scholarly journals Voltage bridge mapping in atrioventricular nodal reentry tachycardia ablation in adult population: results from a multicenter registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Costa ◽  
W Rauhe ◽  
C Martignani ◽  
B Igniatiuk ◽  
P Sabbatani ◽  
...  
Keyword(s):  
Low Voltage ◽  
Adult Population ◽  
Slow Pathway ◽  
Type I ◽  
Type Ii ◽  
Tricuspid Annulus ◽  
Successful Ablation ◽  
Atrioventricular Nodal Reentry Tachycardia ◽  
The Relationship ◽  
Reentry Tachycardia

Abstract Funding Acknowledgements Type of funding sources: None. Background The presence of Low Voltage Bridge (LVB) in Atrioventricular Nodal Reentry Tachycardia (AVNRT) ablation has been described in children populations. Slow pathway ablations visualizing and targeting the LVB has been described to be safe and effective. However, the incidence of LVB in AVNRT ablation has not been widely explored in adult population. Purpose We aim to investigate the presence of LVB in adult patients (pts) undergoing AVNRT ablation, and the relationship between the LVB and the successful ablation site. We have also investigated the correlations between the Koch’s triangle (KT) anatomy and biophysical pts data. Methods The observational registry prospectively collected data of 165 pts. undergoing AVNRT ablation guided by 3D electroanatomical mapping system (EnSite - Abott, St Paul, MN) in 6 EP centers. Gender: 90F – 75M (55% - 45%) - Age: 57 ± 17 ys (min 15 – max 87) - Weight: 73 ± 15 kgs (min 42 - max 150)  Prior of ablation a voltage map of KT was created using diagnostic and ablation catheters. We define as Type I LVB a clear, long area of low voltage within the KT between the CS ostium and the AV node with the base on the edge of the tricuspid annulus and Type II LVB a narrow low voltage channel between normal-voltage regions with the base on the edge of the tricuspid annulus. The relationship between LVB and successful site was evaluated at the end of the procedure. KT anatomical data were correlated to gender, age and weight. Results The LVB was identified in 134 pts (81%) with a prevalence of type I (91 - 68%) over type II (33 - 25%). In 10 pts (7%) the LVB did not match type I nor type II. When an LVB was identified, the correspondence between the LVB and the successful ablation site was verified in 117 pts (87%). In addition, a shorter RF time was applied when an LVB was found (396s vs 298s; p = 0.03). Strong correlations between KT anatomy and biophysical pts data were not identified. The distance between His electrograms and the successful ablation site weakly correlated (ρ = -0.24, p < 0.01) with pts age suggesting a shortening in the distance with age progression. Conclusion The visualization of the Low Voltage Bridge may be a helpful tool to guide AVNRT ablation in a large cohort of pts; furthermore it is associated with reduced RF applications time. The KT characteristics are difficult to be predicted a priori according to patient gender, age or weight.

Abstract 25: The Use of Voltage Mapping for Slow Pathway Visualization and Ablation of Atrioventricular Nodal Reentry Tachycardia in Pediatric and Young Adult Patients

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Lindsey Malloy ◽  
Ian Law ◽  
Nicholas Von Bergen
Keyword(s):  
Low Voltage ◽  
Pediatric Population ◽  
Adult Patients ◽  
Voltage Gradient ◽  
Slow Pathway ◽  
Anatomical Location ◽  
Voltage Mapping ◽  
Atrioventricular Nodal Reentry Tachycardia ◽  
Reentry Tachycardia ◽  
Lower Voltage

Atrioventricular nodal reentry tachycardia (AVNRT) is a common arrhythmia in both pediatric and adult patients. Ablation of the arrhythmia substrate has typically been guided by anatomical location and electrogram morphology within the triangle of Koch. Using an anatomic approach can be challenging because of unusual pathway locations and anatomic variance. The use of voltage gradient mapping has been proposed in adults to aid in identification of the “slow pathway”, guiding placement of the ablation applications. The purpose of this study was to evaluate this novel technique of voltage guided ablation of AVNRT in a pediatric patient population, with a smaller triangle of Koch. Patients with atrioventricular nodal reentry tachycardia at the University of Iowa Children’s Hospital who underwent voltage mapping within the slow pathway area were included. Using intracardiac electrical recordings, three-dimensional voltage maps of the right atrium were created. A voltage map identified a bridge of lower voltage signals surrounded by even lower voltage tissue. This bridge was used to guide cryoablation of the slow pathway. Patient demographics, appearance of the intracardiac voltage mapping, timing of procedure, lesions to success, and total number of lesions was obtained. In this study there were 29 patients with an average age of 14 years (range 7 to 20 years) who underwent AVNRT ablation with voltage mapping. Ten were male. In these patients there was procedural success (no inducible AVNRT, single AV node echo beat or less) in all patients. In 25 of 29 patients, there was an adequate lower voltage saddle to allow guided ablation. The successful ablation site was within the first three lesions in 15/25 patients. Total lesions ranged from 5-34. There has been recurrence in 1 patient over an average follow-up period of one year (range five months - twenty months). The use of voltage guided ablation of a low voltage saddle in atrioventricular nodal reentry tachycardia is a technique that appears to be effective and safe in the pediatric population and has the advantage of allowing an electrically guided ablation therapy. Voltage guided ablation of atrioventricular nodal reentry tachycardia is a safe and effective technique for ablating AVNRT.

Revisiting the Relationships between Turkish Prospective Teachers' Thinking Styles and Behaviors Fostering Creativity

2017 ◽  
pp. 136-157
Author(s):  
Ayhan Dikici
Keyword(s):  
Factor Analysis ◽  
Trend Analysis ◽  
Prospective Teachers ◽  
Zero Order ◽  
Thinking Styles ◽  
Type I ◽  
Type Ii ◽  
Quadratic Trend ◽  
Fostering Creativity ◽  
The Relationship

This chapter aims to reexamine the relationship between Turkish prospective teachers' thinking styles and creativity fostering behaviors. In the study, 182 Turkish prospective teachers were participated. The Thinking Styles Inventory (TSI) and Creativity Fostering Teacher Index Scale (CFTIS) were administered to participants. An exploratory factor analysis, zero order and partial correlation, linear and quadratic trend analysis were conducted on the data. The results indicated that Type I thinking styles are a more powerful predictor for creativity fostering behaviors than Type II thinking styles. Prospective teachers' implicit opinions about creativity negatively predicted to CFTIS. Relationship between Type I and Type II thinking styles, and creativity fostering behaviors were positively significant in the results of quadratic trend analysis; however, the relationship between implicit opinions about creativity and creativity fostering behaviors were negatively significant in the analysis. The results obtained from the study were discussed based on previous studies.

1325Zero-fluoroscopy cryoablation for treatment of atrioventricular nodal reentry tachycardia in adult and pediatric patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Prolic Kalinsek ◽  
D Zizek ◽  
J Stublar ◽  
D Kuhelj ◽  
M Jan
Keyword(s):  
Pediatric Patients ◽  
Slow Pathway ◽  
Imaging Method ◽  
Rf Ablation ◽  
X Ray ◽  
Electroanatomic Mapping System ◽  
First Choice ◽  
Atrioventricular Nodal Reentry Tachycardia ◽  
Study Population ◽  
Reentry Tachycardia

Abstract Funding Acknowledgements None Introduction Cryoablation is considered a safe but somewhat less effective alternative to radiofrequency ablation (RF) for treatment of atrioventricular nodal reentry tachycardia (AVNRT). Additionally, it is traditionally performed with the aid of X-ray fluoroscopy as the principal imaging method causing radiation exposure, which is especially undesired in the pediatric population. Purpose The aim of our study was to assess feasibility, safety and success rate of nonfluoroscopic cryoablation for treatment of AVNRT. Methods Forty-eight consecutive patients with a diagnosed AVNRT (aged 40 ± 22 years, 29 (60%) female, 19 (40%) male) were included in the study. Among the study population, 14 (29%) were pediatric patients aged 11.5 ± 4.1 years. Cryoablation was used at the discretion of the operator. Only three dimensional electroanatomic mapping system and intracardiac electrograms were used to guide catheter movement and positioning. X-ray fluoroscopy was not used. The initial approach in all procedures was cryomapping in the region of the slow pathway during ongoing AVNRT, with a switch to cryoablation when termination of tachycardia within 20 seconds of reaching -30°C was achieved. When cryomapping was not possible due to catheter instability, cryoablation was used during ongoing AVNRT for up to 10 seconds at -70°C or lower. When AVNRT was not readily inducible, termination of slow pathway conduction was targeted with cryomapping during programmed stimulation with atrial extrastimuli. Procedural endpoint was noninducibility of AVNRT. Recorded residual slow pathway conduction was not considered a failure. Results Mean procedural duration was 79 ± 34 minutes. On average, 4 ± 2 cryoablations, with a 240 seconds of cryoablation time per each application. Cryoablation was used as a first choice in 45 (45/48, 93.7%) patients. In the remaining 3 patients (3/48, 6.3%) RF ablation failed as the first choice due to transient AV conduction disturbance and cryoablation had to be used to reach the endpoint. Cryoablation was unsuccessful only in 3 cases (6.6%) where RF ablation was needed to achieve procedural endpoint. Targeting termination of AVNRT during cryomapping or cryoablation was possible in 25 patients (25/48, 52%). In 14 patients AVNRT was not inducible and termination of the slow pathway conduction was targeted instead. In 9 patients inadvertent catheter tip contact mechanically terminated AVNRT or slow pathway conduction; site of mechanical termination was then targeted with cryoablation. After mean follow-up of 349 ± 201 days 47 patients were free of recurrence (47/48, 98%). There were no procedural complications. Conclusions In our study population with adult and pediatric patients, zero-fluoroscopy cryoablation of AVNRT proved feasible, safe and resulted in high success rates. Cryomapping or cryoablation for AVNRT termination was possible in approximately half of the procedures.

Association of Modic changes with health-related quality of life among patients referred to spine surgery

2014 ◽  
Vol 5 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Juhani Määttä ◽  
Hannu Kautiainen ◽  
Ville Leinonen ◽  
Jaakko Niinimäki ◽  
Salme Järvenpää ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spine Surgery ◽  
Modic Changes ◽  
Type I ◽  
Type Ii ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Relationship

AbstractBackground and purposeModic changes (MC) are bone marrow and vertebral endplate lesions seen in magnetic resonance imaging (MRI) which have been found to be associated with low back pain (LBP), but the association between MC and health-related quality of life (HRQoL) is poorly understood. The aim of this study was to assess the relationship between MC and HRQoL among patients referred to spine surgery.MethodsThe study population consisted of 181 patients referred to lumbar spine surgery in Northern and Eastern Finland between June 2007 and January 2011. HRQoL was assessed using RAND-36 health survey. Lumbar MC were evaluated and classified into ‘No MC’, ‘Type I’ (Type I or I/II), and ‘Type II’ (Type II, II/III or III).ResultsIn total, 84 patients (46%) had MC. Of these, 37% had ‘Type I’ and 63% ‘Type II’. Patients with MC were older, more likely females, had longer duration of LBP and a higher degree of disc degeneration than patients without MC. The total physical component or physical dimensions did not differ significantly between the groups. The total mental component of RAND-36 (P = 0.010), and dimensions of energy (P = 0.023), emotional well-being (P = 0.012) and emotional role functioning (P = 0.016) differed significantly between the groups after adjustments for age and gender. In the mental dimension scores, a statistically significant difference was found between ‘No MC’ and ‘Type II’.ConclusionsAmong patients referred to spine surgery, MC were not associated with physical dimensions of HRQoL including dimension of pain. However, ‘Type II’ MC were associated with lower mental status of HRQoL.ImplicationsOur study would suggest that Type II MC were associated with a worse mental status. This may affect the outcome of surgery as it is well recognized that patients with depression, for instance, have smaller improvements in HRQoL and disability. Thus the value of operative treatment for these patients should be recognized and taken into consideration in treatment. Our study shows that MC may affect outcome and thus clinicians and researchers should be cognizant of this and take this into account when comparing outcomes of surgical treatment in the future. A longitudinal study would be needed to properly address the relationship of MC with surgical outcome.

scholarly journals STUDIES ON MENINGOCOCCUS INFECTION

1935 ◽  
Vol 61 (4) ◽  
pp. 545-558 ◽  
Author(s):  
Geoffrey Rake
Keyword(s):  
Carrier State ◽  
The Body ◽  
Type I ◽  
Type Ii ◽  
Serological Reaction ◽  
Protective Antibodies ◽  
Upper Respiratory ◽  
Relationship Of ◽  
The Relationship ◽  
Atypical Strains

The investigation of this isolated epidemic of meningococcus meningitis at a C.C.C. camp gave an opportunity to examine the carrier state in contacts carrying what were presumably virulent epidemic strains of organisms. With the aid of Miller's technique for the enhancement of the demonstrable virulence of meningococci for mice, it proved possible to test the virulence of the carrier strains from Camp Rusk. These results were consistent despite the interval of from 3 to 4 weeks which intervened between the isolation of the strains and the virulence titrations. Type I strains were found to have a high virulence, while the virulence of Type II strains was moderately high but definitely less than that of the Type I, and atypical strains and strains of N. catarrhalis isolated from carriers showed a very low virulence. The question of the precise nature of the carrier state was investigated. No evidence has been obtained yet as to the existence of a relationship between pharyngitis, coryza or upper respiratory disease and the presence and degree of the carrier state. This is unlike the situation with regard to pneumococcus carriers. On the other hand, it has proved possible to demonstrate reactions within the body to the meningococci in the nasopharynx, consisting of the formation of agglutinins and protective antibodies in the blood serum. 32.3 per cent of Type I and 60 per cent of Type II carrier sera showed moderate or good agglutinins for homologous organisms and 80 per cent of Type I and 40 per cent of Type II sera showed moderate or good protective antibodies against virulent homologous strains. No idea could be obtained as to the relationship of the presence or absence and the degree of serological reaction and the duration of the carrier state.

scholarly journals A New Classification of Anterior Choroidal Artery Aneurysms and Its Clinical Application

2021 ◽  
Vol 13 ◽  
Author(s):  
Yu Duan ◽  
Xuanfeng Qin ◽  
Qinqzhu An ◽  
Yikui Liu ◽  
Jian Li ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Type I ◽  
Type Ii ◽  
Anterior Choroidal Artery ◽  
New Classification ◽  
Class 1 ◽  
Anterior Choroidal ◽  
The Relationship ◽  
Choroidal Artery

Background and Purpose: The aim of this study was to compare the different subtypes of anterior choroidal artery (AChoA) aneurysm based on a new classification and to analyze the risk factors according to individual endovascular treatment (EVT).Methods: In the new classification, AChoA aneurysms are classified into independent type (I type) and dependent type (II type) based on the relationship between the AChoA and the aneurysm. II type aneurysms have three subtypes, IIa (neck), IIb (body), and IIc (direct). We retrospectively analyzed 52 cases of AChoA aneurysm treated in our center between 2015 to 2019. There were 13 (25.0%) I type aneurysms, 24 (46.2%) IIa aneurysms, 15 (28.8%) IIb aneurysms, and no IIc type; 28 cases had a subarachnoid hemorrhage. According to our preoperative EVT plan for the different subtypes: II type should achieve Raymond-Roy Occlusion Class 1 (RROC 1) where possible. To protect the AChoA, it is best to preserve the neck of the IIa type aneurysms (RROC 2), and RROC 3 is enough for IIb type.Results: Ten asymptomatic cases with minimal aneurysms were treated conservatively. Of the other cases, 42 were treated with individualized EVT (26 with a simple coil, 6 with balloon-assisted coiling, 7 with stent-assisted coiling, and 3 by flow diverter. Different subtypes had different RROC (Z = 14.026, P = 0.001). IIb type aneurysms (χ2 = 7.54, P = 0.023) were one of the factors related to temporary or permanent AChoA injury during surgery. Overall, two patients (IIa = 1, IIb = 1) developed contralateral hemiparesis.Conclusions: The new classification diagram clearly shows the features of all types of AChoA aneurysm and makes EVT planning more explicit. The II type (particularly IIb) was a potential risk factor for AChoA injury.

scholarly journals CLEAR AS MUD: THE TYPE I/TYPE II MODEL FOR DEATH RECEPTOR-INDUCED APOPTOSIS

2006 ◽  
Vol 43 (2) ◽  
Author(s):  
David Michael Conrad
Keyword(s):  
Death Receptor ◽  
Mitochondrial Pathway ◽  
Type I ◽  
Biological Processes ◽  
Type Ii ◽  
Type Ii Cell ◽  
Mort Cellulaire ◽  
Induced Apoptosis ◽  
First Time ◽  
The Relationship

Apoptosis is a highly organized form of cell death that plays an important regulatory role in many biological processes. The relationship between the two classical signalling pathways of apoptosis, the “death receptor” and “mitochondrial” pathways, was only vaguely appreciated until 1998, when death receptor pathway-mediated activation of the mitochondrial pathway was clearly demonstrated for the first time. The “type I/type II” model of death receptor-mediated apoptosis was proposed and subsequently adopted for use in categorizing cells according to the involvement of the mitochondrion duringdeath receptor-induced apoptosis. Since that time, however, different interpretations of the type I/type II cell definition have appeared in the literature and, consequently, the meaning of type I and type II cells has become less clear.L’apoptose est une forme de mort cellulaire très structurée qui joue un rôle important de régulation dans un grand nombre de processus biologiques. La relation entre les deux voies de signalisation traditionnelles de l’apoptose, la voie des « récepteurs de mort » et la voie mitochondriale, n’était connue que vaguement avant 1998, l'année où l’activation de la voie mitochondriale par l’intermédiaire de la voie des récepteurs de mort a été clairement démontrée pour la première fois. Le modèle « type I / type II » d’apoptose par l’intermédiaire des récepteurs de mort a été proposé puis adopté auxfins de catégorisation des cellules en fonction de la participation des mitochondries à cette apoptose. Depuis, différentes interprétations ont toutefois été formulées dans des ouvrages scientifiques quant à la définition des cellules de type I et de type II et, par conséquent, la signification de « cellules de type I » et de « cellules de type II » est devenue moins évidente.

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