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- Asirvatham, Samuel J4
- Hocini, Mélèze4
- Khairy, Paul4
- Brinker, Jeffrey A3
- Callans, David J3
- D'Avila, Andre3
- Ellenbogen, Kenneth A3
- Enriquez, Andres3
- Haissaguerre3
- Haïssaguerre, Michel3
- Henrikson, Charles A3
- Jaïs, Pierre3
- Marchlinski, Francis E3
- Miller, Marc A3
- Reddy, Vivek Y3
- Sacher, Frédéric3
- Vijayaraman, Pugazhendhi3
- Belott, Peter H2
- Clémenty, Jacques2
- Cochet, Hubert2
- Derval, Nicolas2
- Suleiman, Mahmoud2
- Abbo, Aharon1
- Ali, Hussam1
- Alkhouli, Mohamad A1
Keyword
- Atrial fibrillation16
- Catheter ablation13
- Ablation8
- Lead extraction8
- ventricular tachycardia8
- VT8
- Ventricular tachycardia7
- AF6
- RV6
- atrial fibrillation5
- ICD5
- Implantable cardioverter-defibrillator5
- LA5
- pulmonary vein5
- PV5
- Complications4
- Congenital heart disease4
- Anticoagulation3
- Atrial tachycardia3
- Electrophysiology3
- Accessory pathway2
- Anatomy2
- AP2
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Hands On
92 Results
- Hands on
Ablation above the semilunar valves: When, why, and how? Part II
Heart RhythmVol. 5Issue 11p1625–1630Published online: May 6, 2008- Mahmoud Suleiman
- Samuel J. Asirvatham
Cited in Scopus: 22In this two-part series on arrhythmias occurring above the semilunar valve, we discuss the relevant underlying anatomy and the technique for mapping and ablation above the aortic and pulmonic valve. In part I, we focused on ventricular arrhythmias, and in this paper (part II), we discuss the anatomy and present knowledge of the substrate mapped and ablated above the aortic valve for atrial tachycardia in certain unusual accessory pathways. The background anatomy of the aortic valve has been discussed in part I of this series, to which the reader is referred. - Hands on
How to prevent, recognize, and manage complications of lead extraction. Part III: Procedural factors
Heart RhythmVol. 5Issue 9p1352–1354Published online: February 28, 2008- Charles A. Henrikson
- Jeffrey A. Brinker
Cited in Scopus: 30The major risks of percutaneous lead extraction include cardiac perforation (1%–4%), emergency cardiac surgery (1%–2%), and death (0.4%–0.8%). However, risk to an individual varies in accordance with a number of factors (Table 1), and informed consent must be tailored to the specific patient. Indicators of very high risk (Table 2) define relative contraindications to the procedure; patients without other options should be referred to experienced centers capable of managing these special cases. Surgical backup should be secured prior to every extraction. - Hands on
How to avoid inappropriate shocks
Heart RhythmVol. 5Issue 5p762–765Published online: January 18, 2008- David D. Spragg
- Ronald D. Berger
Cited in Scopus: 14Implantable cardioverter-defibrillator (ICD) usage has increased dramatically over the past decade. In part this is due to improved patient survival after myocardial infarction, but principally this is due to the increased number of implants for primary prevention. While the salutary effects of ICD therapy in this population of patients are generally accepted, complications from ICD implantation have become a common and pressing issue. First among these complications, both in terms of frequency and impact on quality of life, is inappropriate ICD therapy. - Hands on
Ablation using irrigated radiofrequency: A hands-on guide
Heart RhythmVol. 5Issue 6p899–902Published online: January 15, 2008- Daniel L. Lustgarten
- Peter S. Spector
Cited in Scopus: 12The advent of irrigated radiofrequency (RF) catheters has led to the common misconception that irrigation somehow makes ablation both safer and more effective. In fact, this is not true. Irrigation (or any other means of cooling the catheter tip) results in the ability to deliver greater energy and as such can lead to steam pops, collateral damage, and thrombus formation. It is important to recognize that irrigation allows greater energy delivery; it does not mandate it. The operator must determine the appropriate power settings, irrigant flow rates, and lesion duration for each ablation site. - Hands on
Novel ablative approach for atrial fibrillation to decrease risk of esophageal injury
Heart RhythmVol. 5Issue 4p624–627Published online: November 8, 2007- T. Jared Bunch
- John D. Day
Cited in Scopus: 44Percutaneous atrial fibrillation (AF) ablation using catheter-delivered radiofrequency energy continues to improve in safety and effectiveness. Nonetheless, the potential risk of esophageal injury often limits the ability to fully ablate the posterior portion of the left atrium to achieve optimal procedural success without complications. We present a comprehensive approach that addresses this challenge. Our ablative strategies include (1) identifying the esophagus to minimize ablative energy, when possible, in the proximity of the esophagus, (2) maximize the ability of the esophagus to remove heat and to heal from potential thermal injury, and (3) optimizing energy delivery to avoid deep tissue injury while maintaining procedural efficacy. - Hands on
How to prevent, recognize, and manage complications of lead extraction. Part II: Avoiding lead extraction—Noninfectious issues
Heart RhythmVol. 5Issue 8p1221–1223Published online: October 11, 2007- Charles A. Henrikson
- Jeffrey A. Brinker
Cited in Scopus: 11The first part of this review examined the infectious indications for lead extraction. This part discusses noninfectious indications for lead extraction and strategies for reducing the incidence of such indications. - Hands on
How to prevent, recognize, and manage complications of lead extraction. Part I: Avoiding lead extraction—Infectious issues
Heart RhythmVol. 5Issue 7p1083–1087Published online: October 11, 2007- Charles A. Henrikson
- Jeffrey A. Brinker
Cited in Scopus: 21As the number of implanted devices continues to grow, so does the need for extraction of chronic endocardial leads. Extraction carries with it considerable risk of morbidity and mortality (both intraprocedure and postprocedure), even in experienced hands. Although the evolution of technology directed at this approach has facilitated the successful removal of leads, no evidence indicates that this technology has lessened the incidence or nature of adverse events. Risks associated with lead extraction include vascular and cardiac perforation, tricuspid valve injury, various arrhythmias, sepsis, pulmonary embolism, bleeding, stroke, and myocardial infarction. - Hands on
Percutaneous extraction of coronary sinus vein and branch leads
Heart RhythmVol. 5Issue 3p491–495Published online: October 8, 2007- Martin C. Burke
Cited in Scopus: 8Extraction of cardiac leads and electrodes will continue to be a statistical necessity as electrode implant numbers and durations increase. Improved implant success and expanded indications in heart failure patients for left ventricular (LV) pacing electrodes via the coronary sinus (CS) and its branches have resulted in unique interactions among the leads, venous system, and epicardial heart that are not typically seen with traditional endocardial right heart cardiac electrodes. LV lead placement, as well as the myocardium’s response to it, requires continual evaluation to better understand the limitations that may be encountered during extraction of LV leads, especially as the mean duration of implant reaches beyond 1 year. - Hands on
European perspective on lead extraction: Part II
Heart RhythmVol. 5Issue 2p320–323Published online: September 21, 2007- Charles Kennergren
Cited in Scopus: 13If manual extraction is not successful, a locking stylet is used after the inner lumen is reamed using another stylet to remove debris. Use of a locking stylet with a very flexible tip is essential so that a tortuous lead can be negotiated. Equally important is locking the stylet as close as possible to the lead tip and not allowing the stylet to slip during the procedure. The risk of severing the sometimes fragile interpolar section of encapsulated bipolar leads is high if a positive lock close to the lead tip cannot be achieved. - Hands on
A European perspective on lead extraction: Part I
Heart RhythmVol. 5Issue 1p160–162Published online: September 21, 2007- Charles Kennergren
Cited in Scopus: 17The need for lead extraction has increased exponentially in the last decade due to greatly increased “total lead exposure time.” The increased total lead exposure time is the result of new indications for device treatment, device therapy involving more leads per patient, and longer average patient life. Improved general lead reliability noted over recent years may have decreased slightly the need for extraction; however, this effect is more than countered by recent advisories, recalls, and increased complication rates, probably related to many new centers offering device treatment. - Hands on
How to treat and identify device infections
Heart RhythmVol. 4Issue 11p1467–1470Published online: August 15, 2007- Bruce L. Wilkoff
Cited in Scopus: 41The incidence of device-related infections depends directly on the definition employed. The lack of precision is also compounded by the latency between the initiation and manifestation of the infection. It is not rare for there to be some erythema at the incision site during the first week of healing, and it is not clear that this represents infection. Less frequent, but still common, there can be a small, superficial stitch abscess, which will respond to local measures. When the diagnosis of device system infection is made, it should be made on the basis of pocket cellulitis, erosion, abscess, persistent bacteremia, or endocarditis with or without vegetation on the lead. - Hands on
Lead extraction
Heart RhythmVol. 4Issue 9p1238–1243Published online: July 19, 2007- Charles J. Love
Cited in Scopus: 16Lead extraction has grown from a “niche” procedure practiced by a select few individuals to a fairly widely disseminated technique. With the apparent increase in device infections, occluded veins and the need for device “upgrades,” more physicians are attempting to extract chronically implanted pacing and implantable cardioverter-defibrillator (ICD) leads. Unfortunately, obtaining training for this procedure is difficult outside of a training program at a center with a physician experienced in lead extraction. - Hands on
Lead extraction using the femoral vein
Heart RhythmVol. 4Issue 8p1102–1107Published online: June 18, 2007- Peter H. Belott
Cited in Scopus: 11Lead extraction using the femoral vein is an alternate approach for lead removal. It has often been dubbed “the inferior approach.” This is because today it is often reserved for use only after a failed primary approach via the implant vein. In reality it is the most versatile approach for lead removal. Prior to the advent of powered sheaths, it was frequently used as a primary approach. It is also the only approach, and the procedure of choice, for removal of broken or cut leads with free ends. - Hands on
How to select patients for lead extraction
Heart RhythmVol. 4Issue 7p978–985Published online: June 8, 2007- Michael E. Field
- Samuel O. Jones
- Laurence M. Epstein
Cited in Scopus: 32The techniques and tools for percutaneous removal of transvenous leads have undergone substantial development over the past several decades. Although the use of locking stylets and powered sheaths to free leads from encapsulated scar tissue has improved the success rate, the procedure still carries a significant risk of morbidity and mortality even in the hands of experienced operators. The threshold for lead extraction continues to evolve. The initial use of the procedure was limited to patients with life-threatening infections because of limited tools, lower success rates and high complication rates. - Hands on
How to perform linear lesions
Heart RhythmVol. 4Issue 6p803–809Published online: January 22, 2007- Pierre Jaïs
- Mélèze Hocini
- Mark D. O’Neill
- George J. Klein
- Sébastien Knecht
- Matsuo Sheiiro
- and others
Cited in Scopus: 59Atrial fibrillation (AF) is a particularly complex arrhythmia because the mechanisms leading to fibrillation are not fully understood. Accordingly, ablation strategies have evolved largely on an empirical basis. The creation of linear lesions is a fundamental strategy that is indispensable to an electrophysiology laboratory performing ablation for treatment of this arrhythmia. - Hands on
Pacing maneuvers for nonpulmonary vein sources: Part II
Heart RhythmVol. 4Issue 5p681–685Published online: January 15, 2007- Samuel J. Asirvatham
Cited in Scopus: 26Superior vena caval (SVC) potentials are similar to pulmonary vein (PV) potentials. The concepts of multiple far-field electrograms and the use of perivenous pacing and specific site and simultaneous pacing described above are equally applicable to understanding the complex electrograms found within the SVC (Figure 1). Specific sites that require pacing to determine the components of a complex electrogram found in the SVC include the right atrium (RA), azygos vein, anomalous PVs draining into the SVC, and right upper PV; in some cases, an anomalous superior branch of the right inferior PV may be required. - Hands on
Pulmonary vein–related maneuvers: Part I
Heart RhythmVol. 4Issue 4p538–544Published online: January 15, 2007- Samuel J. Asirvatham
Cited in Scopus: 36With the rapid evolution of atrial fibrillation ablation procedures, electrophysiologists have necessarily strived for simple and anatomic-based approaches. In all except the most straightforward procedures, however, questions regarding the significance of various potentials recorded on mapping and ablation catheters arise.1,2 Other articles in this series have described in detail the various approaches to atrial fibrillation ablation. In this article, the anatomic and electrophysiologic bases for pacing maneuvers used with a variety of ablation approaches are reviewed. - Hands on
How to determine and assess endpoints for left atrial ablation
Heart RhythmVol. 4Issue 3p374–380Published online: December 27, 2006- Kazuhiro Satomi
- Feifan Ouyang
- Karl-Heinz Kuck
Cited in Scopus: 4Studies have demonstrated that myocardium surrounding pulmonary vein (PV) ostia plays an important role in the initiation and perpetuation of atrial fibrillation (AF).1,2 This important finding has led to the development of segmental PV ostial isolation, circumferential ablation, and isolation around the PVs using circular linear lesions guided by three-dimensional (3D) electroanatomic mapping. Substrate modification using limited linear ablation also has been demonstrated to improve the clinical outcome after PV isolation in patients with AF inducibility. - Hands on
How to recognize, manage, and prevent complications during atrial fibrillation ablation
Heart RhythmVol. 4Issue 1p108–115Published online: December 1, 2006- Sanjay Dixit
- Francis E. Marchlinski
Cited in Scopus: 31Seminal observations by Haissaguerre et al1 demonstrating initiation of atrial fibrillation (AF) by pulmonary vein (PV) depolarizations led to the development of percutaneous catheter-based endocardial AF ablation procedure. Since its original description, the AF ablation procedure has evolved considerably. Currently, the most accepted ablation strategy involves creating circumferential radiofrequency (RF) ablation lesions around PV ostia (either individually or encircling wide areas around the left-sided and right-sided veins) with or without additional atrial lesions. - Hands on
How to use intracardiac echocardiography for atrial fibrillation ablation procedures
Heart RhythmVol. 4Issue 2p242–245Published online: November 10, 2006- David J. Callans
- Mark A. Wood
Cited in Scopus: 5Intracardiac echocardiography (ICE) has been an important tool in the development of advanced catheter ablation procedures. ICE technology now allows complete echocardiographic interrogation of all four heart chambers from the right atrium. A list of the uses for ICE in ablation procedures is given in Table 1. - Hands on
How and when to ablate the ligament of Marshall
Heart RhythmVol. 3Issue 12p1505–1507Published online: September 18, 2006- Chun Hwang
- Michael C. Fishbein
- Peng-Sheng Chen
Cited in Scopus: 32The ligament of Marshall is an epicardial vestigial fold that marks the location of the embryologic left superior vena cava. It contains the nerve, vein (vein of Marshall), and muscle tracts.1,2 The proximal portions of the muscle tracts connect directly to the coronary sinus myocardial sleeves. The distal portions of the muscle tracts extend upward into the pulmonary vein region. Figure 1 shows a postmortem human heart with the ligament of Marshall located between the left atrial (LA) appendage and left pulmonary vein. - Hands on
Catheter ablation of atrial fibrillation originating from extrapulmonary vein areas: Taipei approach
Heart RhythmVol. 3Issue 11p1386–1390Published online: September 12, 2006- Satoshi Higa
- Ching-Tai Tai
- Shih-Ann Chen
Cited in Scopus: 50The pulmonary veins (PVs) are a dominant source of ectopic activity initiating atrial fibrillation (AF).1,2 We and others have demonstrated that extra-PV ectopic activity could initiate AF, and elimination of ectopic activity can cure this specific group of patients with AF.3-6 The Bordeaux group demonstrated that extensive ablation of extra-PV areas after isolation of all four PVs can convert chronic AF to focal or macroreentrant atrial tachycardias, and further elimination of these atrial tachycardias could maintain sinus rhythm in approximately 90% of patients with chronic AF. - Hands on
How to perform ablation of the parasympathetic ganglia of the left atrium
Heart RhythmVol. 3Issue 10p1237–1239Published online: May 4, 2006- Robert Lemery
Cited in Scopus: 28Catheter ablation of atrial fibrillation (AF) has generally consisted of eliminating pulmonary vein (PV) triggers initiating AF1 or modifying the adjacent atrial substrate to isolate the PVs.2 Mapping and ablation of complex fractionated atrial electrograms, thought to be responsible for maintaining AF, also have been reported.3 However, all of these strategies likely are associated with varying degrees of denervation, as suggested by experimental,4 clinical, and systematic analysis of the effects of modification of autonomic tone on the outcome of AF ablation. - Hands on
How to do circular mapping catheter-guided pulmonary vein antrum isolation: The Cleveland Clinic approach
Heart RhythmVol. 3Issue 7p866–869Published online: April 24, 2006- Mohamed H. Kanj
- Oussama M. Wazni
- Andrea Natale
Cited in Scopus: 65Atrial fibrillation (AF) is one of the 20th-century epidemics. Over the past 2 decades, significant advances have been made in the treatment of AF, the last being percutaneous ablation. Haissaguerre et al1 showed that AF triggers often originate from the thoracic veins. The goal of present-day AF ablation is to electrically “disconnect” the pulmonary veins (PVs) from the rest of the left atrium (LA) by ablating around the origin of the veins.2 At present, at least two techniques are used for AF ablation. - Hands on
How to perform electrogram-guided atrial fibrillation ablation
Heart RhythmVol. 3Issue 8p981–984Published online: March 24, 2006- Koonlawee Nademanee
- Mark Schwab
- Joshua Porath
- Aharon Abbo
Cited in Scopus: 55Over the past decade, several mapping studies of human atrial fibrillation (AF) have made the following important observations: (1) Atrial electrograms during sustained atrial fibrillation have three distinct patterns: single potential, double potential, and complex fractionated potential(s) (CFAEs).1–3 (2) The distribution of these atrial electrograms during AF localizes to specific atrial sites, and these electrograms exhibit remarkable temporal and spatial stability.1,2 (3) The CFAE areas represent AF substrate sites and are important targets for AF ablation. - Hands on
How to perform encircling ablation of the left atrium
Heart RhythmVol. 3Issue 9p1105–1109Published online: March 15, 2006- Carlo Pappone
- Vincenzo Santinelli
Cited in Scopus: 25The purpose of this article is to describe the technique and results of circumferential pulmonary vein ablation (CPVA) in patients with atrial fibrillation (AF) as currently performed in Milan.1–14 Since a significant learning curve still exists with the standard procedure, we have recently developed a new system, called remote magnetic navigation and ablation, which can be performed by less experienced operators while at the same time still reducing complications.13 The results of our standard technique with manually deflectable catheters are based on about 10,000 patients with paroxysmal, persistent, or permanent AF, many of whom have structural heart disease. - Hands on
How to manage the patient with a high defibrillation threshold
Heart RhythmVol. 3Issue 4p492–495Published online: March 7, 2006- Sumeet K. Mainigi
- David J. Callans
Cited in Scopus: 44Defibrillation threshold (DFT) testing is an integral part of implantable cardioverter-defibrillator (ICD) placement and follow-up. Unfortunately, the DFT can vary widely from day to day, influenced by many factors including electrolytes, sympathetic tone, antiarrhythmic drugs, and other medications. For this reason, a 10-J safety margin between the lowest successful defibrillation energy during testing and the maximal device output has been widely adapted as standard practice.1 - Hands on
How to select patients for atrial fibrillation ablation
Heart RhythmVol. 3Issue 5p615–618Published online: January 25, 2006- Hakan Oral
- Fred Morady
Cited in Scopus: 26The goals of therapy for atrial fibrillation (AF) are elimination of symptoms and improvement in quality of life; prevention of complications such as thromboembolic events and tachycardia-mediated cardiomyopathy; and, at least in theory, improvement in survival. - Hands on
How to interpret and identify pulmonary vein recordings with the lasso catheter
Heart RhythmVol. 3Issue 6p748–750Published online: January 25, 2006- Yoshihide Takahashi
- Mark D. O’Neill
- Anders Jönsson
- Prashanthan Sanders
- Frédéric Sacher
- Mélèze Hocini
- and others
Cited in Scopus: 11Curative catheter ablation of atrial fibrillation (AF) began with the recognition of ectopic impulses triggering AF, originating dominantly from the pulmonary veins (PV). Electrical isolation of the PV from the LA was proposed to eliminate these triggers from the PV and is now performed with the aid of a circumferential PV mapping (lasso) catheter. In addition to the initiating role of the PV, this structure is also critical as a substrate maintaining AF.1 The importance of PV isolation in AF ablative therapy therefore remains unchanged since the development of this technique whether it is for paroxysmal, persistent or permanent AF. - Hands on
How to perform noncontact mapping
Heart RhythmVol. 3Issue 1p120–123Published online: November 8, 2005- Larry A. Chinitz
- Jesse S. Sethi
Cited in Scopus: 15The anatomic and electrophysiologic complexity of arrhythmias subject to evaluation and catheter-based therapy has increased over the past several years. Use of advanced mapping systems, capable of three-dimensional rendering of cardiac chambers and superimposition of electrical information, are not designed to replace conventional mapping techniques but to be used as an adjunctive tool in the analysis and treatment of complex arrhythmias. EnSite 3000 (Endocardial Solutions, Minneapolis, MN) was the first component of the EnSite mapping system capable of advanced electroanatomic evaluation through novel catheter design and capabilities. - Hands on
How to access the axillary vein
Heart RhythmVol. 3Issue 3p366–369Published online: November 8, 2005- Peter Belott
Cited in Scopus: 50The axillary vein has become a desirable structure for venous access for implantation of defibrillator and pacemaker leads because the vein is large, easily accessed, and can accommodate multiple leads. Furthermore, axillary vein access is not associated with problems accompanying subclavian vein access, including pneumothorax and subclavian crush syndrome.1,2 - Hands on
How to interpret electroanatomic maps
Heart RhythmVol. 3Issue 2p240–246Published online: November 8, 2005- Steven M. Markowitz
- Bruce B. Lerman
Cited in Scopus: 12Electroanatomic mapping refers to the acquisition and display of electrical information combined with spatial localization. Technologies presently available include both contact and noncontact electroanatomic mapping. This review focuses on the creation and proper interpretation of contact electroanatomic maps, which involves the sequential recording of unipolar or bipolar electrograms with a catheter in contact with the endocardium or epicardium and display of this information on a three-dimensional navigation system. - Hands on
How to analyze T-wave alternans
Heart RhythmVol. 2Issue 11p1268–1271Published online: July 29, 2005- Sergio Richter
- Gabor Duray
- Stefan H. Hohnloser
Cited in Scopus: 24Noninvasive detection of patients prone to ventricular tachyarrhythmias and sudden cardiac death using measurements of ventricular repolarization derived from the 12-lead surface ECG has received enormous interest. Among the methods introduced for this purpose are assessment of QT dispersion, determination of QT dynamics assessed from long-term ECG recordings, and morphologic assessment of T-wave patterns. Analysis of microvolt T-wave alternans has emerged as the most promising. Considerable experimental evidence links microvolt T-wave alternans to the genesis of life-threatening ventricular tachyarrhythmias. - Hands on
How to ablate left atrial flutter
Heart RhythmVol. 2Issue 10p1153–1157Published online: May 26, 2005- Dipen Shah
- Henri Sunthorn
- Haran Burri
- Pascale Gentil-Baron
Cited in Scopus: 5Typical atrial flutter ablation has become an increasingly common indication for catheter ablation, with success rates routinely exceeding 90% in most laboratories. In contrast, catheter ablation of left atrial flutter is technically challenging, and high success rates are uncommon. - Hands on
How to manage patients with inappropriate sinus tachycardia
Heart RhythmVol. 2Issue 9p1015–1019Published online: May 26, 2005- Win K. Shen
Cited in Scopus: 49The objective of this review is to provide an overview of current understanding of inappropriate sinus tachycardia, with a brief discussion on diagnosis, mechanisms, and therapy. I propose a broad and multidisciplinary management approach for the majority of patients with inappropriate sinus tachycardia. - Hands on
How to ablate atrioventricular nodal reentry using cryoenergy
Heart RhythmVol. 2Issue 8p893–896Published online: May 16, 2005- Peter L. Friedman
Cited in Scopus: 15Most electrophysiologists are well acquainted with the technique of radiofrequency (RF) ablation of AV nodal reentrant supraventricular tachycardia (AVNRT). This familiarity has, in turn, translated into a high degree of efficacy and safety with this method of ablation. On the other hand, catheter cryoablation is a relatively new approach for treating patients with AVNRT.1,2 Although the two ablation methods have certain similarities, understanding the unique features of cryoablation is important so that the method can be optimally used. - Hands-on
Locating focal atrial tachycardias from P-wave morphology
Heart RhythmVol. 2Issue 5p561–564Published online: March 22, 2005- Peter M. Kistler
- Jonathan M. Kalman
Cited in Scopus: 20Atrial tachycardia (AT) foci tend to cluster at characteristic anatomic locations that can be gleaned from careful analysis of the P wave. - Hands-on—associate editor: Kenneth A. Ellenbogen
Atrial lead implantation in the Bachmann bundle
Heart RhythmVol. 2Issue 7p784–786Published online: March 22, 2005- Steven J. Bailin
Cited in Scopus: 7The search for alternative atrial pacing sites has been driven by the observation that atrial activation patterns can influence the incidence of atrial fibrillation (AF).1,2 One goal of atrial pacing is to prevent nonphysiologic delay between right and left atrial activation. Pacing from atrial sites that decrease dispersion of atrial refractoriness may decrease the incidence of AF. - Hands on
Using the twelve-lead electrocardiogram to localize the site of origin of ventricular tachycardia
Heart RhythmVol. 2Issue 4p443–446Published online: March 11, 2005- Mark E. Josephson
- David J. Callans
Cited in Scopus: 59The basis of this review is the underlying hypothesis that the QRS morphology on 12-lead ECG is, to a great extent, determined by the site from which a focal ventricular tachycardia (VT) arises or from which a reentrant circuit exits the central isthmus to activate the “normal” myocardium. The ability to localize or, at the very least, regionalize “the sites of origin” of VTs enables the electrophysiologist to concentrate mapping to a specific region. Several factors limit the ability of the QRS patterns to localize VT origin, including (1) presence and size of infarction, (2) degree of intramyocardial fibrosis, (3) shape of the heart (e.g., aneurysm) and its position within the chest cavity, (4) site and mechanism of VT within an infarct or scarred area, (5) influence of nonuniform anisotropy in affecting propagation from the site of the tachycardia, (6) effects of acute ischemia, antiarrhythmic drugs, or metabolic abnormalities on conduction, (7) integrity of the His-Purkinje system, (8) presence of increased myocardial mass, and (9) presence of structural abnormalities unrelated to tachycardia origin or mechanisms. - Hands-on
Para-Hisian pacing: Useful clinical technique to differentiate retrograde conduction between accessory atrioventricular pathways and atrioventricular nodal pathways
Heart RhythmVol. 2Issue 6p667–672Published online: March 7, 2005- Hiroshi Nakagawa
- Warren M. Jackman
Cited in Scopus: 46Para-Hisian pacing is a useful tool to differentiate between retrograde conduction over an accessory pathway and retrograde conduction over the fast or slow atrioventricular (AV) nodal pathways.1–3 Para-Hisian pacing uses right ventricular (RV) pacing close to the His bundle or proximal right bundle branch (RBB). As the position of the ventricular pacing catheter changes subtly during respiration (or by changing pacing output), the pacing stimulus changes capture among (1) basal anteroseptal RV plus His bundle or proximal RBB (His bundle-RBB capture); (2) capture of basal anteroseptal RV alone; and (3) His bundle-RBB capture alone. - Hands on
Determining inferior vena cava-tricuspid isthmus block after typical atrial flutter ablation
Heart RhythmVol. 2Issue 3p328–332Published online: February 7, 2005- Francisco G. Cosío
- Paula Awamleh
- Agustín Pastor
- Ambrosio Núñez
Cited in Scopus: 9In typical atrial flutter, circular activation around the tricuspid ring is possible because the terminal crest prevents short-circuiting on the posterior wall, and the myocardium between the inferior vena cava (IVC) and the lower rim of the tricuspid ring is the obligatory pathway to close the circuit in the low right atrium (RA) (Figure 1). This IVC-tricuspid ring isthmus (cavotricuspid isthmus) has become the preferred target for ablation because it is the narrowest point of the circuit, it is easily accessible, and it is located far from the AV junction. - Hands on
Transseptal catheterization
Heart RhythmVol. 2Issue 2p212–214Published online: January 31, 2005- Emile G. Daoud
Cited in Scopus: 25Transseptal catheterization through the atrial septum has become a useful skill for electrophysiologists. The challenge for a successful transseptal puncture is positioning the Brockenbrough needle at the thinnest aspect of the atrial septum, the membranous fossa ovalis, guided by either intracardiac echocardiography (ICE) or fluoroscopy.1–5 This article describes the technical aspects of performing a transseptal puncture using ICE and fluoroscopic guidance.