Isoproterenol-dependent acute reconnection following superior vena cava isolation: Pitfalls of a novel approach using spontaneous conduction block

Arai, Toshiyasu; Fukamizu, Seiji; Tokioka, Sayuri; Kitamura, Τakeshi; Hojo, Rintaro

doi:10.1016/j.hrcr.2020.06.002

Cited by 1 publication

(2 citation statements)

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“…Previous report has demonstrated a case of isoproterenol‐dependent acute reconnection following SVC isolation using a spontaneous conduction block. 15 They speculated that the reconduction with isoproterenol was because of pacemaker shift or disappearance of spontaneous functional block line, resulting in the difference in the percentage of the spontaneous conduction block here compared to that in previous reports. 12 Another report have stated that with increasing heart rate, the site of the earliest endocardial depolarization remained stationary until a sudden shift in the cranial direction.…”

Section: Discussionmentioning

confidence: 55%

“…Spontaneous RA‐SVC conduction block was observed in approximately 80% of the patients without isoproterenol, and we experienced reconduction of the RA‐SVC conduction block with isoproterenol infusion in eight patients in the block group. Previous report has demonstrated a case of isoproterenol‐dependent acute reconnection following SVC isolation using a spontaneous conduction block 15 . They speculated that the reconduction with isoproterenol was because of pacemaker shift or disappearance of spontaneous functional block line, resulting in the difference in the percentage of the spontaneous conduction block here compared to that in previous reports 12 .…”

Section: Discussionmentioning

confidence: 60%

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A novel approach for effective superior vena cava isolation using the CARTO electroanatomical mapping system

Inagaki

Fukamizu

Tokioka

et al. 2021

Journal of Arrhythmia

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Background Previous studies have demonstrated that some patients have spontaneous right atrium (RA)‐superior vena cava (SVC) conduction block, which could be utilized to isolate the SVC effectively by using the Rhythmia mapping system (Boston Scientific). However, employing this approach for SVC isolation using the CARTO electroanatomical mapping system (Biosense Webster) has not yet been clarified. This study aimed to evaluate the safety and efficacy of SVC isolation using the extended early meets late (EEML) tool with the CARTO system. Methods The patients who underwent SVC isolation using the CARTO system were enrolled in this study. The RA‐SVC conduction block was visualized with an EEML tool. We prospectively assessed the safety and efficacy of SVC isolation using this system. Results We analyzed 54 patients, and all SVCs were successfully isolated with no complications. Altogether, 44 patients (81.5%) had spontaneous RA‐SVC conduction block, and the remaining 10 patients (18.5%) did not. The block group required fewer radiofrequency deliveries for the SVC isolation than the nonblock group (10.7 ± 5.0 vs 15.5 ± 4.8, P = .009). The size of the isolated area in the block group was larger than that in the nonblock group (15.2 ± 5.1 cm2 vs 12.4 ± 2.5 cm2, P = .017). Conclusions Approximately 80% of the patients in this study developed a spontaneous RA‐SVC conduction block, which might contribute to shortening the time of ablation and avoiding complications.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 60%