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  • 1
    Electronic Resource
    Electronic Resource
    Radiofrequency Ablation of Atrial Flutter Using Large-Tip Electrode Catheters (2004)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The use of large-tip ablation catheters in both animal and clinical studies has been documented in work conducted over the last 10 years. These studies have demonstrated the safety and efficacy of the use of 8- and 10-mm tip ablation catheters in the treatment of type I isthmus-dependent atrial flutter. Shorter procedure times are reported with the larger-tip ablation catheters compared to standard 4- or 5-mm tip ablation catheters, with comparable or greater efficacy, no significant increase in complications, and an improved quality of life. Larger-tip ablation electrodes do require the use of higher-power radiofrequency generators up to 100 W. The benefits of large-tip ablation catheters are thus well documented for the treatment of type I isthmus-dependent atrial flutter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.15104.x
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  • 2
    Electronic Resource
    Electronic Resource
    Identification of Pulmonary Vein Potentials by Differential Site Atrial Pacing in Patients with Paroxysmal Atrial Fibrillation: (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 14 (2003), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Pulmonary vein (PV) isolation may cure paroxysmal atrial fibrillation (PAF); however, identification of PV potentials may be difficult in sinus rhythm. Studies have suggested that atrial pacing may improve the identification of PV potentials. Methods and Results: In 25 consecutive patients who underwent PV isolation for PAF, the results of pacing from the distal PV, distal and proximal coronary sinus, and high right atrium compared to sinus rhythm were analyzed to determine the most effective pacing site for identification of PV potentials. The percentage of confirmed PV potentials and the longest interval between atrial and PV potentials in each PV were compared during differential site pacing and sinus rhythm. PV potentials were confirmed in 63 (82%) of 77 PVs that could be mapped during the complete pacing protocol and during sinus rhythm. Distal PV pacing identified significantly more PV potentials (left upper pulmonary vein [LUPV] 100%, left lower pulmonary vein [LLPV] 84%, right upper pulmonary vein [RUPV] 80%, right lower pulmonary vein [RLPV] 53%) compared to other pacing sites and sinus rhythm. Among atrial pacing sites, those ipsilateral to the PV being mapped were the most effective for identifying PV potentials. The intervals between atrial and PV potentials were significantly longer during distal PV pacing than pacing at other sites (LUPV 81.6 ± 26.2 ms, LLPV 61.4 ± 26.1 ms, RUPV 59.7 ± 33.2 ms, RLPV 39.7 ± 26.7 ms). Conclusion: (1) Distal PV pacing was most effective for identifying PV potentials. (2) The interval between atrial and PV potentials was longest during distal PV pacing. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1311-1318, December 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.03117.x
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  • 3
    Electronic Resource
    Electronic Resource
    Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp: Identification of Location of Origin by Endocardial Noncontact Activation Mapping from the Right Ventricular Outflow Tract (2002)
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 13 (2002), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Left Ventricular Outflow Tract Tachycardia. Idiopathic left ventricular outflow tract (LVOT) tachycardia has been shown to originate from a supravalvular site in some patients. Considerable attention recently has focused on identifying this variant of LVOT tachycardia on 12-lead ECG. We report the case of 15-year-old boy in whom a noncontact three-dimensional mapping electrode deployed in the right ventricular outflow tract (RVOT) assisted in identifying a supravalvular LVOT tachycardia. Observation of two early breakthrough sites in the RVOT and right ventricular septum suggested a right aortic cusp origin of the tachycardia. Pace mapping in the right aortic cusp identified a successful ablation site.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2002.01050.x
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  • 4
    Electronic Resource
    Electronic Resource
    Right Atrial Compartmentalization Using Radiofrequency Catheter Ablation for Management of Patients with Refractory Atrial Fibrillation (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 10 (1999), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ablation of Atrial Fibrillation. Introduction: Atrial fibrillation (AF) is often refractory to antiarrhythmic drugs, and patients who are intolerant of AF may require the maze operation for cure. As a less Invasive alternative, a catheter-based, right atrial compartmentalization procedure was evaluated. Methods and Results: Twelve patients with AF refractory to Class I and III antiarrhythmic drugs were studied. Four linear right atrial radiofrequency ablations were performed, from superior to inferior vena cava in the posterior wall and interatrial septum, anteriorly from the superior vena cava to the tricuspid annulus through the appendage, and across the tricuspid valve-inferior vena cava isthmus. The radiofrequency catheter was dragged along each line three to four times, until the atrial electrogram amplitude decreased by 75% and there was bidirectional conduction block in the tricuspid valve-inferior vena cava isthmus. One complication occurred: sinus node dysfunction requiring a pacemaker. Eight patients were discharged from the hospital on no antiarrhythmic drugs, and four were discharged on previously ineffective antiarrhythmic drugs. Total duration of follow-up was 21.3 ± 11.2 months. Four patients discharged on previously ineffective antiarrhythmic drugs had no recurrence of AF. One patient discharged off antiarrhythmic drugs had no recurrence of AF. Seven patients discharged off antiarrhythmic drugs had recurrent AF by 12.6 ± 13.0 months (median 6, range 1 to 39); 3 of these 7 responded to previously ineffective antiarrhythmic drugs without further AF and 4 did not. Thus, 8 of 12 patients (67%) had suppression of AF after ablation on previously ineffective medication or no medication. Conclusion: Right atrial compartmentalization may alter the substrate for AF, thus improving the efficacy of previously ineffective antiarrhythmic drugs. Because it is relatively safe, it may be a reasonable adjunctive intervention to maintain sinus rhythm in patients with drugrefractory AF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1999.tb00255.x
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  • 5
    Electronic Resource
    Electronic Resource
    Prevalence of Retrograde Accessory Pathway Conduction During Atrial Fibrillation (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 8 (1997), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Retrograde Conduction in Atrial Fibrillation. Introduction: Although atrial fibrillation occurs frequently in patients with the preexcitation syndrome, its pathogenesis remains controversial. The purpose of this study was to test the hypothesis that retrograde conduction over the accessory pathway occurs during atrial fibrillation and can serve as an important source of new wavefronts in atrial fibrillation. Methods and Results: Eight patients undergoing surgical division of their accessory path-way(s) were studied. A plaque electrode array containing 56 (7 × 8) bipolar electrodes (5-mm resolution) was placed epicardially at the AV junction over the accessory pathway and atrial fibrillation was electrically induced. Excluding one patient who had only preexcited QRS complexes during atrial fibrillation and another whose accessory pathway was outside the mapped region, 4 of the 6 patients studied showed retrograde conduction over the accessory pathway during atrial fibrillation (mean atrial cycle length 157 ± 59 msec). In these patients, 186 atrial wavefronts near the accessory pathway were analyzed. Among 67 wavefronts immediately following nonpreexcited QRS complexes, 17 originated from retrograde conduction. This constituted 9% (17/186) of total atrial wavefronts near the accessory pathway. Estimated atrial refractory period during atrial fibrillation ranged from 81 to 165 msec. Conclusions: (1) In patients with the preexcitation syndrome and atrial fibrillation, retrograde conduction over the accessory pathway contributed up to 9% of total atrial wavefronts near the accessory pathway. (2) The presence of an excitable gap in human atrial fibrillation was suggested by atrial preexcitation during retrograde conduction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1997.tb00803.x
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  • 6
    Electronic Resource
    Electronic Resource
    Familial Sudden Cardiac Death Associated with a Terminal QRS Abnormality on Surface 12-Lead Electrocardiogram in the Index Case (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 9 (1998), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Familial Sudden Death and ECG Abnormalities. A case is presented of an 18-year-old male who had been resuscitated following an episode of sudden death due to ventricular fibrillation. The patient was noted to have an abnormal deflection in the terminal QRS on surface ECG and an abnormal signal-averaged KCG demonstrating a late potential coincident with the terminal QRS abnormality on the ECG. The patient had easily inducible polymorphic ventricular tachycardia during electrophysiologic study, which was suppressed by quinidine but not by procainamide or beta blockers. The surface ECG and signal-averaged ECG also were normalized by quinidine but not by procainamide or beta blockers. The patient had no further arrhythmias on quinidine for 6 years until he inexplicably discontinued his medication and died suddenly shortly thereafter. The present case may represent a unique familial sudden death syndrome or possibly a variant of the sudden death syndrome associated with right bundle branch block and ST elevation in V1, through V3, Currently available data suggest that, in such patients, an implantable cardioverter defibrillator may provide better protection from sudden death than does antiarrhythmic drug therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1998.tb00947.x
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  • 7
    Electronic Resource
    Electronic Resource
    Quantifying Intracardiac Organization of Atrial Arrhythmias Using Temporospatial Phase of the Electrocardiogram (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 14 (2003), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Separating nonisthmus-dependent atrial flutter (AFL) from “organized” atrial fibrillation (AF), or isthmus-dependent AFL, may be difficult using ECG characteristics alone. We hypothesized that temporal and spatial phase analysis of ECG atrial waveforms could effectively separate these rhythms by quantifying subtle variations in ECG atrial activation during supraventricular tachycardias (SVT). Methods and Results: We studied 52 patients at electrophysiologic study (EPS) who demonstrated isthmus-dependent (n = 15) and nonisthmus-dependent (n = 9) AFL, atrial tachycardia (n = 6), AV nodal reentry (n = 9), orthodromic reciprocating tachycardia (n = 6), and AF (n = 7). Atrial activity was represented as a series of correlations of an atrial template to successive time samples of the arrhythmia ECG. Spatial phase was analyzed as a reproducible relationship of this atrial activity between leads over time; temporal regularity was measured from power spectra. Spatial phase was maintained (coherent) in lead planes V5/aVF (XY), V5/V1 (XZ), and aVF/V1 (YZ) in 15 of 15 cases of isthmus-dependent AFL, but in only 1 of 9 cases of nonisthmus-dependent AFL (P 〈 0.01; χ2). Temporally, all cases of AFL showed one dominant peak on correlation spectra (magnitude 〉6 dB), suggesting one activation wavefront, although this was smeared in nonisthmus-dependent cases. In contrast, AF showed inconsistent spatial phase in all planes and broad band spectra, consistent with multiple and/or variable activation paths. All other SVTs showed spatial coherence and one dominant spectral peak. Conclusion: Coherence of temporal and spatial phase is a powerful approach to measure the spatial organization of intracardiac activation from the ECG that reveals a spectrum from SVT to isthmus-dependent and nonisthmus-dependent AFL, to AF. (J Cardiovasc Electrophysiol, Vol. 14, pp. 971-981, September 2003)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2003.03213.x
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  • 8
    Electronic Resource
    Electronic Resource
    New Approaches for the Management of Atrial Fibrillation: (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 10 (1999), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1999.tb00294.x
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  • 9
    Electronic Resource
    Electronic Resource
    Fibre-optic bronchoscopy during mechanical ventilation (1982)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 37 (1982), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1982.tb01077.x
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  • 10
    Electronic Resource
    Electronic Resource
    Electrophysiologic Effects of the New Class III Antiarrhythmic Drug Dofetilide Compared to the Class IA Antiarrhythmic Drug Quinidine in Experimental Canine Atrial Flutter: (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 7 (1996), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Effects of Dofetilide in Canine Atrial Flutter. Introduction: Previous studios that Class III antiarrhythmic drugs are more effective in reentrant arrhythmias because they prolong refractoriness (ERP) and wavelength and reduce dispersion of refractoriness compared to Class IA antiarrhythmic drugs, which slow conduction velocity (CV) in addition to their effects on refractoriness. Methods and Results: To test this hypothesis, the Class III drug dofetilide and the Class IA drug quinidine were studied in the experimental canine crush-injury model of atrial flutter, utilizing right atrial multipoint programmed stimulation and activation mapping. In seven dogs dofetilide prolonged ERP by 23%, slowed CV by 9% at 200-msec cycle length (P 〈 0.001) and by 39% at 150-msec cycle length (P 〈 0.001), and increased wavelength by 11% (P 〈 0.02). Dofetilide reduced dispersion of ERP by 20% (P = 0.003) and adjacent electrodes with ERP difference ≥: 20 msec by 76% (P 〈 0.001). Dofetilide slowed atrial flutter by 37% (P = 0.003) prior to terminating and suppressing it in all dogs. In eight dogs quinidine prolonged ERP by 14% (P 〈 0.001), slowed CV by 14% at 200-msec cycle length (P 〈 0.00) and by 19% at 150-msec cycle length (P 〈 0.001), and reduced wavelength by 2% (P = NS). Quinidine did not reduce dispersion of refractoriness. Quinidine slowed atrial flutter by 57% (P 〈 0.001), terminating and suppressing it in only three dogs. Efficacy of dofetilide was greater than quinidine (P = 0.026) and correlated with reduced dispersion of ERP (r = -0.653, P = 0.01), reduced adjacent electrodes with ERP difference ≥ 20 msec (r = -0.637, P = 0.012), and prolonged wavelength (r = 0.61, P = 0.018). Dofetilide and quinidine terminated atrial flutter by similar mechanisms. Myocardial fiber orientation was nonuniform around the crush injury. Conclusions: Antiarrhythmic efficacy of dofetilide was greater than that of quinidine and correlated with drug-induced prolongation of wavelength and reduction in dispersion of refractoriness, effects produced only by dofetilide.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1996.tb00594.x
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