Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery

ObjectivesWe investigated the electrocardiographic (ECG) and electrophysiologic characteristics of ventricular tachycardia (VT) originating within the pulmonary artery (PA).BackgroundRadiofrequency catheter ablation (RFCA) is routinely applied to the endocardial surface of the right ventricular outflow tract (RVOT) in patients with idiopathic VT of left bundle branch block morphology. It was recently reported that this arrhythmia may originate within the PA.MethodsActivation mapping and ECG analysis were performed in 24 patients whose VTs or ventricular premature contractions (VPCs) were successfully ablated within the PA (PA group) and in 48 patients whose VTs or VPCs were successfully ablated from the endocardial surface of the RVOT (RV-end-OT group).ResultsR-wave amplitudes on inferior ECG leads, aVL/aVR ratio of Q-wave amplitude, and R/S ratio on lead V2were significantly larger in the PA group than in the RV-end-OT group. On intracardiac electrograms, atrial potentials were more frequently recorded in the PA group than in the RV-end-OT group (58% vs. 12%; p < 0.01). The amplitude of local ventricular potentials recorded during sinus rhythm within the PA was significantly lower than that recorded from the RV-end-OT (0.62 ± 0.56 mV vs. 1.55 ± 0.88 mV; p < 0.01).ConclusionsVentricular tachycardia originating within the PA has different electrocardiographic and electrophysiologic characteristics from that originating from the RV-end-OT. When mapping the RVOT area, the catheter may be located within the PA if a low-voltage atrial or local ventricular potential of <1-mV amplitude is recorded. Heightened attention must be paid if RFCA is required within the PA

Symptomatic periesophageal vagal nerve injury by different energy sources during atrial fibrillation ablation

BackgroundSymptomatic gastric hypomotility (SGH) is a rare but major complication of atrial fibrillation (AF) ablation, but data on this are scarce.ObjectiveWe compared the clinical course of SGH occurring with different energy sources.MethodsThis multicenter study retrospectively collected the characteristics and clinical outcomes of patients with SGH after AF ablation.ResultsThe data of 93 patients (67.0 ± 11.2 years, 68 men, 52 paroxysmal AF) with SGH after AF ablation were collected from 23 cardiovascular centers. Left atrial (LA) ablation sets included pulmonary vein isolation (PVI) alone, a PVI plus a roof-line, and an LA posterior wall isolation in 42 (45.2%), 11 (11.8%), and 40 (43.0%) patients, respectively. LA ablation was performed by radiofrequency ablation, cryoballoon ablation, or both in 38 (40.8%), 38 (40.8%), and 17 (18.3%) patients, respectively. SGH diagnoses were confirmed at 2 (1–4) days post-procedure, and 28 (30.1%) patients required re-hospitalizations. Fasting was required in 81 (92.0%) patients for 4 (2.5–5) days; the total hospitalization duration was 11 [7–19.8] days. After conservative treatment, symptoms disappeared in 22.3% of patients at 1 month, 48.9% at 2 months, 57.6% at 3 months, 84.6% at 6 months, and 89.7% at 12 months, however, one patient required surgery after radiofrequency ablation. Symptoms persisted for &gt;1-year post-procedure in 7 patients. The outcomes were similar regardless of the energy source and LA lesion set.ConclusionsThe clinical course of SGH was similar regardless of the energy source. The diagnosis was often delayed, and most recovered within 6 months, yet could persist for over 1 year in 10%

Is head injury characteristic of arrhythmic syncope?

Background: Of the syncope types, arrhythmic syncope is the most life threatening and therefore requires proper treatment. However, the clinical predictors of arrhythmic syncope remain unknown. Some patients with syncope suffer from head injury, a serious side effect whose importance in the differential diagnosis of syncope has not been fully studied. Here, we attempted to identify the clinical characteristics of arrhythmic syncope, including the role played by head injuries. Methods: We studied inpatients referred to the cardiology section for the diagnosis and treatment of syncope. Clinical characteristics including age, sex, incidence of head injury during syncope, and cardiologic studies were evaluated in patients with arrhythmic and non-arrhythmic syncope. Results: Of 5590 inpatients, 273 (4.8%) (170 men; mean age, 61±17 years) suffered a syncopal episode before admission, 119 (43%) of whom were diagnosed with arrhythmic syncope and 30 (11%) of whom were undiagnosed. In multivariate analysis, age >65 years (65% vs. 42%, p<0.005), abnormal electrocardiogram (66% vs. 43%, p<0.01), and the presence of a head injury (31% vs. 16%, p<0.01) were more prevalent in patients with arrhythmic syncope than in patients with non-arrhythmic syncope. Conclusions: Patients with arrhythmic syncope were older, suffered collateral head injuries more frequently, and were more likely to have abnormal electrocardiograms than patients with non-arrhythmic syncope did

ESSENCE‐Q obtained in routine Japanese public child health check‐ups may be a valuable tool in neurodevelopmental screening

Aim: Our aim was to extend the validity of a questionnaire developed for screening and identifying early symptomatic syndromes eliciting neurodevelopmental clinical examinations‐questionnaire (ESSENCE‐Q) in young children. Methods: Early symptomatic syndromes eliciting neurodevelopmental clinical examinations‐questionnaire data for 207 children, living in Aki City, Japan, in 2014‐2015, were obtained from mothers, public health nurses and psychologists at 20‐ and 40‐month routine check‐ups at child healthcare centres. These were checked against subsequent ESSENCE diagnoses made by physicians. Receiver operating characteristic curves were constructed, and the area under the curves was compared. Sensitivity, specificity, positive predictive values (PPVs) and negative predictive values were calculated at optimal cut‐off values. The clinical utility index was also calculated. Results: When the ESSENCE‐Q was used by public health nurses, it demonstrated good validity, in terms of high sensitivity and high NPVs, at the 20‐month check‐up, but not at 40 months. Psychologists demonstrated good validity at both ages, but mothers did not. Good negative utility indexes, indicating screening accuracy, were obtained from the psychologists at both check‐ups and from nurses at 20 months. Conclusion: The ESSENCE‐Q results used by nurses and psychologists showed good validity. Future studies should confirm the effectiveness of this tool to identify children in need of clinical detailed neurodevelopmental assessment