retrograde trial ctiv Small E L ctiv LO Projection Myocardial Coat C 22
23 blation at Site of Earliest Retrograde trial ctiv blation at Site of Earliest Retrograde trial ctiv Dense L Connections C C Myocardial Coat Myocardial Coat Myocardial Coat deal blation Site Dense L Connections C blation in (entricular Connection) Retrograde Conduction deal blation Site blation of -entricular Connections Sinus Ostium Small L L Earliest L ctiv E Myo Extn L Connection L ctiv 23
24 blation Technique Use Saline rrigated Electrode Catheter blation Technique Use Saline rrigated Electrode Catheter - Will have impedance rise blation Technique Use Saline rrigated Electrode Catheter - Will have impedance rise rrigated RF Watts - Terminate RF MMEDTELY at beginning of any possible mpedance Rise (5 Ohms) LO Prior Unsuccessful blation in 24
25 Prior Unsuccessful blation in RO Projection P R R 4 Selecting the blation Site RO Projection R LO Projection Bip -2 Uni 2 Uni 0 E 5 RO Projection P R R 4 Selecting the blation Site RO Projection P R R 4 Selecting the blation Site R LO Projection Bip -2 Uni 2 Uni 0 E R LO Projection Bip -2 Uni 2 Uni 0 Too Deep E
26 LO Projection Epicardial Posteroseptal ccessory Pathway (-L Connection) R R p d Bip -2 blation of Epicardial Posteroseptal ccessory Pathway E E-L Fusion blation From the () blation of Epicardial Posteroseptal ccessory Pathway blation of Epicardial Posteroseptal ccessory Pathway R p d Bip -2 Uni 2 E Early R p d Bip -2 Uni 2 E Early Deeper in than E-L Connection (No Unipolar E Potential) Uni Uni No E 26
27 Catheter Pullback in Catheter Pullback in R p R p d d Bip -2 Uni 2 Uni E Early E E Bip -2 Uni 2 Uni E Early E E E E No E No E Pre-RF Pre-RF Post-RF R p R p d Bip -2 Uni 2 Uni E E d Bip -2 Uni 2 Uni E E E Loss of E 27
28 Right ngiography RF blation in LO RO RC Close to at Orifice of LO RO RC RC RC Catheter RC Catheter Right rtery - RF njury Before RF blation fter RF pplication in () Chronic Right rtery Stenosis 4 Yr Male 5 yrs after RF in Ostium RC Catheter RC LO Projection 90% Stenosis RC Stenosis 28
29 RF blation Deep in RC Close to at Orifice of blation Site Pre-blation Post-blation Epicardial Posteroseptal ccessory Pathways 79 Patients Distance Between deal blation Site and rtery 2mm 2mm - 5mm 5mm 54 Pts (68%) 7 Pts (8%) 8 Pts (24%) RC blation Site Deep voids Distal RC No Stenosis Sun, Jackman et al J M Coll Cardiology 200;880:3 Epicardial Posteroseptal ccessory Pathways 79 Patients Distance Between deal blation Site and rtery Thank You! 2mm 2mm - 5mm 5mm 54 Pts (68%) 7 Pts (8%) 8 Pts (24%) rterial njury: 2/3 Pts (67%) Sun, Jackman et al J M Coll Cardiology 200;880:3 29
Coronary sinus (CS) diverticula 1 5 have been associated
Coronary Sinus-Ventricular Accessory Connections Producing Posteroseptal and Left Posterior Accessory Pathways Incidence and Electrophysiological Identification Yingxian Sun, MD; Mauricio Arruda, MD; Kenichiro
How to ablate typical slow/fast AV nodal reentry tachycardia
Europace (2000) 2, 15 19 Article No. eupc.1999.0070, available online at http://www.idealibrary.com on OW TO... SERIES ow to ablate typical slow/fast AV nodal reentry tachycardia. eidbüchel Department
A Narrow QRS Complex Tachycardia With An Apparently Concentric Retrograde Atrial Activation Sequence
www.ipej.org 125 Case Report A Narrow QRS Complex Tachycardia With An Apparently Concentric Retrograde Atrial Activation Sequence Miguel A. Arias MD, PhD; Eduardo Castellanos MD, PhD; Alberto Puchol MD;
LONG RP TACHYCARDIA MAPPING AND RF ABLATION
LONG RP TACHYCARDIA MAPPING AND RF ABLATION Dr. Hayam Eldamanhoury Ain shams univeristy Arrhythmia is a too broad topic SVT is broadly defined as narrow complex ( unless aberrant conduction ) Requires
Circulation: Arrhythmia and Electrophysiology CHALLENGE OF THE WEEK
A 14-year-old girl with Wolff-Parkinson-White syndrome and recurrent paroxysmal palpitations due to atrioventricular reentry tachycardia had undergone two prior failed left lateral accessory pathway ablations
EHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology
EHRA Accreditation Exam - Sample MCQs Invasive cardiac electrophysiology Dear EHRA Member, Dear Colleague, As you know, the EHRA Accreditation Process is becoming increasingly recognised as an important
Ankara, Turkey 2 Department of Cardiology, Division of Arrhythmia and Electrophysiology, Yuksek Ihtisas
258 Case Report Electroanatomic Mapping-Guided Radiofrequency Ablation of Adenosine Sensitive Incessant Focal Atrial Tachycardia Originating from the Non-Coronary Aortic Cusp in a Child Serhat Koca, MD
Variants of preexcitation: the tough stuff Case #4. Sergio Richter, MD Heart Center University of Leipzig
Variants of preexcitation: the tough stuff Case #4 Sergio Richter, MD eart Center University of Leipzig Variants of preexcitation the tough stuff Presenter disclosure information Sergio Richter has received
Epicardial Approach to Mapping and Ablation of VT: Clinical and ECG Predictors of Epicardial Location
Epicardial Approach to Mapping and Ablation of VT: Clinical and ECG Predictors of Epicardial Location Mathew D. Hutchinson, MD, FACC, FHRS Perelman School of Medicine University of Pennsylvania Presenter
Bệnh viện trung ương Quân đội 108 Viện tim mạch Triệt phá đường dẫn truyền phụ vùng dưới vách bằng sóng RF (Ablation of Posteroseptal AP)
Bệnh viện trung ương Quân đội 108 Viện tim mạch Triệt phá đường dẫn truyền phụ vùng dưới vách bằng sóng RF (Ablation of Posteroseptal AP) Bs. Phạm Trường Sơn Posteroseptal AP :Inferoseptal AP (inferior
1995 Our First AF Ablation. Atrial Tachycardias During and After Atrial Fibrillation Ablation. Left Atrial Flutter. 13 Hours Later 9/25/2009
1995 Our First AF Ablation Atrial Tachycardias During and After Atrial Fibrillation Ablation G. Neal Kay MD University of Alabama at Birmingham Right Anterior Oblique Left Anterior Oblique Left Atrial
COMPLEX CASE STUDY INNOVATIVE COLLECTIONS. Case presentation
The Journal of Innovations in Cardiac Rhythm Management, 3 (2012), 939 943 INNOVATIVE COLLECTIONS COMPLEX CASE STUDY Subtle Changes in Electrogram Morphology During Para-Hisian Pacing Performed on IV Adenosine:
How to ablate typical atrial flutter
Europace (1999) 1, 151 155 HOW TO... SERIES How to ablate typical atrial flutter A. Takahashi, D. C. Shah, P. Jaïs and M. Haïssaguerre Electrophysiologie Cardiaque, Hopital Cardiologique du Haut-Lévêque,
Electrical disconnection of pulmonary vein (PV) myocardium
Left Atrial Appendage Activity Masquerading as Pulmonary Vein Potentials Dipen Shah, MD; Michel Haissaguerre, MD; Pierre Jais, MD; Meleze Hocini, MD; Teiichi Yamane, MD; Laurent Macle, MD; Kee Joon Choi,
Catheter Ablation of Supraventricular Arrhythmias: State of the Art
124 NASPE 25TH ANNIVERSARY SERIES Catheter Ablation of Supraventricular Arrhythmias: State of the Art FRED MORADY, M.D. From the Division of Cardiology, Department of Medicine, University of Michigan,
Supraventricular Tachycardia (SVT)
Supraventricular Tachycardia (SVT) Bruce Stambler, MD Piedmont Heart Atlanta, GA Supraventricular Tachycardia Objectives Types and mechanisms AV nodal reentrant tachycardia (AVNRT) AV reciprocating tachycardia
Case 1 Left Atrial Tachycardia
Case 1 Left Atrial Tachycardia A 16 years old woman was referred to our institution because of recurrent episodes of palpitations and dizziness despite previous ablation procedure( 13 years ago) of postero-septal
Case Report Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway
109 Case Report Left Ventricular Dysfunction Caused by Unrecognized Surgical AV block in a Patient with a Manifest Right Free Wall Accessory Pathway Rakesh Gopinathannair, MD, MA 1, Dwayne N Campbell,
Mapping and Ablation of Challenging Outflow Tract VTs: Pulmonary Artery, LVOT, Epicardial
Mapping and Ablation of Challenging Outflow Tract VTs: Pulmonary Artery, LVOT, Epicardial Samuel J. Asirvatham, MD Mayo Clinic Rochester California Heart Rhythm Symposium San Francisco, CA September 8,
Catheter Ablation of VT Without Structural Heart Disease 성균관의대 온영근
Catheter Ablation of VT Without Structural Heart Disease 성균관의대 온영근 Idiopathic Monomorphic Ventricular Tachycardia Adenosine-sensitive Verapamil-sensitive Propranolol-sensitive Mech (Triggered activity)
Catheter Ablation for Treatment of Atrial Fibrillation 2010 and Beyond
Catheter Ablation for Treatment of Atrial Fibrillation 2010 and Beyond John M. Miller, MD Professor of Medicine Indiana University School of Medicine Director, Clinical Cardiac Electrophysiology Krannert
Ablation of Ventricular Tachycardia in Non-Ischemic Cardiomyopathy
Ablation of Ventricular Tachycardia in Non-Ischemic Cardiomyopathy Fermin C Garcia, MD University of Pennsylvania Cardiac Electrophysiology Philadelphia, PA Nothing to disclose No conflict of interest
Inappropriate electrical shocks: Tackling the beast
ESC Paris 2011 Inappropriate electrical shocks: Tackling the beast Gerhard Hindricks University of Leipzig Heart Center Dept. of Electrophysiology ESC Paris 2011 Inappropriate electrical shocks: Tackling
From the Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
118 Reprinted with permission from JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Volume 13, No. 2, February 2002 Copyright 2002 by Futura Publishing Company, Inc., Armonk, NY 10504-0418 Differentiation
Succesful Radiofrequency Ablation of Atrial Tachycardia Arising From Within the Coronary Venous Sinus
Succesful Radiofrequency Ablation of Atrial Tachycardia Arising From Within the Coronary Venous Sinus The Harvard community has made this article openly available. Please share how this access benefits
Interventional Cardiology. Research Article
Interventional Cardiology Accuracy of the new electrocardiogram algorithm in predicting localization of accessory pathways in patients with typical Wolff-Parkinson- White syndrome Objective: This study
Differential diagnosis and pacing in maneuvers narrow QRS tachycardia. Richard Schilling
Differential diagnosis and pacing in maneuvers narrow QRS tachycardia Richard Schilling Differential diagnosis of narrow complex QRS tachycardia Anything that activates the ventricle normally via the His
Basic Electrophysiology Protocols
Indian Journal of Cardiology ISSN-0972-1622 2012 by the Indian Society of Cardiology Vol. 15, (3-4), 27-37 [ 27 Review Article Shomu Bohora Assistant Professor, Deptt. of Cardiology, U.N. Mehta Institute
Catheter ablation of monomorphic ventricular tachycardia. Department of Cardiology, IKEM, Prague, Czech Republic
Catheter ablation of monomorphic ventricular tachycardia Department of Cardiology, IKEM, Prague, Czech Republic DECLARATION OF CONFLICT OF INTEREST None Ventricular tachycardia ablation in IKEM, Prague
Case Report Simultaneous Accessory Pathway and AV Node Mechanical Block
185 Case Report Simultaneous Accessory Pathway and AV Node Mechanical Block Daniel Garofalo, MD, FRACP, Alfonso Gomez Gallanti, MD, David Filgueiras Rama, MD, Rafael Peinado Peinado, PhD, FESC Unidad de
AV Node Dependent SVT:Substrates, Mechanisms, and Recognition
AV Node Dependent SVT:Substrates, Mechanisms, and Recognition Ching-Tai Tai Taipei Veterans General Hospital National Yang-Ming University AV Node Reentry Anatomy Physiology Anatomic-Physiologic Relation
Declaration of conflict of interest NONE
Declaration of conflict of interest NONE Transatlantic Electrophysiology Lessons for and from Iberoamerica European Society of Cardiology Mexican Society of Cardiology Wolff-Parkinson-White Syndrome in
Rotor Mapping A FIRM Foundation Exists
Rotor Mapping A FIRM Foundation Exists John M. Miller, MD Professor of Medicine Indiana University School of Medicine Krannert Institute of Cardiology Director, Clinical Cardiac Electrophysiology ~ Disclosures
How to Distinguish Focal Atrial Tachycardia from Small Circuits and Reentry
How to Distinguish Focal Atrial Tachycardia from Small Circuits and Reentry Pierre Jaïs; Bordeaux, France IHU LIRYC ANR-10-IAHU-04 Equipex MUSIC imaging platform ANR-11-EQPX-0030 Eutraf HEALTH-F2-2010-261057
Evidence for Longitudinal and Transverse Fiber Conduction in Human Pulmonary Veins
Evidence for Longitudinal and Transverse Fiber Conduction in Human Pulmonary Veins Relevance for Catheter Ablation Javier E. Sanchez, MD; Vance J. Plumb, MD; Andrew E. Epstein, MD; G. Neal Kay, MD Background
Case Report What Next After Failed Septal Ventricular Tachycardia Ablation?
www.ipej.org 180 Case Report What Next After Failed Septal Ventricular Tachycardia Ablation? Laurent Roten, MD 1, Nicolas Derval, MD 1, Patrizio Pascale, MD 1, Pierre Jais, MD 1, Pierre Coste, MD 2, Frederic
Anatomical Problems with Identification and Interruption of Posterior Septa1 Kent Bundles
Anatomical Problems with Identification and Interruption of Posterior Septa1 Kent Bundles Will C. Sealy, M.D., and Eileen M. Mikat, Ph.D. ABSTRACT To gain insight into the cause of the complex anatomical
Catheter ablation of atrial macro re-entrant Tachycardia - How to use 3D entrainment mapping -
Catheter ablation of atrial macro re-entrant Tachycardia - How to use 3D entrainment mapping - M. Esato, Y. Chun, G. Hindricks Kyoto Ijinkai Takeda Hosptial, Department of Arrhythmia, Japan Kyoto Koseikai
480 April 2004 PACE, Vol. 27
Incremental Value of Isolating the Right Inferior Pulmonary Vein During Pulmonary Vein Isolation Procedures in Patients With Paroxysmal Atrial Fibrillation HAKAN ORAL, AMAN CHUGH, CHRISTOPH SCHARF, BURR
Characteristics of systolic and diastolic potentials recorded in the left interventricular septum in verapamil-sensitive left ventricular tachycardia
CASE REPORT Cardiology Journal 2012, Vol. 19, No. 4, pp. 418 423 10.5603/CJ.2012.0075 Copyright 2012 Via Medica ISSN 1897 5593 Characteristics of systolic and diastolic potentials recorded in the left
Ablation of persistent AF Is it different than paroxysmal?
Ablation of persistent AF Is it different than paroxysmal? Steven J. Kalbfleisch, MD Medical Director Electrophysiology Laboratory Ohio State University Wexner Medical Center Ross Heart Hospital Columbus,
INTERPRETING THE ECG IN PATIENTS WITH PACEMAKERS
INTERPRETING THE ECG IN PATIENTS WITH PACEMAKERS BEFORE INTERPRETING THE ECG: Nora Goldschlager, M.D. MACP, FACC, FAHA, FHRS. Cardiology San Francisco General Hospital UCSF Disclosures: None 1 2 QUESTIONS
Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes
Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes Francis Marchlinski, MD Richard T and Angela Clark President s Distinguished Professor Director Cardiac Electrophysiolgy University
Mechanism of Immediate Recurrences of Atrial Fibrillation After Restoration of Sinus Rhythm
Mechanism of Immediate Recurrences of Atrial Fibrillation After Restoration of Sinus Rhythm AMAN CHUGH, MEHMET OZAYDIN, CHRISTOPH SCHARF, STEVE W.K. LAI, BURR HALL, PETER CHEUNG, FRANK PELOSI, JR, BRADLEY
Determination of Inadvertent Atrial Capture During Para-Hisian Pacing
Determination of Inadvertent Atrial Capture During Para-Hisian Pacing Manoj Obeyesekere, MBBS; Peter Leong-Sit, MD; Allan Skanes, MD; Andrew Krahn, MD; Raymond Yee, MD; Lorne J. Gula, MD; Matthew Bennett,
Ablative Therapy for Ventricular Tachycardia
Ablative Therapy for Ventricular Tachycardia Nitish Badhwar, MD, FACC, FHRS 2 nd Annual UC Davis Heart and Vascular Center Cardiovascular Nurse / Technologist Symposium May 5, 2012 Disclosures Research
Noncontact mapping to idiopathic VT from LCC
Narita S Noncontact mapping to idiopathic VT from LCC Case Report Radiofrequency Catheter Ablation with the Use of a Noncontact Mapping System for Ventricular Tachycardia Originating from the Aortic Sinus
Journal of the American College of Cardiology Vol. 37, No. 6, by the American College of Cardiology ISSN /01/$20.
Journal of the American College of Cardiology Vol. 37, No. 6, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(01)01206-2 Optimized
Double Retrograde Atrial Response After Radiofrequency. ablation of typical AV nodal tieentrant tachycardia
Double Retrograde Atrial Response After Radiofrequency Ablation of Typical AV Nodal Reentrant Tachycardia STEVEN J. KALBFLEISCH, M.D., S. ADAM STRICKBERGER, M.D.. JOHN D. HUMMEL, M.D., BRIAN D. WILLIAMSON,
Uncommon forms of AV reentry: atrio and fasciculo-ventricular fibers, slow conducting fibers. Jesus Almendral, Madrid, Spain
Uncommon forms of AV reentry: atrio and fasciculo-ventricular fibers, slow conducting fibers Jesus Almendral, Madrid, Spain Common forms of AV reentry Accessory pathways: Upper insertion: atrium Lower
Looks Like VT But Isn't - Successful Ablation Of A Left Free Wall Accessory Pathway With Mahaim-like Properties
www.ipej.org 112 Case Report Looks Like VT But Isn't - Successful Ablation Of A Left Free Wall Accessory Pathway With Mahaim-like Properties Faizel Osman MD MRCP 1, Peter J Stafford BSc MD FRCP 2, G Andre
Clinical Data Summary: Avoid FFS Study
Atrial Pacing Lead with 1.1 mm Tip-to-Ring Spacing Clinical Data Summary: Avoid FFS Study A Multi-center, Randomized, Prospective Clinical Study Designed to Evaluate the 1699T Lead Clinical Data Summary:
Should hybrid ablation be the standard of care instead of transcatheter ablation techniques?
Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Christian Shults, MD Assistant Professor, Georgetown University School of Medicine Cardiac Surgeon, Medstar
Advances in Ablation Therapy for Ventricular Tachycardia
Advances in Ablation Therapy for Ventricular Tachycardia Nitish Badhwar, MD, FACC, FHRS Director, Cardiac Electrophysiology Training Program University of California, San Francisco For those of you who
Linear Ablation Should Not Be a Standard Part of Ablation in Persistent AF. Disclosures. LA Ablation vs. Segmental Ostial Ablation With PVI for PAF
Linear Ablation Should Not Be a Standard Part of Ablation in Persistent AF The CA Heart Rhythm Symposium September 7, 2012 Gregory K. Feld, MD Professor of Medicine Director, Cardiac EP Program University
The HISTORIC-AF TRIAL
European Prospective Multicenter Study of Hybrid Thoracoscopic and Transcatheter Ablation of Persistent Atrial Fibrillation: The HISTORIC-AF TRIAL Claudio Muneretto 1, Gianluigi Bisleri 1, Gianluca Polvani
Pre-excited tachycardia: Atrial tachycardia with a bystander left lateral accessory pathway
Pre-excited tachycardia: Atrial tachycardia with a bystander left lateral accessory pathway Jeffrey Munro, DO, Win-Kuang Shen, MD, FHRS, Komandoor Srivathsan, MD From the Department of Cardiovascular Disease,
Overview of Atrial Flutter
Overview of Atrial Flutter Samsung Medical Center Lee, Chang Hee Atrial Flutter A macro-reentrant reentrant atrial arrhythmia that is very regular with rates typically between 240 and 350 bpm. Demographics
II V 1 HRA 3 4 HB 5 6 HB 3 4 HB 1 2 CS 7 8 CS 5 6 CS 3 4 CS 1 2 ABL 3 4 ABL 1 2 RVA 3 4. T. Suga et al.
Table 1. The distance between the positions of the catheter tip Patient Location Before elimination of After elimination of Number of the the accessory pathway the accessory pathway accessory pathway RAO
Epicardial VT Ablation The Cleveland Clinic Experience
Epicardial VT Ablation The Cleveland Clinic Experience Walid Saliba, MD, FHRS Director, EP Lab Cardiac Electrophysiology Heart and Vascular Institute Epicardial Access in the EP Lab Why Epicardial Special
Catheter ablation of atrial fibrillation: Indications and tools for improvement of the success rate of the method. Konstantinos P.
Ioannina 2015 Catheter ablation of atrial fibrillation: Indications and tools for improvement of the success rate of the method Konstantinos P. Letsas, MD, FESC SECOND DEPARTMENT OF CARDIOLOGY LABORATORY
PVI and What Else for Persistent AF Lessons Learned from STAR AF 2 CCCEP 2015 October 31, New York
PVI and What Else for Persistent AF Lessons Learned from STAR AF 2 CCCEP 2015 October 31, New York Atul Verma, MD FRCPC FHRS Director, Arrhythmia Services Southlake Regional Health Centre Faculty of Medicine
Spontaneous clockwise (CW) and counterclockwise
Atypical Right Atrial Flutter Patterns Yanfei Yang, MD; Jie Cheng, MD, PhD; Andy Bochoeyer, MD; Mohamed H. Hamdan, MD; Robert C. Kowal, MD, PhD; Richard Page, MD; Randall J. Lee, MD, PhD; Paul R. Steiner,
Single- versus Dual-Coil ICD Leads: Does it Matter?
Single- versus Dual-Coil ICD Leads: Does it Matter? C. W. Israel, M.D. Dept. of Cardiology Evangelical Hospital Bielefeld Germany Carsten.Israel@evkb.de Conflict of Interest Biotronik Boston-Scientific
ICD Shocks: How to Avoid? Josef Kautzner Department of Cardiology, Institute for Clinical and Experimental Medicine Prague, Czech Republic
ICD Shocks: How to Avoid? Josef Kautzner Department of Cardiology, Institute for Clinical and Experimental Medicine Prague, Czech Republic joka@medicon.cz www.ikem.cz My Disclosures Advisory Board member
Complex Left Atrial (CLA) Best Practices for Navigant
Complex Left Atrial (CLA) Best Practices for Navigant Ischemic Ventricular Tachycardia (VT) Best Practices for Navigant Ischemic VT Ablation Procedures Set Up In the absence of a septal defect or other
Voltage-directed Cavo-tricuspid Isthmus Ablation using Novel Ablation Catheter Mapping Technology
The Journal of Innovations in Cardiac Rhythm Management, 6 (2015), 1908 1912 INNOVATIVE TECHNIQUES RESEARCH ARTICLE Voltage-directed Cavo-tricuspid Isthmus Ablation using Novel Ablation Catheter Mapping
Conventional Mapping. Introduction
Conventional Mapping Haitham Badran Ain Shams University it Introduction The mapping approach used to guide ablation depends on the type of arrhythmia being assessed. Simple fluoroscopic anatomy is essential
Case Report. Sumito Narita MD 1;3, Takeshi Tsuchiya MD, PhD 1, Hiroya Ushinohama MD, PhD 2, Shin-ichi Ando MD, PhD 3
Case Report Identification and Radiofrequency Catheter Ablation of a Nonsustained Atrial Tachycardia at the Septal Mitral Annulus with the Use of a Noncontact Mapping System: A Case Report Sumito Narita
Recurrent Implantable Defibrillator Discharges (ICD) Discharges ICD Storm
Recurrent Implantable Defibrillator Discharges (ICD) Discharges ICD Storm Guy Amit, MD, MPH Soroka University Medical Center Ben-Gurion University of the Negev Beer-Sheva, Israel Disclosures Consultant:
Adenosine-Sensitive Focal Reentrant Atrial Tachycardia Originating From the Mitral Annulus Aorta Junction
Case Report Adenosine-Sensitive Focal Reentrant Atrial Tachycardia Originating From the Mitral Annulus Aorta Junction tsuro Morishima MD, Takahito Sone MD, Hideyuki Tsuboi MD, Hiroaki Mukawa MD, Michitaka
Case Report Epicardial Ablation: Prevention of Phrenic Nerve Damage by Pericardial Injection of Saline and the Use of a Steerable Sheath
87 Case Report Epicardial Ablation: Prevention of Phrenic Nerve Damage by Pericardial Injection of Saline and the Use of a Steerable Sheath Kars Neven, MD 1, Juan Fernández-Armenta, MD 2, David Andreu,
The Future. Sanjiv M. Narayan, MD, PHD, FHRS, FRCP Professor of Medicine, University of California San Diego San Diego Veterans Affairs Medical Center
The Future Sanjiv M. Narayan, MD, PHD, FHRS, FRCP Professor of Medicine, University of California San Diego San Diego Veterans Affairs Medical Center Disclosures: Funded by NIH (HL70529, HL83359, HL103800,
CRT Implantation Techniques 부천세종병원순환기내과박상원
Cardiac Venous System and CRT Implantation Techniques 부천세종병원순환기내과박상원 Cardiac Resynchronization Therapy (CRT) Goal: Atrial synchronous biventricular pacing Transvenous approach for left ventricular lead
PARA-HISSIAN CONCEALED ACCESSORY PATHWAY
PARA-HISSIAN CONCEALED ACCESSORY PATHWAY Anamnestic Findings 41 y.o. man with normal cardiac findings on echocardiography, suffering for paroxysmal supra-ventricular tachycardia since 1982 with rapid onset
Incessant Tachycardia Using a Concealed Atrionodal Bypass Tract
191 Incessant Tachycardia Using a Concealed Atrionodal Bypass Tract ADAM ZIVIN, M.D., atid FRED MORADY, M.D. From the Division of Cardiology. Department of Internal Medicine, University of Michigan Medical
FFR: Tips and Tricks. A/Prof (Adj) Yeo Khung Keong, MBBS, FAMS, FACC, FSCAI National Heart Centre Singapore
FFR: Tips and Tricks A/Prof (Adj) Yeo Khung Keong, MBBS, FAMS, FACC, FSCAI National Heart Centre Singapore Disclosures Abbott Vascular: Speaker, Proctor (MitraClip) Boston Scientific: Consultant, honorarium
Journal of the American College of Cardiology Vol. 45, No. 9, by the American College of Cardiology Foundation ISSN /05/$30.
Journal of the American College of Cardiology Vol. 45, No. 9, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.01.042
Because of the limitations of conventional endocardial activation
Characterization of Left Atrial Activation in the Intact Human Heart Vias Markides, MRCP; Richard J. Schilling, MD; Siew Yen Ho, PhD; Anthony W.C. Chow, MRCP; D. Wyn Davies, MD; Nicholas S. Peters, MD
Original Article. Introduction. Korean Circulation Journal
Original Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Electrophysiological Characteristics Related to Outcome after Catheter Ablation of Idiopathic Ventricular Arrhythmia
Radiofrequency Energy: Irrigation and Alternate Catheters. Andreas Pflaumer
Radiofrequency Energy: Irrigation and Alternate Catheters Andreas Pflaumer Irrigated tip RF ablation Irrigated tip How does it work? Potential benefits? Potential risks? How is this relevant to pediatric
Raphael Rosso MD, Yuval Levi Med. Eng., Sami Viskin MD Tel Aviv Sourasky Medical Center
Radiofrequency Ablation of Atrial Fibrillation: Comparison of Success Rate of Circular Ablation vs Point-by-Point Ablation with Contact Force Assessment in Paroxysmal and Persistent Atrial Fibrillation
Hybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure. Spectrum of Atrial Fibrillation
Hybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure Paul J. Wang, MD Amin Al-Ahmad, MD Gan Dunnington, MD Stanford University Cox J, et al. Ann Thorac Surg. 1993;55:578-580.
Topographic Distribution of Focal Left Atrial Tachycardias Defined by Electrocardiographic and Electrophysiological Data
Circ J 2005; 69: 205 210 Topographic Distribution of Focal Left Atrial Tachycardias Defined by Electrocardiographic and Electrophysiological Data Hitoshi Hachiya, MD; Sabine Ernst, MD; Feifan Ouyang, MD;
Integration of CT and fluoroscopy images in the ablative treatment of atrial fibrillation
Clinical applications Integration of CT and fluoroscopy images in the ablative treatment of atrial fibrillation C. Kriatselis M. Tang M. Roser J-H. erds-li E. leck Department of Internal Medicine/Cardiology,
Principles and Applications of Electrical Circuits and Signal Theories in EP
Principles and Applications of Electrical Circuits and Signal Theories in EP Graydon Beatty, VP Therapy Development Atrial Fibrillation Division, St. Jude Medical, Inc. CardioRhythm 2009 Background Biophysics
Medicine. Dynamic Changes of QRS Morphology of Premature Ventricular Contractions During Ablation in the Right Ventricular Outflow Tract
Medicine CLINICAL CASE REPORT Dynamic Changes of QRS Morphology of Premature Ventricular Contractions During Ablation in the Right Ventricular Outflow Tract A Case Report Li Yue-Chun, MD, Lin Jia-Feng,
Case Report Electroanatomical Mapping and Ablation of Upper Loop Reentry Atrial Flutter
Hellenic J Cardiol 46: 74-78, 2005 Case Report Electroanatomical Mapping and blation of Upper Loop Reentry trial Flutter POSTOLOS KTSIVS, PNGIOTIS IONNIDIS, CHRLMOS VSSILOPOULOS, THIN GIOTOPOULOU, THNSIOS
Catheter mapping and ablation are increasingly performed
Teaching Rounds in Cardiac Electrophysiology Three-Dimensional Mapping of Cardiac Arrhythmias What Do the Colors Really Mean? Freddy Del Carpio Munoz, MD; Traci L. Buescher, RN; Samuel J. Asirvatham, MD
Author s Accepted Manuscript
Author s Accepted Manuscript Cavo-tricuspid isthmus high density mapping Antonio De Simone, Vincenzo La Rocca, Francesco Solimene, Francesco Maddaluno, Maurizio Malacrida, Giuseppe Stabile www.elsevier.com/locate/buildenv
Bipolar radiofrequency catheter ablation for refractory perimitral flutter: a case report
Yamagata et al. BMC Cardiovascular Disorders (2015) 15:139 DOI 10.1186/s12872-015-0132-z CASE REPORT Open Access Bipolar radiofrequency catheter ablation for refractory perimitral flutter: a case report
Catheter Ablation of Atrial Tachycardia Originating from the Tip of Right Atrial Appendage
Case Report Catheter Ablation of Atrial Tachycardia Originating from the Tip of Right Atrial Appendage Masaru Inoue MD, Takao Matsubara MD, Toshihiko Yasuda MD, Kenji Miwa MD, Tadatsugu Gamou MD, Hounin
Catheter Interruption of Atrioventricular Conduction Using Radiofrequency Energy in a Patient with Transposition ofthe Great Arteries
Catheter Interruption of Atrioventricular Conduction Using Radiofrequency Energy in a Patient with Transposition ofthe Great Arteries MARK W. RUSSELL, PARVIN C. DOROSTKAR, MACDONALD DICK, II, - JOSEPHA
Just over a decade ago, the advent of tip temperature monitoring during radiofrequency (RF) energy
EP Lab Digest - ISSN: 1535-2226 - Volume 3 - Issue 2:2003 (March/April) - March 2003 - Pages: 1, 8-11 From: http://www.eplabdigest.com/article/1382# Features: Cooled Tip Catheter Ablation - Linda Moulton
Balloon and Mesh Catheter Ablation of Pulmonary Veins
Balloon and Mesh Catheter Ablation of Pulmonary Veins ISHNE 2009 Atul Verma, MD FRCPC Cardiology/Electrophysiology Heart Rhythm Program, Division of Cardiology Southlake Regional Health Centre Newmarket,
The pulmonary veins have been demonstrated to often
Pulmonary Vein Isolation for Paroxysmal and Persistent Atrial Fibrillation Hakan Oral, MD; Bradley P. Knight, MD; Hiroshi Tada, MD; Mehmet Özaydın, MD; Aman Chugh, MD; Sohail Hassan, MD; Christoph Scharf,
Contemporary Strategies for Catheter Ablation of Atrial Fibrillation
Contemporary Strategies for Catheter Ablation of Atrial Fibrillation Suneet Mittal, MD Director, Electrophysiology Medical Director, Snyder Center for Atrial Fibrillation The Arrhythmia Institute at The
Characteristics of Rapid Rhythms Recorded Within Pulmonary Veins During Atrial Fibrillation
Characteristics of Rapid Rhythms Recorded Within Pulmonary Veins During Atrial Fibrillation HIROSHI TADA, MEHMET ÖZAYDIN, HAKAN ORAL, BRADLEY P. KNIGHT, AMAN CHUGH, CHRISTOPH SCHARF, FRANK PELOSI, Jr.,
Case Report Catheter Ablation of Long-Lasting Accelerated Idioventricular Rhythm in a Patient with Mild Left Ventricular Dysfunction
Volume 2012, Article D 143864, 4 pages doi:10.1155/2012/143864 Case Report Catheter Ablation of Long-Lasting Accelerated dioventricular Rhythm in a Patient with Mild Left Ventricular Dysfunction Takanao
Uncommon Atrial Flutter Originating in the Left Atrioventricular Groove
Jpn Circ J 1999; 63: 416 420 Uncommon Atrial Flutter Originating in the Left Atrioventricular Groove Emergence After Successful Catheter Ablation for a Left Concealed Accessory Pathway Yoshinori Kobayashi,