Long term effects after atrioventricular node slow pathway catheter-ablation

Region atrioventrikularnog (AV)čvora povezan sa nastankom supraventrikularnih tahikardija (SVT). Mogu se javiti u svakom životnom dobu ali veoma često su u pitanju mladi ljudi bez strukturne bolesti srca. Najčešća forma SVT je atrioventrikularna nodalna reentry tahikardija (AVNRT) koja se javlja kod 60-70% pacijenata. AVNRT nastaje zbog postojanja dva funkcionalno različita puta unutar AV čvora što podrazumeva dvojni sprovodni sistem ili dvojnu elektrofiziologiju. Ovakve elektrofiziološke karakteristike pogoduju nastanku kružnog kretanja impulsa (reentry) i nastanka supraventrikularne tahikardije. U sve tri forme AVNRT učestvuje spori put kao jedan krak tahikardije zbog čega je kateter-ablacija ili modifikacija sporog puta uspostavljena kao zlatni standard lečenja ovih pacijenata. Cilj intervencije je neinducibilnost tahikardije na kraju procedure i ovaj rezultat postiže se kod gotovo 99% pacijenata. U periodu dugoročnog praćenja kod 1-3% pacijenata dolazi do ponovne pojave AVNRT odnosno do parcijanog oporavka sprovodljivosti tkiva, što je indikacija za reintervenciju. Kod oko 1% pacijenata periproceduralno se javlja pojava AV bloka većeg stepena i zahteva implantaciju trajnog pejsmejkera. Period praćenja ovih pacijenata podrazumeva anketu o tegobama pre i posle ablacije, praćenje kvaliteta života, pojavu recidiva AVNRT, pojavu novih aritmija nakon ablacije i elektrokardiografsko praćenje PQ intervala odnosno kasne identifikacije AV bloka. Cilj: Cilj rada bio je prikazati dugoročnu uspešnost kateter-ablacije u lečenju najčešće kliničke forme supraventrikularne tahikardije- AVNRT,ustanoviti stopu kasne pojave AV bloka nakon višegodišnjeg praćenja,ustanoviti potrebu za prekidanjem ili redukcijom uzimanja antiaritmijske terapije i ispitati pojavu novih aritmija u periodu praćenja. Materijal i metod: Studija je kohortna. Studija je uključila sve ispitanike oba pola starije od 18 godina kojima je rađena kateter-ablacija sporog puta AV čvora u periodu od januara 2007. do decembra 2009. godine u Klinici za Kardiologiju Kliničkog Centra Srbije, a koji su ispunili uslove za uključenje u studiju. Intervencija je urađena kod 92 ispitanika. Pacijenti su biti klinički praćeni na kontrolnim pregledima nakon 12 meseci i nakon 10 godina posle urađene intervencije , do januara 2018. godine, radi analize ranih i kasnih ishoda intervencije...Region of atrioventricular (AV) node is associated with the development of supraventricular tachycardia (SVT). It can occur at any age, but very often it is the matter are young people without structural heart disease. The most common form of SVT is atrioventricular nodal reentry tachycardia (AVNRT) that occurs in 60-70% of patients. The AVNRT is created due to the existence of two functionally different paths within the AV node, which implies a dual conductive system or dual electrophysiology. Such electrophysiological characteristics favor the occurrence of circular motion of the pulse (reentry) and the formation of supraventricular tachycardia. In all three forms of AVNRT participates slow pathway as one arm of tachycardia, which is why catheter-ablation or modification is slow pathway as the gold standard of treatment for these patients. The goal of intervention is the noninducibility of tachycardia at the end of the procedure, and this result is achieved in almost 99% of patients. In the long-term follow-up period, 1-3% of patients experience AVNRT re-occurrence, or partial recovery of tissue conduction, which is an indication for reintervention. In approximately 1% of patients periprocedural occurrence of AV block of higher degree occurs and requires the implantation of a permanent pacemaker. The follow-up period for these patients involves a preand post-ablation questionnaire, monitoring the quality of life, the occurrence of AVNRT recurrence, the emergence of new arrhythmias after ablation, and electrocardiographic monitoring of the PQ interval or late AV block diagnosis. Objective: The aim of the paper was to demonstrate the long-term effectiveness of catheter ablation in the treatment of the most common clinical form of supraventricular tachycardia- AVNRT, to establish the rate of late AV block appearance after many years of follow-up, to determine the need to interrupt or reduce the use of antiarrhythmic therapy and to investigate the emergence of new arrhythmias during the monitoring period. Material and Method: The study is cohort. The study included all respondents of both sexes older than 18 years old who performed a catheter ablation of the slow AV pathway in the period from January 2007 to December 2009 at the Clinic for Cardiology of the Clinical Center of Serbia, who met the conditions for inclusion in the study..

Long term effects after atrioventricular node slow pathway catheter-ablation

Region atrioventrikularnog (AV)čvora povezan sa nastankom supraventrikularnih tahikardija (SVT). Mogu se javiti u svakom životnom dobu ali veoma često su u pitanju mladi ljudi bez strukturne bolesti srca. Najčešća forma SVT je atrioventrikularna nodalna reentry tahikardija (AVNRT) koja se javlja kod 60-70% pacijenata. AVNRT nastaje zbog postojanja dva funkcionalno različita puta unutar AV čvora što podrazumeva dvojni sprovodni sistem ili dvojnu elektrofiziologiju. Ovakve elektrofiziološke karakteristike pogoduju nastanku kružnog kretanja impulsa (reentry) i nastanka supraventrikularne tahikardije. U sve tri forme AVNRT učestvuje spori put kao jedan krak tahikardije zbog čega je kateter-ablacija ili modifikacija sporog puta uspostavljena kao zlatni standard lečenja ovih pacijenata. Cilj intervencije je neinducibilnost tahikardije na kraju procedure i ovaj rezultat postiže se kod gotovo 99% pacijenata. U periodu dugoročnog praćenja kod 1-3% pacijenata dolazi do ponovne pojave AVNRT odnosno do parcijanog oporavka sprovodljivosti tkiva, što je indikacija za reintervenciju. Kod oko 1% pacijenata periproceduralno se javlja pojava AV bloka većeg stepena i zahteva implantaciju trajnog pejsmejkera. Period praćenja ovih pacijenata podrazumeva anketu o tegobama pre i posle ablacije, praćenje kvaliteta života, pojavu recidiva AVNRT, pojavu novih aritmija nakon ablacije i elektrokardiografsko praćenje PQ intervala odnosno kasne identifikacije AV bloka. Cilj: Cilj rada bio je prikazati dugoročnu uspešnost kateter-ablacije u lečenju najčešće kliničke forme supraventrikularne tahikardije- AVNRT,ustanoviti stopu kasne pojave AV bloka nakon višegodišnjeg praćenja,ustanoviti potrebu za prekidanjem ili redukcijom uzimanja antiaritmijske terapije i ispitati pojavu novih aritmija u periodu praćenja. Materijal i metod: Studija je kohortna. Studija je uključila sve ispitanike oba pola starije od 18 godina kojima je rađena kateter-ablacija sporog puta AV čvora u periodu od januara 2007. do decembra 2009. godine u Klinici za Kardiologiju Kliničkog Centra Srbije, a koji su ispunili uslove za uključenje u studiju. Intervencija je urađena kod 92 ispitanika. Pacijenti su biti klinički praćeni na kontrolnim pregledima nakon 12 meseci i nakon 10 godina posle urađene intervencije , do januara 2018. godine, radi analize ranih i kasnih ishoda intervencije...Region of atrioventricular (AV) node is associated with the development of supraventricular tachycardia (SVT). It can occur at any age, but very often it is the matter are young people without structural heart disease. The most common form of SVT is atrioventricular nodal reentry tachycardia (AVNRT) that occurs in 60-70% of patients. The AVNRT is created due to the existence of two functionally different paths within the AV node, which implies a dual conductive system or dual electrophysiology. Such electrophysiological characteristics favor the occurrence of circular motion of the pulse (reentry) and the formation of supraventricular tachycardia. In all three forms of AVNRT participates slow pathway as one arm of tachycardia, which is why catheter-ablation or modification is slow pathway as the gold standard of treatment for these patients. The goal of intervention is the noninducibility of tachycardia at the end of the procedure, and this result is achieved in almost 99% of patients. In the long-term follow-up period, 1-3% of patients experience AVNRT re-occurrence, or partial recovery of tissue conduction, which is an indication for reintervention. In approximately 1% of patients periprocedural occurrence of AV block of higher degree occurs and requires the implantation of a permanent pacemaker. The follow-up period for these patients involves a preand post-ablation questionnaire, monitoring the quality of life, the occurrence of AVNRT recurrence, the emergence of new arrhythmias after ablation, and electrocardiographic monitoring of the PQ interval or late AV block diagnosis. Objective: The aim of the paper was to demonstrate the long-term effectiveness of catheter ablation in the treatment of the most common clinical form of supraventricular tachycardia- AVNRT, to establish the rate of late AV block appearance after many years of follow-up, to determine the need to interrupt or reduce the use of antiarrhythmic therapy and to investigate the emergence of new arrhythmias during the monitoring period. Material and Method: The study is cohort. The study included all respondents of both sexes older than 18 years old who performed a catheter ablation of the slow AV pathway in the period from January 2007 to December 2009 at the Clinic for Cardiology of the Clinical Center of Serbia, who met the conditions for inclusion in the study..

The occurrence of new arrhythmias after catheter-ablation of accessory pathway: Delayed arrhythmic side-effect of curative radiofrequency lesion?

Introduction. New arrhythmias (NA) may appear late after accessory pathway (AP) ablation, but their relation to curative radiofrequency (RF) lesion is unknown. Objective. The aim of this study was to determine the prevalence and predictors for NA occurrence after AP ablation and to investigate pro-arrhythmic effect of RF. Methods. Total of 124 patients (88 males, mean age 43±14 years) with Wolff-Parkinson-White syndrome and single AP have been followed after successful RF ablation. Post-ablation finding of arrhythmia, not recorded before the procedure, was considered a NA. The origin of NA was assessed by analysis of P-wave and/or QRS-complex morphology, and, thereafter, it was compared with locations of previously ablated APs. Results. Over the follow-up of 4.3±3.9 years, NA was registered in 20 patients (16%). The prevalence of specific NAs was as follows: atrioventricular (AV) block 0.8%, atrial premature beats 1.6%, atrial fibrillation 5.4%, atrial flutter 0.8%, sinus tachycardia 4.8%, ventricular premature beats (VPBs) 7.3%. Multivariate Cox-regression analysis identified (1) pre-ablation history of pathway-mediated tachyarrhythmias >10 years (HR=3.54, p=0.016) and (2) septal AP location (HR=4.25, p=0.003), as the independent predictors for NA occurrence. In four NA cases (two cases of septal VPBs, one of typical AFL and one of AV-block) presumed NA origin was identified in the vicinity of previous ablation target. Conclusion. NAs were found in 16% of patients after AP elimination. In few of these cases, late on-site arrhythmic effect of initially curative RF lesion might be possible. While earlier intervention could prevent NA occurrence, closer follow-up is advised after ablation of septal AP

Physiological behavior during stress anticipation across different chronic stress exposure adaptive models

Anticipation of stress induces physiological, behavioral and cognitive adjustments that are required for an appropriate response to the upcoming situation. Additional research examining the response of cardiopulmonary parameters and stress hormones during anticipation of stress in different chronic stress adaptive models is needed. As an addition to our previous research, a total of 57 subjects (16 elite male wrestlers, 21 water polo player and 20 sedentary subjects matched for age) were analyzed. Cardiopulmonary exercise testing (CPET) on a treadmill was used as the laboratory stress model; peak oxygen consumption (VO2) was obtained during CPET. Plasma levels of adrenocorticotropic hormone (ACTH), cortisol, alpha-melanocyte stimulating hormone (alpha-MSH) and N-terminal-pro-B type natriuretic peptide (NT-pro-BNP) were measured by radioimmunometric, radioimmunoassay and immunoassay sandwich technique, respectively, together with cardiopulmonary measurements, 10 minutes pre-CPET and at the initiation of CPET. The response of diastolic blood pressure and heart rate was different between groups during stress anticipation (p¼0.019, 0.049, respectively), while systolic blood pressure, peak VO2 and carbon-dioxide production responses were similar. ACTH and cortisol increased during the experimental condition, NT-pro-BNP decreased and alpha-MSH remained unchanged. All groups had similar hormonal responses during stress anticipation with the exception of the ACTH/cortisol ratio. In all three groups, DNT-pro-BNP during stress anticipation was the best independent predictor of peak VO2 (B¼36.01, r¼0.37, p¼0.001). In conclusion, the type of chronic stress exposure influences the hemodynamic response during anticipation of physical stress and the path of hormonal stress axis activation. Stress hormones released during stress anticipation may hold predictive value for overall cardiopulmonary performance during the stress condition. LAY SUMMARY The study revealed differences in hormonal and hemodynamic responses during anticipation of stress between athletes and sedentary participants. Stress hormones released during stress anticipation may hold predictive value for overall cardiopulmonary performance during the stress condition. Abbreviations: ACTH: adrenocorticitropic hormone; BSA: body surface area; BW: body weight; C: controls; CPET: cardiopulmonary exercise test; DBP: diastolic arterial blood pressure; FFM: fat-free mass; FM: fat mass; HR: heart rate; MSH: melanocyte-stimulating hormone; NT-pro-BNP: N terminal-pro-B type natriuretic peptide; SBP: systolic arterial blood pressure; VCO2: carbon dioxide production; VE: minute ventilation; VO2: oxygen consumption; W: wrestlers; WP: water polo player

Management and Outcome of Periprocedural Cardiac Perforation and Tamponade with Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Single Medium-Volume Center Experience

INTRODUCTION: Cardiac tamponade (CT) is a life-threatening complication of radiofrequency ablation (RFA). The course and outcome of CT in low-to-medium volume electrophysiology centers are underreported. METHODS: We analyzed the incidence, management and outcomes of CT in 1500 consecutive RFAs performed in our center during 2011–2016. RESULTS: Of 1500 RFAs performed in 1352 patients (age 55 years, interquartile range: 41–63), 569 were left-sided procedures (n = 406 with transseptal access). Conventional RFA or irrigated RFA was performed in 40.9% and 59.1% of procedures, respectively. Ablation was performed mostly for atrioventricular nodal reentrant tachycardia (25.4%), atrial fibrillation (AF; 18.5%), atrial flutter (18.4%), accessory pathway (16.5%) or idiopathic ventricular arrhythmia (VA; 12.3%), and rarely for structural VA (2.1%). CT occurred in 12 procedures (0.8%): 10 AF ablations, 1 idiopathic VA and 1 typical atrial flutter ablation. Factors significantly associated with CT were older age, pre-procedural oral anticoagulation, left-sided procedures, transseptal access, AF ablation, irrigated RFA and longer fluoroscopy time (on univariate analysis), and AF ablation (on multivariable analysis). The perforation site was located in the left atrium (n = 7), right atrium (n = 3), or in the left ventricle or coronary sinus (n = 1 each). Upon pericardiocentesis, two patients underwent urgent cardiac surgery because of continued bleeding. There was no fatal outcome. During the follow-up of 19 ± 14 months, eight patients were arrhythmia free. CONCLUSION: Incidence of RFA-related CT in our medium-volume center was low and significantly associated with AF ablation. The outcome of CT was mostly favorable after pericardiocentesis, but readily accessible cardiothoracic surgery back-up should be mandatory in RFA centers

Long-term follow-up after catheter-ablation of atrioventricular junction and pacemaker implantation in patients with uncontrolled atrial fibrillation and heart failure

Introduction. Atrioventricular (AV) junction ablation coupled with pacemaker implantation is an effective therapeutic option for rate control in atrial fibrillation (AF) and heart failure (HF). However, there is controversy regarding the long-term outcome of the procedure, since right ventricular stimulation can lead to left ventricular remodelling and HF. Objective. The aim of the study was to determine a 5-year outcome of the procedure on survival, HF control and myocardial function in patients with HF and uncontrolled AF. Methods. All patients with AF and HF who underwent AV-junction ablation with pacemaker implantation in our institution were followed after the procedure. HF diagnosis was established if ≥2 of the following criteria were present: 1) ejection fraction (EF) ≤45%; 2) previous episode of congestive HF (CHF); 3) NYHA-class ≥2; and 4) use of drug-therapy for HF. Results. Study included 32 patients (25 males; 53.4±9.6 years). The mean heart rate was 121±25 bpm before and 75±10 bpm after ablation (p=0.001). Over the follow-up of 5.0±4.0 years nine patients (28.1%) died (five died suddenly, three of terminal CHF and one of stroke). After the procedure, CHF occurrence was reduced (p=0.001), as well as the annual number of hospitalizations (p=0.001) and the number of drugs for CHF (p=0.028). In addition, NYHA-class and EF were improved, from 3.3±0.7 to 1.6±0.8 (p<0.001) and from 39±11% to 51±10% (p<0.001), respectively. Conclusion. In HF patients with uncontrolled AF, 5-year mortality after AV-junction ablation and pacemaker implantation was 28%. In the majority of these patients good rate of AF and HF control were achieved, as well as the improvement of functional status and myocardial contractility

Management and Outcome of Periprocedural Cardiac Perforation and Tamponade with Radiofrequency Catheter Ablation of Cardiac Arrhythmias: A Single Medium-Volume Center Experience

<p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found here<b>. </b><a href="https://link.springer.com/article/10.1007/s12325-016-0402-x">https://link.springer.com/article/10.1007/s12325-016-0402-x</a></p><p></p> <p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p><br></p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p