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Clinical and Electrophysiological Characteristics of Marshall Bundle-Related Atrial Tachycardia: Considerations Based on a Definitive Diagnosis.
JACC Clin Electrophysiol
November 2024
Department of Cardiology, Institute of Science Tokyo, Tokyo, Japan.
Background: Conventional endocardial mapping cannot fully elucidate Marshall bundle (MB)-related atrial tachycardia (AT).
Objectives: This study aimed to clarify the clinical and electrophysiological characteristics of MB-related AT definitively diagnosed using catheter insertion.
Methods: Forty-eight patients with AT who had previously undergone mitral isthmus ablation were enrolled in this study.
Approach to the Diagnosis and Management of Complex Fascicular Ventricular Tachycardias.
Circ Arrhythm Electrophysiol
December 2024
Division of Cardiology, University of California San Francisco (H.H.H., A.C.L., M.M.S.).
Complex ventricular tachycardias involving the fascicular system (fascicular ventricular tachycardias [FVTs]) can be challenging. In this review, we describe our approach to the diagnosis and ablation of these arrhythmias with 10 illustrative cases that involve (1) differentiation from supraventricular tachycardia; (2) assessment for atypical bundle branch reentry and other interfascicular FVTs; (3) examination of P1/P2 activation sequences in sinus rhythm, pacing, and tachycardia; and (4) entrainment techniques to establish the tachycardia mechanism and aid circuit localization. To summarize, 5 cases had prior ablation with 2 previously misdiagnosed as supraventricular tachycardia.
View Article and Find Full Text PDFA narrow complex tachycardia with a short HV interval: What is the mechanism?
Pacing Clin Electrophysiol
November 2024
Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
The case was a 15-year-old male with a history of paroxysmal supraventricular tachycardia refractory to medical therapy and prior catheter. A repeat electrophysiology study and catheter ablation were applied. Baseline AH and HV intervals were 100 and 55 ms during normal sinus rhythm (NSR), respectively.
View Article and Find Full Text PDFAtrial Topology for a Unified Understanding of Typical and Atypical Flutter.
Circ Arrhythm Electrophysiol
November 2024
Department of Physics and Astronomy, Ghent University, Belgium (R.V.d.A., N.C., A.S.B., B.V., S.L., K.D., A.O., T.N., S.H., N.V.).
Article Synopsis
- Macroreentry is the main cause of typical and atypical flutter, but many questions about it remain unanswered, prompting a study that uses topology to investigate atrial tachycardia activation patterns.
- Researchers utilized a computational model resembling a closed sphere with holes to analyze cases of tachycardia, focusing on activation maps and ablation responses in 131 clinical cases.
- The study's findings suggest that reentrant activity on closed surfaces consistently shows paired rotation, and through mathematical principles, they established a framework to better understand flutter and its treatment outcomes.
In the case of adenosine-sensitive atrial tachycardia originating near the atrioventricular (AV) node, overdrive pacing from the anterior right atrium showed constant and progressive fusion, indicating that the pacing site is proximal to slow conduction. Shortening the pacing cycle length prolonged conduction times to the orthodromic capture sites; they remained unchanged at the antidromic capture sites. Limited decremental conduction property in the slow conduction zone supports the hypothesis that AV node-like tissue remnants along the AV annulus are involved.
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