Publications by authors named "Krit Jongnarangsin"
Background: Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.
Objectives: The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.
Article Synopsis
- Cather ablation of parahisian PVCs often involves targeting the right sinuses of Valsalva (SoV), but there's limited data on its safety and effectiveness.
- * The study examined 11 male patients (average age 68) undergoing PVC ablation in the right SoV, finding that all had intramural LGE-CMR scar involvement, which affected the success rate.
- * Results showed that 91% of the patients had a successful reduction in PVC burden after the procedure, even though traditional indicators of success were not always present at the effective ablation sites.
Background: Low-to-zero fluoroscopic navigation systems lower radiation exposure which improves health outcomes. Conventional x-ray fluoroscopy (CF) has long been the standard to guide to catheter location for cardiac ablation. With advancements in technology, alternative safety navigation systems have been developed.
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- - Dofetilide, a class III antiarrhythmic, is used to treat atrial fibrillation and flutter, and has been applied off-label for ventricular arrhythmias like PVCs and VTs.
- - In a study involving 81 patients, dofetilide initiation showed a significant decrease in PVC burden, but was discontinued in some cases due to QT prolongation and lack of efficacy.
- - Overall, 72% of patients had to stop dofetilide due to inefficacy or intolerance, and there was no significant difference in event-free survival between those treated with dofetilide and those who weren't.
Article Synopsis
- Catheter ablation for atrial fibrillation (AF) is the most common procedure in electrophysiology, aiming to isolate pulmonary veins, but there is insufficient data on severe complications worldwide.
- A study involved collecting and analyzing data from 23 centers with 33,879 procedures to determine the incidence and management of severe complications during AF ablation.
- The study found that while severe complications like tamponade and stroke have a low incidence, factors like age, gender, and procedure duration play a role in their occurrence; most patients with complications were discharged after about 5 days.
Article Synopsis
- A study evaluated 48 patients undergoing LGE-CMR imaging and ablation, finding that 69% had intramural LGE-CMR scars, which were linked to having more complex PVCs that often required treating multiple heart chambers.
- Despite the increased complexity in patients with scarring, the short-term success rate was 69% and long-term PVC burden was similar between those with and without the scars. *
Output-dependent His bundle pacing: Unexpected His-Purkinje system pathology unmasking.
Ann Noninvasive Electrocardiol
May 2024
The anatomy of the His-Purkinje system has been studied, yet there remains a knowledge gap regarding the impact of His bundle pacing and its electrocardiographic implications. This case report highlights the presence of His-Purkinje system pathology without apparent clues on the surface electrocardiogram (EKG). By observing identical QRS morphology with varying HV intervals resulting from different pacing outputs, we demonstrate the presence of an electrical propagation block within the His bundle.
View Article and Find Full Text PDFVentricular arrhythmias in patients with bicuspid aortic valves.
J Cardiovasc Electrophysiol
June 2024
Article Synopsis
- Bicuspid aortic valves (BAV) are common heart defects, and this study investigates the presence and types of ventricular arrhythmias (VAs) in patients with BAV, particularly looking at late gadolinium enhancement in cardiac imaging.
- The study involved 19 male patients, showing that frequent premature ventricular contractions (PVCs) and monomorphic ventricular tachycardias (VTs) were common, with the majority of VAs linked to the periaortic valve region.
- Results indicated that patients with more significant arrhythmias had larger areas of damaged heart tissue (LGE), and post-ablation, patients experienced a significant reduction in PVCs and improvement in heart function (ejection fraction).
Background: Patients may develop atrial tachycardia (AT) after left atrial (LA) ablation of persistent atrial fibrillation (AF).
Methods: The population consisted of 101 consecutive patients (age = 64.3 ± 8.
The impact of supraventricular arrhythmias on the outcomes of guideline-compliant implantable cardioverter defibrillator programming.
J Cardiovasc Electrophysiol
April 2024
Introduction: Several implantable cardioverter defibrillators (ICD) programming strategies are applied to minimize ICD therapy, especially unnecessary therapies from supraventricular arrhythmias (SVA). However, it remains unknown whether these optimal programming recommendations only benefit those with SVAs or have any detrimental effects from delayed therapy on those without SVAs. This study aims to assess the impact of SVA on the outcomes of ICD programming based on 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines.
View Article and Find Full Text PDFEfficacy and safety between radiofrequency ablation and types of cryoablation catheters for atrioventricular nodal reentrant tachycardia: A Network Meta-analysis and Systematic Review.
Pacing Clin Electrophysiol
March 2024
Article Synopsis
- AVNRT is the most common type of rapid heart rate issue treated with a procedure called ablation, and concerns exist regarding potential damage to the heart's conduction system during this process.
- A study reviewed various ablation techniques, including different catheter types, to understand their impact on the occurrence of permanent AV block and success rates.
- Results from 27 studies involving over 5,100 patients showed that all ablation techniques had high success rates and did not significantly differ in the risk of causing permanent AV block, suggesting both radiofrequency and cryoablation are effective treatment options for AVNRT.
Article Synopsis
- Programed ventricular stimulation (PVS) is used to assess patients' risk for dangerous heart arrhythmias, but those with negative PVS results can still be at risk, especially if they have symptoms.* -
- This study followed 78 patients with symptomatic ventricular arrhythmias who had negative PVS and suffered from cardiac scarring, analyzing their long-term outcomes with implantable monitors.* -
- Findings revealed that 18% of patients required treatment for arrhythmias or experienced fainting, indicating that cardiac scarring significantly increases the likelihood of adverse events despite negative PVS results.*
Background: Patients with arrhythmias originating from papillary muscles (PAPs) often have pleomorphic ventricular arrhythmias (PVAs) that can result in failed ablations. The mechanism of PVAs is unknown.
Objective: The purpose of this study was to assess the prevalence and mechanisms of PVAs and the impact on outcomes in patients with focal left ventricular PAP ventricular arrhythmias (VAs).
Introduction: Variants of cardiomyopathy genes in patients with nonischemic cardiomyopathy (NICM) generate various phenotypes of cardiac scar and delayed enhancement cardiac magnetic resonance (DE-CMR) imaging which may impact ventricular tachycardia (VT) management.
Methods: The objective was to compare the findings of cardiomyopathy genetic testing on DE-CMR imaging and long-term outcomes among patients with NICM undergoing VT ablation procedures. Image phenotyping and genotyping were performed in a consecutive series of patients referred for VT ablation and correlated to survival free of VT.
Introduction: The concurrent data on sex disparities in VT management and outcomes have remained unclear. Therefore, our objective was to determine the impact of sex on ventricular tachycardia (VT) management and outcomes in patients admitted with VT, dervied from the US National Inpatient Sample database (NIS).
Methods: We used data from the US NIS to identify hospitalized adult patients who were admitted with VT between 2016 and 2018.
Article Synopsis
- - The study focused on how the anatomy of papillary muscles (PAPs) relates to the mapping and successful ablation of ventricular arrhythmias (VAs) in patients.
- - Among 43 patients with frequent PAP arrhythmias, 40% had VAs originating from connections between PAPs and the surrounding myocardium, showing distinct electrocardiographic patterns.
- - Results indicated that patients with a higher number of PAP-myocardial connections (PAP-MYCs) had higher failure rates during ablation procedures, highlighting the importance of detailed anatomical imaging in treatment success.
Background: Frequent premature ventricular complexes (PVCs) can cause PVC-induced cardiomyopathy. The value of PVC ablation in patients with preserved left ventricular function in the low-normal range (ejection fraction: 50-55%) is not established. Strain analysis has been used to estimate changes in left ventricular function beyond assessment of the ejection fraction (EF).
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- The study investigates the unintended isolation of the left atrial appendage (LAA) during radiofrequency ablation for persistent atrial fibrillation (AF) and its impact on long-term thromboembolic risk.
- It involved analyzing 41 patients with incidental LAA isolation and comparing thromboembolic occurrences to a matched group of 82 patients without such isolation over an average follow-up of 4.2 years.
- Results showed that patients with LAA isolation had a significantly higher rate of thromboembolism (17%) compared to those without (4%), highlighting the need to consider the risks of LAA isolation in treatment plans.
Background: Frequent premature ventricular complexes (PVCs) can result in a reversible form of cardiomyopathy that usually affects the left ventricle (LV).
Objectives: The objective of this study was to assess whether frequent PVCs have an impact on right ventricular (RV) function.
Methods: Serial cardiac magnetic resonance (CMR) studies were performed in a series of 47 patients before and after ablation of frequent PVCs.
Article Synopsis
- - This study investigates the characteristics and outcomes of patients with post-myocardial infarction ventricular tachycardia (PMI VT) who require ablation in the right ventricle (RV), noting a lack of previous reporting on this group.
- - Out of 277 patients studied, 30 were found to have RV target sites for ablation, with those having free wall VTs showing greater RV dysfunction and better left ventricular ejection fractions compared to those with septal VTs.
- - The findings indicate that while the RV can be an arrhythmogenic substrate post-PMI, patients with septal target sites tend to have poorer long-term outcomes after ablation, highlighting differences in prognosis based on target site location.
Introduction: Thromboembolic events after catheter ablation of ventricular tachycardia (VT) can result in significant morbidity. Thromboembolic prophylaxis after catheter ablation can be achieved by the use of antiplatelet agents, vitamin K antagonists, or direct oral anticoagulants (DOACs). The relative safety and efficacy of these modes of prophylaxis are uncertain.
View Article and Find Full Text PDFBackground: Left bundle branch area pacing (LBBAP) has recently become a promising option for the near-natural restoration of electrical activation. However, the clinical relevance of therapeutic effects in individuals with heart failure with reduced ejection fraction (HFrEF) and dyssynchrony remains unknown.
Methods: MEDLINE, EMBASE, and Cochrane databases were searched from inception until June 2022.
Background: Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT).
Objectives: To assess the impact of sex differences on outcomes of catheter ablation of VT.