Atrial double potentials associated with a left‐sided accessory pathway having a single ventricular and two remote atrial insertions

Hluchý, Ján; Lautermann, Dirk; Sabin, Georg

doi:10.1002/clc.4960200323

Cited by 11 publications

(5 citation statements)

References 17 publications

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“…Several studies have addressed the LA-CS relationship in terms of both anatomy 39) and electrophysiologic behavior. [40][41][42][43] These studies and the current one emphasize the fact that during AF, both structures behave as uncoupled, at least in some parts; thus, the CS does not reflect LA activity in terms of cycle lengths and/or activation patterns.…”

Section: La-cs Relationship In Patients With Afmentioning

confidence: 52%

Atrial Fibrillation and Atrial Fibrillation Intervals-Frequency Analysis and Interpretation-

Shimizu¹

2005

J Arrhythmia

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Introduction: Atrial fibrillation (AF) is the most frequently occurring atrial arrhythmia. Fibrillation intervals are used to characterize AF and have a potential to determine the strategy for AF therapy regardless of its etiology. However, measuring local fibrillation intervals requires an extensive period of time when using visual methods, and such methods are also subject to data bias. Recently several methods for measuring the atrial fibrillation cycle length (AFCL) using computers have been developed. Atrial activation during AF was considered to be random or chaotic. From recent studies, however, it was found that AF has various degrees of organization, and therefore activation during AF can be analyzed by spectral analysis. Several kinds of spectral analysis have become available for characterization of AF, and fast Fourier transform analysis is most frequently used. Autocorrelation function also can be used for analysis of AF intervals and could give us further information, such as minimum AFCL. Further, the frequency analysis of AF may be useful to predict the effect of antiarrhythmic drugs, cardioversion and catheter ablation for AF. This review was designed to investigate the analysis of AF intervals and to assess methods, interpretation and clinical implications. (J Arrhythmia 2005; 21: 495-509) Left side panel: 5-second data from the beginning of recording, Right side panel: 20-25 second from the beginning of recording. Atrial electrograms (left side) was more organized than atrial electrograms (right side). A) atrial electrogram filtered with band pass 30-500 Hz, B) rectified signals, C) and resulting low-pass filtered signals (cut off 20 Hz). Rectified signals were smoothed. D) a 4096-point FFT (spectral resolution, 0.24 Hz) analysis using 5-second data after signal processing (through A to B). Domain frequency (DF) in FFT was 5.1 Hz in 0-5 second segment (right panel) and 6.6 Hz in 20-25 second segment (left panel). DF in more disorganized signals was higher than that in organized signals.

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Section: La-cs Relationship In Patients With Afmentioning

confidence: 52%

Atrial Fibrillation and Atrial Fibrillation Intervals-Frequency Analysis and Interpretation-

Shimizu¹

2005

J Arrhythmia

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“…Theoretically, complete blockade of most Aps could be achieved by single-point. However, the insertion is not always accurately located due to unique anatomical factors, such as a wide Ap or a dendritic 16 insertion far from the valve annulus, resulting in incomplete bypass damage and recurrence. Mccleland et al 17 reported a group of bypass ducts in which 18% required ablation within the range of 3 cm along the CS to achieve a completely bidirectional block.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of the application of extensive ablation in patients with atrioventricular re-entrant tachycardia (a retrospective study)

Chen

Lin

2021

Sci Rep

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Radiofrequency catheter ablation (RFCA) has become the standard effective therapy for supraventricular tachycardia, but the reported success rates of ablation have differed across a large number of single-center studies. The main reason for tachycardia recurrence is accessory pathway (Ap)-mediated tachycardia, and the use of the RFCA strategy may be related to recurrence. This study compared the efficacy and safety of two different RFCA strategies for Ap-mediated tachycardia. We compared patients (group M) who underwent RFCA at multiple sites to patients (group S) who underwent RFCA at a single site during the index procedure for Ap-mediated tachycardia. The efficacy and safety were assessed in the two groups. Follow-up was conducted, and the main complications and the incidence of recurrence after RFCA procedures were recorded. Eight hundred eighty-two patients with 898 Aps were enrolled in group S, and 830 patients with 843 Aps were enrolled in group M. The cumulative number of recurrences (rates) in group M and group S at the 1st, 3rd, 6th, 12th, and 24th months after ablation were 4 (0.5%) and 17 (1.9%), p < 0.05; 5 (0.6%) and 27 (3.0%), p < 0.05; 6 (0.7%) and 34 (3.8%), p < 0.05; 6 (0.7%) and 43 (4.8%), p < 0.05; and 7 (0.8%) and 45 (5.0%), p < 0.05, respectively. Complications of chest pain, overactive vasovagal reaction, steam pop, and angina pectoris were rare in both groups. One patient in group M suffered from myocardial infarction before extensive ablation. No valve damage, cardiac tamponade, or other serious adverse events occurred in either group. The extensive ablation strategy reduced the recurrence rate and the need for subsequent ablation of the Ap without increasing the risk of complications.

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“…Left‐sided inputs to the AV node are usually ablated at the roof of the CS, the left paraseptal region, or just more lateral on the mitral annulus 19 . In addition, others have also reported dual atrial insertion sites in patients with PJRT 7,20,21 . It is not completely clear why AVNRT was not inducible in case in either of the first two procedures, despite pacing and isoproterenol, but may have been due to the effects of sedation and alteration of autonomic tone on pathway conduction and refractoriness.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiologic approach to diagnosis and ablation of patients with permanent junctional reciprocating tachycardia associated with complex anatomy and/or physiology

Oesterle

Lee

Voskoboinik

et al. 2020

Cardiovasc electrophysiol

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Introduction: Permanent junctional reciprocating tachycardia (PJRT) is a rare supraventricular tachycardia (SVT), typically involving a single decremental posteroseptal accessory pathway (AP). Methods: Four patients with long RP SVT underwent electrophysiology (EP) study and ablation. The cases were reviewed. Results: Case 1 recurred despite 3 prior ablations at the site of earliest retrograde atrial activation during orthodromic reciprocating tachycardia (ORT). Mapping during a repeat EP study demonstrated a prepotential in the coronary sinus (CS). Ablation over the earliest atrial activation in the CS resulted in dissociation of the potential from the atrium during sinus rhythm. The potential was traced back to the CS os and ablated. Case 2 underwent successful ablation at 6 o'clock on the mitral annulus (MA). ORT recurred and successful ablation was performed at 1 o'clock on the MA. Case 3 had tachycardia with variation in both V-A and A-H intervals which precluded the use of usual maneuvers so we used simultaneous atrial and ventricular pacing and introduced a premature atrial contraction with a closely coupled premature ventricular contraction. Case 4 had had two prior atrial fibrillation ablations with continued SVT over a decremental atrioventricular bypass tract that was successfully ablated at 5 o'clock on the tricuspid annulus. A second SVT consistent with a concealed nodoventricular pathway was successfully ablated at the right inferior extension of the AV nodal slow pathway.

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Atrial double potentials associated with a left‐sided accessory pathway having a single ventricular and two remote atrial insertions

Cited by 11 publications

References 17 publications

Atrial Fibrillation and Atrial Fibrillation Intervals-Frequency Analysis and Interpretation-

Atrial Fibrillation and Atrial Fibrillation Intervals-Frequency Analysis and Interpretation-

Efficacy and safety of the application of extensive ablation in patients with atrioventricular re-entrant tachycardia (a retrospective study)

Electrophysiologic approach to diagnosis and ablation of patients with permanent junctional reciprocating tachycardia associated with complex anatomy and/or physiology

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