1.Characteristics of Intracardiac Electrogram at Successful Sites of Radiofrequency Catheter Ablation in Patients with Accessory Pathways.
Korean Circulation Journal 1998;28(6):947-952
BACKGROUND: Radiofrequency catheter ablation was introduced the curative method of supraventricular tachycardia in patients with accessory pathways. The success of catheter ablation depends on the accurate localization of accessory pathway and the destruction of accessory pathways. METHOD: We analyzed the local electrograms in 35 patients to be underwent the successful catheter ablation and measured the catheter stability, A/V ratio, AV interval, Accessory pathway potential, and the interval from the onset of RF energy to loss of accessory pathway from local electrograms at the successful ablation sites. RESULTS: The ratio of A wave and V wave range from 0.06 to 6.33 and the mean of A/V ratio is 0.62. The shortest AoVo interval is 20 msec and the longest AoVo interval is 120 msec and the mean of AoVo interval is 58.23 msec. The shortest ApVp interval is 20 msec and the longest ApVp interval is 100 msec and the mean of this interval is 51.88 msec. The incidence of accessory pathway potential among 35 successful ablation sites in 25%. The mean of time from RF energy to loss of accessory pathway is 4.48 sec. CONCLUSION: We concluded that the finding of local electrogram during catheter ablation is very important for shortening of procedure time and the successful procedure.
Catheter Ablation*
;
Catheters
;
Electrophysiologic Techniques, Cardiac*
;
Humans
;
Incidence
;
Tachycardia, Supraventricular
2.A Case of Recurrent Pacemaker Twiddler's Syndrome.
Jeong Gwan CHO ; Myung Ho JEONG ; Soon Chul SHIN ; Seung Jin YANG ; Chan Hyung PARK ; Gwang Chae GILL ; Keal Woo CHO ; Jong Chun PARK ; Jung Chaee KANG
Korean Circulation Journal 1989;19(2):349-354
Pacemaker twiddler's syndrome is reported as a very rare complication of permanent pacemaker implantation. There was a recent report suggesting that the incidence of pacemaker twiddler's syndrome increase recently presumably as a result of the implantation of thinner and smaller pacemaker system than before. We experienced a case of pacemaker twiddler's syndrome complicated 3 times with the conventional method of implantation or replacement during 14 months after the first implantation(Optims MP 158C and Pacing lead 400, Telectronic)on June 13th 1987. This case was an 18 year-old high school girl who had suffered frequent syncope for 2 years and extertionl dyspnea for 5 years due to congenital complete heart block, of which block site was proved to be AV nodal by His bundle electrogram. Pacemaker twiddler's syndrome developed 3 times;firstly 6 weeks after the first implantation in the right subclavicular fossa, secondly 10 weeks after the replacement of the twisted pacing lead, thirdly 10 months after the change of implantation site to the left subcalvicular fossa with the replacement of the twisted and fractured lead. Finally, the pacemaker generator was anchored to the clavicular periostium and pectoralis fascia at several points by using Dacron pouch.
Adolescent
;
Dyspnea
;
Electrophysiologic Techniques, Cardiac
;
Fascia
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Female
;
Heart Block
;
Humans
;
Incidence
;
Polyethylene Terephthalates
;
Syncope
3.Local Atrial/Ventricular Ratio as an Adjuvant Marker for Catheter Ablation of Atrioventricular Accessory Pathways.
Ki Hun KIM ; Dae Kyeong KIM ; Hyun Ji IM ; Jeong Sook SEO ; Han Young JIN ; Jae Sik JANG ; Tae Hyun YANG ; Dong Soo KIM ; So Young JEONG ; Yun Seok SONG ; Dong Kie KIM ; Pil Sang SONG ; Sang Hoon SEOL ; Doo IL KIM
Korean Circulation Journal 2017;47(4):462-468
BACKGROUND AND OBJECTIVES: The earliest atrial (A)/ventricular (V) activation potential, or accessory pathway (AP) potential are commonly used as ablation targets for atrioventricular (AV) APs. However, these targets are sometimes ambiguous. SUBJECTS AND METHODS: We reviewed 119 catheter ablation cases in 112 patients diagnosed with orthodromic atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Local A/V amplitude potentials with the earliest activation or AP potential were measured shortly before achieving antegrade AP conduction block, ventriculoatrial block during right ventricle (RV) pacing, or AVRT termination with no AP conduction. RESULTS: APs were located in the left lateral (55.5%), left posterior (17.6%), left posteroseptal (10.1%), midseptal (1.7%), right posteroseptal (7.6%), right posterior (1.7%), and right lateral (5.9%) regions. The mean earliest activation time was 16.7±15.5 ms, mean A/V potential was 1.1±0.9/1.0±0.9 mV, and mean A/V ratio was 1.7±2.0. There was no statistically significant difference between the activation methods (antegrade vs. RV pacing vs. orthodromic AVRT) or AP locations (left vs. right atrium). However, when the local A/V ratio was divided into 3 groups (≤0.6, 1.0±0.3, and ≥1.4), the antegrade approach resulted in an A/V ratio greater than 1.0±0.3 (86.7%, p=0.007), and the orthodromic AVRT state resulted in a ratio of less than 1.0±0.3 (87.5%, p<0.001). CONCLUSION: The mean local A/V potential and ratio did not differ by activation method or AP location. However, a different A/V ratio based on activation method (≥1.0±0.3, antegrade approach; and ≤1.0±0.3, orthodromic AVRT state) could be a good adjuvant marker for targeting AV APs.
Catheter Ablation*
;
Catheters*
;
Electrophysiologic Techniques, Cardiac
;
Heart Ventricles
;
Humans
;
Methods
;
Tachycardia
;
Tachycardia, Supraventricular
4.Predictors of successful catheter ablation of AV nodal reentrant tachycardia.
Jung Chaee KANG ; Myung Ho JEONG ; Jang Hyun CHO ; Sung Hee KIM ; Young Keun AHN ; Joo Hyung PARK ; Jeong Gwan CHO ; Jong Chun PARK ; Sang Hyun LEE ; Jun Woo KIM
Korean Journal of Medicine 1999;57(5):867-874
Catheter ablation of the AV nodal slow pathway using radiofrequency (RF) energy has been established as the first-line curative therapeutic modality of recurrent symptomatic AV nodal reentrant tachycardia (AVNRT). In contrast to catheter ablation of the AV bypass tract, there was no useful marker to localize succesful site of the pathway. This study was performed to determine predictors of successful catheter ablation of the AV nodal slow pathway in patients with AVNRT. METHODS: Forty patients (18 men, 22 women; 47.9+/-13.3 years) with AVNRT undergoing successful catheter ablation of the AV nodal slow pathway were included in this study, in which 217 attempts were tried to ablate the AV nodal slow pathway. Characteristics of local atrial electrogram, anatomical site at each attempt, junctional rhythm during RF delivery were analyzed (40 successful, 177 failed). Maximum difference and duration of atrial electrograms were measured and local atrial electrograms were classified into 5 types (A1, A2, B1, B2 and C type) according to the type and the degree of fragmentation. Finally, the occurrence of junctional rhythm during RF discharge and its onset time were compared between successful and failed attempts. RESULTS: There was no significant difference in the maximum difference of amplitude and duration of atrial electrograms between successful and failed attempts. The success rate in each type of atrial electrogram was significantly different. And, the success rate in non-C type atrial electrograms (A1, A2, B1, and B2) was significantly higher than that in type C atrial electrograms (25.0% vs 10.3%, p<0.01). No significant difference was noted in success rates according to attempted sites. Junctional rhythms during radiofrequency application occured significantly more frequent in successful attempts than in failed attempts (87.5% vs 47.5%, p<0.001). The time to onset of junctional rhythm was not different between successful and failed attempts (5.2+/-4.9 sec vs 6.1+/-5.5 sec). CONCLUSION: Fragmented local atrial electrogram and junctional rhythm during RF energy delivery may be used to predict successful catheter ablation of AVNRT. It is recommended that RF energy should be applied to the site where fragmented atrial electrogram is recorded and terminated if junctional rhythm does not develop within 15 seconds after starting RF energy delivery.
Catheter Ablation*
;
Catheters*
;
Electrophysiologic Techniques, Cardiac
;
Female
;
Humans
;
Male
;
Tachycardia, Atrioventricular Nodal Reentry*
5.Predictors of successful catheter ablation of AV nodal reentrant tachycardia.
Jung Chaee KANG ; Myung Ho JEONG ; Jang Hyun CHO ; Sung Hee KIM ; Young Keun AHN ; Joo Hyung PARK ; Jeong Gwan CHO ; Jong Chun PARK ; Sang Hyun LEE ; Jun Woo KIM
Korean Journal of Medicine 1999;57(5):867-874
Catheter ablation of the AV nodal slow pathway using radiofrequency (RF) energy has been established as the first-line curative therapeutic modality of recurrent symptomatic AV nodal reentrant tachycardia (AVNRT). In contrast to catheter ablation of the AV bypass tract, there was no useful marker to localize succesful site of the pathway. This study was performed to determine predictors of successful catheter ablation of the AV nodal slow pathway in patients with AVNRT. METHODS: Forty patients (18 men, 22 women; 47.9+/-13.3 years) with AVNRT undergoing successful catheter ablation of the AV nodal slow pathway were included in this study, in which 217 attempts were tried to ablate the AV nodal slow pathway. Characteristics of local atrial electrogram, anatomical site at each attempt, junctional rhythm during RF delivery were analyzed (40 successful, 177 failed). Maximum difference and duration of atrial electrograms were measured and local atrial electrograms were classified into 5 types (A1, A2, B1, B2 and C type) according to the type and the degree of fragmentation. Finally, the occurrence of junctional rhythm during RF discharge and its onset time were compared between successful and failed attempts. RESULTS: There was no significant difference in the maximum difference of amplitude and duration of atrial electrograms between successful and failed attempts. The success rate in each type of atrial electrogram was significantly different. And, the success rate in non-C type atrial electrograms (A1, A2, B1, and B2) was significantly higher than that in type C atrial electrograms (25.0% vs 10.3%, p<0.01). No significant difference was noted in success rates according to attempted sites. Junctional rhythms during radiofrequency application occured significantly more frequent in successful attempts than in failed attempts (87.5% vs 47.5%, p<0.001). The time to onset of junctional rhythm was not different between successful and failed attempts (5.2+/-4.9 sec vs 6.1+/-5.5 sec). CONCLUSION: Fragmented local atrial electrogram and junctional rhythm during RF energy delivery may be used to predict successful catheter ablation of AVNRT. It is recommended that RF energy should be applied to the site where fragmented atrial electrogram is recorded and terminated if junctional rhythm does not develop within 15 seconds after starting RF energy delivery.
Catheter Ablation*
;
Catheters*
;
Electrophysiologic Techniques, Cardiac
;
Female
;
Humans
;
Male
;
Tachycardia, Atrioventricular Nodal Reentry*
6.Intracardiac Electrogram at Successful Site of Radiofrequency Catheter Ablation in Patients with Atrioventricular Nodal Reentrant Tachycardia.
Jang Ho BAE ; Yoon Nyun KIM ; Kee Sik KIM ; Kwon Bae KIM ; Jae Ho PARK ; Sang Min LEE
Korean Circulation Journal 1998;28(11):1852-1860
BACKGROUND AND OBJECTIVES: Ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia (AVNRT) can be performed by using a specific intracardiac electrogram findings predicting a successful radiofrequency catheter ablation. The purpose of the present study is to recognize a specific intracardiac electrogram findings predicting a successful sites of radiofrequency catheter ablation in patients with AVNRT. MATERIALS AND METHODS: The study population consisted of the 18 patients (7 males, mean age:46 yr) to undergo successful catheter ablation using radiofrequency current in order to eliminate AVNRT from January 1993 to september 1994. We have analyzed local intracardiac electrogram at successful and unsuccessful sites of radiofrequency catheter ablation before the radiofrequency application: Atrial electrogram amplitude, duration, number of peaks in atrial electrogram, atrial/ventricular (A/V) electrogram amplitude ratio, and presence of His potential and/or slow potential. RESULTS: Of 18 patients, 16 patients underwent a slow pathway ablation, the other 2 patients a fast pathway ablation. The mean A/V electrogram amplitude ratio at successful and unsuccessful sites was 0.69+/-0.91 and 1.86+/-2.03, respectively. The mean atrial electrogram duration and number of peaks at successful and unsuccessful sites was 57+/-16 msec vs 69+/-16 msec and 1.7+/-0.5 vs 2.2+/-0.7, respectively. His bundle electrogram was seen in one slow pathway ablated and one fast pathway ablated patient. No slow potential could be identified in any of these 18 patients. CONCLUSION: We think that A/V electrocardiogram amplitude ratio below 0.5 at posterior interatrial septum along tricuspid annulus is important marker indicating a successful ablation sites.
Catheter Ablation*
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Electrocardiography
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Electrophysiologic Techniques, Cardiac*
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Humans
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Male
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Tachycardia, Atrioventricular Nodal Reentry*
7.Clinical Cardiac Electrophysiological Study on the Sinus Node and Atrioventricular Conduction System.
Yun Shik CHOI ; Myoung Mook LEE ; Young Bae PARK ; Jung Don SEO ; Young Woo LEE
Korean Circulation Journal 1985;15(2):255-268
Clinical EPS was performed in 16 normal adults without evidence of conduction disease on the surface standard 12 lead electrocardiogram in order to provide normal electrophysiological values of the sinus node function and AV conduction. EPS was also performed in 15 patients with sick sinus syndrome and 10 patients with AV conduction disturbance to evaluate the clinical usefulness of EPS in detecting sinus node dysfunction and AV conduction disturbance. The results were as follows. 1) The results of sinus node function test in the normal group were m-SNRT 853+/-198msec(range 800-1,560msec), c-SNRT 230+/-66msec(range 120-370msec), and %m -SNRT/SCL 127+/-11%(range 114-149%). 2) In 15 patients with SSS, the M-SNRT were ranged from 1,270 to 12,330msec and 10 patients(66%) had significantly increased m-SNRT exceeding 1,560msec. The c-SNRT were ranged from 230 to 10,730msec and 13 patients(83%) had significantly increased c-SNRT exceeding 370msec. The % m-SNRT/SCL were ranged from 136 to 770% and 12 patients(80%) had significantly increased % m-SNRT/SCL exceeding 150%. 3) The SACT in normal group were 84+/-14msec(range 70-105msec) measured by continuous atrial pacing method and 80+/-19 msec(range 60-115msec) measured by atrial extrastimulation method. 4) In SSS, the SACT measured by continuous atrial pacing method was ranged from 80 to 1,050msec and 11/12 patients(92%) had significantly increased SACT exceeding 112 msec. The SACT measured by atrial extrastimulation method was ranged from 90 to 310msec and 7/8 patients(88%) had significantly increased SACT exceeding 118 msec. 5) C-SNRT, % m-SNRT/SCL, and SACT were more useful in detecting sinus node dysfunction than m-SNRT. 6) The AV conduction intervals in normal group were PA interval 17+/-6(range 5-25msec), AH interval 96+/-18 msec(range 70-135msec), and HV interval 46+/-7msec(range 35-55msec). 7) Rapid atrial pacing induced Wenckebach type second degree AV block proximal to H at pacing rate of 90 to 190/min in 14/16 normal adults. 2 patients maintained intact AV conduction upto maximum pacing rate of 200/min. 8) His bundle electrogram showed the site of AV block in 9 of 10 patients with AV conduction disturbances. The sites of AV block were AV nodal area 1 case, intraHis bundle 4 cases, and infraHis bundle 4 cases. 9) EPS provided a good supportive information that was useful in selecting pacemaker therapy in a patient with chronic bifascicular block who revealed prolonged HV interval and infraHis bundle block at a pacing rate of 70min. 10) The refractory periods of AV conduction system in normal group were AERP 274+/-54msec (range 170-410msec), AVN-FRp 467+/-74msec(range 285-600msec), AVN-ERP 341+76msec(range 190-460), and V-ERP 280+/-25msec(range 240-320msec).
Adult
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Atrioventricular Block
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Electrocardiography
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Electrophysiologic Techniques, Cardiac
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Humans
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Sick Sinus Syndrome
;
Sinoatrial Node*
8.A Case of Complete A-V Block due to Intra-His Block.
Tai Ho RHO ; Jang Seong CHAE ; Chong Sang KIM ; Jae Hyung KIM ; Soon Jo HONG ; Sam Soo KIM ; Hak Joong KIM
Korean Circulation Journal 1983;13(2):443-447
His bundle recordings enable us to diagnose conduction disturbances not discernable in the standard leads, and to localize conduction block in the subdivisions of the conduction system. Cases of intra-His bundle block were first reported in 1970 by Narula and Samet. Thereafter many additional reports and studies were made. We report a case of 3degrees A-V block due to conduction block at the His bundle level. A 71-year-old woman was admitted because of dizziness. Surface ECG showed 3degrees A-V block. His bundle electrogram revealed typical split His potential. A-H intervals were 80 msec and H'-V intervals 50~70 msec. And there found no relation between AH and H'A. Atrial pacing resulted only prolongation of A-H to 90 msec but dissociation between h and H' was consistent. We implanted a permanent endocardial pacemaker in her chest.
Aged
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Bundle of His
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Dizziness
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Electrocardiography
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Electrophysiologic Techniques, Cardiac
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Female
;
Humans
;
Thorax
9.Substrate of complex fractionated atrial electrograms: evidence by pathologic analysis.
De-jun YOU ; Dong CHANG ; Shu-long ZHANG ; Dong-hui YANG ; Lian-jun GAO ; Xiao-meng YIN ; Zhen-liang CHU ; Yun-long XIA ; Yu-chun WANG ; Ying-xue DONG ; Yan-zong YANG
Chinese Medical Journal 2012;125(24):4393-4397
BACKGROUNDAblation of complex fractionated atrial electrograms (CFAE) is an important adjunctive therapy in atrial fibrillation (AF). The present study was to elucidate the substrate underlying CFAE.
METHODSNine adult mongrel dogs were involved in the present study. AF was induced through rapid atrial pacing with vagosympathetic nerve stimulation. CFAE was recorded during AF. Ablation was performed at CFAE sites. Based on the location of the ablation scar, the atrial specimens were divided into CFAE and non-CFAE sites. Serial sections of the atrium were stained respectively with hematoxylin-eosin (HE) and the general neural marker protein gene product 9.5 (PGP9.5). We compared the characteristics of the myocardium and the ganglionated plexus (GPs) distribution between the CFAE and non-CFAE sites.
RESULTSThe myocardium of non-CFAE sites was well-organized with little intercellular substance. However, the myocardium in the CFAE site was disorganized with more interstitial tissue ((61.7 ± 24.3)% vs. (34.1 ± 9.2)%, P < 0.01). GPs in the CFAE site were more abundant than in non-CFAE sites ((34.45 ± 37.46) bundles/cm(2) vs. (6.73 ± 8.22) bundles/cm(2), P < 0.01).
CONCLUSIONThe heterogeneity of the myocardium and GPs distribution may account for the substrate of CFAE and serve as a potential target of ablation.
Animals ; Atrial Fibrillation ; pathology ; Dogs ; Electrophysiologic Techniques, Cardiac ; methods ; Myocardium ; pathology
10.Discrete potentials guided ablation for idiopathic outflow tract ventricular arrhythmias.
Liu ENZHAO ; Zhang QITONG ; Xu GANG ; Liu TONG ; Ye LAN ; Zhao YANSHU ; Li GUANGPING
Chinese Journal of Cardiology 2015;43(8):700-704
OBJECTIVEDiscrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias. The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs).
METHODSSeventeen out of 24 consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation between September 2012 and December 2013 in our department were included. Intracardiac electrograms during the mapping and ablation were analyzed.
RESULTSDuring sinus rhythm, sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular electrograms in all of the 17 patients, peak amplitude was (0.51 ± 0.21) mV. The same potential was recorded prior to the local ventricular potential of the PVCs/VTs. Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram was noted during the arrhythmias. The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping. At the sites with DPs, unipolar and bipolar ventricular voltage of sinus beats were lower compared with the adjacent regions without DPs (unipolar: (6.1 ± 1.8) mV vs. (8.3 ± 2.3) mV, P < 0.05; bipolar: (0.62 ± 0.45) mV vs. (1.03 ± 0.60) mV, P < 0.05). The targeted DPs were still present in 12 patients after successful elimination of the ectopies. Discrete potentials were not present in seven controls.
CONCLUSIONSDiscrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias. Discrete potential- and substrate-guided ablation strategy could help to reduce the recurrence of idiopathic outflow tract arrhythmias.
Catheter Ablation ; Electrophysiologic Techniques, Cardiac ; Heart Ventricles ; Humans ; Recurrence ; Tachycardia, Ventricular