Ablation of idiopathic ventricular tachycardia originating from posterior mitral annulus by using electroanatomical mapping

Tolga Aksu,1 Tumer Erdem Guler,1 Ebru Golcuk,2 Kazim Serhan Ozcan,1 Ismail Erden1 1Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey; 2Department of Cardiology, School of Medicine, Koç University, Istanbul, Turkey Abstract: Idiopathic ventricular tachycardia (IVT) is an important type of arrhythmia, which has distinct electrocardiographic features and treatment options. Most of the cases originate from right ventricular outflow tract and less frequently from the left ventricular outflow tract. IVTs originating from mitral annulus are rare, and little is known about the efficacy of radiofrequency catheter ablation in this form. We hereby present a rare case of IVT arising from posterior mitral annulus. The electrocardiographic, electrophysiological, and electroanatomical characteristics of this tachycardia are discussed. Keywords: radiofrequency, ventricular arrhythmia&nbsp

Successful focal ablation in a patient with electrical storm in the early postinfarction period: case report

Tolga Aksu,1 Tumer Erdem Guler,1 Ebru Golcuk,2 Kazim Serhan Ozcan,1 Ismail Erden1 1Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey; 2Department of Cardiology, School of Medicine, Koç University, Istanbul, Turkey Abstract: Electrical storm (ES) is associated with a poor prognosis if it occurs in the early postinfarction period (within 4 weeks). There are limited data on the efficacy and safety of catheter ablation in the early period. In the patients with postinfarction cardiomyopathy, ventricular tachycardia (VT) is usually caused by re-entry through slowly conducting tissue within areas of a myocardial scar, whereas for the early postinfarction period, the underlying mechanism of ES is not fully understood. We report a case of ES for which macroreentry was excluded as a mechanism of VT because of the clinical and electrophysiological properties of the tachycardia. The tachycardia was terminated by focal radiofrequency catheter ablation of the earliest site. The total procedure time was only 35 minutes. During a 12-month follow-up period, the patient has remained free of monomorphic VT episodes. On the basis of this case, we aimed to discuss the underlying mechanism of ES in the early postinfarction period and to evaluate the role of radiofrequency catheter ablation as a primary approach for treating ES. Keywords: ablation, electrical storm, ventricular tachycardi

Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report

Tolga Aksu, Tumer Erdem Guler, Ebru Golcuk, Ismail Erden, Kazim Serhan Ozcan Department of Cardiology, Kocaeli Derince Education and Research Hospital, Derince, Kocaeli, Turkey Abstract: Radiofrequency catheter ablation of the slow pathway is considered to be the treatment of choice for patients with atrioventricular nodal reentrant tachycardia. We report a 34-year-old female with mirror image dextrocardia due to unilateral pulmonary agenesis who underwent successful slow pathway ablation for typical atrioventricular nodal reentrant tachycardia. Using contrast injection, cardiac anatomy was identified in a short time and successfully ablated. Keywords: dextrocardia, AVNRT, ablation, pulmonary agenesi

Predictors of atrial fibrillation recurrence after cryoballoon ablation

Tolga Aksu,1 Erkan Baysal,2 Tümer Erdem Guler,1 Sukriye Ebru Golcuk,3 İsmail Erden,1 Kazim Serhan Ozcan11Department of Cardiology, Derince Education and Research Hospital, Kocaeli, 2Department of Cardiology, Diyarbakir Education and Research Hospital, Diyarbakir, 3Department of Cardiology, Faculty of Medicine, Koc University, Istanbul, TurkeyObjective: Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein isolation in the treatment of paroxysmal atrial fibrillation (AF). There are conflicting results about the predictors of AF recurrence. The aim of this study is to evaluate the role of hematological indices to predict AF recurrence after CA.Methods: A total of 49 patients (mean age 58.3±12.2 years, 51.02% female) with symptomatic paroxysmal AF underwent CA procedure. One hundred and sixty-eight pulmonary veins were used for pulmonary vein isolation with the second-generation cryoballoon. The hematological samples were obtained before and 24 hours after ablation.Results: At a mean follow-up of 10.2±2.4 months, the probability of being arrhythmia-free after a single procedure was 86%. Patients with AF recurrence had higher red cell distribution width levels (16.10%±1.44% vs 14.87%±0.48%, P=0.035). The neutrophil/lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein levels were detected in the patients with or without recurrence. Left atrial diameter (46.28±4.30 mm vs 41.02±4.10 mm, P=0.002), duration of AF (6.71±4.57 years vs 3.59±1.72 years, P=0.003), and age (65.01±15.39 years vs 54.29±11.32 years, P=0.033) were the other independent predictors of clinical recurrence after CA. Multiple regression analysis revealed that left atrial diameter was the only independent predictor for AF recurrence (P=0.012).Conclusion: In this study of patients with paroxysmal AF undergoing cryoablation, increased preablation red cell distribution width levels, and not C-reactive protein or erythrocyte sedimentation rate, was associated with a higher rate of AF recurrence. Our results support the role of a preablation, proinflammatory, and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important.Keywords: ablation, atrial fibrillation, cryoballoon, neutrophil, CRP, oxidative stres

Postpacing interval during right ventricular overdrive pacing to discriminate supraventricular from ventricular tachycardia

Introduction: Failure to differentiate supraventricular from ventricular arrhythmias is the most frequent cause of inappropriate implantable cardioverter-defibrillator (ICD) therapies. We hypothesized that the postpacing interval (PPI) after overdrive right ventricular pacing may differentiate ventricular (VT) from supraventricular tachycardia (SVT) such as sinus tachycardia, atrial flutter and atrial tachycardia. This hypothesis is based on the entrainment maneuver. Reentrant tachycardia circuit for VTs would haveshorter distance to RV apex than SVTs have, and the conduction time between a ventricular pacing site and the tachycardia origin is expected to be shorter in VTs than in SVTs. Methods: 220episodes from 38 patients with single chamber ICDs that RV overdrive pacing could not terminate or change the tachycardia cycle length (TCL) were retrospectively reviewed. Episodes were classified as VTs (n=115) and SVTs (n=105). TCLs, PPIs and PPI-TCL were compared between groups. Results: The cycle length of VTs was shorter than SVTs (320.6±30.3 vs 366.5±40 ms, p=0.001). PPI and PPI-TCL of VTs were shorter than SVTs (504.7±128.3 vs 689.2±121.8 ms, p=0.001, 184±103 vs 322.6±106.6 ms, p=0.001; respectively). ROC curve analysis demonstrated a 525 ms cut-off value for PPI has 89% sensitivity and 57.4% specificity to predict inappropriate ICD therapies due to SVTs (AUC:0.852). Similarly, A PPI-TCL <195 ms favored VT as a diagnosis rather than SVT with a 90% sensitivity, and 51% specificity (AUC:0.838). Conclusions: Analyzing of PPI during overdrive pacing from RV apex may discriminate supraventricular from ventricular tachycardia. This criterion may have a potential role in implantable devices that use a single ventricular lead