Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways

Torok, Tamas Szili; Vries, Lennart J. de; Özcan, Emin Evren; Hasdemir, Can; Kis, Zsolt; Kardos, Attila; Géczy, Tamás; Kovács, István; Benedek, Imre; Oosterwerff, Erik; Hendriks, Astrid; Khan, Muchtiar; Yap, Sing-Chien

doi:10.1111/jce.13098

Cited by 2 publications

(2 citation statements)

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“…However, it is well known that the Marshall bundle itself can have triggered activities and can be a source of ectopic beats triggering AF 7 . A Kent bundle can also be a rare source of ventricular arrhythmias 16 . In Case 3, detailed activation mapping during PV pacing, observation of the spontaneous initiation of AF, and ablation results strongly suggested the contribution of an EC as a trigger of AF and unidirectional conduction to the LA.…”

Section: Discussionmentioning

confidence: 95%

“…7 A Kent bundle can also be a rare source of ventricular arrhythmias. 16 on the intercaval epicardial fiber and possible preferential or unidirectional conduction to the RA. An anisotropic characteristic, complex arrangement of the myofibers, abrupt changes in the fiber direction, and stretch, which may play a role in the genesis of electrical instability, can be mechanisms for increased ability of triggered activities in ECs, similar to the PV sleeves.…”

Section: Intercaval Bundle Between Right Pv Carina and Ra (Cases 1 An...mentioning

confidence: 99%

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Unidirectional conduction characterizing epicardial connections in patients with atrial tachyarrhythmias

Yoshida,

Hasebe,

Hattori

et al. 2023

Cardiovasc electrophysiol

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IntroductionElectrophysiological characteristics of epicardial connections (ECs) in atria and pulmonary veins (PVs) are unclear despite their important contributions to atrial fibrillation (AF). Unidirectional conduction associated with source‐sink mismatch can occur in ECs due to their fine fibers with abrupt changes in orientation. We detailed the prevalence and electrophysiological characteristics of unidirectional conduction in the atria and investigated its association with the clinical manifestation of AF.MethodsThis study retrospectively reviewed electrophysiological studies and radiofrequency catheter ablation in 261 consecutive patients with AF.ResultsUnidirectional conduction was observed during ablation encircling the PVs in eight (3.1%) patients, and all occurred in the suspected (N = 4) or definitively (N = 4) recognized ECs. These ECs included three intercaval bundles, four septopulmonary bundles, and one Marshall bundle, and were first manifested in a second procedure in 6 (75%) patients. The unidirectional property was from PV to atrium (exit conduction) in all intercaval bundles and three septopulmonary bundles, and from atrium to PV (entrance conduction) in the remaining two bundles. Intercaval bundles acted as a limb of bi‐atrial macro‐reentrant tachycardia (50%, three of the six including previous cases). Ablation of the exit outside the PVs, including the right atrium, eliminated ECs in three (38%) patients. All patients remain free from arrhythmia recurrence after a mean 13‐month follow‐up.ConclusionA unidirectional conduction property was closely associated with the EC, as estimated by histological findings. Recognition of this fact by electrophysiologists may help to clarify mechanisms for AF and atrial tachycardia and guide the creation of efficient and safe ablation lesion sets.

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Section: Discussionmentioning

confidence: 95%

Section: Intercaval Bundle Between Right Pv Carina and Ra (Cases 1 An...mentioning

confidence: 99%

Unidirectional conduction characterizing epicardial connections in patients with atrial tachyarrhythmias

Yoshida,

Hasebe,

Hattori

et al. 2023

Cardiovasc electrophysiol

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show abstract

Inter-atrial epicardial muscular fibers as a possible source of atrial tachyarrhythmias

Hattori

Baba

Hasebe

et al. 2023

Journal of Cardiology Cases

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Disappearance of Idiopathic Outflow Tract Premature Ventricular Contractions After Catheter Ablation of Overt Accessory Pathways

Abstract: The coexistence of pre-excitation and PVCs from the OTs and the fact that in 5 of 6 cases PVCs disappeared after AP ablation suggests a common mechanism for arrhythmia genesis.

Cited by 2 publications

References 44 publications

Unidirectional conduction characterizing epicardial connections in patients with atrial tachyarrhythmias

Unidirectional conduction characterizing epicardial connections in patients with atrial tachyarrhythmias

Inter-atrial epicardial muscular fibers as a possible source of atrial tachyarrhythmias

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