Intracardiac Echocardiography to Guide the Ablation of Parahisian Arrhythmias

Campbell, Timothy; Bennett, Richard G.; Kumar, Saurabh

doi:10.1016/j.ccep.2022.01.001

Cited by 5 publications

(5 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The parahisian (PH) region consists of several anatomical structures, including the atrioventricular node and the bundle of His, which are associated with a high risk of atrioventricular block in EP procedures [ 74 ]. The PH region is bounded by the aorta, tricuspid, and mitral annulus structures alongside the bundle of His and ventricular outflow tracts [ 75 ].…”

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

“…Real-time ICE visualization provides a comprehensive understanding of the complex anatomy of PH, thus, increasing the safety of ablation in this area. ICE imaging of the PH region can be performed at four positions: Mid-RA, low lateral RA, CS, and RV inflow [ 74 ]. The ICE probe placed in the middle of the RA provides a view of the long axis of the aorta and the septal aspect of the RV, whereas the ICE probe located in the RV inflow captures the cross-section of the aorta [ 74 ].…”

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

“…ICE imaging of the PH region can be performed at four positions: Mid-RA, low lateral RA, CS, and RV inflow [ 74 ]. The ICE probe placed in the middle of the RA provides a view of the long axis of the aorta and the septal aspect of the RV, whereas the ICE probe located in the RV inflow captures the cross-section of the aorta [ 74 ]. Using ICE imaging obtained from the low lateral RA and CS, the interventricular septum and the PH region can be visualized [ 74 ].…”

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

“…The ICE probe placed in the middle of the RA provides a view of the long axis of the aorta and the septal aspect of the RV, whereas the ICE probe located in the RV inflow captures the cross-section of the aorta [ 74 ]. Using ICE imaging obtained from the low lateral RA and CS, the interventricular septum and the PH region can be visualized [ 74 ]. A single-center study analyzed 34 patients undergoing ablation for parahisian AT from RA, LA, or non-coronary cusp (NCC) with the support of ICE imaging [ 76 ].…”

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

See 3 more Smart Citations

Intracardiac Echocardiography: An Invaluable Tool in Electrophysiological Interventions for Atrial Fibrillation and Supraventricular Tachycardia

Hu,

Chen,

Maduray

et al. 2024

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

Researchers have investigated ways to develop optimal imaging techniques to increase the safety and effectiveness of electrophysiological (EP) procedures. Intracardiac echocardiography (ICE) is an advanced imaging tool that can directly visualize cardiac anatomical structures in high resolution, assess tissue heterogeneity and arrhythmogenic substrates, locate intracardiac catheters, monitor catheter-tissue contact and ablation injury in real-time, excluding intracardiac thrombi, and quickly detect procedural complications. Additionally, real-time imaging via ICE can be integrated with a three-dimensional (3D) electroanatomical mapping (EAM) system to reconstruct cardiac anatomy. This technique also promotes the development of zero-radiation EP procedures. Many EP studies and procedures have implemented ICE because it has several advantages over fluoroscopy and transesophageal echocardiography (TEE). ICE-guided EP procedures can be performed under conscious sedation; esophageal intubation and additional anesthesiologists are not required. Atrial fibrillation (AF) and supraventricular tachycardias (SVT) are the most common tachyarrhythmias in clinical settings. A comprehensive understanding of critical anatomical structures, such as the atrial septum, fossa ovalis (FO), and great heart vessels, is needed for the successful catheter ablation of these arrhythmias.

show abstract

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

Section: Parahisian Arrhythmiasmentioning

confidence: 99%

See 2 more Smart Citations

Intracardiac Echocardiography: An Invaluable Tool in Electrophysiological Interventions for Atrial Fibrillation and Supraventricular Tachycardia

Hu,

Chen,

Maduray

et al. 2024

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…These electrophysiological observations contrast with the superior SP, the retrograde activation of which is not always detectable. Intracardiac echocardiography may be useful to navigate the tip of the ablation catheter in the non-coronary sinus of Valsalva [ 48 , 49 , 47 ], the perihisian region [ 50 ] or along the tricuspid annulus [ 51 , 52 ].…”

Section: Variants Of Sp Extending To the Tricuspid Annulus And Their ...mentioning

confidence: 99%

Atrioventricular Ring Tachycardias: Atypical Fast-Slow Atrioventricular Nodal Reentrant Tachycardia and Atrial Tachycardia Share a Common Arrhythmogenic Substrate—A Unifying Proposal

Kaneko¹,

Tamura²,

Kubo³

et al. 2022

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

Our understanding of the variants of slow pathway (SP) and associated atypical atrioventricular (AV) nodal reentrant tachycardia (NRT) is still growing. We have identified variants extending outside Koch's triangle along the tricuspid annulus, including superior, superoanterior and inferolateral right atrial SP and associated atypical, fast-slow AVNRT. We review the history of each variant, their electrophysiological characteristics and related atypical AVNRT, and their treatment by catheter ablation. We focused our efforts on organizing the published information, as well as some unpublished, reliable data, and show the pitfalls of electrophysiological observations, along with keys to the diagnosis of atypical AVNRT. The superior-type of fast-slow AVNRT mimics adenosine-sensitive atrial tachycardia originating near the AV node and can be successfully treated by ablation of a superior SP form the right side of the perihisian region or from the non-coronary sinus of Valsalva. Fast-slow AVNRT using a superoanterior or inferolateral right atrial SP also mimics atrial tachycardia originating from the tricuspid annulus. We summarize the similarities among these variants of SP, and the origin of the atrial tachycardias, including their anatomical distributions and electrophysiological and pharmacological characteristics. Moreover, based on recent basic research reporting the presence of node-like AV ring tissue encircling the annuli in adult hearts, we propose the term "AV ring tachycardia" to designate the tachycardias that share the AV ring tissue as a common arrhythmogenic substrate. This review should help the readers recognize rare types of SP variants and associated AVNRT, and diagnose and cure these complex tachycardias. We hope, with this proposal of a unified tachycardia designation, to open a new chapter in clinical electrophysiology.

show abstract