Pub Date : 2024-07-01DOI: 10.1016/j.ipej.2024.06.004
A 70-year-old man with hypertensive heart disease underwent catheter ablation of persistent atrial fibrillation. After completing the pulmonary vein isolation, atrial burst pacing induced an annular atrial tachycardia (AT). Overdrive pacing exhibited constant fusion, indicating a macroreentrant mechanism of the AT. However, the CARTO3 activation map created using the Octaray catheter (both Biosense Webster, Irvine, CA) exhibited a centrifugal spread with the earliest activation site at the 4 o'clock position of the tricuspid annulus. In contrast, the Ripple map revealed a clear reentrant circuit with its isthmus located at the 4–6 o'clock position of the tricuspid annulus. The local electrograms in these areas recorded systolic and diastolic potentials simultaneously, and the misannotation of the large far-field potentials caused this discrepant result. Handling low-amplitude complex fractionated electrograms remains a challenge in creating a precise activation mapping. The Ripple map, especially when combined with the Octaray catheter, was effective in dynamically visualizing all these electrograms and accurately delineating the reentrant circuit.
{"title":"Ripple map delineation of the reentrant circuit in a tricuspid annular atrial tachycardia mimicking focal activity","authors":"","doi":"10.1016/j.ipej.2024.06.004","DOIUrl":"10.1016/j.ipej.2024.06.004","url":null,"abstract":"<div><p>A 70-year-old man with hypertensive heart disease underwent catheter ablation of persistent atrial fibrillation. After completing the pulmonary vein isolation, atrial burst pacing induced an annular atrial tachycardia (AT). Overdrive pacing exhibited constant fusion, indicating a macroreentrant mechanism of the AT. However, the CARTO3 activation map created using the Octaray catheter (both Biosense Webster, Irvine, CA) exhibited a centrifugal spread with the earliest activation site at the 4 o'clock position of the tricuspid annulus. In contrast, the Ripple map revealed a clear reentrant circuit with its isthmus located at the 4–6 o'clock position of the tricuspid annulus. The local electrograms in these areas recorded systolic and diastolic potentials simultaneously, and the misannotation of the large far-field potentials caused this discrepant result. Handling low-amplitude complex fractionated electrograms remains a challenge in creating a precise activation mapping. The Ripple map, especially when combined with the Octaray catheter, was effective in dynamically visualizing all these electrograms and accurately delineating the reentrant circuit.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S097262922400072X/pdfft?md5=4480d86832621eb3e655befa662d1332&pid=1-s2.0-S097262922400072X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433021","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 : 2024-07-01DOI: 10.1016/j.ipej.2024.05.007
Background
Atrial fibrillation (AF) ablation can lead to oesophageal thermal injuries (ETI). These are thought to be the precursor of the much rarer but frequently fatal atrio-oesophageal fistulas. Many centers performing AF ablation routinely use oesophageal temperature monitoring (ETM). This meta-analysis aims to determine the utility of ETM in preventing ETI in the context of radiofrequency catheter ablation of AF.
Methods
A systematic search of PubMed, Embase databases and Cochrane registry was performed comparing ETI between ETM and non-ETM strategies in AF ablation. Data on endoscopically determined ETI, AF recurrence, procedure time and ablation time were extracted. Statistical analyses including subgroup and covariate analyses were performed using random effect model in R platform.
Results
ETI were similar in both ETM (n = 864) and non- ETM groups (n = 639) (RR 1.04, 95 % CI 0.34–3.23) across 12 studies. AF recurrence was statistically similar in both groups (IRR 0.92, 95 % CI 0.73–1.17) but showed a lower trend in non-ETM group. Ablation time was numerically lower in the ETM group and procedure time was numerically higher trend in the ETM group; but they were not statistically significant. Covariate analysis found that posterior wall ablation power setting, additional linear ablation, BMI, use of GA or prophylactic PPI after ablation had no significant correlation in the incidence of ETI.
Conclusion
ETM was not associated with a reduced incidence of ETI during AF ablation. Evidence supporting the routine use of ETM to reduce the risk of ETI or atrio-oesophageal fistulas is lacking.
背景:心房颤动(房颤)消融术可导致食道热损伤(ETI)。这些损伤被认为是更罕见但经常致命的贲门食管瘘的前兆。许多进行房颤消融的中心都会常规使用食道温度监测(ETM)。本荟萃分析旨在确定 ETM 在房颤射频导管消融术中预防 ETI 的效用:对 PubMed、Embase 数据库和 Cochrane 登记处进行了系统性检索,比较了 ETM 和非 ETM 策略在房颤消融中的 ETI。研究人员提取了有关内镜确定的 ETI、房颤复发、手术时间和消融时间的数据。使用 R 平台中的随机效应模型进行了包括亚组和协变量分析在内的统计分析:在 12 项研究中,ETM 组(n=864)和非 ETM 组(n=639)的 ETI 相似(RR 1.04,95% CI 0.34-3.23)。两组的房颤复发率在统计学上相似(IRR 0.92,95% CI 0.73-1.17),但非 ETM 组的复发率呈下降趋势。ETM 组的消融时间在数字上较低,而 ETM 组的手术时间在数字上呈上升趋势,但在统计学上并不显著。协变量分析发现,后壁消融功率设置、额外的线性消融、体重指数、消融后使用 GA 或预防性 PPI 与 ETI 发生率无显著相关性:结论:ETM 与房颤消融过程中 ETI 发生率的降低无关。目前还缺乏支持常规使用 ETM 以降低 ETI 或贲门食管瘘风险的证据。
{"title":"Clinical utility of oesophageal temperature monitoring in AF ablation: An updated meta-analysis and review of literature","authors":"","doi":"10.1016/j.ipej.2024.05.007","DOIUrl":"10.1016/j.ipej.2024.05.007","url":null,"abstract":"<div><h3>Background</h3><p>Atrial fibrillation (AF) ablation can lead to oesophageal thermal injuries (ETI). These are thought to be the precursor of the much rarer but frequently fatal atrio-oesophageal fistulas. Many centers performing AF ablation routinely use oesophageal temperature monitoring (ETM). This meta-analysis aims to determine the utility of ETM in preventing ETI in the context of radiofrequency catheter ablation of AF.</p></div><div><h3>Methods</h3><p>A systematic search of PubMed, Embase databases and Cochrane registry was performed comparing ETI between ETM and non-ETM strategies in AF ablation. Data on endoscopically determined ETI, AF recurrence, procedure time and ablation time were extracted. Statistical analyses including subgroup and covariate analyses were performed using random effect model in R platform.</p></div><div><h3>Results</h3><p>ETI were similar in both ETM (n = 864) and non- ETM groups (n = 639) (RR 1.04, 95 % CI 0.34–3.23) across 12 studies<strong>.</strong> AF recurrence was statistically similar in both groups (IRR 0.92, 95 % CI 0.73–1.17) but showed a lower trend in non-ETM group. Ablation time was numerically lower in the ETM group and procedure time was numerically higher trend in the ETM group; but they were not statistically significant. Covariate analysis found that posterior wall ablation power setting, additional linear ablation, BMI, use of GA or prophylactic PPI after ablation had no significant correlation in the incidence of ETI.</p></div><div><h3>Conclusion</h3><p>ETM was not associated with a reduced incidence of ETI during AF ablation. Evidence supporting the routine use of ETM to reduce the risk of ETI or atrio-oesophageal fistulas is lacking.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S097262922400069X/pdfft?md5=6c0c6a32e787ac36849d0c47c6d9d9b6&pid=1-s2.0-S097262922400069X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089112","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 : 2024-05-01DOI: 10.1016/j.ipej.2024.01.007
Francesco De Sensi, Luigi Addonisio, Alberto Cresti, Ugo Limbruno
{"title":"Anatomical reconstruction of right ventricular structures with intracardiac echocardiography during ablation of premature contractions from moderator band","authors":"Francesco De Sensi, Luigi Addonisio, Alberto Cresti, Ugo Limbruno","doi":"10.1016/j.ipej.2024.01.007","DOIUrl":"10.1016/j.ipej.2024.01.007","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139565069","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 : 2024-05-01DOI: 10.1016/j.ipej.2024.02.001
Sanjeev S. Mukherjee , Debabrata Bera , Ashesh Halder , Saroj Kumar Choudhury
We report a case of symptomatic supraventricular tachycardia who had absent VA conduction during electrophysiology study. The interesting finding was appearance of VA conduction only at a specific cycle length of ventricular pacing which reproducibly induced a sustained orthodromic re-entrant tachycardia (ORT). We review the literature and conclude that supernormal AP conduction can explain such phenomenon.
我们报告了一例有症状的室上性心动过速患者,该患者在电生理学研究中没有 VA 传导。有趣的发现是,只有在特定周期长度的心室起搏时才出现 VA 传导,而这一周期长度可重复诱发持续的正交再发性心动过速(ORT)。我们回顾了相关文献并得出结论:超常 AP 传导可以解释这种现象。
{"title":"“On-Off” phenomenon in a case of concealed left lateral atrio-ventricular accessory pathway - What is the mechanism?","authors":"Sanjeev S. Mukherjee , Debabrata Bera , Ashesh Halder , Saroj Kumar Choudhury","doi":"10.1016/j.ipej.2024.02.001","DOIUrl":"10.1016/j.ipej.2024.02.001","url":null,"abstract":"<div><p>We report a case of symptomatic supraventricular tachycardia who had absent VA conduction during electrophysiology study. The interesting finding was appearance of VA conduction only at a specific cycle length of ventricular pacing which reproducibly induced a sustained orthodromic re-entrant tachycardia (ORT). We review the literature and conclude that supernormal AP conduction can explain such phenomenon.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139693086","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 : 2024-05-01DOI: 10.1016/j.ipej.2024.05.004
{"title":"Dr. C. Thomas Peter: A celebration of life","authors":"","doi":"10.1016/j.ipej.2024.05.004","DOIUrl":"10.1016/j.ipej.2024.05.004","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S097262922400055X/pdfft?md5=14f775166aaa26ab98dceeaedb3d0e3f&pid=1-s2.0-S097262922400055X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141055434","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 : 2024-05-01DOI: 10.1016/j.ipej.2024.03.001
Masato Okada, Koji Tanaka, Nobuaki Tanaka
{"title":"Enhanced identification of ventricular tachycardia isthmus within a scar using Ripple map and Octaray catheter","authors":"Masato Okada, Koji Tanaka, Nobuaki Tanaka","doi":"10.1016/j.ipej.2024.03.001","DOIUrl":"10.1016/j.ipej.2024.03.001","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140068820","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 : 2024-05-01DOI: 10.1016/j.ipej.2024.03.003
Mahmoud Baraka, Diaa Kamal, Ahmad E. Mostafa
Background
Conduction disturbances remain one of the most common complications occurring post TAVI. We aim to determine the predictors of cardiac conduction disturbances after Transcatheter Aortic Valve Implantation (TAVI) and propose a relevant predictive model.
We included 70 consecutive patients with severe symptomatic AS who underwent TAVI using the self-expanding valve Evolut R or the balloon expandable Sapien XT valve. All patients were subjected to electrocardiographic evaluation pre- and post-TAVI and at 30 days. Clinical, echocardiographic, CT-derived, and procedural parameters were collected and analyzed.
Results
Conduction disturbances affected 28 patients (40%): 16 patients (22.9 %) developed Left Bundle Branch Block (LBBB), 7 patients (10%) experienced transient Complete Heart Block (CHB), and 5 patients (7.1%) experienced permanent CHB requiring Permanent Pacemaker Implantation (PPI). We classified predictors into preprocedural and procedural predictors. Multivariate logistic regression analysis of pre-procedural predictors showed that the presence of basal septal calcification is the most powerful independent predictor (OR: 28.63, 95% CI: 4.59–178.68, p < 0.001). Multivariate logistic regression analysis for pre and post procedural predictors showed that the relationship between depth of implantation at the septum and membranous septum expressed in percentage (sDIMS) with cut-off >70.42% is the most powerful independent procedural predictor (OR: 1.11, 95% CI: 1.03–1.2, p 0.006).
Conclusion
Conduction disturbances remain a common complication of TAVI. Presence of basal septal calcification is a non-modifiable risk factor that increase patient propensity of development such complication after TAVI. A depth of implantation exceeding 70% of the membranous septal length has been found to strongly predict conduction disturbances post TAVI. sDIMS can be used in planning the depth of implantation to reduce incidence of conduction disturbances post TAVI.
{"title":"Depth of implantation in relation to membranous septum as a predictor of conduction disturbances after transcatheter aortic valve implantation","authors":"Mahmoud Baraka, Diaa Kamal, Ahmad E. Mostafa","doi":"10.1016/j.ipej.2024.03.003","DOIUrl":"10.1016/j.ipej.2024.03.003","url":null,"abstract":"<div><h3>Background</h3><p>Conduction disturbances remain one of the most common complications occurring post TAVI. We aim to determine the predictors of cardiac conduction disturbances after Transcatheter Aortic Valve Implantation (TAVI) and propose a relevant predictive model.</p><p>We included 70 consecutive patients with severe symptomatic AS who underwent TAVI using the self-expanding valve Evolut R or the balloon expandable Sapien XT valve. All patients were subjected to electrocardiographic evaluation pre- and post-TAVI and at 30 days. Clinical, echocardiographic, CT-derived, and procedural parameters were collected and analyzed.</p></div><div><h3>Results</h3><p>Conduction disturbances affected 28 patients (40%): 16 patients (22.9 %) developed Left Bundle Branch Block (LBBB), 7 patients (10%) experienced transient Complete Heart Block (CHB), and 5 patients (7.1%) experienced permanent CHB requiring Permanent Pacemaker Implantation (PPI). We classified predictors into preprocedural and procedural predictors. Multivariate logistic regression analysis of pre-procedural predictors showed that the presence of basal septal calcification is the most powerful independent predictor (OR: 28.63, 95% CI: 4.59–178.68, p < 0.001). Multivariate logistic regression analysis for pre and post procedural predictors showed that the relationship between depth of implantation at the septum and membranous septum expressed in percentage (sDIMS) with cut-off >70.42% is the most powerful independent procedural predictor (OR: 1.11, 95% CI: 1.03–1.2, p 0.006).</p></div><div><h3>Conclusion</h3><p>Conduction disturbances remain a common complication of TAVI. Presence of basal septal calcification is a non-modifiable risk factor that increase patient propensity of development such complication after TAVI. A depth of implantation exceeding 70% of the membranous septal length has been found to strongly predict conduction disturbances post TAVI. sDIMS can be used in planning the depth of implantation to reduce incidence of conduction disturbances post TAVI.</p></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319405","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 : 2024-05-01DOI: 10.1016/j.ipej.2024.04.005
Tuppence Richman , Matthew Tung
{"title":"Erratum to “Pseudo loss of capture on 12 lead electrocardiogram in patient with an implantable cardiac defibrillator” [Indian Pacing Electrophysiol. J. 23, Issue 3 (May–June 2023), Pages 88–90]","authors":"Tuppence Richman , Matthew Tung","doi":"10.1016/j.ipej.2024.04.005","DOIUrl":"10.1016/j.ipej.2024.04.005","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000457/pdfft?md5=d308b6f10c926ac941194037fbf4a108&pid=1-s2.0-S0972629224000457-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140771514","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":"Erratum to “A case of successful radiofrequency catheter ablation for atrial tachycardia originating from the inferior vena cava using high-resolution mapping” [Indian Pacing Electrophysiol. J. 22, Issue 5 (September–October 2022), 245–250]","authors":"Yusaku Fukumoto , Yuji Kamikawa , Tatsuya Koike , Masahiro Esato","doi":"10.1016/j.ipej.2024.04.006","DOIUrl":"10.1016/j.ipej.2024.04.006","url":null,"abstract":"","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0972629224000469/pdfft?md5=0b7b79489f7cdc59b21b42a1e72a0397&pid=1-s2.0-S0972629224000469-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140782652","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}