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Journal of Arrhythmia
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     ISSN (Print) 1880-4276 - ISSN (Online) 1883-2148
     Published by Elsevier Homepage  [2563 journals]   [H-I: 1]
  • Editorial Board
    • Pages: iii - iv
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-08-01
      DOI: 10.1016/S1880-4276(14)00116-1
      Issue No: Vol. 30, No. 4 (2014)
       
  • Idiopathic ventricular arrhythmias arising from the left ventricular
           outflow tract: Tips and tricks
    • Authors: Koji Kumagai
      Pages: 211 - 221
      Abstract: Abstract: Idiopathic left ventricular outflow tract ventricular arrhythmias (LVOT-VAs) arising from the LVOT are rare compared with the VAs arising from the RVOT. Idiopathic LVOT-VAs have been divided into four subgroups based on successful catheter ablation sites: the aorto-mitral continuity (AMC), the anterior site around the mitral annulus (MA), the aortic sinus cusps (ASC), and the epicardium. Recognition of the ECG characteristics of LVOT-VAs combined with anatomical information should facilitate their appropriate diagnosis and treatment. In particular, the AMC is located adjacent to the anterior site of the MA, ASC, and epicardium. All subtypes of LVOT-VAs, except those with epicardial origins, are successfully treated with endocardial radiofrequency catheter ablation combined with pace mapping and the identification of the earliest ventricular electrogram with a prepotential, if it is recordable. In addition, LVOT-VAs originating from an inaccessible area in the LV summit of the epicardium, which cannot be treated by epicardial catheter ablation, should be differentiated from those in an accessible area using novel electrophysiological characteristics. Despite many morphological similarities among the subtypes of LVOT-VAs, the ECG characteristics and anatomical information obtained from visualization using computed tomographic image integration with electroanatomical mapping may advance the safety and success of catheter ablation of idiopathic LVOT-VAs.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-04-07
      DOI: 10.1016/j.joa.2014.03.002
      Issue No: Vol. 30, No. 4 (2014)
       
  • Radiofrequency catheter ablation of macroreentrant ventricular tachycardia
           after corrective surgery for tetralogy of Fallot
    • Authors: Masaomi Chinushi; Osamu Saitou, Hiroshi Furushima
      Pages: 222 - 229
      Abstract: Abstract: Ventricular tachycardia (VT) may occur in patients after corrective surgery for tetralogy of Fallot (ToF), and this can be a cause of sudden cardiac death. Macroreentrant VT is a unique mechanism in these patients, although other mechanisms are involved in VT development. Owing to advances in electrophysiological knowledge and medical technology, macroreentrant VT after corrective surgery for ToF can be treated by catheter ablation. In the macroreentrant circuit of VT, several critical isthmuses (types 1–4) could be included, and these are supported by anatomical obstacles and operative interventions in the right ventricle. Linear radiofrequency (RF) application through the critical isthmus can terminate and prevent the recurrence of macroreentrant VT. Among the critical isthmuses, the type 1 isthmus (between the right ventricular outflow scar and tricuspid annulus) is the most common, but compared with the other types of isthmuses, it is longer so and has a thicker myocardium. Therefore, higher-energy RF application using irrigation and/or large-tip ablation catheters is usually required to complete the linear conduction block. Since other isthmuses may simultaneously work as critical components of the macroreentrant circuit, detailed mapping is encouraged before starting RF application in the type 1 isthmus. Since long-term evidence of the effectiveness of catheter ablation for VT in patients after ToF repair is limited, hybrid treatment with implantable cardioverter defibrillators (ICDs) would be a reasonable strategy for secondary prevention of cardiac events, such as that in patients with other underlying heart diseases. Indications of electrophysiological study, catheter ablation, and/or ICD therapy for primary prevention of sudden cardiac death should be further examined in high-risk patients after ToF repair.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-04-07
      DOI: 10.1016/j.joa.2014.02.007
      Issue No: Vol. 30, No. 4 (2014)
       
  • Noninvasive risk stratification of lethal ventricular arrhythmias and
           sudden cardiac death after myocardial infarction
    • Authors: Kenji Yodogawa; Wataru Shimizu
      Pages: 230 - 234
      Abstract: Abstract: Prediction of lethal ventricular arrhythmias leading to sudden cardiac death is one of the most important and challenging problems after myocardial infarction (MI). Identification of MI patients who are prone to ventricular tachyarrhythmias allows for an indication of implantable cardioverter-defibrillator placement. To date, noninvasive techniques such as microvolt T-wave alternans (MTWA), signal-averaged electrocardiography (SAECG), heart rate variability (HRV), and heart rate turbulence (HRT) have been developed for this purpose. MTWA is an indicator of repolarization abnormality and is currently the most promising risk-stratification tool for predicting malignant ventricular arrhythmias. Similarly, late potentials detected by SAECG are indices of depolarization abnormality and are useful in risk stratification. However, the role of SAECG is limited because of its low predictive accuracy. Abnormal HRV and HRT patterns reflect autonomic disturbances, which may increase the risk of lethal ventricular arrhythmias, but the existing evidence is insufficient. Further studies of noninvasive assessment may provide a new insight into risk stratification in post-MI patients.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-04-24
      DOI: 10.1016/j.joa.2014.02.013
      Issue No: Vol. 30, No. 4 (2014)
       
  • Molecular mechanisms of heart failure progression associated with
           implantable cardioverter-defibrillator shocks for ventricular
           tachyarrhythmias
    • Authors: Yukiomi Tsuji; Taisuke Ishikawa, Naomasa Makita
      Pages: 235 - 241
      Abstract: Abstract: Implantable cardioverter-defibrillators (ICDs) are highly effective in reducing mortality related to ventricular tachyarrhythmias (VTAs). Despite this benefit, the occurrence of ICD shocks for VTAs in patients with heart failure (HF) and depressed left ventricular function has been associated with adverse outcomes. Patients with shocked VTAs are at an elevated risk of HF and death. While VTAs may be markers for high-risk patients, it is possible that the harmful effects of electrical shocks and VTAs are involved in HF progression and associated mortality. Some investigators have speculated that shocked VTAs may activate signaling pathways in the molecular cascade of HF. We recently reported in an experimental model of ventricular fibrillation storm that multiple ICD shocks for recurrent ventricular fibrillation caused striking activation of Ca2+/calmodulin-dependent protein kinase II, a validated signaling molecule for HF. This review article describes the harmful effects of shocks and VTAs and proposes that Ca2+/calmodulin-dependent protein kinase II could connect shocked VTAs to adverse outcomes.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-05-09
      DOI: 10.1016/j.joa.2014.04.003
      Issue No: Vol. 30, No. 4 (2014)
       
  • Management of electrical storm: The mechanism matters
    • Authors: Mitsunori Maruyama
      Pages: 242 - 249
      Abstract: Abstract: An electrical storm is a life-threatening syndrome that is characterized by clustering of recurrent episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) within a relatively short period of time. Electrical storms occur in a wide variety of conditions, and successful treatment depends on a correct understanding of the mechanism underlying the recurrent arrhythmias. Management of electrical storms is challenging, but classifying patients according to the type of recurrent arrhythmia (monomorphic VT or polymorphic VT/VF) and the presence or absence of structural heart disease would aid differential diagnosis and allow for more specific therapies.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-05-16
      DOI: 10.1016/j.joa.2014.03.012
      Issue No: Vol. 30, No. 4 (2014)
       
  • Evolution of ventricular tachycardia ablation in structural heart disease
    • Authors: Roderick Tung
      Pages: 250 - 261
      Abstract: Abstract: The field of catheter ablation of VT has evolved conceptually and technologically over the past three decades. From the fundamental understanding of the reentrant mechanism in scar-mediated VT to the advent and routine implementation of electroanatomic mapping, catheter ablation has emerged from a palliative last-resort therapy to a more preemptive strategy for patients at risk for arrhythmia recurrence. An increasing utilization of pre-procedural imaging, high-density mapping, epicardial access, and more extensive ablation strategies have all contributed to improved clinical success. Advances in ablation technology and randomized trials are needed to build upon the progress in this growing field as sudden cardiac death from ventricular tachyarrhythmia continues to be the one of leading causes of death throughout the world.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-06-09
      DOI: 10.1016/j.joa.2014.04.005
      Issue No: Vol. 30, No. 4 (2014)
       
  • Catheter ablation of epicardial ventricular tachycardia
    • Authors: Takumi Yamada
      Pages: 262 - 271
      Abstract: Abstract: Ventricular tachycardias (VTs) can usually be treated by endocardial catheter ablation. However, some VTs can arise from the epicardial surface, and their substrate can be altered only by epicardial catheter ablation. There are two approaches to epicardial catheter ablation: transvenous and transthoracic. The transvenous approach through the coronary venous system (CVS) has been commonly used because it is easily accessible. However, this approach may be limited by the distribution of the CVS and insufficient radiofrequency energy delivery. Transthoracic epicardial catheter ablation has been developed to overcome these limitations of the transvenous approach. It is a useful supplemental or even preferred strategy to eliminate epicardial VTs in the electrophysiology laboratory. This technique has been applied for scar-related VTs secondary to often non-ischemic cardiomyopathy and sometimes ischemic cardiomyopathy, and idiopathic VTs as the epicardial substrates of these VTs have become increasingly recognized. When endocardial ablation and epicardial ablation through the CVS are unsuccessful, transthoracic epicardial ablation should be the next option. Intrapericardial access is usually obtained through a subxiphoidal pericardial puncture. This approach might not be possible in patients with pericardial adhesions caused by prior cardiac surgery or pericarditis. In such cases, a hybrid procedure involving surgical access with a subxiphoid pericardial window and a limited anterior or lateral thoracotomy might be a feasible and safe method of performing an epicardial catheter ablation in the electrophysiology laboratory. Potential complications associated with this technique include bleeding and collateral damage to the coronary arteries and phrenic nerve. Although the risk of these complications is low, electrophysiologists who attempt epicardial catheter ablation should know the complications associated with this technique, how to minimize their occurrence, and how to rapidly recognize and treat the complications that they encounter. This review discusses the indications, techniques, and complications of the transvenous and transthoracic epicardial catheter ablation of VTs.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-06-09
      DOI: 10.1016/j.joa.2014.04.011
      Issue No: Vol. 30, No. 4 (2014)
       
  • Substrate-based approach for ventricular tachycardia in structural heart
           disease: Tips for mapping and ablation
    • Authors: Yuki Komatsu
      Pages: 272 - 282
      Abstract: Abstract: Catheter ablation of scar-related ventricular tachycardia (VT) often relies on substrate-based approaches because of hemodynamic instability during VT, multiple VT morphologies, and poor reproducibility of VT-inducibility, rendering the VT unmappable. As substrate-guided ablation is performed in stable sinus rhythm, any VT can potentially be targeted regardless of its hemodynamic state. So-called “late potentials,” conventionally defined as signals detected after the end of QRS, have been traditionally proposed as ablation targets. However, late potentials cannot be detected in up to 30% of patients with VT in the setting of ischemic and non-ischemic cardiomyopathy. Recently, a substrate-based approach that targets poorly coupled fibers surviving within the scar has been developed. These bundles generate local abnormal ventricular activities (LAVA) and are believed to be responsible for VT. Considering the limitations of late potential ablation, substrate homogenization with the aim of eliminating all identified LAVA appears to be an ideal procedural endpoint. This article reviews substrate-based approaches and tips for mapping and ablation of VT substrate.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-06-26
      DOI: 10.1016/j.joa.2014.04.014
      Issue No: Vol. 30, No. 4 (2014)
       
  • Mapping of ventricular tachycardia in patients with structural heart
           disease
    • Authors: Hiroya Mizuno
      Pages: 283 - 291
      Abstract: Abstract: Catheter ablation is now recognized as one of the potent options to reduce the number of implantable cardioverter defibrillator (ICD) shock therapies by modifying arrhythmic substrate in patients affected by ventricular tachycardia (VT). However, operators often face some difficulties during mapping and ablation procedure of VT; unstable VT makes it difficult to create activation map, the thick ventricular myocardium yields complex tachycardia circuit, and endocardial radiofrequency (RF) energy application hardly creates transmural lesion. Thus some novel approaches are required to improve outcome of VT ablation. Substrate mapping aiming low voltage or abnormal fragmented potential could identify the critical slow conduction area during sinus rhythm and define the target of RF delivery. CT and MRI image integrated to electroanatomical mapping (EAM) system also could help to find diseased myocardium.In this article focused on VT mapping procedure, conventional and novel mapping technique as well as some technical tips should be reviewed comprehensively.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-07-11
      DOI: 10.1016/j.joa.2014.04.015
      Issue No: Vol. 30, No. 4 (2014)
       
  • The morphology of unipolar potentials predicts the depth of activation
           foci
    • Authors: Yoshiaki Kaneko; Tadashi Nakajima, Masahiko Kurabayashi
      Pages: 292 - 299
      Abstract: Abstract: Background: The depth of an arrhythmic focus is a major determinant of ablation procedural outcome. This study examined the relationship between the morphology of unipolar potentials and the depth and horizontal distance to activation foci.Methods: Unipolar left ventricular epicardial mapping was performed in 7 open-chest dogs, using silicon sheets with 12 unipolar electrodes 1mm apart, during bipolar pacing from an octopolar plunge electrode with 1-mm interelectrode spacing. The morphology of the unipolar electrograms was classified as QS, rS, qrS, qRS, rsr’S, or rsR’S.Results: A QS complex was recorded immediately above a subepicardial or mid-myocardial pacing site. An rS complex was recorded away from a subepicardial pacing site. A positive wave originating from a down sloping deflection (R-in-QR) such as r wave in qrS, R wave in qRS, r′ wave in rsr’S or R′ wave in rsR’S complexes was observed when the recording was above a deep myocardial pacing site or away from a mid-myocardial pacing site. The amplitude of negative wave immediately before R-in-QR (Q-in-QR) was inversely correlated with the horizontal (R=−0.40; P
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-04-28
      DOI: 10.1016/j.joa.2014.02.009
      Issue No: Vol. 30, No. 4 (2014)
       
  • Inducibility of ventricular arrhythmias in early repolarization syndrome
           and Brugada syndrome: From the J-wave associated with prior cardiac event
           (J-PREVENT) registry
    • Authors: Yoshihide Takahashi; Yuki Osaka, Akihiko Nogami, Mitsuhiro Nishizaki, Kaoru Okishige, Makoto Suzuki, Yasuteru Yamauchi, Yuichi Ono, Kou Suzuki, Kenzo Hirao, Mitsuaki Isobe
      Pages: 300 - 304
      Abstract: Abstract: Background: Although electrophysiological study is often performed in Brugada syndrome (BrS) to assess inducibility of ventricular arrhythmias (VA), the utility of electrophysiological study in early repolarization syndrome (ERS) remains unknown. The aim of the present multi-center observational study was to compare inducibility of VA in ERS with BrS, and to investigate any association between inducibility and recurrence of arrhythmic events in these patients.Methods: The J-PREVENT registry consists of patients with early repolarization or Brugada type 1 ECGs, a history of prior cardiac events, and no structural heart disease. Patients in the registry with implantable cardioverter-defibrillators (ICDs) and who underwent electrophysiological study were enrolled. VA inducibility was assessed by programmed electrical stimulation performed at two different sites in the right ventricle with up to three extrastimuli. The occurrence of VA during follow-up was determined by interrogation of the patients׳ ICDs.Results: Of the 79 patients studied (72 males, mean age 44±13 years), 21 patients (27%) had ERS, and 58 had BrS, 20 of whom also had early repolarization in the inferolateral leads. VA was induced in 9 patients (43%) and 45 (78%) with ERS and BrS, respectively (p=0.006). During a median follow-up of 1453 days, occurrence rate of VA was similar between ERS and BrS (p=0.35). Inducibility was not associated with occurrence of VA in either syndrome.Conclusions: In patients with ERS with prior history of cardiac events, VA was induced in 43% of patients during electrophysiological study, approximately half that of BrS. Inducibility was not associated with occurrence of VA during follow-up, although this was true of BrS patients as well. Electrophysiological study may play a limited role in risk stratification in ERS.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-04-14
      DOI: 10.1016/j.joa.2014.03.004
      Issue No: Vol. 30, No. 4 (2014)
       
  • Usefulness of non-contact mapping for catheter ablation of ventricular
           tachycardias originating at the right ventricular outflow tract
    • Authors: Tadashi Hoshiyama; Hiroshige Yamabe, Junjiroh Koyama, Hisanori Kanazawa, Miwa Ito, Hisao Ogawa
      Pages: 305 - 311
      Abstract: Abstract: Background: Different QRS morphologies are often observed in idiopathic ventricular tachycardias or premature ventricular contractions originating from the right ventricular outflow tract (RVOT). However, the precise mechanism underlying multiple QRS morphologies has not been clarified adequately. The purpose of this study was to examine the mechanism underlying different QRS morphologies in RVOT arrhythmia. We also investigated the usefulness of non-contact mapping guided radiofrequency catheter ablation for RVOT arrhythmia.Methods: Endocardial mapping of RVOT was performed using a non-contact mapping system in 20 patients with RVOT arrhythmia. We analyzed the underlying mechanism that produces different QRS morphologies during catheter ablation of RVOT arrhythmia.Results: Forty-six QRS morphologies of RVOT arrhythmia were observed in 20 patients. Five patients showed monofocal QRS morphology, whereas the remaining 15 patients showed multiple QRS morphologies (from 2 to 4 morphologies each). Among these, all patients presented a shift in the origin of tachycardia. Additionally, different QRS morphologies were observed in 5 of these patients that were caused by a change in the local activation after radiofrequency energy delivery. Radiofrequency energy application to the site of origin of the RVOT arrhythmia using non-contact mapping navigation eliminated the RVOT arrhythmias in all patients. However, 1 patient presented a recurrence of RVOT arrhythmia (success rate, 95.0%).Conclusions: The multiple QRS morphologies of RVOT arrhythmia were caused by a shift in the origin of tachycardia or by a change in the local activation following the radiofrequency energy application. Non-contact mapping was useful to identify the appropriate target site of RVOT arrhythmia irrespective of the changes in QRS morphologies.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-05-16
      DOI: 10.1016/j.joa.2014.03.010
      Issue No: Vol. 30, No. 4 (2014)
       
  • Clinical utility of multielectrode contact mapping for scar-related
           ventricular tachycardia ablation: A prospective single-center experience
    • Authors: Shiro Nakahara; Yuichi Hori, Tohru Kamijima, Naofumi Tsukada, Naoki Nishiyama, Kohta Yamada, Akiko Hayashi, Takaaki Komatsu, Sayuki Kobayashi, Yoshihiko Sakai, Isao Taguchi, Kan Takayanagi
      Pages: 312 - 319
      Abstract: Abstract: Background: As with the use of circular catheters for pulmonary vein antral ablation, it may be favorable to use multipolar catheters for substrate mapping of the left ventricle (LV). The purpose of this study was to investigate the clinical feasibility of using multielectrode mapping combined with an impedance-based electroanatomic mapping system for scar-mediated ventricular tachycardia (VT).Methods: By using the multielectrode catheter in conjunction with the Velocity system, we obtained both geometric and electrogram data simultaneously, through transseptal and transsubxiphoid approaches. Higher-density mapping was performed in areas of dense scar (
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-06-09
      DOI: 10.1016/j.joa.2014.04.010
      Issue No: Vol. 30, No. 4 (2014)
       
  • His-Purkinje system-related incessant ventricular tachycardia arising from
           the left coronary cusp
    • Authors: Eiji Sato; Tetsuo Yagi, Akio Namekawa, Akihiko Ishida, Yoshiaki Mibiki, Yoshihiro Yamashina, Hirokazu Sato, Takashi Nakagawa, Manjirou Sakuramoto, Jyuri Komatsu, Tomoyuki Yambe
      Pages: 323 - 326
      Abstract: Abstract: We describe the case of a 23-year-old woman who had His-Purkinje system-related incessant ventricular tachycardia with a narrow QRS configuration. The ventricular tachycardia was ablated successfully in the left coronary cusp where the earliest endocardial activation had been recorded. We hypothesize that a remnant of the subaortic conducting tissue was the source of the ventricular arrhythmias.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2014-06-16
      DOI: 10.1016/j.joa.2014.04.004
      Issue No: Vol. 30, No. 4 (2014)
       
  • Dissociated late potentials during sinus rhythm after radiofrequency
           ablation in a patient with postinfarction ventricular tachycardia
    • Authors: Shiro Nakahara; Yuichi Hori, Sayuki Kobayashi, Naofumi Tsukada, Yoshihiko Sakai, Kan Takayanagi
      Pages: 320 - 322
      Abstract: Abstract: A 72-year-old man with ischemic cardiomyopathy was admitted for the treatment of ventricular tachycardia (VT). Because his VT was poorly tolerated hemodynamically, substrate mapping was performed. The map revealed the presence of low-voltage areas in the inferolateral wall of the LV. Late potentials (LPs) were recorded during sinus rhythm, and pacing at the site revealed a good pacemap for targeting the VT. Delivery of radiofrequency (RF) current to the area where LPs were recorded rendered the targeted VT noninducible. After RF delivery, dissociation of the LPs with an interval of 3140ms was documented during sinus rhythm.
      Citation: Journal of Arrhythmia 30, 4 (2014)
      PubDate: 2013-11-18
      DOI: 10.1016/j.joa.2013.09.008
      Issue No: Vol. 30, No. 4 (2013)
       
 
 
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