We sought to evaluate prospectively the safety and efficacy of cryothermal energy to ablate typical atrial flutter (AFL). Ablation of cardiac tissue using cryothermal energy has recently been developed as an alternative to radiofrequency energy, which may offer certain advantages in the treatment of AFL. This prospective, multicenter nonrandomized study ...

Ablation of supraventricular tachycardia in elderly persons presents a challenging problem to electrophysiologists. Friable cardiac structures, prone to catheter perforation, comorbid cardiovascular disease, and the propensity to develop atrial fibrillation and thromboembolic complications, place these patients at high risk. Newer techniques for cardiac mapping and ablation, the establishment of precise ...

Non-surgical transpericardial approach for catheter-based epicardial radiofrequency ablation of post-infarction left ventricular tachycardia has been described as an alternative and additive procedure to standard endocardial technique for delivery of radiofrequency energy in difficult situations. We report our initial experience with this approach in three patients of post-infarction recurrent ventricular tachycardia, ...

Cardiac neuroablation is a new technique for management of patients with dominantly adverse parasympathetic autonomic influence. The technique is based on radiofrequency (RF) ablation of autonomic connections in the three main ganglia around the heart. Their connections are identified by Fast-Fourier Transforms (FFTs) of endocardial signals: sites of autonomic nervous ...

PURPOSE OF REVIEW: The purpose of the review is to provide an update on the safety and efficacy of catheter cryoablation. RECENT FINDINGS: Catheter cryoablation is a safe and clinically effective method for ablation of atrioventricular nodal reentrant supraventricular tachycardia. Although the acute procedural success rate of catheter cryoablation for ...

Linear left atrial ablation is performed in combination with pulmonary vein (PV) isolation to improve the clinical results of atrial fibrillation (AF) ablation. These procedures require long procedures and fluoroscopic exposure. The aim of the present study was to evaluate the performance of a new, nonfluoroscopic, real-time, three-dimensional navigation system ...

Atrial tachycardias resulting from recipient-to-donor atrio-atrial conduction after orthotopic heart transplantation are difficult to treat. We present two patients in whom atrial tachycardia originating in the recipient heart were successfully treated by radiofrequency ablation guided by electroanatomical CARTO mapping system. These cases illustrate that such atrial tachycardia are curable by ...

Arrhythmogenic right ventricular dysplasia/cardiomyopathy is a disorder characterized by frequent ventricular tachycardia originating from the right ventricle and fibro-fatty replacement of right ventricular myocardium. Though the disorder was originally described during surgical ablation of refractory ventricular tachycardia, catheter ablation of tachycardia is one of the options for patients not responding ...

Long-term infusion of benzodiazepines and opioids is strongly associated with dependence and withdrawal syndromes. We report the first case of severe benzodiazepine and opioid withdrawal resulting in transient myocardial ischemia. A 6-month-old female born at 25 weeks gestation with severe opioid and benzodiazepine dependence resulting from multiple operative procedures and ...

OBJECTIVES: In a series of in vitro and in vivo experiments, we evaluated the feasibility of integrating three-dimensional (3D) magnetic resonance imaging (MRI) and electroanatomic mapping (EAM) data to guide real-time left ventricular (LV) catheter manipulation. BACKGROUND: Substrate-based catheter ablation of post-myocardial infarction ventricular tachycardia requires delineation of the scarred ...

A 6 Fr guiding catheter is commonly used in the percutaneous coronary intervention (PCI). However, one of the limitations of the 6 Fr guiding catheter is its weak backup support compared to a 7 or an 8 Fr guiding catheter. In this article, we present a new system for PCI ...

A 45-year-old woman underwent radiofrequency ablation (RFA) for symptomatic idiopathic left ventricular tachycardia (ILVT). The clinical arrhythmias had two different patterns, a wide QRS tachycardia with right bundle branch block (RBBB) and left axis deviation (LAD) and another with RBBB and right axis deviation (RAD). The electrophysiology study localized the ...

INTRODUCTION: Radiofrequency ablation of some right-sided accessory pathways continues to be challenging. The purpose of this study was to evaluate the efficacy of introducing a multielectrode microcatheter in the right coronary artery to localize accessory pathways when conventional mapping was unsuccessful. METHODS AND RESULTS: A retrospective study was conducted of ...

Severe acute liver dysfunction occurred following transjugular intrahepatic portosystemic shunt (TIPS) creation in a patient with massive ascites due to portal hypertension associated with primary myelofibrosis. On US and TIPS venography, we considered that the acute liver ischemia was induced by TIPS. To avoid diffuse hepatic infarction and irreversible liver ...

BACKGROUND: Despite the current clinical use of radiofrequency (RF) catheter ablation in infants and children, the late effects of RF current application at immature myocardium remain unclear. The purpose of this study was to investigate incidence and time course of coronary lesions after RF current application at developing myocardium in ...

For select individuals with chronic, drug-resistant, paroxysmal atrial fibrillation, who have failed pharmacologic suppression or mechanical cardioversion, radiofreqency ablation of ectopic foci in and around the ostia of the pulmonary veins can restore normal sinus rhythm, prevent recurrence of the arrhythmia, and improve the quality of life. Radiofrequency ablation of ...

BACKGROUND: We assessed the hypothesis that "virtual electrograms" from a noncontact mapping system (EnSite 3000) could be used to localize myocardial scar. METHODS AND RESULTS: Myocardial infarctions were induced in sheep by inflating an angioplasty balloon in the left anterior descending coronary artery for 3 hours. Scar mapping was performed ...

The common condition of atrial fibrillation is often treated by cutting diseased cardiac tissue to disrupt abnormal electrical conduction pathways. Heating abnormal tissue with electromagnetic power provides a minimally invasive surgical alternative to treat these cardiac arrhythmias. Radio frequency ablation has become the method of choice of many physicians. Recently, ...

INTRODUCTION: The aim of this study was to investigate the early qualitative and quantitative structural changes in the left atrial wall after endocardial microwave ablation in patients with chronic atrial fibrillation (AF) undergoing mitral surgery. METHODS AND RESULTS: Seven patients with chronic AF of for at least 6 months underwent ...

BACKGROUND: This prospective clinical study evaluates the feasibility and efficacy of combined linear mitral isthmus ablation and pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). METHODS AND RESULTS: One hundred consecutive patients (13 women; age 55+/-10 years) with drug-refractory, symptomatic paroxysmal AF underwent PV isolation and linear ...

This report describes a patient who underwent RF catheter ablation of atrial tachycardia. Two applications of RF energy near the His-bundle region transiently terminated the tachycardia. With detailed mapping at the aortic sinus of Valsalva using a retrograde transaortic approach, the earliest atrial activation was found in the noncoronary sinus ...

The Safe-Cross radiofrequency guidewire (IntraLuminal Therapeutics, Carlsbad, California) combines 3 capabilities: (1) steerability of a conventional 0.014-in intermediate-stiffness guidewire, (2) optical coherence reflectometry to warn the operator when the wire tip approaches within 1 mm of the vessel wall, and (3) delivery of radiofrequency energy pulses to the wire tip ...

BACKGROUND: Idiopathic verapamil-sensitive left ventricular tachycardia (ILVT) is the most common form of idiopathic left ventricular tachycardia (VT). Different methods have been proposed for ablation of ILVT. METHODS: Between June 2002 and February 2004, 15 patients (12 men; age 28 +/- 11 years, range 12 to 51) with ILVT underwent ...

We describe catheter ablation of recurrent ventricular tachycardia using high-resolution definition of a myocardial infarct scar by contrast-enhanced cardiac computed tomography (CT). Positron emission tomography scanning as well as three-dimensional electroanatomic mapping confirmed the extent of scar prior to ablation. Catheter ablation based on substrate mapping was successful in eliminating ...

A 65-year-old patient with history of ischemic cardiomyopathy admitted to the hospital for chest pain and subsequently experienced incessant ventricular fibrillation (VF), requiring repeated defibrillation. Coronary angiogram was unchanged, compared to a study a year before, and acute ischemia was not considered to be the etiology of the VF. A ...

One of the more common regular supraventricular tachyarrhythmias encountered in clinical practice is atrioventricular nodal re-entrant tachycardia (AVNRT). Catheter-based radiofrequency ablation is becoming a common modality for the treatment of symptomatic tachyarrhythmias. It is safe and effective, but complications can occur. We present a patient with asymptomatic acute inferior ST ...

OBJECTIVES: The aim of this study was to define the role of percutaneous epicardial mapping for the ablation of previous failed ablation of accessory pathways. BACKGROUND: Cardiac surgery is the only curative option for failed radiofrequency (RF) catheter ablation of accessory pathway (AP)-mediated tachycardias. We investigated a combined percutaneous epicardial ...

OBJECTIVES: The aim of this study was to evaluate irrigated-tip catheter for ablation of intraatrial reentrant tachycardias late after surgical repair of congenital heart disease. BACKGROUND: In congenital heart disease patients, the right atrium can be markedly enlarged with areas of low blood flow. Radiofrequency (RF) lesion creation may be ...

A 60-year-old man presented with the chief complaint of seeing a blurred area just up and to the left of the center of his vision. The patient noted this visual field defect immediately after he awoke from a cardiac electrophysiologic study with a catheter ablation procedure. On neuro-ophthalmologic testing, a ...

BACKGROUND: Percutaneous epicardial mapping and ablation are successful in some patients with ventricular epicardial reentry circuits but may be impossible when pericardial adhesions are present, such as from prior cardiac surgery. The purpose of this study was to evaluate the feasibility of direct surgical exposure of the pericardial space to ...

BACKGROUND AND OBJECTIVE: Placement of central venous catheters in patients is associated with several risks including endocardial lesions and dysrhythmias. Correct positioning of central venous catheters in the superior vena cava is essential for immediate use. The objective of a first study was to evaluate the signal quality of an ...

The aim of this study was to identify the characteristics of electrograms that may be helpful in predicting successful ablation of idiopathic ventricular tachycardia from the aortic sinus of Valsalva. Data were obtained from 23 patients with symptomatic ventricular tachycardia or premature ventricular contractions (LV-VT) who underwent RF catheter ablation ...

Ischemia-modified albumin (IMA) levels were measured after radiofrequency (RF) catheter ablation to evaluate the effect of direct myocardial necrosis on IMA formation. IMA levels have been shown to increase in patients after RF catheter ablation compared with those who undergo diagnostic electrophysiologic studies. The results of this study suggest that ...

A novel variation in the relationship of the great cardiac vein to the circumflex artery was observed in an otherwise normal cadaver heart. Vessels originated and terminated normally, but in their midcourse they were twisted around each other such that each made one complete loop around the other. This variation ...

PURPOSE: Pulmonary vein isolation is a simple procedure, which has recently been reported as an effective treatment for the termination of atrial fibrillation. Although there are several clinical reports of beating-heart epicardial ablation, the optimal temperature has not been experimentally investigated. We evaluated the effective temperature for the placement of ...

We compared 5 versus 6 French (Fr) guiding catheters in coronary intervention using the transradial approach. Smaller guiding catheters may have advantages over larger ones in transradial coronary intervention. However, there is uncertainty about how small is small enough, and when smaller would become too small. Eligible patients were randomized ...

We report on a boy with recurrent drug resistant atrioventricular reentrant tachycardia. The patient had complex structural heart disease consisting of right atrial isomerism, systemic venous anomaly (mirror image orientation of the intrathoracic veins, hemiazygos continuation to the left-sided superior vena cava, with separate drainage of the hepatic veins into ...

The manual occipital ventricular puncture is a standard surgical procedure, but specific targeting has not received sufficient attention despite the experience of anatomical disorientation. This study tried to identify an exact site for the ideal trajectory with this method, especially in the sagittal plane, which avoids contact with the choroid ...

Histopathologic examination of the cavotricuspid isthmus in which a large-tip catheter was necessary to achieve conduction block is presented. No thickened myocardium or prominent trabeculation was observed on the ablation line. A small cardiac vein extending through the isthmus across the ablation scar was detected. The remaining myocardial cells were ...

Two cases of systemic sclerosis with sustained ventricular tachycardia (VT) are presented. The first patient received hydroxychloroquine for skeletal muscle disease coexisting with cardiac involvement. In both cases, 3D-electroanatomic mapping showed low-voltage areas in the right ventricle. In the first patient the tachycardia was mapped and a protected isthmus suggesting ...

We report the case of a 64-year-old woman who was admitted to our hospital for radiofrequency ablation of isthmus-dependent counterclockwise atrial flutter. Following an initially uncomplicated right atrial linear isthmus ablation that was associated with conversion of atrial flutter to sinus rhythm and evidence of complete isthmus block, the patient ...

OBJECTIVES: The purpose of this study was to investigate the characteristics of the second component of local virtual unipolar electrograms recorded at the ablation line during coronary sinus (CS) pacing after radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) for typical atrial flutter (AFL). BACKGROUND: Radiofrequency ablation of the CTI ...

Cure of typical atrial flutter (AFL) by catheter ablation to produce bidirectional block across the tricuspid annulus-inferior vena cava isthmus (IS) is highly effective, but failures may occur. We describe a technique that may allow creation of bidirectional block where a conventional strategy has failed. AFL ablation was performed using ...

INTRODUCTION: Radiofrequency ablation produces a localized endomyocardial necrosis that may result in release of biochemical markers reflecting myocardial cell damage, inflammation, and tissue reparation. The aim of this study was to determine the extent of rise and time course of markers of inflammation and tissue reparation in patients undergoing radiofrequency ...

INTRODUCTION: Irrigated tip radiofrequency ablation of cardiac arrhythmias was developed to increase the size of the radiofrequency-induced lesion, since cooling of the electrode tip allows use of higher power settings. The purpose of this study was to determine if the increased lesion size during irrigated tip ablation is caused by ...

Transcoronary alcohol ablation of septal hypertrophy (TASH) is a therapeutic catheter based option and an alternative to surgery in the treatment of patients with hypertrophic obstructive cardiomyopathy. However, the anatomic variability of the vascularisation of the obstructing septal bulge may limit the therapeutic efficacy. Thus, we examined an endocardial approach ...

There is growing interest in delivering cellular agents to infarcted myocardium to prevent postinfarction left ventricular remodeling. MRI can be effectively used to differentiate infarcted from healthy myocardium. MR-guided delivery of cellular agents/therapeutics is appealing because the therapeutics can be precisely targeted to the desired location within the infarct. In ...

INTRODUCTION: Radiofrequency catheter ablation of the tricuspid valve-inferior vena cava (TV-IVC) isthmus for treatment of atrial flutter (AFL), may in some cases require a large number of energy applications and a long procedure and fluoroscopy time. AIMS OF STUDY: Therefore, we studied the safety and efficacy of a 4 cm ...

INTRODUCTION: Pulmonary vein (PV) isolation for the curative treatment of atrial fibrillation using conventional radiofrequency ablation (RF) catheters with the point by point technique is time consuming and carries a remaining risk for thrombembolic complications. AIMS OF THE STUDY: Aim of the present in vivo study was to evaluate feasibility ...

BACKGROUND: Radiofrequency ablation for atrial fibrillation is becoming widely practiced. METHODS AND RESULTS: Two patients undergoing circumferential pulmonary vein ablation for atrial fibrillation in different centers developed symptoms compatible with endocarditis 3 to 5 days after the procedure. Their clinical condition deteriorated rapidly, and both suffered multiple gaseous and/or septic ...