Clinical recurrence of palpitations following slow pathway ablation in patients with suspected paroxysmal supraventricular tachycardias but non-documented, non-inducible tachycardias

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Ramos Jimenez ◽  
A Marco Del Castillo ◽  
VC Lozano Granero ◽  
C Lazaro Rivera ◽  
R Salgado ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Clinical Suspicion ◽  
Therapeutic Modality ◽  
P Value ◽  
Slow Pathway ◽  
Clinical Recurrence ◽  
Slow Pathway Ablation ◽  
Supraventricular Tachycardias

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Catheter ablation is recommended as first-line treatment in patients with atrioventricular nodal reentry tachycardias (AVNRT). However, the best therapeutic modality in patients with dual AV nodal physiology but non-inducible tachycardias in electrophysiological study (EPS) remains controversial, especially when no tachycardias have been documented. Our objective was to evaluate the results of empirical slow pathway ablation in patients showing dual AV nodal physiology but non-inducible AVNRT. Methods Multicenter, retrospective, observational registry of consecutive patients undergoing EPS due to clinical suspicion of paroxysmal supraventricular tachycardias (PSVT), but with no prior ECG documentation. Clinical, EPS and ablation (when performed) data were collected and andalyzed.  Results 427 patients of 12 centers were included. Mean age was 46.3 ±16.1 and 297 (69.6%) were females. AVNRT was induced in 188 patients (typical in 181 cases, atypical in 7). Dual AV nodal physiology with or without single nodal echo beats, but with no sustained tachycardia and without evidence of accessory pathway was present in 68 patients. Ablation of the slow pathway was performed in 187/188 patients with AVNRT and in 30/68 patients with dual physiology. Among subjects with non-inducible tachycardia, ablation reduced significantly recurrences (39.5% in non-ablated vs. 16.7%; p = 0.04), with a level equivalent to those with ablated AVNRT(14.4% vs. 16.7%; p = 0.75). Procedure-related complications were similar in both groups: empirical ablation n = 1; 3.3% vs. induced tachycardia n = 6; 3.2% (p = 0.98). Conclusions In patients with high clinical suspicion of PSVT but non-documented and non-inducible arrhythmias, the presence of dual AV nodal physiology makes AVNRT a likely mechanism of the clinical tachycardia. Catheter ablation of slow pathway reduces the risk of recurrence to a level equivalent to those with inducible and ablated AVNRT. AVNRT (n = 188) Dual nodal physiology (n = 68) p value Age (years) 48.6 ± 16.3 41.9 ± 14.0 <0.01 Female 71.8% 67.7% 0.52 Years symptomatic 9.3 ± 11.3 3.6 ± 8.1 <0.01 Sudden onset 83.9% 88.0% 0.54 Abrupt end 73.4% 74.6% 0.96 Previous rate-slowing drugs 30.9% 25.0% 0.36 Previous antiarrhythmic drugs 5.9% 2.9% 0.35 Isoproterenol in EPS 70.0% 89.7% <0.01

scholarly journals Recurrence of palpitations following electrophysiological study and ablation in suspected but undocumented paroxysmal supraventricular tachycardias: follow-up results of the BELIEVE-SVT registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Marco Del Castillo ◽  
J Ramos Jimenez ◽  
VC Lozano Granero ◽  
M Rodriguez Manero ◽  
P Ramos Fernandez ◽  
...  
Keyword(s):  
Electrophysiological Study ◽  
Clinical Suspicion ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Early Referral ◽  
Clinical Recurrence ◽  
Funding Sources ◽  
High Clinical Suspicion ◽  
Pr Interval ◽  
Supraventricular Tachycardias

Abstract Funding Acknowledgements Type of funding sources: None. Introduction ECG documentation of paroxysmal supraventricular tachycardias (PSVT) may be challenging due to their short duration and usually abrupt end.  As ablation represents first-line treatment of this pathologies, it is not uncommon that physicians refer patients to electrophysiological study (EPS) when symptoms are suggestive of PSVT even though no ECG documentation has been obtained. Our objective was to evaluate the results of ablation performed in patients with induced arrhythmias in EPS but no previous ECG documentation. Methods Retrospective and observational multicenter registry of consecutive patients undergoing EPS, followed or not by ablation, referred because of undocumented clinical suspicion of PSVT. We collected clinical, EPS and clinical follow-up data, along with data regarding ablation, when performed. Descriptive statistical analysis was carried out using Stata. Results 427 patients of 12 centers were included. Mean age was 46.3 ± 16.1 and 297 (69.6%) were females. Sustained arrhythmias were induced in most patients (n = 255; 59.7%) and ablation was performed in 274 (64.2%). 10 complications (2.3% of procedures) were reported: 3 transient AV block, 2 PR interval prolongation, 2 puncture-related hematoma, 2 painful sites of puncture and 1 catheter entrapment in mitral chordae. During a mean follow-up of 3.1 ± 2.0 years, 111 patients experienced recurrence of palpitations, mostly (n = 77; 69.4%) without ECG documentation. Clinical recurrence was more frequent in subjects who had not been ablated (41.8% vs 17.2% in ablated patients; risk ratio 2.44 (CI 95% 1.77-3.36); p < 0.001). Table 1 shows types of clinical recurrences. Conclusions EPS in patients with high clinical suspicion of PSVT, followed by ablation when tachycardia is induced is effective in preventing future recurrences of palpitations. Early referral for EPS can, therefore, reduce visits to the emergency room, admissions and healthcare burden due to other low-yield, unnecessary tests. Type of recurrence ECG documentation 34(8.0%) ·Sinus rhythm 12(2.8%) ·Atrial tachycardia 6(1.4%) ·Typical atrioventricular nodal reentrant tachycardia 5(1.2%) ·Atrial fibrillation 5(1.2%) ·Premature ventricular beats 3(0.7%) ·Orthodromic atriventricular tachycardia 2(0.5%) Non documented recurrence 77(18.0%)

Radiofrequency catheter ablation for the treatment of supraventricular tachycardias in children and adolescents

2000 ◽  
Vol 10 (4) ◽  
pp. 376-383 ◽  
Author(s):  
Pedro Iturralde ◽  
Luís Colín ◽  
Sergio Kershenovich ◽  
Milton E. Guevara ◽  
Argelia Medeiros ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Atrial Flutter ◽  
Radiofrequency Catheter Ablation ◽  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Slow Pathway ◽  
Accessory Pathways ◽  
Children And Young Adults ◽  
Supraventricular Tachycardias ◽  
Fast Pathway

AbstractWe report our experience in radiofrequency catheter ablation between April, 1992 and December, 1998, in which we treated 287 parients less than 18 years of age (mean 14.3±3.1 years) with supraventricular tachycardia. Accessory pathways were the arrhythmic substrate in 252 of the patients (87.8%), the patients having a total of 265 accessory pathways. Atrioventricular nodal re-entry was the cause of tachycardia in 26 patients (9.0%), while atrial flutter was detected in the remaining 9 patients (3.1%). We were able successfully to eliminate the accessory pathway in 236 patients (89%), but 25 patients had recurrent arrhythmias. Ablation proved successful in all cases of atrioventricular node re-entry tachycardia, the slow pathway being ablated in 25 patients, and the fast pathway in only one case. Recurrence of the arrhythmia occurred in three patients (11.5%). We performed a second ablation in these children, all then proving successful. The ablation was successful in all cases of atrial flutter, with one recurrence (11.1%). Overall, therefore, ablation was immediately successful in 271 patients (94.4%), with a recurrence of the arrhythmia in 29 cases (10.7%). The incidence of serious complications was 2.09% There was one late death due to infective endocarditis, 3 patients suffered complete heart block, 1 had mild mitral regurgitation, and 1 patient developed an haematoma in the groin. We conclude that radiofrequency catheter ablation can now be considered a standard option for the management of paroxysmal supraventricular tachycardias in children and young adults.

P1450Deep vein thrombosis after right sided catheter ablation; more common then previously thought?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Bruce ◽  
S Rogers ◽  
K Saraf ◽  
G Kirkwood ◽  
N Kirkland ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Femoral Vein ◽  
Accessory Pathway ◽  
Significant Proportion ◽  
Anticoagulation Therapy ◽  
Vena Cava ◽  
Iliac Vein ◽  
P Value ◽  
Cardiac Catheter ◽  
Vein Thrombosis

Abstract Funding Acknowledgements Bristol-Myers Squibb Background Right sided cardiac catheter ablation has become an indispensable tool to treat supraventricular cardiac dysrhythmias, with ablation of certain arrhythmias having cure rates over 90%. Due to this the frequency of these procedures is increasing annually and it is imperative we understand the incidence of all complication. One lesser studied complication is that of deep vein thrombosis (DVT), for which catheter ablation demonstrates all elements of Virchow"s triad.  As right sided ablations are carried out to treat troublesome palpitations, not to reduce mortality, it is important all risks are identified, especially those which are themselves potentially life threatening and can be modified. Purpose   To determine the incidence of DVT after right sided cardiac catheter ablation. Methods   We undertook a prospective multi-center study recruiting adult patients undergoing clinically indicated cardiac ablation for atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia with right sided accessory pathway. Important exclusion criteria included patients on anticoagulation or antiplatelet therapy. Participants underwent bilateral compression venous duplex ultrasonography from the inferior vena cava to the popliteal vein to access for DVT at 24 hours and between 10 to 14 days post-procedure. The uncannulated contralateral leg acted as a control. Result   At interim analysis 71 participants had completed the study with average age 47 year (+/- 14), procedure duration 67 minutes, and with a female predominance. Seven patients developed acute DVT in either the femoral or internal iliac vein in the access leg. No thrombus was seen in the control leg. This gives an incidence of 10% (95% CI 4-19%) with p value of 0.023 on Chi-square testing. Conclusion We found a statistically significant proportion of patients undergoing right sided cardiac catheter ablation developed acute proximal DVT on ultrasound. All patients were treated with 3 to 6 months of anticoagulation therapy in accordance with NICE guidelines. These results suggest that DVT may occur at a high frequency then previously thought in this cohort and supports the consideration of peri-procedural prophylactic anticoagulation. Abstract Figure. Acute thrombus in the femoral vein

scholarly journals Twenty-five-year-old woman with palpitations and hypertrophic cardiomyopathy

Heart Asia ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. e011174 ◽  
Author(s):  
Krittapoom Akrawinthawong ◽  
Vineet Kumar
Keyword(s):  
Genetic Testing ◽  
Hypertrophic Cardiomyopathy ◽  
Catheter Ablation ◽  
Membrane Protein ◽  
Similar Condition ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
List Type ◽  
Danon Disease ◽  
Unexplained Syncope

Clinical introductionA 25-year-old woman with a diagnosis of hypertrophic cardiomyopathy (HCM) and pre-excitation on ECG presented with unexplained syncope and daily palpitation. Genetic testing was positive for lysosome-associated membrane protein 2 (LAMP2) mutation which confirmed the diagnosis of Danon disease. Her younger sister was diagnosed with a similar condition and received a defibrillator implantation. Her 12-lead ECG (figure 1) and a long strip tracing (figure 2) are shown below.Figure 112-lead ECG.QuestionWhere is the location of the accessory pathway and what is the next appropriate management?Anteroseptal pathway and catheter ablationMid-septal pathway and pacemaker/defibrillator implantationRight lateral pathway and catheter ablationFasciculoventricular pathway and electrophysiological studyLeft lateral pathway and electrophysiological study

scholarly journals Colchicine is an effective treatment for late onset AV-block caused by radiofrequency catheter ablation

2021 ◽  
Author(s):  
Tadashi Hoshiyama ◽  
Katsuo Noda ◽  
Kenichi Tsujita
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Late Onset ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Av Block ◽  
Reentrant Tachycardia ◽  
Slow Pathway Ablation ◽  
Complete Atrioventricular ◽  
Complete Av Block

We present a case of complete atrioventricular (AV) block following slow pathway ablation for atrioventricular nodal reentrant tachycardia (AVNRT) treated only by colchicine administration. The patient’s electrocardiogram showed complete AV-block at two weeks after catheter ablation. Colchicine is effective for late-onset AV-block caused by catheter ablation for AVNRT.

scholarly journals Radiofrequency Catheter Ablation of Left-sided Accessory Atrioventricular Pathways at Atrial Insertion Sites.

2013 ◽  
Vol 8 (2) ◽  
pp. 103-109
Author(s):  
Sabina Hashem ◽  
Mohsin Hossain ◽  
M Atahar Ali ◽  
Amal Kumar Choudhury ◽  
SM Ahsan Habib ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Radiofrequency Energy ◽  
Ablation Catheter ◽  
Accessory Pathways ◽  
Left Posterior ◽  
Primary Success ◽  
Insertion Sites

Background: This study assessed the efficacy and safety of techniques used to ablate left-sided accessory atrioventricular pathways at atrial insertion sites by retrograde aortic approach. Radiofrequency catheter ablation of left-sided accessory pathways by way of retrograde aortic approach can be highly successful. Methods: This study were done in the department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka from June 2009 and March 2010, a total 30 patients with recurrent SVT who has left sided accessory atrioventricular pathways found after electrophysiological study, underwent attempted radiofrequency catheter ablation of one or more accessory atrioventricular pathways by retrograde aortic approach. The ablation catheter was inserted into the femoral artery and passed retrogradely across the aortic valve .Once an optimal target site has been identified, radiofrequency energy at a pre-selected temperature of 55 - 60 0 C and power output set at 50 watts was delivered through the ablation catheter. Loss of preexcitation or interruption of the tachycardia within 5 seconds of RF application was considered effective and RF current was continued in this location 30 to 60 seconds. Ablation success was defined at completion of procedure as acutely successful or unsuccessful on the basis of successful elimination of all ablation targets. Results: During EP study it was found that 9 patients had concealed accessory pathways and 21 had manifest pre-excitation. WPW left-lateral pathway was present in 10 (33.3%), concealed left lateral in 08 (26.7%) ,WPW left posterior in 11 (36.7%), concealed left posterior in 1 (3.3%). Out of 30 accessory pathways, 24 were successfully interrupted with radiofrequency catheter ablation with a primary success rate of 80 %. The ratio of atrial/ ventricular electrogram in successful sites was 0.83 ±0.27 (0.53-1.46). There were no major complications with retrograde aortic approach. Six failed patients were ablated via transseptal method. Conclusion: The retrograde atrial insertion approach to left-sided accessory pathway ablation is very safe and high effective, especially suitable for the failed patients by using retrograde ventricular insertion ablation procedure and by using single-catheter ablation of accessory pathway. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16081 University Heart Journal Vol. 8, No. 2, July 2012

scholarly journals Delayed radiofrequency ablation efficacy in slow pathway ablation: a case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Ivan Zeljković ◽  
Nikola Pavlović ◽  
Vjekoslav Radeljić ◽  
Šime Manola
Keyword(s):  
Accessory Pathway ◽  
Three Dimensional ◽  
Premature Ventricular Contraction ◽  
Slow Pathway ◽  
Rf Ablation ◽  
Delayed Effect ◽  
Mapping Procedure ◽  
Junctional Rhythm ◽  
Slow Pathway Ablation

Abstract Background The delayed effect of radiofrequency (RF) ablation was described in cases of accessory pathway and premature ventricular contraction ablation, as well as delayed atrioventricular (AV) block after slow pathway ablation. Case summary We report a case of a female patient with AV nodal re-entry tachycardia (AVNRT), in whom the first electrophysiology study ended with acute failure of slow pathway ablation, despite using long steerable sheath, both right and left-sided ablation with >15 min of RF energy application and repeatedly achieving junctional rhythm. Six weeks afterwards, during scheduled three-dimensional electroanatomical mapping procedure, there was no proof of dual AV nodal conduction nor could the tachycardia be induced. Also, the patient did not have palpitations between the two procedures nor during the 12-month follow-up period. Discussion This case illustrates that watchful waiting for delayed RF ablation efficacy in some cases of AVNRT ablation could be reasonable, in order to reduce the risk of complications associated with slow pathway ablation.

scholarly journals Sudden Cardiac Death: The Most Feared but Potentially Preventable Presentation of Wolff-Parkinson-White Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ana Rita Pereira ◽  
Alexandra Briosa ◽  
Rita Miranda ◽  
Sofia Sequeira Almeida ◽  
Luís Brandão ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Life Support ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Haemodynamic Instability ◽  
White Syndrome ◽  
Asymptomatic Patients ◽  
Wolff Parkinson White Syndrome

Background. Wolff-Parkinson-White syndrome is an uncommon cardiac disorder characterized by the presence of one or more accessory pathways that predispose patients to frequent episodes of arrhythmias. The prognosis is usually good, but there is a lifetime risk of malignant arrhythmias and sudden cardiac death. Case Summary. A 25-year-old male presented a witnessed out-of-hospital cardiac arrest with ventricular fibrillation rhythm. Due to rapid initiation of prehospital advanced life support, return of spontaneous circulation was observed. During the transport to the hospital, an irregular wide complex tachycardia suggestive of preexcited atrial fibrillation with haemodynamic instability was also observed and a synchronized shock was applied. Baseline 12-lead electrocardiogram was compatible with sinus rhythm and ventricular preexcitation pattern. After clinical stabilization, an electrophysiological study was performed confirming the presence of a left anterolateral accessory pathway with a short antegrade effective refractory period. Successful radiofrequency catheter ablation was achieved. Discussion. The reported clinical case recalls fundamental features of the Wolff-Parkinson-White syndrome and outlines the increasing evidence and importance of the invasive risk stratification and even catheter ablation in asymptomatic patients who suffer from this uncommon disease that may have a dramatic and fatal initial clinical manifestation.

Association of age with clinical features and ablation outcomes of paroxysmal supraventricular tachycardias

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319685
Author(s):  
Pablo Ávila ◽  
David Calvo ◽  
María Tamargo ◽  
Aitor Uribarri ◽  
Tomas Datino ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Clinical Features ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
Continuous Variable ◽  
Recurrence Rates ◽  
Age Related ◽  
Acute Success ◽  
Supraventricular Tachycardias ◽  
Relationship Of

ObjectiveThe role of age in clinical characteristics and catheter ablation outcomes of atrioventricular nodal re-entrant tachycardia (AVNRT) or orthodromic atrioventricular re-entrant tachycardia (AVRT) has been assessed in retrospective studies categorising age by arbitrary cut-offs, but contemporary analyses of age-related trends are lacking. We aimed to study the relationship of age with epidemiological, clinical features and catheter ablation outcomes of AVNRT and AVRT.MethodsWe recruited 600 patients (median age 56 years, 60% female) with a confirmed diagnosis of AVNRT (n=455) or AVRT (n=145) by means of an electrophysiological study. They were interrogated for arrhythmia-related symptoms with a structured questionnaire and followed up to 1 year. We analysed age as a continuous variable using regression models and adjusting for relevant covariables.ResultsBoth typical and atypical forms of AVNRT upraised with age while AVRT decreased (p<0.001 by regression). Female sex predominance in AVNRT was not observed in older patients. Overall, these tachycardias became more symptomatic with ageing despite a longer tachycardia cycle length (p<0.001) and regardless of the presence of structural heart disease, with a higher proportion of dizziness, syncope, chest pain or dyspnoea (p<0.005 for all) and a lower presence of palpitations or neck pounding (p<0.001 for both). Age was not associated with catheter ablation acute success, periprocedural complications or 1-year recurrence rates (p>0.05 for all).ConclusionsAge, evaluated as a continuous variable, had a significant association with the clinical profile of patients with AVNRT and AVRT. Nevertheless, catheter ablation outcomes and complications were not significantly related to patients’ age.

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