Circulation: Arrhythmia and Electrophysiology最新文献

{"title":"Assessment of the 2017 AHA/ACC/HRS Guideline Recommendations for Implantable Cardioverter-Defibrillator Implantation in Cardiac Sarcoidosis.","authors":"Felipe Kazmirczak, Ko-Hsuan Amy Chen, Selcuk Adabag, Lisa von Wald, Henri Roukoz, David G Benditt, Osama Okasha, Afshin Farzaneh-Far, Jeremy Markowitz, Prabhjot S Nijjar, Pratik S Velangi, Maneesh Bhargava, David Perlman, Sue Duval, Mehmet Akçakaya, Chetan Shenoy","doi":"10.1161/CIRCEP.119.007488","DOIUrl":"10.1161/CIRCEP.119.007488","url":null,"abstract":"<p><strong>Background: </strong>Implantable cardioverter-defibrillators are used to prevent sudden cardiac death in patients with cardiac sarcoidosis. The most recent recommendations for implantable cardioverter-defibrillator implantation in these patients are in the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. These recommendations, based on observational studies or expert opinion, have not been assessed. We aimed to assess them.</p><p><strong>Methods: </strong>We performed a large retrospective cohort study of patients with biopsy-proven sarcoidosis and known or suspected cardiac sarcoidosis that underwent cardiovascular magnetic resonance imaging. Patients were followed for a composite end point of significant ventricular arrhythmia or sudden cardiac death. The discriminatory performance of the Guideline recommendations was tested using time-dependent receiver operating characteristic analyses. The optimal cutoff for the extent of late gadolinium enhancement predictive of the composite end point was determined using the Youden index.</p><p><strong>Results: </strong>In 290 patients, the class I and IIa recommendations identified all patients who experienced the composite end point during a median follow-up of 3.0 years. Patients meeting class I recommendations had a significantly higher incidence of the composite end point than those meeting class IIa recommendations. Left ventricular ejection fraction (LVEF) >35% with >5.7% late gadolinium enhancement on cardiovascular magnetic resonance imaging was as sensitive as and significantly more specific than LVEF >35% with any late gadolinium enhancement. Patients meeting 2 class IIa recommendations, LVEF >35% with the need for a permanent pacemaker and LVEF >35% with late gadolinium enhancement >5.7%, had high annualized event rates. Excluding 2 class IIa recommendations, LVEF >35% with syncope and LVEF >35% with inducible ventricular arrhythmia, resulted in improved discrimination for the composite end point.</p><p><strong>Conclusions: </strong>We assessed the Guideline recommendations for implantable cardioverter-defibrillator implantation in patients with known or suspected cardiac sarcoidosis and identified topics for future research.</p>","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84902572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variable Presentations and Ablation Sites for Manifest Nodoventricular/Nodofascicular Fibers.","authors":"B. Nazer, Tomos E. Walters, Thomas A. Dewland, Aditi Naniwadekar, J. Koruth, Mohammed Najeeb Osman, A. Intini, Minglong Chen, Jürgen Biermann, J. Steinfurt, J. Kalman, R. Tanel, Byron K. Lee, N. Badhwar, E. Gerstenfeld, M. Scheinman","doi":"10.1161/CIRCEP.119.007337","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007337","url":null,"abstract":"BACKGROUND\u0000Nodofascicular and nodoventricular (NFV) accessory pathways connect the atrioventricular node and the Purkinje system or ventricular myocardium, respectively. Concealed NFV pathways participate as the retrograde limb of supraventricular tachycardia (SVT). Manifest NFV pathways can comprise the anterograde limb of wide-complex SVT but are quite rare. The purpose of this report is to highlight the electrophysiological properties and sites of ablation for manifest NFV pathways.\u0000\u0000\u0000METHODS\u0000Eight patients underwent electrophysiology studies for wide-complex tachycardia (3), for narrow-complex tachycardia (1), and preexcitation (4).\u0000\u0000\u0000RESULTS\u0000NFV was an integral part of the SVT circuit in 3 patients. Cases 1 to 2 were wide-complex tachycardia because of manifest NFV SVT. Case 3 was a bidirectional NFV that conducted retrograde during concealed NFV SVT and anterograde causing preexcitation during atrial pacing. NFV was a bystander during atrioventricular node re-entrant tachycardia, atrial fibrillation, atrial flutter, and orthodromic atrioventricular re-entrant tachycardia in 4 cases and caused only preexcitation in 1. Successful NFV ablation was achieved empirically in the slow pathway region in 1 case. In 5 cases, the ventricular insertion was mapped to the slow pathway region (2 cases) or septal right ventricle (3 cases). The NFV was not mapped in cases 5 and 7 because of its bystander role. QRS morphology of preexcitation predicted the right ventricle insertion sites in 4 of the 5 cases in which it was mapped. During follow-up, 1 patient noted recurrent palpitations but no documented SVT.\u0000\u0000\u0000CONCLUSIONS\u0000Manifest NFV may be critical for wide-complex tachycardia/manifest NFV SVT, act as the retrograde limb for narrow-complex tachycardia/concealed NFV SVT, or cause bystander preexcitation. Ablation should initially target the slow pathway region, with mapping of the right ventricle insertion site if slow pathway ablation is not successful. The QRS morphology of maximal preexcitation may be helpful in predicting successful right ventricle ablation site.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75576851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grid Mapping Catheter for Ventricular Tachycardia Ablation.","authors":"K. Okubo, A. Frontera, C. Bisceglia, G. Paglino, A. Radinovic, L. Foppoli, F. Calore, P. Della Bella","doi":"10.1161/CIRCEP.119.007500","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007500","url":null,"abstract":"BACKGROUND\u0000A new grid mapping catheter (GMC)-allowing for bipolar recordings of the electrograms in each orthogonal direction-became available. The aim of the current study is to evaluate the utility of the GMC in creating substrate and ventricular tachycardia (VT) activation maps during VT ablation procedures.\u0000\u0000\u0000METHODS\u0000From December 2017 to July 2018, 41 consecutive patients undergoing a VT ablation procedure using a GMC were studied. During the substrate mapping, 3 different maps were created using the 3 GMC bipolar configurations (along the spline, across the spline, HD wave solution); the low voltage area and late potential areas were compared. In case of inducible VTs, the GMC was used to create the VT activation maps focusing on the diastolic interval. The relation between diastolic activities during VT and substrate abnormality during sinus rhythm was also investigated.\u0000\u0000\u0000RESULTS\u0000The median low-voltage area drawn by the HD wave configuration was 28.9 cm2, 13% and 15% smaller than the low-voltage areas identified by the along and across configuration, respectively (33.1 and 33.9 cm2; P<0.0001). The late potential areas obtained with the 3 GMC configuration did not differ (P>0.05). VT activation mappings using the GMC were performed in 40 VTs, visualizing the full diastolic pathway in 22 (55%) of them. While the latest late potential areas were included in VT diastolic pathway in 17 VTs, the other 6 VTs showed mismatching of them. Identifying the full diastolic pathway led to a higher ongoing VT termination rate during the ablation than in case of partial recordings (88% versus 45%; P=0.03); furthermore, in the former situation, the noninducibility of the targeted VTs was achieved in all cases.\u0000\u0000\u0000CONCLUSIONS\u0000The GMC is a useful tool for performing substrate and VT activation mappings during the VT ablation procedure, precisely identifying the low-voltage areas and quickly visualizing the diastolic pathways.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75285504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Natural History of Left Bundle Branch Block Induced Cardiomyopathy.","authors":"W. Barake, Chance M. Witt, Vaibhav R. Vaidya, Y. Cha","doi":"10.1161/CIRCEP.119.007393","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007393","url":null,"abstract":"September 2019 1 Left bundle branch block (LBBB) is associated with left ventricular dysfunction, heart failure, and increased mortality in patients with/without cardiac diseases.1–3 In our previous study of 1436 patients with mild to moderately reduced left ventricular ejection fraction (LVEF) and LBBB, the clinical outcomes were significantly worse than those of patients without conduction disease.3 Current data on incidence of LBBB-induced cardiomyopathy remain sparse. We further studied adult patients with LBBB and baseline normal LVEF of >50% from 1994 to 2014. Institutional Review Board approval was obtained for this study. Informed consents were waived given the retrospective aspect of the study and the minimal risks involved. Categorical variables were compared with the χ2 test and continuous variables with the ANOVA test. All statistical analysis was performed using JMP software (SAS Institute, Cary, NC). Only 549 patients who had baseline and follow-up echocardiograms were included out of a total 2235 patient with LBBB and baseline LVEF >50%. Patients who had a significant drop in LVEF (>10%) to less than 50% were reviewed to determine the cause of cardiomyopathy. The study cohort consisted of 549 patients (age 66.7±11.0 years; 55% females) with a LBBB, normal LVEF (>50%) at baseline, and a follow-up echocardiogram. Of these, 134 (24.4%) had a significant drop in LVEF. The baseline characteristics were comparable between patients with and without drop in the LVEF except for sex and hyperlipidemia (Table). Patients who had a drop in LVEF were more likely to be males (P=0.02) and more likely to be hyperlipidemic (P=0.04). The majority of patients who developed LV dysfunction had clearly identifiable causes of worsening LVEF (Figure). It is important to note that patients with other potential causes of cardiomyopathy may, in fact, have developed LV dysfunction due the LBBB. Nevertheless, to limit potential confounders, we did not consider the LBBB as the cause unless there were no other causes. Ischemic heart disease was the most common condition associated with LVEF drop (10%). The cause of cardiomyopathy in the remaining 29 patients (5.3%) was potentially related to the LBBB itself. All patients with suspected LBBB-induced cardiomyopathy had been evaluated with advanced imaging (cardiac MRI and cardiac positron emission tomography /computed tomography) to rule out other etiologies. Patients with possible LBBB-induced cardiomyopathy were more likely to be younger (average of 59.8 versus 66.6 years, P=0.02). Mean baseline LVEF was 56% and dropped to a low EF of 31% at an average of 4.6 years. Of this group, 83% developed new onset of heart failure; 30% died at an average of 7.2 years from the drop in EF. The EF was ≤35% in 24 (83%) patients, with cardiac resynchronization therapy instituted in only 7 (24%). In these patients, there was a significantly greater improvement in EF in those receiving cardiac resynchronization therapy compared w","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87967508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and Sex Estimation Using Artificial Intelligence From Standard 12-Lead ECGs","authors":"Z. Attia, P. Friedman, P. Noseworthy, F. Lopez‐Jimenez, Dorothy J. Ladewig, Gaurav Satam, P. Pellikka, T. Munger, S. Asirvatham, C. Scott, R. Carter, S. Kapa","doi":"10.1161/CIRCEP.119.007284","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007284","url":null,"abstract":"Supplemental Digital Content is available in the text.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76639118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Spacing and Orientation on the Scar Threshold With a High-Density Grid Catheter.","authors":"M. Takigawa, J. Relan, T. Kitamura, Claire A. Martin, Steven J. Kim, Ruairidh Martin, G. Cheniti, K. Vlachos, G. Massoullié, A. Frontera, N. Thompson, Michael Wolf, F. Bourier, A. Lam, J. Duchâteau, T. Pambrun, A. Denis, N. Derval, X. Pillois, J. Magat, J. Naulin, M. Merle, Florent Collot, B. Quesson, H. Cochet, M. Hocini, M. Haïssaguerre, F. Sacher, P. Jaïs","doi":"10.1161/CIRCEP.119.007158","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007158","url":null,"abstract":"BACKGROUND\u0000Multipolar catheters are increasingly used for high-density mapping. However, the threshold to define scar areas has not been well described for each configuration. We sought to elucidate the impact of bipolar spacing and orientation on the optimal threshold to match magnetic resonance imaging-defined scar.\u0000\u0000\u0000METHOD\u0000The HD-Grid catheter uniquely allows for different spatially stable bipolar configurations to be tested. We analyzed the electrograms with settings of HD-16 (3 mm spacing in both along and across bipoles) and HD-32 (1 mm spacing in along bipoles and 3 mm spacing in across bipoles) and determined the optimal cutoff for scar detection in 6 infarcted sheep.\u0000\u0000\u0000RESULTS\u0000From 456 total acquisition sites (mean 76±12 per case), 14 750 points with the HD-16 and 32286 points with the HD-32 configuration for bipolar electrograms were analyzed. For bipolar voltages, the optimal cutoff value to detect the magnetic resonance imaging-defined scar based on the Youden's Index, and the area under the receiver operating characteristic curve (AUROC) differed depending on the spacing and orientation of bipoles; across 0.84 mV (AUROC, 0.920; 95% CI, 0.911-0.928), along 0.76 mV (AUROC, 0.903; 95% CI, 0.893-0.912), north-east direction 0.95 mV (AUROC, 0.923; 95% CI, 0.913-0.932), and south-east direction, 0.87 mV (AUROC, 0.906; 95% CI, 0.895-0.917) in HD-16; and across 0.83 mV (AUROC, 0.917; 95% CI, 0.911-0.924), along 0.46 mV (AUROC, 0.890; 95% CI, 0.883-0.897), north-east direction 0.89 mV (AUROC, 0.923; 95% CI, 0.917-0.929), and south-east direction 0.83 mV (AUROC, 0.913; 95% CI, 0.906-0.920) in HD-32. Significant differences in AUROC were seen between HD-16 along versus across (P=0.002), HD-16 north-east direction versus south-east direction (P=0.01), HD-32 north-east direction versus south-east direction (P<0.0001), and HD-16 along versus HD-32 along (P=0.006). The AUROC was significantly larger (P<0.01) when only the best points on each given site were selected for analysis, compared with when all points were used.\u0000\u0000\u0000CONCLUSIONS\u0000Spacing and orientation of bipoles impacts the accuracy of scar detection. Optimal threshold specific to each bipolar configuration should be determined. Selecting one best voltage point among multiple points projected on the same surface is also critical on the Ensite-system to increase the accuracy of scar-mapping.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74320065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter Ablation Versus Medical Therapy for Atrial Fibrillation.","authors":"Z. Asad, A. Yousif, M. Khan, S. Al‐Khatib, S. Stavrakis","doi":"10.1161/CIRCEP.119.007414","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007414","url":null,"abstract":"BACKGROUND\u0000Despite the publication of several randomized clinical trials comparing catheter ablation (CA) with medical therapy (MT) in patients with atrial fibrillation (AF), the superiority of one strategy over another is still questioned by many. In this meta-analysis of randomized controlled trials, we compared the efficacy and safety of CA with MT for AF.\u0000\u0000\u0000METHODS\u0000We systematically searched MEDLINE, EMBASE, and other online sources for randomized controlled trials of AF patients that compared CA with MT. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular hospitalizations and recurrence of atrial arrhythmia. Subgroup analyses stratified by the presence of heart failure with reduced ejection fraction, type of AF, age, and sex were performed. Risk ratios (RRs) with 95% CIs were calculated using a random effects model, and Mantel-Haenszel method was used to pool RR.\u0000\u0000\u0000RESULTS\u0000Eighteen randomized controlled trials comprising 4464 patients (CA, n=2286; MT, n=2178) were included. CA resulted in a significant reduction in all-cause mortality (RR, 0.69; 95% CI, 0.54-0.88; P=0.003) that was driven by patients with AF and heart failure with reduced ejection fraction (RR, 0.52; 95% CI, 0.35-0.76; P=0.0009). CA resulted in significantly fewer cardiovascular hospitalizations (hazard ratio, 0.56; 95% CI, 0.39-0.81; P=0.002) and fewer recurrences of atrial arrhythmias (RR, 0.42; 95% CI, 0.33-0.53; P<0.00001). Subgroup analyses suggested that younger patients (age, <65 years) and men derived more benefit from CA compared with MT.\u0000\u0000\u0000CONCLUSIONS\u0000CA is associated with all-cause mortality benefit, that is driven by patients with AF and heart failure with reduced ejection fraction. CA reduces cardiovascular hospitalizations and recurrences of atrial arrhythmia for patients with AF. Younger patients and men appear to derive more benefit from CA.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75754300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation After Sudden Death in the Young.","authors":"B. Gray, M. Ackerman, C. Semsarian, E. Behr","doi":"10.1161/CIRCEP.119.007453","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007453","url":null,"abstract":"Sudden cardiac death is defined as a death occurring usually within an hour of onset of symptoms, arising from an underlying cardiac disease. Sudden cardiac death is a complication of a number of cardiovascular diseases and is often unexpected. In individuals aged <35 years, unexplained sudden cardiac death is the most common presentation. A significant proportion of sudden cardiac death in the young (≤35 years) events may be precipitated by underlying inherited cardiac conditions, including both heritable cardiomyopathies and inherited arrhythmia syndromes (also known as cardiac channelopathies). Tragically, sudden death may be the first manifestation of the disease in a family and, therefore, clinical and genetic evaluation of surviving family members forms a key role in diagnosing the underlying inherited cardiac condition in the family. This is particularly relevant when considering that most inherited cardiac conditions are inherited in an autosomal dominant manner meaning that surviving family members have a 50% chance of inheriting the same disease substrate. This review will outline the underlying causes of sudden cardiac death in the young and outline our universal approach to familial evaluation following a young person's sudden death.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86457896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eccentric Activation Patterns in the Left Ventricular Outflow Tract during Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit.","authors":"Takumi Yamada, Vineet Kumar, Naoki Yoshida, Harish Doppalapudi","doi":"10.1161/CIRCEP.119.007419","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007419","url":null,"abstract":"BACKGROUND\u0000Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS) can be ablated from the great cardiac vein and remote endocardial sites. The ablation sites are determined by mapping in the great cardiac vein and left ventricular outflow tract. This study investigated whether that mapping could accurately predict the sites of LVS-VA origins.\u0000\u0000\u0000METHODS\u0000We studied 26 consecutive patients with idiopathic LVS-VA origins that were identified in the basal and apical LVS in 15 and 11 patients, respectively.\u0000\u0000\u0000RESULTS\u0000Radiofrequency catheter ablation of the apical LVS-VAs was successful in the great cardiac vein in 9 patients and in the apical LV outflow tract in 2. That of the basal LVS-VAs was successful in the aortomitral continuity in 9 patients, at the junction of the left and right coronary cusps in 4, and in the left coronary cusp in 2. Three apical LVS-VAs exhibited an eccentric endocardial activation pattern that was from the basal to apical LV outflow tract. In 11 basal LVS-VAs, the activation pattern was eccentric because the ventricular activation within the great cardiac vein in the apical LVS was earlier than that in the basal LV outflow tract. In 2 basal LVS-VAs, the activation pattern was eccentric because a relatively early ventricular activation was recorded at multiple sites away from the successful ablation site.\u0000\u0000\u0000CONCLUSIONS\u0000Eccentric activation patterns often occurred during idiopathic LVS-VAs, which could mislead the catheter ablation of those VAs. Understanding such eccentric activation patterns was suggested to be able to improve the outcomes of the catheter ablation of those VAs by the anatomic approach.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86192766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Feasibility of an Entirely Extracardiac, Minimally Invasive,Temporary Pacing System","authors":"","doi":"10.1161/hae.0000000000000042","DOIUrl":"https://doi.org/10.1161/hae.0000000000000042","url":null,"abstract":"","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86649399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}