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.

scholarly journals Catheter ablation of Idiopathic Ventricular Arrhythmias in Nepal-5 Years Single Centre Experience

2021 ◽  
Vol 18 (2) ◽  
pp. 33-37
Author(s):  
Roshan Raut ◽  
Murari Dhungana ◽  
Man Bahadur KC ◽  
Mukunda Sharma ◽  
Surakshya Joshi ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Clinical Success ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Single Centre Experience ◽  
Single Operator ◽  
Acute Success

Background and Aims: Idiopathic ventricular arrhythmia (IVAs) is defined as premature ventricular complexes (PVCs), nonsustained ventricular tachycardia or sustained ventricular tachycardia (VT) in the absence of obvious structural heart disease. Catheter ablation has become an established treatment strategy for wide varieties of idiopathic ventricular arrhythmias. The aim of this study is to report the efficacy and safety of catheter ablation of idiopathic ventricular arrhythmias, for the first time in Nepal. Methods: This is a retrospective observational descriptive study of all patients who underwent electrophysiological study and radiofrequency catheter ablation for IVAs from March, 2015 to February 2020 at Shahid Gangalal National Heart center (SGNHC). Results: Altogether 101 patients underwent an EP study with intent to ablations for idiopathic ventricular arrhythmias. In 13 patients, ventricular arrhythmias were not present on the procedure day and also could not be induced in the lab, therefore ablation was performed in 88 patients only. RVOT was the most common site of these arrhythmias comprising 51% of all cases, followed by fascicular VT (34%) and basal left ventricular IVAs (15%). Out of 88 patients, the acute success of 7 patients could not be assessed because of very infrequent PVCs. Out of remaining 81 patients, acute success achieved in 77 patients (95%). Recurrence occurred in 9 patients (10.7%) and 4 patients underwent repeat ablation giving rise to over clinical success during follow up in 78 patients (88.7%). There were two major complications, one pulmonary embolism and another cardiac tamponade both managed successfully. Conclusion: This single-center single operator study demonstrates that catheter ablation of idiopathic ventricular arrhythmias has a high success and low complication rate

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 &lt;0.01 Female 71.8% 67.7% 0.52 Years symptomatic 9.3 ± 11.3 3.6 ± 8.1 &lt;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% &lt;0.01

P5701Impact of VT pleomorphism on the prognostic value of non-inducibility after catheter ablation in patients with non-ischemic cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Kimura ◽  
M Ebert ◽  
A P Wijnmaalen ◽  
S Trines ◽  
M De Riva Silva ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ischemic Cardiomyopathy ◽  
Cox Regression ◽  
Low Voltage ◽  
Electrical Storm ◽  
Genetic Mutations ◽  
Recurrence Rates ◽  
Cox Regression Analysis ◽  
Favorable Prognosis ◽  
Acute Success

Abstract Background In patients with non-ischemic cardiomyopathy (NICM), non-inducibility after catheter ablation has been associated with lower VT recurrence rates. We hypothesized that induced VT pleomorphism (PL-VT) may be indicative for a complex VT substrate that might be associated with poor ablation outcome independently of non-inducibility at the end of the procedure. Methods Consecutive patients with left-dominant NICM undergoing VT ablation (2008–2018) were included. All patients underwent genetic screening. PL-VT was defined as occurrence of ≥1 morphologically distinct QRS lasting for ≥6 consecutive beats during the same induced VT episode. Complete acute success was defined as non-inducibility of any VT at the end of procedure. Results Eighty-five patients (56±15 yrs, LVEF 38±12%), inducible for 365 VTs (median 3/patient, IQR 1–6) were included. PL-VT was observed in 29 patients (34%). Patients with PL-VT had more often anteroseptal substrates, a higher number of induced VTs, and larger endocardial bipolar (<1.5 mV) and unipolar low voltage (<8.01 mV) areas. Pathogenic genetic mutations were more frequently recognized in patients with PL-VT than in those without (59 vs. 34%, P=0.03), but there was no significant correlation in each representative mutation (Lamin A/C, Phospholamban, or Titin). Complete acute success was achieved in 34 patients (40%) and comparable between patients with PL-VT and those without (41 vs. 39%, P=0.85). After a median of 24 months, 53 patients (62%) had VT recurrence and 23 (27%) died. In multivariate Cox regression analysis, PL-VT and inducibility of any VT were significantly associated with VT recurrence (HR 4.07, CI 1.82–8.92; P=0.001, HR 2.22, CI 1.10–4.78; P=0.026, respectively) independent of NYHA, LVEF, electrical storm, genetic mutations, low voltage area, substrate location, and number of induced VTs. Of importance, the co-existence of PL-VT and persistent VT inducibility identified those at highest risk for VT recurrence after 2-years. (PL-VT (−)/complete success, 27%, PL-VT (−)/non-complete success, 50%, PL-VT (+)/complete success, 58%, PL-VT (+)/non-complete success 94%, Log-rank P<0.001, see figure). Figure 1 Conclusions Induced PL-VT was not associated with acute outcome but higher VT recurrence rate after catheter ablation in patients with NICM. Moreover, co-existence of PL-VT and persistent VT inducibility identifies patients at highest risk for VT recurrence whereas non-inducible patients without PL-VT have a favorable prognosis.

scholarly journals Successful Ablation of Ventricular Arrhythmia Without Fluoroscopy Guided by Carto 3 System in Pregnant Woman Without Structural Heart Disease

2020 ◽  
Vol 8 (2) ◽  
pp. 236-238
Author(s):  
Ayan Abdrakhmanov ◽  
Aliya Smagulova ◽  
Bayan Ainabekova
Keyword(s):  
Heart Disease ◽  
Pregnant Woman ◽  
Catheter Ablation ◽  
Pregnant Women ◽  
Electrophysiological Study ◽  
Harmful Effect ◽  
Structural Heart Disease ◽  
Interventional Treatment ◽  
Navigation Systems ◽  
Premature Ventricular Contractions

Introduction: Arrhythmias can take place in any period of pregnancy. In addition, the incidence of life-threatening ventricular arrhythmias in a pregnant woman without the organic pathology of the heart is rare. Interventional treatment should be carried out in cases of severe arrhythmias and drug resistance. The radiation exposure during ablation carries a potentially harmful effect on the mother and fetus although data on the zero-fluoroscopy ablation of arrhythmias in pregnant women is limited. Case Presentation: A 26-year-old female without structural heart disease at the gestation period of 26-28 weeks was admitted to a hospital due to severe symptoms of ventricular tachycardia (VT) and premature ventricular contractions. In this regard, the conservative therapy of β-blockers was ineffective and accompanied by a decrease in blood pressure to 60/40 mm Hg. Results: An intracardiac electrophysiological study and non-fluoroscopic catheter ablation were carried out considering the drug refractory and severe symptoms of VT. The ablation of the arrhythmia substrate was successfully performed using the Carto 3 System without fluoroscopy. Based on the results, the procedure was not associated with any maternal or fetal complications. Conclusions: In general, the non-fluoroscopic catheter ablation guided by electro-anatomical mapping and navigation systems is safe and applicable in the treatment of pregnant women with severe types of arrhythmias.

Age related macular degeneration (ARMD) – pathophysiological and clinical features and therapeutic concepts

2001 ◽  
Vol 58 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Ursula Körner-Stiefbold
Keyword(s):  
Macular Degeneration ◽  
Clinical Features ◽  
Altersbedingte Makuladegeneration ◽  
Age Related Macular Degeneration ◽  
Genetische Faktoren ◽  
Age Related ◽  
Therapeutic Concepts

Die altersbedingte Makuladegeneration (AMD) ist eine der häufigsten Ursachen für einen irreversiblen Visusverlust bei Patienten über 65 Jahre. Nahezu 30% der über 75-Jährigen sind von einer AMD betroffen. Trotz neuer Erkenntnisse in der Grundlagenforschung ist die Ätiologie, zu der auch genetische Faktoren gehören, noch nicht völlig geklärt. Aus diesem Grund sind die Behandlungsmöglichkeiten zum jetzigen Zeitpunkt noch limitiert, so dass man lediglich von Therapieansätzen sprechen kann. Die derzeit zur Verfügung stehenden Möglichkeiten wie medikamentöse, chirurgische und laser- und strahlentherapeutische Maßnahmen werden beschrieben.

Cognitive Factors Mediate the Relation Between Age and Flight Path Maintenance in General Aviation

2016 ◽  
Vol 6 (2) ◽  
pp. 81-90 ◽  
Author(s):  
Kathleen Van Benthem ◽  
Chris M. Herdman
Keyword(s):  
Cognitive Functioning ◽  
Flight Path ◽  
General Aviation ◽  
Cognitive Factors ◽  
Pilot Performance ◽  
Pilot Error ◽  
Age Related ◽  
And Performance ◽  
Relationship Of ◽  
The Relationship

Abstract. Identifying pilot attributes associated with risk is important, especially in general aviation where pilot error is implicated in most accidents. This research examined the relationship of pilot age, expertise, and cognitive functioning to deviations from an ideal circuit trajectory. In all, 54 pilots, of varying age, flew a Cessna 172 simulator. Cognitive measures were obtained using the CogScreen-AE ( Kay, 1995 ). Older age and lower levels of expertise and cognitive functioning were associated with significantly greater flight path deviations. The relationship between age and performance was fully mediated by a cluster of cognitive factors: speed and working memory, visual attention, and cognitive flexibility. These findings add to the literature showing that age-related changes in cognition may impact pilot performance.

scholarly journals Minimising radiation exposure in catheter ablation of ventricular arrhythmias

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matevž Jan ◽  
David Žižek ◽  
Tine Prolič Kalinšek ◽  
Dimitrij Kuhelj ◽  
Primož Trunk ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Ventricular Arrhythmias ◽  
Major Complication ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Complex Nature ◽  
Group 2 ◽  
Procedural Outcomes ◽  
Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

scholarly journals Vision before and after scharioth macular lens implantation in patients with AMD: an electrophysiological study

2021 ◽  
Author(s):  
Jan Kremláček ◽  
Jana Nekolová ◽  
Markéta Středová ◽  
Jana Langrová ◽  
Jana Szanyi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Peripheral Vision ◽  
Electrophysiological Study ◽  
Age Related Macular Degeneration ◽  
Peak Time ◽  
Pattern Reversal ◽  
Motion Onset ◽  
Age Related ◽  
Lens Implantation ◽  
Near Visual Acuity

Abstract Background For patients with age-related macular degeneration (AMD), a special intraocular lens implantation partially compensates for the loss in the central part of the visual field. For six months, we evaluated changes in neurophysiological parameters in patients implanted with a “Scharioth macula lens” (SML; a center near high add + 10 D and peripheral plano carrier bifocal lens designed to be located between the iris and an artificial lens). Methods Fourteen patients (5 M, 9 F, 63–87 years) with dry AMD were examined prior to and at 3 days after, as well as 1, 2, and 6 months after, implantation using pattern-reversal, motion-onset, and cognitive evoked potentials, psychophysical tests evaluating distant and near visual acuity, and contrast sensitivity. Results Near visual acuity without an external aid was significantly better six months after implantation than before implantation (Jaeger table median (lower; upper quartile): 4 (1; 6) vs. 15 (13; 17)). Distant visual acuity was significantly altered between the pre- (0.7 (0.5; 0.8) logMAR) and last postimplantation visits (0.8 (0.7; 0.8) logMAR), which matched prolongation of the P100 peak time (147 (135; 151) ms vs. 161 (141; 166) ms) of 15 arc min pattern-reversal VEPs and N2 peak time (191.5 (186.5; 214.5) ms vs. 205 (187; 218) ms) of peripheral motion-onset VEPs. Conclusion SML implantation significantly improved near vision. We also observed a slight but significant decrease in distant and peripheral vision. The most efficient electrophysiological approach to test patients with SML was the peripheral motion-onset stimulation, which evoked repeatable and readable VEPs.

Sign in / Sign up

Export Citation Format

Share Document