Polarity reversal mapping for localization of the left free wall accessory pathway (AP) at the atrial insertion site has been shown to be effective for successful ablation, but this technique requires atrial septal puncture. We evaluated the safety, efficacy, and reproducibility of two dimensional polarity reversal mapping at the ventricular insertion site of the accessory pathway without atrial septal puncture in symptomatic patients with manifested left free wall AP. Polarity reversal mapping under the mitral annulus by transaortic approach was performed in 10 consecutive patients with conventional ablation catheter (6 French, 4 mm tip, 2 mm interelectrode distance), during sinus rhythm or atrial pacing. A low set high, bandpass filter (0.005-400Hz) was used. Radiofrequency (RF) ablation was performed at the site of ventricular electrocardiogram polarity reversal during sinus rhythm. Polarity reversal was identified in all patients at the ventricular side of the mitral annulus. Ablation was successful in all patients without complications. The procedure time was 86.0 +/- 21.1 min, the fluoroscopic exposure time was 16 +/- 12 min, the number of RF applications was 8 +/- 6, the power level 21 +/- 7 watts, and the time to initial AP block was 3.0 +/- 0.9 sec. Polarity reversal mapping is a safe and efficient technique at the ventricular insertion site. This technique might be complementary to the currently-utilized activation mapping technique.
Adult ; Catheter Ablation/methods* ; Electrocardiography ; Electrodiagnosis* ; Female ; Heart Conduction System/physiopathology ; Human ; Male ; Middle Age ; Radiography, Thoracic ; Tachycardia, Supraventricular/surgery* ; Tachycardia, Supraventricular/physiopathology ; Tachycardia, Supraventricular/diagnosis*

Discrete radiofrequency lesion at the atrial insertion site of the tendon of Todaro in the perfused rabbit preparation lengthens A-H interval, mimicking fast pathway input ablation. This study attempts to define the cellular electrophysiology of the ablation region prior to and after the elimination of fast AV node conduction. In six superfused rabbit AV node preparations, the cellular electrophysiology around the region of the atrial insertion to the tendon of Todaro was recorded using standard microelectrode technique prior to and after ablation. Before ablation, the action potentials recorded in the area of proposed lesion were exclusively from atrial or AN cells. At postablation, the superior margin of the lesion was populated with atrial or AN cells. AN, N, or NH cells bordered the lower part of the lesion. Electrophysiology of surviving cells at the edges of the lesion showed no significant changes in their Vmax, APD50 or APD90 and MDP from preablation values. Fast AV node pathway input ablation in the rabbit heart can be accomplished with a singular lesion around the atrial insertion site of the tendon of Todaro, involving atrial or AN cells. The results of the studies imply that inputs to the compact node may act as a substrate for successful ablation of AV node reentry tachycardia.
Action Potentials/physiology ; Animal ; Atrioventricular Node/surgery* ; Atrioventricular Node/physiology ; Atrioventricular Node/cytology* ; Catheter Ablation/methods* ; Electrophysiology ; Rabbits ; Recovery of Function ; Tachycardia, Supraventricular/surgery ; Tachycardia, Supraventricular/physiopathology

Atrial Appendage ; physiopathology ; Catheter Ablation ; Child ; Child, Preschool ; Female ; Humans ; Male ; Tachycardia, Ectopic Atrial ; etiology ; surgery ; Tachycardia, Supraventricular ; etiology ; surgery

A patient with non-ischaemic cardiomyopathy, and pre-existing atypical atrial flutter and left bundle branch block, developed broad complex tachycardia. In this unique and uncommon case of double tachycardia, we discuss the diagnostic approach of ventricular tachycardia in patients with broad complex tachycardia, and the use of different contemporary algorithms to help diagnose ventricular tachycardia and differentiate it from supraventricular tachycardia with aberrant conduction.
Algorithms ; Atrial Flutter ; complications ; diagnosis ; Bundle-Branch Block ; physiopathology ; Cardiomyopathies ; complications ; diagnosis ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Humans ; Male ; Middle Aged ; Tachycardia, Supraventricular ; diagnosis ; physiopathology ; Tachycardia, Ventricular ; diagnosis ; physiopathology

Cholestasis ; etiology ; Gestational Age ; Humans ; Hydrops Fetalis ; physiopathology ; Infant, Newborn ; Liver Function Tests ; Male ; Tachycardia, Paroxysmal ; complications ; embryology ; physiopathology ; Tachycardia, Supraventricular ; complications ; embryology ; physiopathology

We discuss two cases of incessant atrial tachycardia (AT), including the presentation and clinical course. It is important to differentiate AT from other causes of supraventricular tachycardia, such as atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT), as it would have implications on clinical management. Electrocardiographic features of AT, especially the presence of an AV Wenckebach phenomenon with 'grouped beating', are critical for differentiating AT from AVRT and AVNRT. It is also vital to identify the P waves and their relations to QRS on electrocardiography, as this would aid in the differentiation of various supraventricular tachycardias.
Aged ; Diagnosis, Differential ; Electrocardiography ; Electrophysiology ; Female ; Heart Conduction System ; abnormalities ; Hemodynamics ; Humans ; Male ; Respiration ; Tachycardia ; diagnosis ; Tachycardia, Atrioventricular Nodal Reentry ; diagnosis ; Tachycardia, Supraventricular ; diagnosis ; Tricuspid Valve ; physiopathology

OBJECTIVEThe aVR lead four steps is a new algorithm for differential diagnosis of wide QRS complex tachycardia (WCT). The study explores the clinical value of this new algorithm on differential diagnosis of WCT.

METHODSApplication of aVR lead four steps to analysis the electrocardiogram of patients with WCT proved by electrophysiological study. Every step's accuracy rate, sensitivity and specificity to differential diagnosis of ventricular tachycardia (VT) were calculated. The first step diagnosed VT according to presence of an initial R wave in the aVR lead. The second step diagnosed VT according to width of an initial r or q wave > 40 ms in the aVR lead. The third step diagnosed VT according to notching on the initial downstroke of a predominantly negative QRS complex in the aVR lead. The fourth step diagnosis VT according to ventricular activation-velocity ratio (Vi/Vt) in the aVR lead, Vi/Vt ≤ 1 suggested VT. Results derived from aVR lead four steps algorithm were compared with results derived from Brugada and Vereckei four steps algorithm.

RESULTSA total of 113 patients with WCT were analyzed (31 supraventricular tachycardia, SVT and 82 ventricular tachycardia, VT). The accuracy rate of differential diagnosis VT is 91.2%, sensitivity is 90.2% and specificity is 77.4%. The accuracy and sensitivity of the aVR lead four steps algorithm for differential diagnosis of WCT were superior to the Brugada Vereckei four steps algorithm (P < 0.05). The specificity of the Vereckei four steps algorithm was superior to aVR lead and Brugada four steps algorithm (P < 0.05), while the specificity of the aVR lead four steps algorithm was similar as Brugada four steps algorithm (P > 0.05).

CONCLUSIONSThe aVR lead four steps algorithm is associated with excellent accuracy rate, sensitivity for differential diagnosis of WCT. This algorithm is simple and could be easily learned and applied by physician.

Adolescent ; Adult ; Aged ; Algorithms ; Diagnosis, Differential ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Tachycardia, Supraventricular ; diagnosis ; physiopathology ; Tachycardia, Ventricular ; diagnosis ; physiopathology ; Young Adult

Catheter ablation of the left free-wall accessory pathways (APs) is normally performed by the retrograde transaortic approach via a femoral artery or the transseptal approach. Here we report a case of an overt left free-wall AP, which was successfully ablated with a retrograde transaortic approach via the radial artery without any vascular complications. The patient has remained free of any symptoms or pre-excitation observed on the ECG during a 10-month post- ablation follow-up.
Adult ; Catheter Ablation/*methods ; Electrocardiography ; Humans ; Male ; Tachycardia, Supraventricular/complications/physiopathology/*therapy ; Treatment Outcome ; Wolff-Parkinson-White Syndrome/complications/pathology

The effectiveness and safety of acupuncture for the treatment of supraventricular tachycardia were systematically reviewed. The randomized controlled trials (RCTs) regarding acupuncture for supraventricular tachycardia were searched in domestic and overseas databases, and the evaluation tool of bias risk in Cochrane Handbook 5.1.0 software was used to perform the evaluation of bias risk in literature, and RevMan 5.2 software was applied for statistics and Meta-analysis. Five RCTs involving 323 patients were included. The results showed that compared with the blank control group, the acupuncture reduced the heart rate by 18.8 times/min [95% CI (12.68, 24.92)]; the clinical effective rate in the acupuncture group was superior to that in the diltiazem group [OR= 3.11, 95% CI (1.50, 6.46)]; the difference of immediate effect between propafenone and acupuncture was not significant. No reports regarding adverse events was described in 5 RCTs. As was shown in the present evidence, acupuncture is safe and effective for the treatment of supraventricular tachycardia, but the level of evidence was low and the intensity of conclusion needed to be improved.
Acupuncture Points ; Acupuncture Therapy ; adverse effects ; Humans ; Randomized Controlled Trials as Topic ; Tachycardia, Supraventricular ; physiopathology ; therapy ; Treatment Outcome

Electrocardiographic (ECG) artefacts may closely simulate both supraventricular and ventricular tachycardias. We describe a case initially diagnosed as rapid atrial fibrillation, based on 12-lead surface ECG (especially the limb leads) and monitor tracing. The arrhythmia was resistant to beta blockers. Because of the at times apparently regular rhythm, an esophageal ECG recording was performed, and adenosine was administered. When the presumed atrial fibrillation terminated after sodium pentothal was administered while preparing for electrical cardioversion, the oesophageal ECG recordings and the ECGs during adenosine administration were reviewed. An ECG artefact diagnosis was suspected, and then confirmed, during relapse of the "arrhythmia," with simple palpation of the radial pulse and cardiac auscultation.
Adenosine/diagnostic use ; Adult ; *Artifacts ; Atrial Fibrillation/*diagnosis/physiopathology/therapy ; *Diagnostic Errors ; *Electrocardiography ; Female ; Humans ; Predictive Value of Tests ; Tachycardia, Supraventricular/*diagnosis/physiopathology/therapy ; Time Factors ; *Unnecessary Procedures