VE arising from the ISP-LV represents a distinct subset of idiopathic arrhythmia and can be successfully treated by endocardial catheter ablation from the inferoseptal recess. They share common surface ECG and electrophysiological findings with special anatomical features that need recognition for successful catheter ablation.
CRT induces LA anatomic, electrical, and structural reverse remodeling that could be assessed by conventional 2D echocardiography and 2D (ɛ) strain imaging. LA dimension and volumes were independent predictors of response to CRT and can help in selection of candidates for it.
Background
Differentiation between atrioventricular nodal re‐entrant tachycardia (AVNRT), atrioventricular re‐entrant tachycardia (AVRT), and atrial tachycardia (AT) is often challenging during electrophysiology studies. This study compared the sensitivity and specificity of identifying anterograde His bundle activation during entrainment with commonly used right ventricular (RV) pacing maneuvers to differentiate between these types of supraventricular tachycardia (SVT).
Methods
Out of 112 consecutive patients with SVT, 90 (36 males [40%], age 37 ± 16 years) were prospectively studied. After entrainment during RV pacing, atrial response upon cessation of pacing, anterograde His activation during entrainment, stimulus‐atrial (SA), ventriculoatrial (VA) intervals, and post‐pacing interval minus tachycardia cycle length (PPI‐TCL) were determined. Ventricular extrastimulation during tachycardia and para‐Hisian pacing were performed.
Results
The final diagnosis was AVNRT in 54, AVRT in 33, and AT in 3 patients. Entrainment was achieved in 87(96%) patients. Anterograde His bundle activation predicted AVRT (sensitivity: 62.5%, specificity: 100%). PPI‐TCL ≥129 ms predicted AVNRT (sensitivity: 83%, specificity: 84%), as did SA‐VA value ≥85 ms (sensitivity: 91%, specificity: 87%). Atria were advanced during transition zone in 57% of AVRTs. Atrial pre‐excitation in response to progressively premature ventricular extrastimuli identified AVRT (sensitivity: 90%, specificity: 85%). Pre‐excitation index ≥87 ms identified AVNRT (sensitivity: 80%, specificity: 100%). Para‐Hisian pacing identified AVRT (sensitivity: 25%, specificity: 100%).
Conclusion
RV pacing maneuvers, applied in isolation, can misclassify a significant proportion of SVTs. Identifying anterograde His bundle activation during entrainment can complement other discriminators in differential diagnosis of SVT, with greatest sensitivity in septal and right‐sided accessory pathways.
During ablation of re-entrant ventricular tachycardia (VT) 3-dimensional mapping systems are now used to properly delineate the scar tissue and aid ablation of scar-related VT. The aim of our study was to outline how the mode of ablation predicts success and recurrence in large scar-related VT. When comparing patients with recurrence and patients with no recurrence, univariate analysis showed that number of ablation lesions (28 ± 8 vs. 12 ± 8, P = 0.01) and more linear ablation lesions rather than focal lesions (P = 0.03) were associated with long-term success. We demonstrated that more extensive ablation lesions and creation of linear lesions is associated with better success rate and lower recurrence rate during ablation of large scar-related ventricular tachycardia.
This study aims to determine the incidence of atrial fibrosis in patients with non-valvular AF and its impact on recurrence after pulmonary vein antrum isolation.
Patients and methods:This study enrolled 30 patients referred to the cardiology department at Ain Shams University hospitals for first-time pulmonary vein antrum isolation for the treatment of symptomatic paroxysmal nonvalvular AF. Of these patients catheter ablation was postponed in 2 patients because of the development of cardiac tamponade during transseptal puncture, thus the 28 patients were included in the study.All patients included were free of hypertension, diabetes mellitus, coronary artery disease, and cardiomyopathy thus they were defined as having lone AF. Inclusion criteria included patients with symptomatic paroxysmal atrial fibrillation who were younger than sixty years and AF was documented by 12 lead ECG or Holter monitoring.Exclusion criteria included patients with history of previous pulmonary vein isolation, patients with history of previous cardiac ablation procedures, patients with history of previous cardiac surgery, patients with persistent or permanent AF and patients with valvular heart disease.After giving informed written consent and approval of the ethical committee, the selected patients were subjected to the
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