Simultaneous Multisite Mapping Studies During Induced Atrial Fibrillation in the Sterile Pericarditis Model

Kumagai, Koji; Khrestian, Celeen M.; Waldo, Albert L.

doi:10.1161/01.cir.95.2.511

Cited by 214 publications

(208 citation statements)

References 26 publications

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“…Pairs of stainless steel wire electrodes coated with FEP polymer except for the tip were sutured to Bachmann's bundle (BB), the right atrial appendage (RAA), and the posterior-inferior left atrium (PLA). One more pair of stainless steel wire electrodes was sutured onto the right ventricular apex to be used for ventricular pacing, principally after ablating the His bundle to achieve complete AV block as part of the studies in the open chest state (22). All electrodes were brought out through the chest wall, and exteriorized posteriorly in the midline of the neck for subsequent use for pacing and recording.…”

Section: Creation Of Sterile Pericarditismentioning

confidence: 99%

“…Since superimposition of atrial and ventricular activation may interfere with interpretation of atrial electrograms, prior to the open chest study, His bundle ablation via a femoral approach using an EPT-1000 Cardiac Ablation System (EP Technologies, San Jose, Ca, USA) with subsequent right ventricular pacing at 100 beats per minute was performed in all experiments. The ventricular pacing rate was decreased to 60 beats per minute during mapping (22).…”

Section: Open Chest Studies: Simultaneous Multisite Mappingmentioning

confidence: 99%

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Termination of a tachyarrhythmia by flunarizine is not a specific marker for a triggered mechanism

2007

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Section: Creation Of Sterile Pericarditismentioning

confidence: 99%

Section: Open Chest Studies: Simultaneous Multisite Mappingmentioning

confidence: 99%

Termination of a tachyarrhythmia by flunarizine is not a specific marker for a triggered mechanism

2007

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“…56 However, it also may be induced by single reentrant loops or automatic foci. 8,[57][58][59] Multiple wavelet reentry may incorporate unstable circuits of short cycle length 57,[60][61][62][63] and may include Bachmann's bundle as a critical contributor. In a canine model of the latter, a single radiofrequency lesion in Bachmann's bundle often abolishes the arrhythmia.…”

Section: The Relationship Of the Electrophysiologic Mechanisms Of Atrmentioning

confidence: 99%

“…In a canine model of the latter, a single radiofrequency lesion in Bachmann's bundle often abolishes the arrhythmia. 63 Multiple wavelet reentry has been successfully prevented by making lesions in the atria surgically in animal models, and in some patients, via surgery or radiofrequency current. 60,61,[64][65][66] In addition, cases of human atrial fibrillation arising from discrete foci of abnormal electrical activity have been identified and treated successfully by ablation of the focus.…”

Section: The Relationship Of the Electrophysiologic Mechanisms Of Atrmentioning

confidence: 99%

The Search for Novel Antiarrhythmic Strategies

Gambit¹

1998

Jpn Circ J

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he first 2 meetings of the Sicilian Gambit focused on a pathophysiologic approach to evaluate antiarrhythmic drugs in light of the electrophysiologic mechanisms for cardiac arrhythmias; 1,2 on the extent to which this approach was effective in identifying the most appropriate therapy for clinical arrhythmias; and on areas where further information was needed to provide rational directions for therapy. 3 The stimulus for the third Sicilian Gambit meeting (the subject of this report) was continued concern over the future of antiarrhythmic drug therapy, based on (1) the increased mortality reported with d-sotalol in the SWORD trial; 4 (2) the failure of amiodarone to reduce all-cause mortality in CAMIAT 5 , EMIAT 6 and CHF-STAT 7 ; and (3) the extent to which international differences in perceived needs and guidelines for drug development might reduce enthusiasm for drug discovery. Participating in the meeting were basic and clinical scientists, investigators involved in drug trials and representatives of regulatory and funding agencies.In the following pages we emphasize that (1) traditional modalities of antiarrhythmic drug development have reached a near-impasse; (2) new perspectives should, nonetheless, lead to novel antiarrhythmic approaches; (3) information derived from molecular technology should facilitate the identification of specific targets for pharmacologic intervention; (4) at least one condition, congenital long QT syndrome, may soon represent "proof of concept" of the linkage between molecular biology and novel treatment strategies; (5) common arrhythmias like atrial fibrillation and ventricular tachycardia and fibrillation may be amenable to a similar approach; and (6) new thinking on development of novel compounds must be complemented by innovative decisions in clinical trials. We stress, as well, that a major market for antiarrhythmic drug therapy still exists: the frequency of lethal ventricular tachyarrhythmias as well as of atrial fibrillation is such that therapies having widespread applicability at modest cost must be sought. RationaleEarly approaches to antiarrhythmic drug development involved the serendipitous identification of antiarrhythmic actions of natural compounds such as cinchona 8 or compounds synthesized for other applications such as procaine. 9 This was followed by synthesis of derivative molecules (respectively, quinidine 10 and procainamide 11 ) and their testing in animal models and in human subjects. Identification of a perceived benefit in human subjects (eg, suppression of ventricular premature depolarizations) could lead to a search for related molecules the effects of which might be more sustained, less toxic and/or more potent, or with properties that might be modified advantageously. These molecules also were tested in animal models for their antiarrhythmic efficacy and toxicity and, if they passed muster, were tested in patients. Shortcomings of this approach are that molecules thus identified tend to incorporate not only the potential benefits of the so-called paren...

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“…[14][15][16][17] In contrast, mapping studies of AF in the canine sterile pericarditis model have shown that AF is generated by multiple unstable reentrant circuits. 18) In this model, ablation cured AF by making a linear lesion at a single location to prevent the continued formation of mother reentrant circuits which were identified by their organized activation pattern. Therefore, we hypothesized that an organized activation pattern around the tricuspid annulus during AF indicated a mother reentrant circuit that could be terminated by a cavocaval isthmus ablation, thus preventing AF.…”

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Effects of Cavotricuspid Isthmus Catheter Ablation on Paroxysmal Atrial Fibrillation

et al. 2001

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SUMMARYIt has been demonstrated that successful cavotricuspid isthmus ablation of typical atrial flutter combined with atrial fibrillation (AF) sometimes influences the preablation history of paroxysmal AF. However, the effectiveness of only isthmus ablation on AF itself is unclear.Endocardial catheter mapping during induced AF was performed around the tricuspid annulus using duodecapolar electrode catheters in 39 patients with drug-refractory paroxysmal AF. Isthmus ablation was performed in 16 patients (41%) in whom catheter mapping during AF showed an organized activation pattern around the tricuspid annulus.During a mean follow-up of 12.3 months, isthmus ablation was successful in preventing AF in 12 (75%) patients, 8 without medication and 4 with a previously ineffective drug. This success group had a significantly higher F wave amplitude in lead V1 (0.29 ± 0.10 vs 0.15 ± 0.04 mV, p < 0.01), a higher left ventricular ejection fraction (74 ± 9 vs 58 ± 2%, p < 0.05), and a smaller left atrial dimension (35 ± 6 vs 43 ± 4mm, p < 0.05) than the failure group.Isthmus ablation may be effective in preventing paroxysmal AF with an organized activation pattern around the tricuspid annulus. F wave amplitude, left ventricular ejection fraction, and left atrial dimension were significant predictors of success. (Jpn Heart J 2001; 42: 79-89)

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Simultaneous Multisite Mapping Studies During Induced Atrial Fibrillation in the Sterile Pericarditis Model

Cited by 214 publications

References 26 publications

Termination of a tachyarrhythmia by flunarizine is not a specific marker for a triggered mechanism

Termination of a tachyarrhythmia by flunarizine is not a specific marker for a triggered mechanism

The Search for Novel Antiarrhythmic Strategies

Effects of Cavotricuspid Isthmus Catheter Ablation on Paroxysmal Atrial Fibrillation

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