Accessory pathway ablation during atrial fibrillation in ebstein anomaly

2021 ◽  
Author(s):  
Taro Miyamoto ◽  
Yasushi Oginosawa ◽  
Keishiro Yagyu ◽  
Yasunobu Yamagishi ◽  
Keita Tsukahara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Accessory Pathway ◽  
Ebstein Anomaly

scholarly journals Ebstein Anomaly Focusing on Pre-excited Atrial Fibrillation Management

2021 ◽  
Vol 1 (2) ◽  
pp. 41-46
Author(s):  
Imelda Krisnasari ◽  
Sasmojo Widito ◽  
Ardian Rizal
Keyword(s):  
Atrial Fibrillation ◽  
Beta Blockers ◽  
Accessory Pathway ◽  
Ebstein’S Anomaly ◽  
Ebstein Anomaly ◽  
Ebstein's Anomaly ◽  
Wpw Syndrome ◽  
Downward Displacement ◽  
Long Time ◽  
History Of

Introduction: Ebstein’s anomaly is a rare abnormality of the heart associated with atrialization right ventricle and apical (downward) displacement of the tricuspid valve functional annulus. Twenty percents of patients with Ebstein’s anomaly accompanied with accessory pathway. The dilatation of atrium and aging process may develop atrial fibrillation (AF).Case Description: A 35 years old patient with recurrency palpitation, accompanied with dizziness and epigastric discomfort. He had history of taking propafenone 3 x 150 mg for long time while the palpitation recurrent. He was hospitalization due to propafenone could not suppress the palpitation. During monitor in hospital revealed haemodynamic stable with heart rate 160-180 beats/minute irregularly irregular. The electrocardiography showed atrial fibrillation with pre-excitation WPW syndrome. We performed electrical cardioversion 100 joule. Then the atrial fibrillation was convert to sinus rhythm with WPW pattern. The propafenone 3 x 150mg was continued. The patient was performed catheter radiofrequency ablation of the accessory pathway. Electrophysiology showed AV fusion at right anteroseptal pathway and preexcited atrial fibrillation with shortest RR interval 220 ms that converted by cardioversion. The ablation was successfully performed. Discussion: The accessory pathway is a complication of ebstein anomaly. Digoxin, beta-blockers, diltiazem, verapamil, and amiodarone are potentially harmful in pre-excited atrial fibrillation. Propafenone reduces fast inward potential by sodium channels, reduces spontaneous automaticity and prolongs the effective refractory periode so could be used in this case. Catheter ablation of accessory pathway in Ebstein anomaly with WPW syndrome was class I recommendation. In our case, the accessory pathway was successfully ablated.

Clinical Experience with a Novel, Irrigated, Flexible Tip Ablation Catheter to Optimise Therapy Delivery

2010 ◽  
Vol 6 (3) ◽  
pp. 66 ◽  
Author(s):  
Carlo Pappone ◽  
Luigi Giannelli ◽  
Vincenzo Santinelli ◽  
◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Clinical Experience ◽  
Accessory Pathway ◽  
Surrounding Tissue ◽  
Ablation Catheter ◽  
Innovative Design ◽  
Cavotricuspid Isthmus ◽  
Arrhythmogenic Substrate ◽  
Therapy Delivery

Innovative technologies are being developed to make current ablation procedures safer and easier. Sometimes conventional ablation catheters cannot easily adapt to anatomical targets, making radiofrequency applications challenging, time consuming or even ineffective. The Cool Flex is a novel, flexible and fully-irrigated tip catheter with an innovative design and various angular orientations to better adapt the ablation tip to the surrounding tissue. Here, peliminary experience with this new ablation catheter is reported in the treatment of different tachyarrhythmias, including slow and accessory pathway ablation, cavotricuspid isthmus-dependent atrial flutter and atrial fibrillation. One or two radiofreqency applications may be sufficient to eliminate the arrhythmogenic substrate in most patients without complications.

scholarly journals Abolishment of high-risk left lateral accessory pathway by myocardial infarction: a blessing in disguise? A case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Jim O’Brien ◽  
Nikola Kozhuharov ◽  
Shui Hao Chin ◽  
Mark Hall
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Case Report ◽  
High Risk ◽  
Coronary Sinus ◽  
Refractory Period ◽  
Accessory Pathway ◽  
Coronary Syndrome ◽  
Electrophysiology Study ◽  
Anomalous Coronary

Abstract Background Antegradely conducting left lateral accessory pathways are a risk for supraventricular tachycardias and pre-excited atrial fibrillation. Rarely, an anomalous coronary sinus can cause difficulty in locating the pathway. The left circumflex coronary artery and obtuse marginal branches supply the posterolateral left ventricle. We describe a case report of a high-risk accessory pathway associated with an anomalous coronary sinus which, between successive electrophysiology studies, was obliterated by a felicitous acute coronary syndrome in the left circumflex territory. Case summary A 49-year-old male with palpitations and manifest pre-excitation was referred for electrophysiology study. Initial study revealed a high-risk left lateral accessory pathway with antegrade effective refractory period of 240 ms and rapidly conducting pre-excited atrial fibrillation. The coronary sinus could not be cannulated to localize the pathway. Coronary angiography and cardiac computed tomography showed an anomalous coronary sinus emptying into the right atrial free wall and patent coronaries. While awaiting repeat electrophysiology study, the patient suffered an acute coronary syndrome with immediate loss of previously visible pre-excitation on electrocardiogram, and underwent stenting of an occluded marginal branch of the circumflex. Repeat electrophysiology study demonstrated a now low-risk accessory pathway (effective refractory period 390 ms). Since infarction, the patient’s palpitations have fully settled with all subsequent electrocardiograms devoid of manifest pre-excitation. Discussion Left lateral accessory pathways, which can associate with an anomalous coronary sinus, derive from tissue similar to normal ventricular myocardium and are vulnerable to ischaemic insults in the area subtended by the circumflex artery.

Self – Assessment MCQ Questions for Vol.1 No.3

2002 ◽  
Vol 1 (3) ◽  
Author(s):  
D Phil ◽  
DK Satchithananda ◽  
David McNamara ◽  
Joanna C Girling ◽  
Marguerite E Hill ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Pulmonary Embolism ◽  
Sinus Thrombosis ◽  
Accessory Pathway ◽  
Foot Drop ◽  
Ventricular Rate ◽  
Repeat Endoscopy ◽  
Increased Risk ◽  
Bleeding Gastric Ulcer

(DK Satchithananda, A Macnab & AJF Page) · The following are true of atrial fibrillation: 1. An irregularly irregular pulse is pathognomonic of atrial fibrillation. 2. Co-ordinated atrial activity at around 300 beats per minute is usually apparent on the 12 lead ECG. 3. Ventricular rate is usually between 100-160 beats per minute in untreated AF. 4. Bradycardia usually implies the presence of an accessory pathway. 5. P-waves may be visible on the baseline of a 12-lead ECG. · The following are true of cardioversion for AF: 6. Following successful electrical cardioversion, more than 90% of patients remain in sinus rhythm at 1 year. 7. Anticoagulation prior to cardioversion is not mandatory if the duration of AF is less than 48 hours. 8. Biphasic energy defibrillation is associated with a higher success rate. 9. Sotalol is contraindicated for patients with ischaemic heart disease. 10. Flecainide is the pharmacological treatment of choice for patients with structurally normal hearts. (P Bhandari & P Patel) · The following are associated with a higher mortality following upper GI haemorrhage: 11. Older age. 12. Co-existent liver disease. 13. Reflux oesophagitis on endoscopy. 14. Systolic blood pressure >100mmHg on admission. 15. Pulse rate · Following the diagnosis of bleeding gastric ulcer: 16. Oral proton pump inhibitors reduce likelihood of rebleeding. 17. Intravenous ranitidine should be administered if peptic ulcer disease is identified on endoscopy. 18. Helicobacter pylori eradication may be beneficial. 19. Repeat endoscopy is not required. 20. Aspirin is less likely to cause recurrence if enteric-coated. (A J Lindahl, M E Hill & D Phil) · Which of the following are common clinical features of Myasthenia Gravis? 21. Unilateral foot drop. 22. Nasal regurgitation when swallowing liquids. 23. Fluctuating hemiparesis. 24. Headache. 25. Unilateral dilated unreactive pupil. · Which of the following statements about MG are true? 26. It is predominantly a disease of young women. 27. Removal of a thymoma may result in disease remission. 28. It is rare before puberty. 29. The elderly are less likely to respond to medication. 30. A negative anti-acetylcholine receptor antibody test does not rule out the diagnosis. · When treating MG: 31. It is generally safe to start steroid treatment as an outpatient. 32. Steroids should be introduced slowly. 33. Most myasthenics manage well on anticholinesterases and do not require immunosuppression. 34. Gastrointestinal side effects are common with anticholinerases. (J C Girling) · During pregnancy: 35. The ECG finding of an S wave in lead I, Q-wave in lead III and inverted T-wave in lead III usually implies pulmonary embolism. 36. PO2 is usually lower with the patient supine. 37. Increased risk of pulmonary embolism is confined to the 3rd trimester. 38. Low molecular weight heparin should be avoided. 39. D-dimer is usually positive. · Following a first fit during pregnancy: 40. The absence of proteinuria and normal blood pressure excludes the diagnosis of eclampsia. 41. Treatment with magnesium sulphate is recommended for eclampsia. 42. Cortical sinus thrombosis should be considered. 43. Sodium valproate is the drug of choice for non-eclamptic fits. 44. Amniotic fluid embolism should be considered. (D McNamara) · Neuroleptic Malignant Syndrome (N.M.S.) and Serotonin Syndrome (S.S.) have the following differences: 45. S.S. has a higher mortality. 46. N.M.S. has a quicker onset. 47. S.S. has a slower course. 48. S.S. has a higher recurrence rate following drug rechallenge. 49. Laboratory findings are more supportive diagnostically of N.M.S. · Strategies with proven efficacy include: 50. ECT for S.S. 51. Cyproheptadine for N.M.S. 52. Dantrolene for S.S. 53. Benzodiazepines for both. 54. Artificial ventilation for both. · Risk factors for N.M.S. include: 55. agitation. 56. rapid neuroleptisation. 57. previous ECT. 58. brain injury. 59. females.

scholarly journals Catheter ablation for atrial fibrillation in very young patients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
K Yalin ◽  
B Ikitimur ◽  
T Aksu ◽  
AU Soysal ◽  
E Lyan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Accessory Pathway ◽  
Young Patients ◽  
Old Patients ◽  
Index Procedure ◽  
Holter Ecg ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pulmonary vein automaticity is an established trigger of paroxysmal atrial fibrillation (PAF) making pulmonary vein isolation (PVI)  the cornerstone for catheter ablation. However, data on triggers of AF and catheter ablation strategy in very young (<30 years old) patients are sparse. Methods and results: Sixteen young patients (mean age 25.2 ± 4.9 years; 75% men) with recurrent drug refractory PAF underwent EP study and ablation at 3 EP centers. None of the patients had structural heart disease or family history of AF. EP study revealed degeneration of induced supraventricular tachycardia (SVT) into AF in 5 patients (n = 5, 31.2%). Induced SVTs were left lateral concealed accessory pathway mediated orthodromic AVRT in two patients, typical AVNRT in two patients, and left superior PV tachycardia in one patient respectively. In patients with induced SVTs, SVT ablation without PVI was performed as an index procedure. Remaining patients underwent second generation cryoballoon (CB-2) based PVI (n = 11, 68.7%). There were no major complications related to ablation procedures. Follow-up was based on outpatient visits including 24-h Holter-ECG at 3, 6 and, 12 months post ablation, or additional Holter-ECG was ordered in case of symptoms suggesting recurrence. Recurrence was defined as any atrial tachyarrhythmia (ATA) episode >30s following a 3-month blanking period. After a median follow-up of 18.3 ± 6.2 months, 13 of 16 (81.2%) patients were free of ATA recurrence. None of the patients belonging to SVT ablation only group experienced ATA recurrence. Three patients with previous CB-2 PVI recurred, one had typical atrial flutter and underwent CTI ablation, remaining 2 patients had AF recurrence and medically followed. Conclusion In a considerable fraction of young adult patients with history of PAF SVTs may be responsible and SVT ablation without PVI may be sufficient as an index procedure. Catheter ablation AF seems to be safe and effective in this population.

scholarly journals The role of the accessory pathway radiofrequency catheter ablation in the secondary prevention of the malignant tachyarrhythmias in patients with Wolff-Parkinson-White syndrome

2010 ◽  
Vol 67 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Nebojsa Mujovic ◽  
Miodrag Grujic ◽  
Stevan Mrdja ◽  
Aleksandar Kocijancic ◽  
Tatjana Potpara ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Secondary Prevention ◽  
Emotional Stress ◽  
Drug Administration ◽  
Clinical Manifestation ◽  
Accessory Pathway

Background/Aim. The occurrence of atrial fibrillation (AF) in the presence of an accessory pathway (AP) that conducts rapidly is potentially lethal because the rapid ventricular response may lead to ventricular fibrillation (VF). The aim of the study was to determine long-term efficacy of AP catheter-ablation using radiofrequency (RF) current in secondary prevention of VF in WPW patients. Methods. Study included a total of 192 symptomatic WPW patients who underwent RF catheter-ablation of AP in our institution from 1994 to 2007 and were available for clinical follow-up for more than 3 months after procedure. Results. Before ablation, VF was recorded in total of 27 patients (14.1%). In 14 of patients (51.9%) VF was the first clinical manifestation of WPW syndrome. A total of 35 VF episodes were identified in 27 patients. The occurrence of VF was preceded by physical activity or emotional stress in 17.1% of cases, by alcohol abuse in 2.9% and by inappropriate intravenous drug administration in 28.6%. In addition, no clear precipitating factor was identified in 40% of VF cases, while informations about activities preceding 11.4% of VF episodes were not available. The follow-up of 5.7 ? 3.3 years was obtained in all of 27 VF patients. Of the 20 patients who underwent successful AP ablation, all were alive, without syncope or ventricular tachyarrhythmias during long-term follow-up. In 4 of 7 unsuccessfully treated patients, recurrence of supraventricular tachycardia and/or preexcited atrial fibrillation were recorded; one of these patients suddenly died of VF, 6 years after procedure. Conclusion. In significant proportion of WPW patients, VF was the first clinical manifestation of WPW syndrome, often precipitated by physical activity, emotional stress or inappropriate drug administration. Successful elimination of AP by percutaneous RF catheter-ablation is highly effective in secondary prevention of life-threatening tachyarrhythmias in patients with ventricular preexcitation.

Atrial fibrillation and supraventricular arrhythmias

2021 ◽  
pp. 719-739
Author(s):  
Demosthenes G Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Cycle Length ◽  
Accessory Pathway ◽  
Atrial Arrhythmias ◽  
Supraventricular Arrhythmias ◽  
Acute Setting ◽  
Epidemiology Data ◽  
Life Threatening ◽  
Appropriate Therapy

The term supraventricular tachycardia (SVT) refers to atrial arrhythmias, including atrial fibrillation, atrioventricular nodal reentry, and atrioventricular reentry due to accessory pathway(s). In clinical practice, SVT may present as narrow- or wide-QRS tachycardias, and with the potential exception of atrial fibrillation, most of them are usually, although not invariably, manifest as regular rhythms. They are usually intrusive, symptomatic, and anxiety provoking but not dangerous. However, depending on their cycle length and the patient's background, they could also be, rarely, life-threatening conditions. In the acute setting, consideration of epidemiology data, clinical presentation, and the 12 lead ECG can provide diagnostic clues for differential diagnosis between SVT and ventricular arrhythmias, and guide appropriate therapy.

Sign in / Sign up

Export Citation Format

Share Document