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[PMID]:29018165
[Au] Autor:Maurer T; Metzner A; Ho SY; Wohlmuth P; Reißmann B; Heeger C; Lemes C; Hayashi K; Saguner AM; Riedl J; Sohns C; Mathew S; Kuck KH; Wissner E; Ouyang F
[Ad] Endereço:From the Department of Cardiology, Asklepios-Klinik St Georg, Hamburg, Germany (T.M., A.M., B.R., C.H., C.L., K.H., A.M.S., J.R., C.S., S.M., K.-H.K., F.O.); Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom (S.Y.H.); Asklepios Proresearch, Hamburg, Germany (P.W.); and Division
[Ti] Título:Catheter Ablation of the Superolateral Mitral Isthmus Line: A Novel Approach to Reduce the Need for Epicardial Ablation.
[So] Source:Circ Arrhythm Electrophysiol;10(10), 2017 Oct.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The mitral isthmus is a critical part of perimitral reentrant tachycardia, as well as an important substrate of persistent atrial fibrillation. Deployment of an endocardial mitral isthmus line (MIL) with the end point of bidirectional block may be challenging and often requires additional epicardial ablation within the coronary sinus. METHODS AND RESULTS: The study population comprised 114 patients with perimitral flutter who underwent de novo ablation of an MIL. The initial 57 patients (group A) underwent catheter ablation using a novel superolateral MIL design, connecting the left-sided pulmonary veins with the mitral annulus along the posterior base of the left atrial appendage visualized by selective angiography. The next 57 patients (group B) served as a control group and underwent ablation using a conventional MIL design, connecting the left inferior pulmonary vein with the mitral annulus. Bidirectional block was achieved in 56 of 57 patients in group A (98.2%) and 50 of 57 patients in group B (87.7%; =0.06). Deployment of a superolateral MIL required significantly less ablation from within the coronary sinus (7.0% versus 71.9%; <0.01). Predictors for unsuccessful bidirectional mitral isthmus blockade were the need for epicardial ablation from within the coronary sinus ( <0.01) and the total length of the MIL (29.3±6.35 mm versus 40.8±7.29 mm; =0.005). A higher rate of pericardial tamponade was observed in group A (5.2% versus 0%; =0.24). CONCLUSIONS: The superolateral MIL is associated with a high acute success rate to achieve bidirectional block using endocardial ablation only with minimal need for epicardial ablation from within the coronary sinus.
[Mh] Termos MeSH primário: Flutter Atrial/cirurgia
Ablação por Cateter/métodos
Valva Mitral/cirurgia
[Mh] Termos MeSH secundário: Idoso
Fibrilação Atrial/diagnóstico por imagem
Fibrilação Atrial/fisiopatologia
Fibrilação Atrial/cirurgia
Flutter Atrial/diagnóstico por imagem
Flutter Atrial/fisiopatologia
Angiografia Coronária
Seio Coronário/diagnóstico por imagem
Seio Coronário/fisiopatologia
Seio Coronário/cirurgia
Ecocardiografia
Eletrocardiografia
Endocárdio/fisiopatologia
Endocárdio/cirurgia
Mapeamento Epicárdico
Feminino
Seres Humanos
Masculino
Meia-Idade
Valva Mitral/diagnóstico por imagem
Valva Mitral/fisiopatologia
Veias Pulmonares/diagnóstico por imagem
Veias Pulmonares/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE


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[PMID]:28912205
[Au] Autor:Mouws EMJP; Lanters EAH; Teuwen CP; van der Does LJME; Kik C; Knops P; Bekkers JA; Bogers AJJC; de Groot NMS
[Ad] Endereço:From the Department of Cardiology (E.M.J.P.M., E.A.H.L., C.P.T., L.J.M.E.v.d.D., P.K., N.M.S.d.G.) and Department of Cardiothoracic Surgery (E.M.J.P.M., C.K., J.A.B., A.J.J.C.B.), Erasmus Medical Center, Rotterdam, The Netherlands.
[Ti] Título:Epicardial Breakthrough Waves During Sinus Rhythm: Depiction of the Arrhythmogenic Substrate?
[So] Source:Circ Arrhythm Electrophysiol;10(9), 2017 Sep.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Epicardial breakthrough waves (EBW) during atrial fibrillation are important elements of the arrhythmogenic substrate and result from endo-epicardial asynchrony, which also occurs to some degree during sinus rhythm (SR). We examined the incidence and characteristics of EBW during SR and its possible value in the detection of the arrhythmogenic substrate associated with atrial fibrillation. METHODS AND RESULTS: Intraoperative epicardial mapping (interelectrode distances 2 mm) of the right atrium, Bachmann's bundle, the left atrioventricular groove, and the pulmonary vein area was performed during SR in 381 patients (289 male, 67±10 years) with ischemic or valvular heart disease. EBW were referred to as sinus node breakthrough waves if they were the earliest right atrial activated site. A total of 218 EBW and 57 sinus node breakthrough waves were observed in 168 patients (44%). EBW mostly occurred at right atrium (N=105, 48%) and left atrioventricular groove (N=67, 31%), followed by Bachmann's bundle (N=27, 12%) and pulmonary vein area (N=19, 9%; <0.001). EBW occurred most often in ischemic heart disease patients (N=114, 49%) compared with (ischemic and) valvular heart disease patients (N=26, 17%; <0.001). EBW electrograms most often consisted of double and fractionated potentials (N=137, 63%). In case of single potentials, an R wave was observed in 88% (N=71) of EBW, as opposed to 21% of sinus node breakthrough waves (N=5; <0.001). Fractionated EBW potentials were more often observed at the right atrium and Bachmann's bundle ( <0.001). CONCLUSIONS: During SR, EBW are present in over a third of patients, particularly in thicker parts of the atrial wall. Features of SR EBW indicate that muscular connections between endo- and epicardium underlie EBW and that a slight degree of endo-epicardial asynchrony required for EBW to occur is already present in some areas during SR. Hence, an anatomic substrate is present, which may enhance the occurrence of EBW during atrial fibrillation, thereby promoting atrial fibrillation persistence.
[Mh] Termos MeSH primário: Fibrilação Atrial/fisiopatologia
Mapeamento Epicárdico
Átrios do Coração/fisiopatologia
Pericárdio/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Eletrocardiografia
Feminino
Seres Humanos
Masculino
Meia-Idade
Veias Pulmonares/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170916
[St] Status:MEDLINE


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[PMID]:28887362
[Au] Autor:Haldar SK; Magtibay K; Porta-Sanchez A; Massé S; Mitsakakis N; Lai PFH; Azam MA; Asta J; Kusha M; Dorian P; Ha ACT; Chauhan V; Deno DC; Nanthakumar K
[Ad] Endereço:From the The Hull Family Cardiac Fibrillation Management Laboratory (S.K.H., K.M., A.P.-S., S.M., P.F.H.L., M.A.A., J.A., M.K., A.C.T.H., V.C., K.N.) and Toronto Health Economics and Technology Assessment Collaborative (N.M.), Toronto General Hospital, University Health Network, Ontario, Canada; St.
[Ti] Título:Resolving Bipolar Electrogram Voltages During Atrial Fibrillation Using Omnipolar Mapping.
[So] Source:Circ Arrhythm Electrophysiol;10(9), 2017 Sep.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Low-voltage-guided substrate modification is an emerging strategy in atrial fibrillation (AF) ablation. A major limitation to contemporary bipolar electrogram (EGM) analysis in AF is the resultant lower peak-to-peak voltage (V ) from variations in wavefront direction relative to electrode orientation and from fractionation and collision events. We aim to compare bipole V with novel omnipolar peak-to-peak voltages (V ) in sinus rhythm (SR) and AF. METHODS AND RESULTS: A high-density fixed multielectrode plaque was placed on the epicardial surface of the left atrium in dogs. Horizontal and vertical orientation bipolar EGMs, followed by omnipolar EGMs, were obtained and compared in both SR and AF. Bipole orientation has significant impact on bipolar EGM voltages obtained during SR and AF. In SR, vertical values were on average 66±119% larger than horizontal ( =0.004). In AF, vertical values were on average 31±96% larger than horizontal ( =0.07). Omnipole V values were 99.9±125% larger than both horizontal (99.9±125%; <0.001) and vertical (41±78%; <0.0001) in SR and larger than both horizontal (76±109%; <0.001) and vertical (52±70%; value <0.0001) in AF. Vector field analysis of AF wavefronts demonstrates that omnipolar EGMs can account for collision and fractionation and record EGM voltages unaffected by these events. CONCLUSIONS: Omnipolar EGMs can extract maximal voltages from AF signals which are not influenced by directional factors, collision or fractionation, compared with contemporary bipolar techniques.
[Mh] Termos MeSH primário: Fibrilação Atrial/fisiopatologia
Fibrilação Atrial/cirurgia
Ablação por Cateter
Mapeamento Epicárdico/métodos
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Cães
Eletrocardiografia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170910
[St] Status:MEDLINE


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[PMID]:28798020
[Au] Autor:Venlet J; Piers SRD; Kapel GFL; de Riva M; Pauli PFG; van der Geest RJ; Zeppenfeld K
[Ad] Endereço:From the Departments of Cardiology (J.V., S.R.D.P., G.F.L.K., M.d.R., P.F.G.P., K.Z.) and Image Processing (R.J.v.d.G.), Leiden University Medical Center, The Netherlands.
[Ti] Título:Unipolar Endocardial Voltage Mapping in the Right Ventricle: Optimal Cutoff Values Correcting for Computed Tomography-Derived Epicardial Fat Thickness and Their Clinical Value for Substrate Delineation.
[So] Source:Circ Arrhythm Electrophysiol;10(8), 2017 Aug.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Low endocardial unipolar voltage (UV) at sites with normal bipolar voltage (BV) may indicate epicardial scar. Currently applied UV cutoff values are based on studies that lacked epicardial fat information. This study aimed to define endocardial UV cutoff values using computed tomography-derived fat information and to analyze their clinical value for right ventricular substrate delineation. METHODS AND RESULTS: Thirty-three patients (50±14 years; 79% men) underwent combined endocardial-epicardial right ventricular electroanatomical mapping and ablation of right ventricular scar-related ventricular tachycardia with computed tomographic image integration, including computed tomography-derived fat thickness. Of 6889 endocardial-epicardial mapping point pairs, 547 (8%) pairs with distance <10 mm and fat thickness <1.0 mm were analyzed for voltage and abnormal (fragmented/late potential) electrogram characteristics. At sites with endocardial BV >1.50 mV, the optimal endocardial UV cutoff for identification of epicardial BV <1.50 mV was 3.9 mV (area under the curve, 0.75; sensitivity, 60%; specificity, 79%) and cutoff for identification of abnormal epicardial electrogram was 3.7 mV (area under the curve, 0.88; sensitivity, 100%; specificity, 67%). The majority of abnormal electrograms (130 of 151) were associated with transmural scar. Eighty-six percent of abnormal epicardial electrograms had corresponding endocardial sites with BV <1.50 mV, and the remaining could be identified by corresponding low endocardial UV <3.7 mV. CONCLUSIONS: For identification of epicardial right ventricular scar, an endocardial UV cutoff value of 3.9 mV is more accurate than previously reported cutoff values. Although the majority of epicardial abnormal electrograms are associated with transmural scar with low endocardial BV, the additional use of endocardial UV at normal BV sites improves the diagnostic accuracy resulting in identification of all epicardial abnormal electrograms at sites with <1.0 mm fat.
[Mh] Termos MeSH primário: Tecido Adiposo/diagnóstico por imagem
Tecido Adiposo/fisiopatologia
Cicatriz/diagnóstico por imagem
Mapeamento Epicárdico/métodos
Taquicardia Ventricular/cirurgia
Tomografia Computadorizada por Raios X
Disfunção Ventricular Direita/cirurgia
[Mh] Termos MeSH secundário: Cicatriz/fisiopatologia
Eletrocardiografia
Endocárdio/diagnóstico por imagem
Endocárdio/fisiopatologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Pericárdio/diagnóstico por imagem
Pericárdio/fisiopatologia
Sensibilidade e Especificidade
Taquicardia Ventricular/diagnóstico por imagem
Taquicardia Ventricular/fisiopatologia
Disfunção Ventricular Direita/diagnóstico por imagem
Disfunção Ventricular Direita/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170812
[St] Status:MEDLINE


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[PMID]:28630171
[Au] Autor:Derval N; Duchateau J; Mahida S; Eschalier R; Sacher F; Lumens J; Cochet H; Denis A; Pillois X; Yamashita S; Komatsu Y; Ploux S; Amraoui S; Zemmoura A; Ritter P; Hocini M; Haissaguerre M; Jaïs P; Bordachar P
[Ad] Endereço:From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest H
[Ti] Título:Distinctive Left Ventricular Activations Associated With ECG Pattern in Heart Failure Patients.
[So] Source:Circ Arrhythm Electrophysiol;10(6), 2017 Jun.
[Is] ISSN:1941-3084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In contrast to patients with left bundle branch block (LBBB), heart failure patients with narrow QRS and nonspecific intraventricular conduction delay (NICD) display a relatively limited response to cardiac resynchronization therapy. We sought to compare left ventricular (LV) activation patterns in heart failure patients with narrow QRS and NICD to patients with LBBB using high-density electroanatomic activation maps. METHODS AND RESULTS: Fifty-two heart failure patients (narrow QRS [n=18], LBBB [n=11], NICD [n=23]) underwent 3-dimensional electroanatomic mapping with a high density of mapping points (387±349 LV). Adjunctive scar imaging was available in 37 (71%) patients and was analyzed in relation to activation maps. LBBB patients typically demonstrated (1) a single LV breakthrough at the septum (38±15 ms post-QRS onset); (2) prolonged right-to-left transseptal activation with absence of direct LV Purkinje activity; (3) homogeneous propagation within the LV cavity; and (4) latest activation at the basal lateral LV. In comparison, both NICD and narrow QRS patients demonstrated (1) multiple LV breakthroughs along the posterior or anterior fascicles: narrow QRS versus LBBB, 5±2 versus 1±1; =0.0004; NICD versus LBBB, 4±2 versus 1±1; =0.001); (2) evidence of early/pre-QRS LV electrograms with Purkinje potentials; (3) rapid propagation in narrow QRS patients and more heterogeneous propagation in NICD patients; and (4) presence of limited areas of late activation associated with LV scar with high interindividual heterogeneity. CONCLUSIONS: In contrast to LBBB patients, narrow QRS and NICD patients are characterized by distinct mechanisms of LV activation, which may predict poor response to cardiac resynchronization therapy.
[Mh] Termos MeSH primário: Arritmias Cardíacas/diagnóstico
Bloqueio de Ramo/diagnóstico
Eletrocardiografia
Técnicas Eletrofisiológicas Cardíacas
Sistema de Condução Cardíaco/fisiopatologia
Insuficiência Cardíaca/complicações
Ventrículos do Coração/fisiopatologia
Disfunção Ventricular Esquerda/diagnóstico
Função Ventricular Esquerda
[Mh] Termos MeSH secundário: Potenciais de Ação
Adulto
Idoso
Arritmias Cardíacas/etiologia
Arritmias Cardíacas/fisiopatologia
Arritmias Cardíacas/terapia
Bloqueio de Ramo/fisiopatologia
Terapia de Ressincronização Cardíaca
Mapeamento Epicárdico
Feminino
Insuficiência Cardíaca/diagnóstico
Insuficiência Cardíaca/fisiopatologia
Insuficiência Cardíaca/terapia
Frequência Cardíaca
Ventrículos do Coração/diagnóstico por imagem
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Miocárdio/patologia
Seleção de Pacientes
Valor Preditivo dos Testes
Volume Sistólico
Disfunção Ventricular Esquerda/etiologia
Disfunção Ventricular Esquerda/fisiopatologia
Disfunção Ventricular Esquerda/terapia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170621
[St] Status:MEDLINE


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[PMID]:28167090
[Au] Autor:Pathak RK; Garcia FC
[Ad] Endereço:Clinical Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion - Cardiology, 3400 Spruce Street, Philadelphia, PA 19104, USA.
[Ti] Título:Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia.
[So] Source:Card Electrophysiol Clin;9(1):99-106, 2017 Mar.
[Is] ISSN:1877-9190
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Endocardial and epicardial electroanatomical mapping and ablation is a safe and effective therapy in the treatment of right ventricle arrhythmias occurring in the setting of arrhythmogenic right ventricular cardiomyopathy (ARVD). Careful mapping and ablation plans must be tailored for each patient based on comorbidities and ventricular tachycardia morphologies. This review focuses on the catheter ablation for ventricular arrhythmias in patients with ARVD.
[Mh] Termos MeSH primário: Displasia Arritmogênica Ventricular Direita
Taquicardia Ventricular
[Mh] Termos MeSH secundário: Displasia Arritmogênica Ventricular Direita/complicações
Displasia Arritmogênica Ventricular Direita/fisiopatologia
Ablação por Cateter
Mapeamento Epicárdico
Seres Humanos
Taquicardia Ventricular/complicações
Taquicardia Ventricular/fisiopatologia
Taquicardia Ventricular/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE


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[PMID]:28167080
[Au] Autor:Aryana A; d'Avila A
[Ad] Endereço:Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital, Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA 95819, USA.
[Ti] Título:Epicardial Catheter Ablation of Ventricular Tachycardia.
[So] Source:Card Electrophysiol Clin;9(1):119-131, 2017 Mar.
[Is] ISSN:1877-9190
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Over the last two decades, epicardial catheter ablation has evolved into a practical approach for treatment of ventricular tachycardia (VT). There are certain considerations when performing this procedure. First, presence of epicardial fat can diminish peak-to-peak electrogram amplitude and also impede radiofrequency energy delivery. Hence, epicardial VT ablation should be performed with cooled-tip radiofrequency using reduced irrigation flow within a relatively 'dry' pericardial milieu. Furthermore, catheter orientation is key when performing epicardial ablation. Lastly, hemo-pericardium remains the most common major adverse event of epicardial ablation and its presenting timeline may be used to identify the precise nature of this complication.
[Mh] Termos MeSH primário: Ablação por Cateter
Mapeamento Epicárdico
Taquicardia Ventricular
[Mh] Termos MeSH secundário: Seres Humanos
Taquicardia Ventricular/fisiopatologia
Taquicardia Ventricular/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE


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[PMID]:28122031
[Au] Autor:Wei W; Liao H; Xue Y; Fang X; Huang J; Liu Y; Deng H; Liang Y; Liao Z; Liu F; Lin W; Zhan X; Wu S
[Ad] Endereço:Guangdong Cardiovascular Institute, Guangzhou, P.R. China.
[Ti] Título:Long-Term Outcomes of Radio-Frequency Catheter Ablation on Ventricular Tachycardias Due to Arrhythmogenic Right Ventricular Cardiomyopathy: A Single Center Experience.
[So] Source:PLoS One;12(1):e0169863, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIMS: To summarize our experience of radiofrequency catheter ablation (RFCA) for recurrent drug-refractory ventricular tachycardias (VTs) due to arrhythmogenic right ventricular cardiomyopathy (ARVC) in our center over the past 11 years and its related factors. METHODS AND RESULTS: We reviewed 48 adults (mean age 39.9 ± 12.9 years, range: 14 to 65) who met the present ARVC diagnostic criteria and accepted RFCA for VTs from December 2004 to April 2016. The patients received a total of 70 procedures using two ablation approaches, the endocardial approach in 52 RFCAs, and the combined epicardial and endocardial approach (the combined approach) in 18 RFCAs. Kaplan-Meier survival analysis showed that the combined approach achieved better acute procedural success (p = 0.003) and better long-term outcomes (p = 0.028) than the endocardial approach. Patients who obtained acute procedural success with non-inducibility had better long-term outcomes (p < 0.001). COX regression of multivariate analysis showed that procedural success was the only factor that benefited long-term outcome, irrespective of the endocardial or the combined approach (p = 0.001). The rate of sudden cardiac death (SCD) in patients without procedural success was significantly higher than that in patients with procedural success (p = 0.005). All patients without implantable cardioverter defibrillator (ICD) implantation who had successful final RFCA survived. CONCLUSIONS: The combined approach resulted in better procedural success and long-term VT-free survival compared with the endocardial approach in ARVC patients with recurrent VTs. Acute procedural success with non-inducibility was strongly related to better long-term VT-free survival and reduced SCD, irrespective of whether this was achieved by the endocardial approach or the combined approach.
[Mh] Termos MeSH primário: Displasia Arritmogênica Ventricular Direita/complicações
Ablação por Cateter
Taquicardia Ventricular/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Displasia Arritmogênica Ventricular Direita/diagnóstico
Displasia Arritmogênica Ventricular Direita/diagnóstico por imagem
Displasia Arritmogênica Ventricular Direita/fisiopatologia
Ablação por Cateter/métodos
Ablação por Cateter/estatística & dados numéricos
Morte Súbita Cardíaca/epidemiologia
Morte Súbita Cardíaca/etiologia
Desfibriladores Implantáveis
Mapeamento Epicárdico
Feminino
Seguimentos
Insuficiência Cardíaca/etiologia
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Modelos de Riscos Proporcionais
Recidiva
Estudos Retrospectivos
Taquicardia Ventricular/etiologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170818
[Lr] Data última revisão:
170818
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170126
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0169863


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[PMID]:28011584
[Au] Autor:Rossi S; Buccarello A; Ershler PR; Lux RL; Callegari S; Corradi D; Carnevali L; Sgoifo A; Miragoli M; Musso E; Macchi E
[Ad] Endereço:Department of Life Sciences, Università degli Studi, Parma, Italy.
[Ti] Título:Effect of anisotropy on ventricular vulnerability to unidirectional block and reentry by single premature stimulation during normal sinus rhythm in rat heart.
[So] Source:Am J Physiol Heart Circ Physiol;312(3):H584-H607, 2017 Mar 01.
[Is] ISSN:1522-1539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Single high-intensity premature stimuli when applied to the ventricles during ventricular drive of an ectopic site, as in Winfree's "pinwheel experiment," usually induce reentry arrhythmias in the normal heart, while single low-intensity stimuli barely do. Yet ventricular arrhythmia vulnerability during normal sinus rhythm remains largely unexplored. With a view to define the role of anisotropy on ventricular vulnerability to unidirectional conduction block and reentry, we revisited the pinwheel experiment with reduced constraints in the in situ rat heart. New features included single premature stimulation during normal sinus rhythm, stimulation and unipolar potential mapping from the same high-resolution epicardial electrode array, and progressive increase in stimulation strength and prematurity from diastolic threshold until arrhythmia induction. Measurements were performed with 1-ms cathodal stimuli at multiple test sites ( = 26) in seven rats. Stimulus-induced virtual electrode polarization during sinus beat recovery phase influenced premature ventricular responses. Specifically, gradual increase in stimulus strength and prematurity progressively induced make, break, and graded-response stimulation mechanisms. Hence unidirectional conduction block occurred as follows: ) along fiber direction, on right and left ventricular free walls ( = 23), initiating figure-eight reentry ( = 17) and tachycardia ( = 12), and ) across fiber direction, on lower interventricular septum ( = 3), initiating spiral wave reentry ( = 2) and tachycardia ( = 1). Critical time window (55.1 ± 4.7 ms, 68.2 ± 6.0 ms) and stimulus strength lower limit (4.9 ± 0.6 mA) defined vulnerability to reentry. A novel finding of this study was that ventricular tachycardia evolves and is maintained by episodes of scroll-like wave and focal activation couplets. We also found that single low-intensity premature stimuli can induce repetitive ventricular response ( = 13) characterized by focal activations. We performed ventricular cathodal point stimulation during sinus rhythm by progressively increasing stimulus strength and prematurity. Virtual electrode polarization and recovery gradient progressively induced make, break, and graded-response stimulation mechanisms. Unidirectional conduction block occurred along or across fiber direction, initiating figure-eight or spiral wave reentry, respectively, and tachycardia sustained by scroll wave and focal activations.
[Mh] Termos MeSH primário: Ventrículos do Coração/efeitos dos fármacos
Ventrículos do Coração/fisiopatologia
[Mh] Termos MeSH secundário: Animais
Anisotropia
Arritmia Sinusal
Estimulação Elétrica
Eletrodos
Mapeamento Epicárdico
Bloqueio Cardíaco/fisiopatologia
Sistema de Condução Cardíaco/efeitos dos fármacos
Septos Cardíacos/fisiopatologia
Ratos
Período Refratário Eletrofisiológico
Taquicardia por Reentrada no Nó Sinoatrial/fisiopatologia
Taquicardia Ventricular/fisiopatologia
Função Ventricular Esquerda
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170726
[Lr] Data última revisão:
170726
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161225
[St] Status:MEDLINE
[do] DOI:10.1152/ajpheart.00366.2016


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[PMID]:27943299
[Au] Autor:Calzolari V; Barbato G; Crosato M; DE Mattia L; Daniotti A; Indiani S; Squasi PA; Olivari Z
[Ad] Endereço:Ospedale Ca' Foncello, Treviso, Italy.
[Ti] Título:A Nonfluoroscopic Technique for Coronary Arteries Three-Dimensional Mapping during Epicardial Ventricular Tachycardia Ablation.
[So] Source:Pacing Clin Electrophysiol;40(3):330-332, 2017 Mar.
[Is] ISSN:1540-8159
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:When performing epicardial ablation of ventricular tachycardia (VT), caution must be taken not to damage the coronary arteries. We report a case in which a new, nonfluoroscopic technique for incorporating an accurate, real-time reconstruction of the main coronary vessels into a three-dimensional electroanatomic map was used for epicardial VT ablation.
[Mh] Termos MeSH primário: Ablação por Cateter/métodos
Angiografia Coronária/métodos
Vasos Coronários/diagnóstico por imagem
Mapeamento Epicárdico/métodos
Taquicardia Ventricular/diagnóstico
Taquicardia Ventricular/cirurgia
[Mh] Termos MeSH secundário: Idoso
Feminino
Fluoroscopia
Seres Humanos
Técnica de Subtração
Cirurgia Assistida por Computador/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161213
[St] Status:MEDLINE
[do] DOI:10.1111/pace.12984



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