Ablation of Incessant Left Atrial Tachycardia Without Fluoroscopy in a Pregnant Woman

Ablation Without Fluoroscopy in Pregnancy. Background: Management of symptomatic atrial arrhythmia in pregnancy remains a challenge. In this case report, a pregnant woman with incessant tachycardia underwent successful left atrial ablation. The entire procedure was performed without fluoroscopy. Methods and Results: A 20‐year‐old woman, 27 weeks pregnant, was admitted with congestive cardiac failure and incessant atrial tachycardia. She had an elevated brain natriuretic peptide (BNP) and chest X‐ray demonstrating heart failure. The 12‐lead electrocardiogram (ECG) showed atrial tachycardia with a cycle length of 310 ms, inverted P waves in lead I and the inferior leads, and a ventricular rate of 84 bpm during 2:1 block. Echocardiogram showed a global reduction in left ventricular function with a left ventricular ejection fraction (LVEF) of 0.40. Electrical cardioversion failed. Rate control could not be achieved with beta‐blockers and calcium antagonists. Amiodarone with repeat cardioversion was also unsuccessful. The patient then underwent catheter ablation. The entire procedure was performed using intracardiac echocardiography (ICE) and electroanatomical mapping with no fluoroscopy. Electrophysiology (EP) study and an activation map of the left atrium confirmed a focal left atrial tachycardia which was successfully ablated. Six weeks postablation, the left ventricular function had normalized and the patient delivered a healthy child at term, without complication. Conclusion: Ablation of left atrial tachycardia using ICE and electroanatomical guidance is feasible in pregnant women. (J Cardiovasc Electrophysiol, Vol. 22, pp. 346‐349, March 2011)     

Transcoronary Venous Radiofrequency Catheter Ablation of Ventricular Tachycardia

Coronary Venous Ablation of VT. Ventricular tachycardias in coronary artery disease arise mostly from endocardial sites. However, little is known about the site of origin in other diseases. We present the case of an incessant, adenosine-sensitive ventricular tachycardia arising from the lateral wall of the left ventricle in a patient with mildly reduced left ventricular function. Intracardiac mapping suggested an epicardial origin, and the tachycardia was successfully ablated from a coronary sinus branch. After ablation, left ventricular function returned to normal. Transcoronary venous radiofrequency catheter ablation is a new approach for the treatment of ventricular tachycardia. Its value in the management of other types of ventricular tachycardia has yet to he determined.     

Remote Navigation Guided Ablation of Incessant Atrial Tachycardia in a Patient with Restricted Venous Access

We report a case of a 45-year-old man with incessant supraventricular tachycardia (SVT) in the setting of intrahepatic inferior vena cava thrombus and a left upper extremity arteriovenous fistula. A diagnostic electrophysiology study (EPS) was performed via the right internal jugular and right subclavian veins. After confirming the mechanism of SVT was atrial tachycardia (AT), mapping, and successful ablation was performed using remote catheter navigation. This case demonstrates that remote navigation can facilitate the therapy of complex arrhythmias in challenging clinical situations.     

Catheter Ablation of Atrial Tachycardia Following Atrial Fibrillation Ablation

Atrial tachycardias represent the second front of atrial fibrillation (AF) ablation. They are frequently encountered during the index ablation for patients with persistent AF and are common following ablation of persistent AF, occurring in half of all patients who have had AF successfully terminated. An atrial tachycardia is rightly seen as a failure of AF ablation, as these tachycardias are poorly tolerated by patients. This article describes a simple, practical approach to diagnosis and ablation of these atrial tachycardias.     

Cure of Incessant Pacemaker Circus Movement Tachycardia by Radiofrequency Catheter Ablation

Ablation of Pacemaker Circus Movement Tachycardia. Introduction : Treatment of pacemaker circus movement tachycardia (PCMT) in patients with very long VA conduction times may present a problem.
Methods and Results : PCMT occurred in a 46-year-old woman with an uncommon AV nodal reentrant tachycardia who developed 2:1 AV block after fast pathway radiofrequency catheter (RF) ablation performed at another institution. Due to the long VA conduction time, PCMT could not be prevented by reprogramming the pacemaker or by the addition of antiarrhythmic drugs. Cure of the PCMT was obtained after selective RF ablation of the slow AV nodal pathway.
Conclusion : RF ablation of the retrograde conduction offers another alternative for treatment of PCMT.     

Clinical Significance of Early Recurrences of Atrial Tachycardia After Atrial Fibrillation Ablation

Early Recurrence After AF Ablation. Background: Atrial tachycardia (AT) commonly recurs within 3 months after radiofrequency catheter ablation for atrial fibrillation (AF). However, it remains unclear whether early recurrence of atrial tachycardia (ERAT) predicts late recurrence of AF or AT. Methods: Of 352 consecutive patients who underwent circumferential pulmonary vein isolation with or without linear ablation(s) for AF, 56 patients (15.9%) with ERAT were identified by retrospective analysis. ERAT was defined as early relapse of AT within a 3‐month blanking period after ablation. Results: During 21.7 ± 12.5 months, the rate of late recurrence was higher in patients with ERAT (41.1%) compared with those without ERAT (11.8%, P < 0.001). In a multivariable model, positive inducibility of AF or AT immediately after ablation (65.2% vs 36.4%, P = 0.046; odd ratio, 3.9; 95% confidence interval, 1.0–14.6) and the number of patients who underwent cavotricuspid isthmus (CTI) ablation (73.9% vs 42.4%, P = 0.042; odd ratio, 4.5; 95% confidence interval, 1.1–19.5) were significantly related to late recurrence in the ERAT group. The duration of ablation (174.3 ± 62.3 vs 114.7 ± 39.5 minutes, P = 0.046) and the procedure time (329.3 ± 83.4 vs 279.2 ± 79.7 minutes, P = 0.027) were significantly longer in patients with late recurrence than in those without late recurrence following ERAT. Conclusions: The late recurrence rate is higher in the patients with ERAT compared with those without ERAT following AF ablation, and is more often noted in the patients who underwent CTI ablation and had a prolonged procedure time. Furthermore, inducibility of AF or AT immediately after ablation independently predicts late recurrence in patients with ERAT. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1331‐1337, December 2010)     

射频导管消融术治疗房性心动过速23例分析

目的：分析房性心动过速（房速）的电生理特点,探讨射频导管消融术在房速治疗中的价值。 方法：对２３例房速患者进行心电生理检查和射频导管消融治疗。 结果：２３例患者中,２０例为折返性房速,３例为自律性增高性房速。２３例患者,２１例消融成功,其中１９例成功靶点位于右心房,２例位于左心房。成功靶点 ＰＡ为－６０～－２５ ｍｓ,平均－３６ ｍｓ。 结论：射频导管消融术是治疗房速的安全有效的方法。     

房性心动过速的射频导管消融术治疗

目的：为治疗房性心动过速（房速）,对8例患者进行了射频导管消融术（RFCA）治疗。方法：采用两根大头消融导管,在房速发作时标测心房最早激动点放电消融。结果：8例房速（包括房速伴心房扑动及房速伴房室结折返性心动过速各1例）RFCA治疗全部成功,无并发症;其中4例在冠状静脉窦口附近、2例在右心房侧壁、2例在右心耳处放电消融成功,成功靶点局部电位（A波）较体表心电图P波平均提前34.23±5.23（22～46）ms。结论：心房激动顺序标测是房速消融的基本方法,AP间期≥30ms的部位可作为试消融靶点;对房速伴其他类型心动过速者可一次消融成功。     

Possible Role for Cryoballoon Ablation of Right Atrial Appendage Tachycardia when Conventional Ablation Fails

Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial tachycardia originates from the right atrial appendage.     

持续性心房颤动射频导管消融术中房性心动过速的处置及预后

目的评估持续性心房颤动射频导管消融(下称消融)术中房性心动过速是否消融终止对预后的影响.方法持续心房颤动行分步法消融术中转为房性心动过速的患者86例,43例继续消融终止房性心动过速(消融终止组),43例消融不能终止房性心动过速而行电复律(未终止组).随访2年,比较两组房性快速性心律失常的复发率.结果消融术后维持窦性心律55例(63.95%),房性快速性心律失常复发31例(36.05%).复发率消融终止组(27.91%)与消融未终止组(44.19%)比较,差异无统计学意义(P >0.05).左心房前后径窦性心律组[(41.78±7.95)mm]小于复发组[(45.85±8.51) mm],差异有统计学意义(P<0.05).结论持续性心房颤动消融术中房性心动过速能否消融终止不影响房性快速性心律失常的复发.     

DDD-Pacing-Induced Cardiomyopathy Following AV Node Ablation for Persistent Atrial Tachycardia

Ventricular rate control by catheter ablation of the AV node and pacing in patients with persistent atrial tachycardia has been reported to improve left ventricular function. However, this approach requires careful selection of the pacing mode. We report a patient who underwent AV node ablation for persistent multiple atrial tachycardias, and who then had a non-mode-switching pacemaker implanted. Because of an inappropriately programmed relatively high upper rate limit, the patient developed left ventricular dysfunction after 6 years. This resolved after programming the pacemaker to VVI at 70 bpm.     

导管射频消融治疗房性心动过速的体会

总结５例房性心动过速的电生理特点，探讨提高导管射频消融成功率的标测与消融方法。男１例、女４例，平时心电图正常，心动过速发作时心室率１５０～２２０ｂｐｍ，ＲＰ＞ＰＲ。大头电极在右房内标测到最早的心房激动点，在心动过速时放电。２例在冠状窦口附近、２例在右房侧壁（双大头法标测）消融成功，靶点局部电位较体表心电图的Ｐ波提前２９ｍｓ以上；１例窦房折返性心动过速，消融失败。结果表明：激动标测是最基本的方法，结合拖带或隐匿性拖带、起搏标测、机械阻断等选择靶点的方法可以提高成功率；适当选择双大头法标测能够缩短手术时间。     

射频消融源于三尖瓣环的房性心动过速

目的:报道起源于三尖瓣环上的房性心动过速(房速)的电生理特点和射频消融结果。方法:根据成功靶点影像位置和靶点图A:V比值,5例房速起源于三尖瓣环。结果:5例房速心动过速平均周长(340.2±30.5)ms,心房刺激可以诱发和终止心动过速,3例心室刺激可以诱发, 三磷酸腺苷可以终止所有心动过速。成功靶点图的A:V之比为0.7±0.9,3例位于右侧游离壁,2例为右后游离壁,5 例均消融成功。结论:部分房速可以起源于三尖瓣环并可以被成功地消融。