Role of Electrophysiological Studies and Arrhythmia Intervention in Repairing Ebstein's Anomaly

Huang, Chien-Hua; Chiu, Ing‐Sh; Lin, Fang Yue; Chen, W.-J.; Lin, Jing; Lo, Huey‐Ming; Wu, Mei‐Hwan; Chu, Shu‐Hsun

doi:10.1055/s-2000-8348

Cited by 41 publications

(15 citation statements)

References 9 publications

(13 reference statements)

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“…484 In a series of patients undergoing repair of Ebstein anomaly, patients who underwent preoperative EP study with intraoperative ablation of arrhythmia substrate had lower risk of SCD than patients without arrhythmia intervention. 479 In patients with Ebstein anomaly undergoing planned surgical intervention, an integrated approach of arrhythmia intervention has been demonstrated to be safe and effective.…”

Section: -485mentioning

confidence: 99%

“…are more common in patients with longer-duration persistent AF or more dilated left atria or when linear ablation lesions are used. [333][334][335][336][337][338] Non-reentrant focal arrhythmias often originate at lesion edges or reconnected segments of prior isolated pulmonary veins. 333 Reisolation of the pulmonary vein and ablation of any nonpulmonary vein foci are often effective in treating these arrhythmias.…”

Section: Non-isthmus-dependent Atrial Fluttersmentioning

confidence: 99%

See 1 more Smart Citation

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Page¹,

Joglar²,

Caldwell³

et al. 2016

Circulation

332

127

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Section: -485mentioning

confidence: 99%

Section: Non-isthmus-dependent Atrial Fluttersmentioning

confidence: 99%

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Page¹,

Joglar²,

Caldwell³

et al. 2016

Circulation

332

127

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“…Repairing Ebstein's anomaly without correction of associated arrhytmia may result in sudden death. Catheter or surgical ablation is indicated for various symptomatic tachyarrhythmias in Ebstein's anomaly [4].…”

Section: Discussionmentioning

confidence: 99%

Tricuspid Endocarditis in an Adult Patient with Ebstein’s Anomaly who has a Residual Pacemaker Lead

Bilge

Adalet

Özyiğit

et al. 2005

Int J Cardiovasc Imaging

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Ebstein's anomaly is defined as an apical displacement of the attachment of the septal tricuspid valve leaflet from the right atrioventricular annulus that exceeded 1.2 cm in length. Patients with Ebstein's anomaly are known to have a high potential for developing arrhythmia, in the vast majority, of the tachycardia type. Infective endocarditis is characterized by ulcerovegetational lesions that result from the graft of a microorganism, usually bacterial, on the valvuler endocardium (native valve endocarditis) or on a prosthesis (prosthetic valve endocarditis). Ebstein's anomaly with tricuspid regurgitation is also thought to be a predisposing condition for infective endocarditis. In this case, we report a patient who presented with atrial flutter and infective endocarditis due to residual pacemaker lead and Ebstein's anomaly.

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“…2,3 Okishige et al reported a case of Ebstein anomaly in which catheter ablation for common atrial flutter was performed; 4 in that case, the atrial flutter cycle length was 312 ms and the flutter waves were wider and deeper on the 12-lead ECG. The unusually slow conduction in the right atrium of the present patient may have been caused by changes in the myocardium, such as fibrosis and dilatation, and the atypical flutter wave possibly resulted from the enlargement and distortion of the atria.…”

Section: Discussionmentioning

confidence: 99%

Ebstein Anomaly Associated With Unusual Conduction Delay and Sick Sinus Syndrome-A Case Report-

Mani

Shirayama

Yamamura

et al. 2004

Circ J

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bstein anomaly is characterized by apical displacement of the septal or posterior leaflet of the tricuspid valve and may be related to abnormal cell death. Furthermore, conduction abnormalities associated with this anomaly are often confined to the atrioventricular junction. We report a rare case of Ebstein anomaly associated with an unusual conduction delay in the whole heart, as well as systolic dysfunction of both ventricles, which indicates that the entire myocardium can be impaired globally in this anomaly. Case ReportA 64-year-old man was admitted to our hospital because he had often felt palpitation and dyspnea on effort, and he had facial edema. On admission, the 12-lead electrocardiogram (ECG) revealed atrial tachycardia with 2:1 conduction and intraventricular conduction delay; his heart rate was 75 beats/min (atrial rate: 150 beats/min) (Fig 1). The cardiothoracic ratio was 61% on chest rentogenogram. Echocardiography showed severe enlargement of the right atrium and ventricle, decreased systolic function of both ventricles (end-diastolic and end-systolic left ventricular dimensions were 48 mm and 41 mm, respectively), apical displacement of the septal leaflet of the tricuspid valve by 16 mm (10.5 mm/m 2 ), and mild tricuspid regurgitation with a peak velocity of 0.78 m/s and pressure gradient of 2.4 mmHg (Fig 2). The diagnosis was Ebstein anomaly.An electrophysiological study revealed that the atrial rhythm was common atrial flutter. Atrial mapping showed a counterclockwise rotation of excitation along the tricusCirculation Journal Vol.68, July 2004 pid annulus; the atrial flutter cycle length was 400 ms (Fig 3). The post pacing interval after an extra-stimulation at the proximal coronary sinus and the low lateral right atrium was the same as the atrial flutter cycle length. Right atrial mapping showed that the slowest atrial conduction existed between RA3 and RA1 (Fig 3), located on the inferior vena cava -tricuspid annulus isthmus where low A 64-year-old man was admitted to our hospital because of palpitation, dyspnea on effort, and facial edema. The echocardiographic diagnosis was Ebstein anomaly. Although the 12-lead electrocardiogram showed an atrial rate of 150 beats/min and no typical flutter wave, the electrophysiological study showed counterclockwise rotation of excitation along the tricuspid annulus. Because of sinus arrest and syncope, a permanent pacemaker was implanted, but the right atrium was not captured by electrical stimulation at 5V/0.4 ms, except for the orifice of coronary sinus, and the intracardiac P wave was only 0.2 mV or less. This is a rare case of Ebstein anomaly characterized by unusually prolonged conduction in the atrium, the basis of which was global myocardial damage, including the ventricles.

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Role of Electrophysiological Studies and Arrhythmia Intervention in Repairing Ebstein's Anomaly

Abstract: We conclude that detailed preoperative electrophysiological evaluation in patients with Ebstein's anomaly is mandatory. Aggressive surgical intervention of the associated arrhythmias in addition to anatomic correction can reduce the sudden death in Ebstein's anomaly.

Cited by 41 publications

References 9 publications

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Tricuspid Endocarditis in an Adult Patient with Ebstein’s Anomaly who has a Residual Pacemaker Lead

Ebstein Anomaly Associated With Unusual Conduction Delay and Sick Sinus Syndrome-A Case Report-

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