Atrioventricular nodal ablation versus antiarrhythmic drugs after permanent pacemaker implantation for bradycardia-tachycardia syndrome

Nagamoto, Yasutsugu; Inage, Tomohito; Yoshida, Tetsuji; Takeuchi, Tomohiro; Gondo, Takeki; Fukuda, Yujiro; Takii, Eiichi; Murotani, Kenta; Imaizumi, Tsutomu

doi:10.1007/s00380-011-0126-4

Cited by 7 publications

(2 citation statements)

References 30 publications

(39 reference statements)

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“…Therefore, as in previous clinical studies [9, 10], we measured the distance between the earliest H recording and the superior margin of the CS ostium (Fig. 1) as the length of Koch’s triangle (Koch-L) [23]. …”

Section: Methodsmentioning

confidence: 99%

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

et al. 2013

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The length of the slow pathway (SP-L) in atrioventricular (AV) nodal reentrant tachycardia (NRT) has never been measured clinically. We studied the relationship among (a) SP-L, i.e., the distance between the most proximal His bundle (H) recording and the most posterior site of radiofrequency (RF) delivery associated with a junctional rhythm, (b) the length of Koch’s triangle (Koch-L), (c) the conduction time over the slow pathway (SP-T), measured by the AH interval during AVNRT at baseline, and (d) the distance between H and the site of successful ablation (SucABL-L) in 26 women and 20 men (mean age 64.6 ± 11.6 years), using a stepwise approach and an electroanatomic mapping system (EAMS). SP-L (15.0 ± 5.8 mm) was correlated with Koch-L (18.6 ± 5.6 mm; R2 = 0.1665, P < 0.005), SP-T (415 ± 100 ms; R2 = 0.3425, P = 0.036), and SucABL-L (11.6 ± 4.7 mm; R2 = 0.5243, P < 0.0001). The site of successful ablation was located within 10 mm of the posterior end of the SP in 38 patients (82.6 %). EAMS-guided RF ablation, using a stepwise approach, revealed individual variations in SP-L related to the size of Koch’s triangle and AH interval during AVNRT. Since the site of successful ablation was also correlated with SP-L and was usually located near the posterior end of the SP, ablating anteriorly, away from the posterior end, is not a prerequisite for the success of ablation procedures.

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Section: Methodsmentioning

confidence: 99%

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

et al. 2013

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“…In addition, an irregular sequence of RR intervals produces adverse hemodynamic consequences that are independent of the heart rate (4,5). A regular ventricular rhythm was achieved after the first biventricular pacemaker implantation, and the patient's heart failure symptoms improved in association with decreases in her plasma BNP levels.…”

Section: Discussionmentioning

confidence: 84%

Heart Failure Exacerbation Associated with Newly Developed Atrioventricular Dyssynchrony after Chemical Conversion to a Sinus Rhythm in a Patient Receiving Cardiac Resynchronization Therapy

et al. 2013

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A 58-year-old woman with chronic heart failure (CHF) received cardiac resynchronization-defibrillator (CRT-D) therapy without atrial lead implantation due to longstanding atrial fibrillation (AF). Three months after oral amiodarone therapy was initiated for the treatment of non-sustained ventricular tachycardia detected by the CRT-D device, the patient's heart failure symptoms worsened and 12-lead electrocardiography showed newly emerged p-waves with atrioventricular (AV) dissociation. Immediately after the device was upgraded to the DDD-biventricular pacemaker, the patient's heart failure symptoms and cardiac function dramatically improved, which suggests that AV dissociation has a much more negative impact on the cardiac function than AF in patients with CHF.

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Beneficial effects of losartan for prevention of paroxysmal atrial fibrillation in patients with sick sinus syndrome: analysis with memory function of pacemaker

et al. 2015

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Renin-angiotensin system (RAS) inhibitors may be useful in preventing the occurrence of paroxysmal atrial fibrillation (PAF). However, evaluation of such effect is difficult because many PAF episodes are asymptomatic and not all episodes are detected by intermittent electrocardiographic monitoring. A pacemaker has been developed with dedicated functions for AF detection and electrocardiogram storage. Accordingly, we examined the effect of losartan, an angiotensin receptor blocker on PAF occurrence using this new modality. We enrolled 70 consecutive patients who had undergone dual-chamber pacemaker implantation for sick sinus syndrome. Finally, 62 patients participated in the study. Thirty patients were randomized to the losartan group (mean 43 ± 12 mg/day) and 32 patients to the control group. They were followed up for 3 months. The frequency, the maximum duration and the total duration of PAF recorded by the stored electrocardiograms for the last 1 month during the observation period and study period were compared between the two groups. The change in the frequency of PAF from the observation period in the losartan and control groups was similar (-35 ± 25 vs. -67 ± 62 times; NS). However, the change in the maximum duration and the total duration of PAF was significantly shorter in the losartan group than in the control group (-493 ± 158 vs. -10 ± 69 min; p < 0.05, and -4007 ± 2334 vs. 1119 ± 714 min; p < 0.05, respectively). Losartan suppressed the maximum duration and the total duration of PAF in patients with sick sinus syndrome without hemodynamic changes. This is the first study to show the effect of a renin-angiotensin system inhibitor on the secondary prevention of PAF using the dedicated functions of a pacemaker for PAF detection and electrocardiogram storage.

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Atrioventricular nodal ablation versus antiarrhythmic drugs after permanent pacemaker implantation for bradycardia-tachycardia syndrome

Cited by 7 publications

References 30 publications

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

Electroanatomically estimated length of slow pathway in atrioventricular nodal reentrant tachycardia

Heart Failure Exacerbation Associated with Newly Developed Atrioventricular Dyssynchrony after Chemical Conversion to a Sinus Rhythm in a Patient Receiving Cardiac Resynchronization Therapy

Beneficial effects of losartan for prevention of paroxysmal atrial fibrillation in patients with sick sinus syndrome: analysis with memory function of pacemaker

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