Apple Watch® facilitates single‐session catheter ablation of coexisting atrioventricular nodal reentrant tachycardia and atrioventricular reentrant tachycardia

We report a case of a 52-year old patient complaining of palpitations and syncope. His heart rate trends from his Apple Watch SE suggested two types of tachycardia, and we successfully performed ablation for both of them in a single session. Our case demonstrates the cardiological potential of smart watches.

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Introduction

ESC CardioMed ◽

10.1093/med/9780198784906.003.0475 ◽

2018 ◽

pp. 2049-2050

Author(s):

Carina Blomström-Lundqvist

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Tachycardia ◽

Atrioventricular Node ◽

Supraventricular Arrhythmia ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Reentrant Tachycardia ◽

Atrioventricular Reentrant Tachycardia ◽

Dc Cardioversion ◽

Premature Beats

Supraventricular arrhythmias encompass atrial premature beats, supraventricular tachycardias (SVTs), and atrial fibrillation. SVT is used to describe tachycardias in which the mechanism involves tissue from the His bundle or above, thus including atrial tachycardias, atrioventricular nodal reentrant tachycardia, and atrioventricular reentrant tachycardia due to accessory pathways. Atrial fibrillation is not included among the SVTs and is described elsewhere. The term tachycardia refers to atrial and/or ventricular rates greater than 100 beats per minute at rest. Atrial premature beats, the most common supraventricular arrhythmia, can be seen in Holter recordings in the majority of healthy individuals, and increase in frequency with age and presence of structural heart disease. Paroxysmal SVTs that can be terminated by vagal manoeuvres are usually reentrant tachycardias involving the atrioventricular node, such as atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia. Symptoms may result in a poor quality of life. Rarely, patients with the Wolff–Parkinson–White syndrome develop atrial fibrillation that may degenerate into ventricular fibrillation in case the anterograde refractory period of the accessory pathway is very short and permanent forms of SVTs result in tachycardiomyopathy with left ventricular dysfunction. Paroxysmal SVT can be terminated by vagal manoeuvres, adenosine, overdrive pacing, and DC cardioversion. Atrial flutter, the most common atrial tachycardia, is a macro-reentrant atrial tachycardia that can be terminated by drugs, overdrive atrial pacing, and DC cardioversion. Most SVTs can be successfully treated by catheter ablation facilitated by modern electroanatomical mapping systems. Long-term antiarrhythmic drug therapy may be required for patients who are not suitable for or cured by catheter ablation.

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Laser catheter ablation of atrial flutter and of atrioventricular nodal reentrant tachycardia in a single session

European Heart Journal ◽

10.1093/oxfordjournals.eurheartj.a060643 ◽

1994 ◽

Vol 15 (8) ◽

pp. 1147-1149 ◽

Cited By ~ 12

Author(s):

H. P. WEBER ◽

A. HEINZE

Keyword(s):

Catheter Ablation ◽

Atrial Flutter ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Single Session ◽

Reentrant Tachycardia

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Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.766571 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hong-Da Zhang ◽

Lei Ding ◽

Si-Xian Weng ◽

Bin Zhou ◽

Xiao-Tong Ding ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Catheter Ablation ◽

Left Ventricular ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Supraventricular Arrhythmias ◽

Reentrant Tachycardia ◽

Characteristic Analysis ◽

Free Survival ◽

Atrioventricular Reentrant Tachycardia

Background: A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated.Methods: We retrospectively enrolled 101 consecutive patients with HCM who were referred to the electrophysiology and arrhythmia service from May 2010 to October 2020. The clinical features and ablation outcomes were analyzed.Results: Seventy-eight patients had SVAs, which comprised 50 (64.1%) cases of atrial fibrillation (AF), 16 (20.5%) of atrial flutter (AFL), 15 (19.2%) of atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) of atrial arrhythmia (AT), and 3 (3.8%) of atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation and were followed up for a median (interquartile range) of 58.5 (82.9) months. There was no recurrence in patients with non-AF SVAs. In patients with AF, the 1- and 7-year AF-free survival rates were 87.5 and 49.5%, respectively. A receiver operator characteristic analysis showed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with a higher recurrence of AF, with an optimum cutoff value of 47 mm (c-statistic = 0.91, p = 0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan–Meier analysis, patients with a LVEDD ≥ 47 mm had worse AF-free survival than those with a LVEDD <47 mm (log-rank p = 0.014).Conclusions: In this unique population of HCM, AF was the most common SVA, followed in order by AFL, AVRT, AT, and AVNRT. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfactory. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM.

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Radiofrequency Catheter Ablation in Children with Supraventricular Tachycardias: Intermediate Term Follow up Results

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s8578 ◽

2012 ◽

Vol 6 ◽

pp. CMC.S8578 ◽

Cited By ~ 6

Author(s):

Mm. Hafez ◽

Mm. Abu-Elkheir ◽

M. Shokier ◽

Hf. Al-Marsafawy ◽

Hm. Abo-Haded ◽

...

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Reentrant Tachycardia ◽

Electrophysiologic Study ◽

Atrioventricular Reentrant Tachycardia ◽

Pediatric Age Group ◽

Line Of Therapy ◽

Supraventricular Tachycardias

The Purpose of the Study Radiofrequency (RF) catheter ablation represents an important advance in the management of children with cardiac arrhythmias and has rapidly become the standard and effective line of therapy for supraventricular tachycardias (SVTs) in pediatrics. The purpose of this study was to evaluate the intermediate term follow up results of radiofrequency catheter ablation in treatment of SVT in pediatric age group. Methods A total of 60 pediatric patients (mean age = 12.4 ± 5.3 years, ranged from 3 years to 18 years; male: female = 37:23; mean body weight was 32.02 ± 12.3 kg, ranged from 14 kg to 60 kg) with clinically documented SVT underwent an electrophysiologic study (EPS) and RF catheter ablation at Children's Hospital Mansoura University, Mansoura, Egypt during the period from January 2008 to December 2009 and they were followed up until October 2011. Results The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 45, 75%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 6, 10%), and atrial tachycardia (AT; n = 9, 15%). The success rate of the RF catheter ablation was 93.3% for AVRT, 66.7% for AVNRT, and 77.8% for AT, respectively. Procedure-related complications were infrequent (7/60, 11.7%), (atrial flutter during RF catheter ablation (4/60, 6.6%); ventricular fibrillation during RF catheter ablation (1/60, 1.6%); transient complete heart block during RF catheter ablation (2/60, 3.3%)). The recurrence rate was 8.3% (5/60) during a follow-up period of 34 ± 12 months. Conclusion RF catheter ablation is an effective and safe method to manage children with SVT.

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Characteristics and long-term ablation outcomes of supraventricular arrhythmias in hypertrophic cardiomyopathy: a 10-year, single-center experience

European Heart Journal ◽

10.1093/eurheartj/ehab724.0291 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

H D Zhang ◽

L Ding ◽

S X Weng ◽

B Zhou ◽

X T Ding ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Catheter Ablation ◽

Left Ventricular ◽

Atrioventricular Nodal Reentrant Tachycardia ◽

Supraventricular Arrhythmias ◽

Reentrant Tachycardia ◽

Free Survival ◽

Atrioventricular Reentrant Tachycardia ◽

Single Center Experience

Abstract Background A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated. Methods We retrospectively enrolled 101 consecutive symptomatic HCM patients with suspected arrhythmia from May 2010 to October 2020. The clinical features and ablation outcomes of patients with SVAs were further analyzed. Results Seventy-eight patients had SVAs, consisting of 50 (64.1%) atrial fibrillation (AF), 16 (20.5%) atrial flutter (AFL), 15 (19.2%) atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) atrial arrhythmia (AT), and 3 (3.8%) atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation including 14 for AF, 9 for AVRT, 6 for AFL, 3 for AVNRT, 1 for both AF and AFL, and 1 for both AF and AVRT. They were followed up for a median (interquartile range) of 58.5 (82.9) months. There were no recurrences for patients with non-AF SVAs. For patients with AF, the 1- and 7-year AF-free survival were 87.5% and 49.5%, respectively. A ROC analysis revealed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with higher recurrence of AF with an optimum cutoff value of 47mm (c-statistic = 0.91, p=0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan-Meier analysis, patients with LVEDD ≥47mm had worse AF-free survival (log-rank p=0.014). Conclusions AF is the most common SVA in HCM, with AFL, AVRT, AT, and AVNRT ranking the second to the last according to the prevalence. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfying. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): National Natural Science Foundation of China Figure 1 Figure 2

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