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Approach to the Diagnosis and Management of Complex Fascicular Ventricular Tachycardias.
Circ Arrhythm Electrophysiol
January 2025
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 PDFInappropriate Therapy and Shock Rates Between the Subcutaneous and Transvenous Implantable Cardiac Defibrillator: A Secondary Analysis of the PRAETORIAN Trial.
Circ Arrhythm Electrophysiol
December 2024
Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences Heart failure and Arrhythmias, the Netherlands (L.R.A.O.N., S.P., L.V.A.B., T.F.B., A.-F.B.E.Q., W.v.d.S., L.S., J.A.d.V., J.G.P.T., N.R.B., J.R.d.G., K.M.K., A.d.W., A.A.M.W., R.E.K.).
Article Synopsis
- Inappropriate therapy (IAT) is a significant issue associated with implantable cardiac defibrillator (ICD) therapy, particularly highlighted in early subcutaneous ICD (S-ICD) studies which showed high rates of inappropriate shocks (IAS).
- The PRAETORIAN trial, an international study with 849 patients, found no major differences in IAT and IAS rates between S-ICD and transvenous ICD (TV-ICD) groups, as both groups had similar cumulative incidences.
- Key predictors for IAT varied between the two groups, with TV-ICD patients experiencing IAT mainly from supraventricular tachycardias, while S-ICD patients faced issues from cardiac oversensing
Atrial 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.
Decremental properties of a concealed nodoventricular pathway.
J Cardiovasc Electrophysiol
November 2024
Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA.
Article Synopsis
- The study investigates the properties of the nodoventricular pathway (NVP) and its role in supraventricular tachycardia events.
- During the research, a specific type of premature ventricular contraction (PVC) was observed to effectively terminate the tachycardia, revealing unique behavior in the NVP.
- The findings suggest that the behavior of the NVP contributes to the mechanism of slow-fast AV nodal reentrant tachycardia (AVNRT), with the timing of the PVC affecting the conduction properties and ultimately the termination of the tachycardia.
A Case of Cardioversion and Management of Atrial Flutter in the Emergency Department.
Adv Emerg Nurs J
August 2024
Author Affiliation: ENP Program, Beyster Institute for Nursing Research, Advanced Practice, and Simulation, Hahn School of Nursing and Health Science, University of San Diego, San Diego, California.
Atrial flutter is a supraventricular cardiac arrhythmia commonly characterized by two or three rapid atrial contractions for every ventricular contraction and a rapid ventricular rate that can be identified by a sawtooth pattern on an electrocardiogram. Patients often present with symptoms of heart failure and face the risk of atrial thrombus with a potential for systemic embolization. As such, pharmacologic rate and rhythm control, transesophageal echocardiogram, direct current cardioversion, and anticoagulation therapies may all be required for patient management.
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