{"title":"The \"bow and backbend\" technique with a balloon lever for challenging right inferior pulmonary vein isolation in cryoballoon ablation.","authors":"Yuhei Kasai, Kizuku Iitsuka, Junji Morita, Takayuki Kitai","doi":"10.1016/j.ipej.2024.09.010","DOIUrl":"10.1016/j.ipej.2024.09.010","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":"370-372"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355628","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}
Pub Date : 2024-10-18DOI: 10.1016/j.ipej.2024.10.004
Daniel Cortez
Introduction: Pediatric patients with congenital heart disease repair may develop sinus node dysfunction. Leadless pacemakers have provided an alternative option to transvenous and epicardial device implants for pediatric patients in need of ventricular pacing. We describe the first adolescent patient to receive a leadless pacemaker in the atrium due to symptomatic sinus pauses.
Methods: The study was approved by the internal review board of the University of California at Davis. Femoral vein implant was performed of an Aveir VR due to the higher impedance and larger battery capacity.
Results: The 16-year-old male with dextro-transposition of the great arteries and ventricular septal defect repair had an uncomplicated atrial appendage implant of an Atrial Aveir VR, under transesophageal echocardiographic guidance. Three-month follow-up demonstrated stable threshold of 0.5 V @ 0.2 milliseconds, impedance of 720 Ω and sensing of 9.1 mV, with 10 % pacing and predicted battery longevity of 22.8 years.
Conclusion: Atrial implant of a leadless pacemaker is possible in the older pediatric population without complications, including of the Aveir VR.
{"title":"Atrial leadless pacemaker implant using Aveir VR in an adolescent with congenital heart disease.","authors":"Daniel Cortez","doi":"10.1016/j.ipej.2024.10.004","DOIUrl":"10.1016/j.ipej.2024.10.004","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric patients with congenital heart disease repair may develop sinus node dysfunction. Leadless pacemakers have provided an alternative option to transvenous and epicardial device implants for pediatric patients in need of ventricular pacing. We describe the first adolescent patient to receive a leadless pacemaker in the atrium due to symptomatic sinus pauses.</p><p><strong>Methods: </strong>The study was approved by the internal review board of the University of California at Davis. Femoral vein implant was performed of an Aveir VR due to the higher impedance and larger battery capacity.</p><p><strong>Results: </strong>The 16-year-old male with dextro-transposition of the great arteries and ventricular septal defect repair had an uncomplicated atrial appendage implant of an Atrial Aveir VR, under transesophageal echocardiographic guidance. Three-month follow-up demonstrated stable threshold of 0.5 V @ 0.2 milliseconds, impedance of 720 Ω and sensing of 9.1 mV, with 10 % pacing and predicted battery longevity of 22.8 years.</p><p><strong>Conclusion: </strong>Atrial implant of a leadless pacemaker is possible in the older pediatric population without complications, including of the Aveir VR.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476565","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}
Radiofrequency (RF) catheter ablation is the primary treatment for cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), with cryothermal energy as an alternative. While cryoablation offers comparable effectiveness and safety to RF ablation, it poses a risk of coronary artery spasm leading to ST-elevation. This case report presents a 65-year-old man with drug-refractory atrial fibrillation (AF) and AFL undergoing cryothermal CTI ablation guided by intracardiac echocardiography (ICE). During the procedure, two distinct ST-elevation episodes were observed. The first episode coincided with the pull-down of the cryoablation catheter, potentially resulting in coronary compression, as indicated by ICE, and was rapidly resolved by discontinuing the freezing process. The second episode, occurring without active freezing, was attributed to coronary artery spasm and resolved with intracoronary nitroglycerin administration. During the second episode, emergent right coronary angiography confirmed total occlusion in the segment 4 AV adjacent to the region where cryoablation was performed, which fully resolved post-nitroglycerin. This report underscores the dual mechanisms of ST-elevation-coronary artery compression and spasm-during cryothermal CTI ablation, highlighting the critical role of ICE in enhancing procedural safety.
射频（RF）导管消融术是治疗腔隙性窦房结（CTI）依赖性心房扑动（AFL）的主要方法，低温消融术可作为替代方法。虽然低温消融的有效性和安全性与射频消融相当，但它存在冠状动脉痉挛导致 ST 段抬高的风险。本病例报告介绍了一名 65 岁的男性患者，他患有药物难治性房颤（AF）和 AFL，在心内超声心动图（ICE）的引导下接受了低温 CTI 消融术。在手术过程中，观察到两次明显的 ST 段抬高发作。第一次发作与低温消融导管下拉同时发生，可能导致冠状动脉受压，如 ICE 所示，停止冷冻过程后迅速缓解。第二次发作是在没有主动冷冻的情况下发生的，原因是冠状动脉痉挛，在冠状动脉内注射硝酸甘油后缓解。在第二次发作期间，紧急进行的右冠状动脉造影证实，在进行冷冻消融术的区域附近的第 4 AV 段出现了完全闭塞，使用硝酸甘油后完全消退。该报告强调了 ST 抬高的双重机制--低温 CTI 消融过程中的冠状动脉压迫和痉挛，突出了 ICE 在提高手术安全性方面的关键作用。
{"title":"Two distinct stages and mechanisms of ST-elevation during cryothermal cavotricuspid isthmus ablation guided by intracardiac echocardiography: A case report.","authors":"Yuhei Kasai, Kizuku Iitsuka, Junji Morita, Takayuki Kitai","doi":"10.1016/j.ipej.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.ipej.2024.10.002","url":null,"abstract":"<p><p>Radiofrequency (RF) catheter ablation is the primary treatment for cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), with cryothermal energy as an alternative. While cryoablation offers comparable effectiveness and safety to RF ablation, it poses a risk of coronary artery spasm leading to ST-elevation. This case report presents a 65-year-old man with drug-refractory atrial fibrillation (AF) and AFL undergoing cryothermal CTI ablation guided by intracardiac echocardiography (ICE). During the procedure, two distinct ST-elevation episodes were observed. The first episode coincided with the pull-down of the cryoablation catheter, potentially resulting in coronary compression, as indicated by ICE, and was rapidly resolved by discontinuing the freezing process. The second episode, occurring without active freezing, was attributed to coronary artery spasm and resolved with intracoronary nitroglycerin administration. During the second episode, emergent right coronary angiography confirmed total occlusion in the segment 4 AV adjacent to the region where cryoablation was performed, which fully resolved post-nitroglycerin. This report underscores the dual mechanisms of ST-elevation-coronary artery compression and spasm-during cryothermal CTI ablation, highlighting the critical role of ICE in enhancing procedural safety.</p>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381819","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}
Pub Date : 2024-09-01DOI: 10.1016/j.ipej.2024.07.006
Álvaro Estévez Paniagua , Sem Briongos-Figuero , Ana Sánchez Hernández, Roberto Muñoz-Aguilera
Background
Variation in human left bundle branch (LBB) anatomy has a significant effect on the sequence of left ventricular depolarization. However, little is known regarding the electrophysiological characteristics of pacing different LBB fascicles.
Objective
We aimed to analyse the different electrocardiographic characteristics of LBB pacing (LBBP) attending to the site of pacing at the LBB system.
Methods
In 200 consecutive patients with confirmed LBBP, we distinguished left bundle trunk capture (LBTP) from any LB fascicular pacing (LBFP) based on the presence of LB potentials and paced QRS morphologies. We compared them regarding procedure, LBBP criteria and electrical synchrony parameters.
Results
One hundred and seventy-three patients with LBFP were compared to 25 patients with LBTP. Left septal and posterior fascicles were significantly more prevalent than left anterior in LBFP (46.8 %, 41.0 % and 12.2 % respectively). QRS transition criteria (80.0 % vs 61.8 %; p = 0.077), selective LBBP (40.0 vs 21.5 %; p = 0.101), paced QRS width (110.3 ± 16.8 ms vs 115.4 ± 14.9 ms; p = 0.117), V6-RWPT (79.2 ± 10.7 ms vs 75.3 ± 9.7 ms; p = 0.068) and interpeak interval (42.5 ± 19.1 ms vs 45.7 ± 12.9 ms; p = 0.282) were not significantly different between LBTP and LBFP. All short-term complications occurred in LBFP, mainly driven by septal perforations (n = 23), without any difference in the pacing parameters. Among the LBFP subgroups, only aVL-RWPT was longer when the posterior fascicle was paced.
Conclusions
LBFP is much more prevalent than LBTP in unselected consecutive patients with LBBP. LBFP seems more feasible, and as good as LBTP in terms of electrical synchrony and pacing safety.
背景：人体左束支（LBB）解剖结构的变化对左心室除极顺序有显著影响。然而，人们对不同 LBB 束支起搏的电生理特征知之甚少：我们的目的是分析 LBB 起搏（LBBP）的不同心电图特征与 LBB 系统起搏部位的关系：在 200 名确诊 LBBP 的连续患者中，我们根据 LB 电位和起搏 QRS 形态的存在，区分了左束干捕获（LBTP）和任何 LB 筋膜起搏（LBFP）。我们比较了它们的手术方法、LBBP 标准和电同步参数：结果：173 名 LBFP 患者与 25 名 LBTP 患者进行了比较。在 LBFP 患者中，左室间隔和后束明显多于左前束（分别为 46.8%、41.0% 和 12.2%）。QRS转换标准（80.0% vs 61.8%；p=0.077）、选择性LBBP（40.0 vs 21.5%；p=0.101）、起搏QRS宽度（110.3±16.8 ms vs 115.4±14.9 ms；p=0.117）、V6-RWPT（79.2±10.7 ms vs 75.3±9.7 ms; p=0.068）和峰间期（42.5±19.1 ms vs 45.7±12.9 ms; p=0.282）在 LBTP 和 LBFP 之间无显著差异。所有短期并发症都发生在 LBFP，主要是室间隔穿孔（23 例），起搏参数没有任何差异。在LBFP亚组中，只有后束起搏时aVL-RWPT较长：结论：在未经选择的连续 LBBP 患者中，LBFP 比 LBTP 更为普遍。LBFP 似乎更可行，在电同步性和起搏安全性方面与 LBTP 不相上下。
{"title":"Left bundle fascicular versus left bundle trunk pacing: A comparison of their electrical synchrony parameters","authors":"Álvaro Estévez Paniagua , Sem Briongos-Figuero , Ana Sánchez Hernández, Roberto Muñoz-Aguilera","doi":"10.1016/j.ipej.2024.07.006","DOIUrl":"10.1016/j.ipej.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Variation in human left bundle branch (LBB) anatomy has a significant effect on the sequence of left ventricular depolarization. However, little is known regarding the electrophysiological characteristics of pacing different LBB fascicles.</div></div><div><h3>Objective</h3><div>We aimed to analyse the different electrocardiographic characteristics of LBB pacing (LBBP) attending to the site of pacing at the LBB system.</div></div><div><h3>Methods</h3><div>In 200 consecutive patients with confirmed LBBP, we distinguished left bundle trunk capture (LBTP) from any LB fascicular pacing (LBFP) based on the presence of LB potentials and paced QRS morphologies. We compared them regarding procedure, LBBP criteria and electrical synchrony parameters.</div></div><div><h3>Results</h3><div>One hundred and seventy-three patients with LBFP were compared to 25 patients with LBTP. Left septal and posterior fascicles were significantly more prevalent than left anterior in LBFP (46.8 %, 41.0 % and 12.2 % respectively). QRS transition criteria (80.0 % vs 61.8 %; p = 0.077), selective LBBP (40.0 vs 21.5 %; p = 0.101), paced QRS width (110.3 ± 16.8 ms vs 115.4 ± 14.9 ms; p = 0.117), V6-RWPT (79.2 ± 10.7 ms vs 75.3 ± 9.7 ms; p = 0.068) and interpeak interval (42.5 ± 19.1 ms vs 45.7 ± 12.9 ms; p = 0.282) were not significantly different between LBTP and LBFP. All short-term complications occurred in LBFP, mainly driven by septal perforations (n = 23), without any difference in the pacing parameters. Among the LBFP subgroups, only aVL-RWPT was longer when the posterior fascicle was paced.</div></div><div><h3>Conclusions</h3><div>LBFP is much more prevalent than LBTP in unselected consecutive patients with LBBP. LBFP seems more feasible, and as good as LBTP in terms of electrical synchrony and pacing safety.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 5","pages":"Pages 239-246"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861141","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}
Pub Date : 2024-09-01DOI: 10.1016/j.ipej.2024.09.007
Scott Eaves MBChB, Joshua Hawson MBBS PhD
{"title":"Use of 3D electroanatomic mapping systems allows us to see the past and predict the future of SVT ablation","authors":"Scott Eaves MBChB, Joshua Hawson MBBS PhD","doi":"10.1016/j.ipej.2024.09.007","DOIUrl":"10.1016/j.ipej.2024.09.007","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 5","pages":"Pages 255-256"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297259","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}
Pub Date : 2024-09-01DOI: 10.1016/j.ipej.2024.06.007
Background
Electrocardiographic diagnosis of causes of supraventricular tachycardia (SVT) is sometimes difficult and application of routine algorithms can lead to misdiagnosis in as many as 37 % of patients. ST segment depression may be useful in diagnosing the nature of SVT.
Methods
We reviewed surface electrocardiogram (ECG) characteristics of 300 patients having SVT with 1:1 AV relationship and correlated findings with electrophysiology study (EPS) findings. Final diagnosis of AVNRT (Atrioventricular nodal reentrant tachycardia), Orthodromic AVRT (atrioventricular reentrant tachycardia) and atrial tachycardia (AT) was correlated with ECG parameters like heart rate, ST segment depressions and QRS morphology.
Results
Out of 300 patients, majority patients included in study, were having AVNRT or AVRT. ST depression predicted AVRT if the ST depression was ≥ 2 mm (overall sensitivity of 38.3 % and specificity of 93.8 % to predict AVRT) and was downsloping in morphology (sensitivity of 36.9 % and specificity of 94.7 % to predict AVRT). At heart rates ≥214 beats per minute (bpm) as measured by 7 small squares of ECG at 25 mm/s, downsloping ST depression ≥2 mm had a sensitivity 37.9 % of and specificity of 89.2 % to predict AVRT. At heart rate <214 bpm, downsloping ST depression ≥2 mm had sensitivity of 37.2 % and specificity of 96.5 % to predict AVRT. Downsloping ST depression of ≥2 mm helps to differentiate AVNRT from AVRT.
Conclusion
A downsloping ST segment depression ≥2 mm predicted SVT being an AVRT and can be used as a useful criteria in diagnosing the tachycardia.
{"title":"Analysis of ST segment depression in supraventricular tachycardia and its relationship with underlying mechanism","authors":"","doi":"10.1016/j.ipej.2024.06.007","DOIUrl":"10.1016/j.ipej.2024.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Electrocardiographic diagnosis of causes of supraventricular tachycardia (SVT) is sometimes difficult and application of routine algorithms can lead to misdiagnosis in as many as 37 % of patients. ST segment depression may be useful in diagnosing the nature of SVT.</div></div><div><h3>Methods</h3><div>We reviewed surface electrocardiogram (ECG) characteristics of 300 patients having SVT with 1:1 AV relationship and correlated findings with electrophysiology study (EPS) findings. Final diagnosis of AVNRT (Atrioventricular nodal reentrant tachycardia), Orthodromic AVRT (atrioventricular reentrant tachycardia) and atrial tachycardia (AT) was correlated with ECG parameters like heart rate, ST segment depressions and QRS morphology.</div></div><div><h3>Results</h3><div>Out of 300 patients, majority patients included in study, were having AVNRT or AVRT. ST depression predicted AVRT if the ST depression was ≥ 2 mm (overall sensitivity of 38.3 % and specificity of 93.8 % to predict AVRT) and was downsloping in morphology (sensitivity of 36.9 % and specificity of 94.7 % to predict AVRT). At heart rates ≥214 beats per minute (bpm) as measured by 7 small squares of ECG at 25 mm/s, downsloping ST depression ≥2 mm had a sensitivity 37.9 % of and specificity of 89.2 % to predict AVRT. At heart rate <214 bpm, downsloping ST depression ≥2 mm had sensitivity of 37.2 % and specificity of 96.5 % to predict AVRT. Downsloping ST depression of ≥2 mm helps to differentiate AVNRT from AVRT.</div></div><div><h3>Conclusion</h3><div>A downsloping ST segment depression ≥2 mm predicted SVT being an AVRT and can be used as a useful criteria in diagnosing the tachycardia.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 5","pages":"Pages 257-262"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141499224","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}
Pub Date : 2024-09-01DOI: 10.1016/j.ipej.2024.07.001
Background and aims
The rate of cardiac implantable electronic device (CIED) implantations and the need for transvenous lead extraction (TLE) are growing worldwide. This study examined a large Swedish cohort with the aim of identifying possible predictors of post-TLE mortality with special focus on systemic infection patients and frailty.
Methods
This was a single centre study. Records of patients undergoing TLE between 2010 and 2018 were analysed. Statistical analyses were conducted to compare baseline characteristics of patients with different indications and identify risk factors of 30-day and 1-year mortality.
Results
A total of 893 patients were identified. Local infection was the dominant indication and pacemaker was the most common CIED. The mean age was 65 ± 16 years, 73 % were male and median follow-up was 3.9 years. Heart failure was the most common comorbidity. Patients with systemic infection were significantly older, frailer and had significantly higher levels of comorbidities. 30-day mortality and 1-year mortality rates were 2.5 % and 9.9 %, respectively. Systemic infection and chronic kidney disease (CKD) were independently associated with 30-day and 1-year mortality. Clinical frailty scale (CFS) 5–7 correlated independently with 1-year mortality in the entire cohort and specifically in systemic infection patients. CKD, cardiac resynchronization therapy and CFS 5–7 were significant risk factors for long-term mortality (death >1 year after TLE) in multivariable analysis.
Conclusions
Systemic infection, kidney failure in addition to the novel parameter of frailty were associated with post-TLE all-cause mortality. These risk factors should be considered during pre-procedure risk stratification to improve post-TLE outcomes.
{"title":"Long- and short-term outcomes after transvenous lead extraction in a large single-centre patient cohort using the clinical frailty scale as a risk assessment tool","authors":"","doi":"10.1016/j.ipej.2024.07.001","DOIUrl":"10.1016/j.ipej.2024.07.001","url":null,"abstract":"<div><h3>Background and aims</h3><div>The rate of cardiac implantable electronic device (CIED) implantations and the need for transvenous lead extraction (TLE) are growing worldwide. This study examined a large Swedish cohort with the aim of identifying possible predictors of post-TLE mortality with special focus on systemic infection patients and frailty.</div></div><div><h3>Methods</h3><div>This was a single centre study. Records of patients undergoing TLE between 2010 and 2018 were analysed. Statistical analyses were conducted to compare baseline characteristics of patients with different indications and identify risk factors of 30-day and 1-year mortality.</div></div><div><h3>Results</h3><div>A total of 893 patients were identified. Local infection was the dominant indication and pacemaker was the most common CIED. The mean age was 65 ± 16 years, 73 % were male and median follow-up was 3.9 years. Heart failure was the most common comorbidity. Patients with systemic infection were significantly older, frailer and had significantly higher levels of comorbidities. 30-day mortality and 1-year mortality rates were 2.5 % and 9.9 %, respectively. Systemic infection and chronic kidney disease (CKD) were independently associated with 30-day and 1-year mortality. Clinical frailty scale (CFS) 5–7 correlated independently with 1-year mortality in the entire cohort and specifically in systemic infection patients. CKD, cardiac resynchronization therapy and CFS 5–7 were significant risk factors for long-term mortality (death >1 year after TLE) in multivariable analysis.</div></div><div><h3>Conclusions</h3><div>Systemic infection, kidney failure in addition to the novel parameter of frailty were associated with post-TLE all-cause mortality. These risk factors should be considered during pre-procedure risk stratification to improve post-TLE outcomes.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 5","pages":"Pages 263-270"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591609","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}
Pub Date : 2024-09-01DOI: 10.1016/j.ipej.2024.06.009
Speech induced atrial tachycardia is peculiar and an extremely uncommon clinical situation. Though the exact patho-mechanism for such an association cannot be ascertained. It is postulated to be caused by cardiac autonomic modulation by vagal innervation around the ganglionated plexus (GP) of the heart. We hereby present a unique case of atrial tachycardia which could be induced only by speech and was successfully mapped and ablated on to the floor of left atrium (LA), which is a possible site of posteromedial left atrial ganglionated plexus.
{"title":"Speech induced atrial tachycardia – Case report and review of literature","authors":"","doi":"10.1016/j.ipej.2024.06.009","DOIUrl":"10.1016/j.ipej.2024.06.009","url":null,"abstract":"<div><div>Speech induced atrial tachycardia is peculiar and an extremely uncommon clinical situation. Though the exact patho-mechanism for such an association cannot be ascertained. It is postulated to be caused by cardiac autonomic modulation by vagal innervation around the ganglionated plexus (GP) of the heart. We hereby present a unique case of atrial tachycardia which could be induced only by speech and was successfully mapped and ablated on to the floor of left atrium (LA), which is a possible site of posteromedial left atrial ganglionated plexus.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 5","pages":"Pages 295-297"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471280","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}
Pub Date : 2024-09-01DOI: 10.1016/j.ipej.2024.06.008
This paper presents a novel approach to gap mapping in pulmonary vein isolation (PVI) for atrial fibrillation (AF) treatment, utilizing the real-time Ripple (RR) technique. Radiofrequency (RF) catheter ablation, particularly encircling PVI, is a common intervention for AF. Identifying left atrium–pulmonary vein conduction gaps is crucial for achieving PVI with minimal additional ablation if first-pass PVI is unsuccessful. However, identifying conduction gaps can be relatively challenging, often necessitating manual electrocardiogram reannotation due to the limitations of local activation time (LAT) maps. In the case of a 63-year-old patient with drug-resistant symptomatic persistent AF, the RR technique was utilized to identify conduction gaps during RF ablation. The technique involved pausing fast anatomical mapping (FAM), activating Ripple map (RM) feature on the CARTO 3 system and acquiring points with an ultrahigh-resolution mapping catheter. This approach revealed that the actual site of earliest activation differs from the LAT map indication, enabling successful PVI.
The RM feature's capability to reflect actual excitation propagation without reliance on map annotations was crucial for precise conduction gap identification, overcoming inter-operator variability and inaccuracies of conventional methods. The RR technique not only facilitated real-time analysis during gap mapping but also significantly reduced the procedure time, minimizing potential complications.
This case report highlights the efficacy of the RR technique in real-time gap mapping, demonstrating its value in cases where first-pass PVI is unsuccessful. The integration of this technique into PVI procedures can enhance both the accuracy and efficiency of catheter ablation for AF.
{"title":"Real-time Ripple technique: A case report on Ripple map for real-time identification of conduction gaps without first-pass pulmonary vein isolation","authors":"","doi":"10.1016/j.ipej.2024.06.008","DOIUrl":"10.1016/j.ipej.2024.06.008","url":null,"abstract":"<div><div>This paper presents a novel approach to gap mapping in pulmonary vein isolation (PVI) for atrial fibrillation (AF) treatment, utilizing the real-time Ripple (RR) technique. Radiofrequency (RF) catheter ablation, particularly encircling PVI, is a common intervention for AF. Identifying left atrium–pulmonary vein conduction gaps is crucial for achieving PVI with minimal additional ablation if first-pass PVI is unsuccessful. However, identifying conduction gaps can be relatively challenging, often necessitating manual electrocardiogram reannotation due to the limitations of local activation time (LAT) maps. In the case of a 63-year-old patient with drug-resistant symptomatic persistent AF, the RR technique was utilized to identify conduction gaps during RF ablation. The technique involved pausing fast anatomical mapping (FAM), activating Ripple map (RM) feature on the CARTO 3 system and acquiring points with an ultrahigh-resolution mapping catheter. This approach revealed that the actual site of earliest activation differs from the LAT map indication, enabling successful PVI.</div><div>The RM feature's capability to reflect actual excitation propagation without reliance on map annotations was crucial for precise conduction gap identification, overcoming inter-operator variability and inaccuracies of conventional methods. The RR technique not only facilitated real-time analysis during gap mapping but also significantly reduced the procedure time, minimizing potential complications.</div><div>This case report highlights the efficacy of the RR technique in real-time gap mapping, demonstrating its value in cases where first-pass PVI is unsuccessful. The integration of this technique into PVI procedures can enhance both the accuracy and efficiency of catheter ablation for AF.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"24 5","pages":"Pages 291-294"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471279","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}
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