Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia

Hamdan, Mohamed H.; Hare, George F. Van; Fisher, Westby G.; González, Rolando; Dorostkar, Parvin C.; Lee, Randall; Lesh, Michael D.; Saxon, Leslie A.; Kalman, Jonathan M.; Scheinman, Melvin M.

doi:10.1016/s0002-9149(96)00616-9

Cited by 58 publications

(29 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If the diagnosis is JT, then further ablation may be avoided because of lower success rates and higher rates of possible atrioventricular block. 5 AVNRT and JT share many common characteristics, including clinical features, similar intracardiac activation pattern, similar sites of earliest activation, and negative ventricular-atrial intervals. However, the mechanisms of AVNRT and JT differ; with the former being reentry and the latter usually enhanced normal automaticity.…”

Section: Discussionmentioning

confidence: 99%

“…Slow pathway (SP) modification has evolved as the first-line treatment for AVNRT with acute success rates of 95% to 98% 3,4 ; however, catheter ablation of JT has lower success rates and a higher rate of atrioventricular block. 5 Previous studies have suggested that premature atrial contractions (PACs) or atrial overdrive pacing can rapidly differentiate AVNRT from JT.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Differentiating Atrioventricular Nodal Re-Entrant Tachycardia From Junctional Tachycardia

Chen

Shehata

Cingolani

et al. 2015

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

T ypical atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common supraventricular tachycardia; however, junctional tachycardia (JT) is rare and occurs mostly in children or during infusion of isoproterenol. 1,2 Distinguishing between these arrhythmias can often be challenging during electrophysiology testing. They share many common characteristics, including similar intracardiac activation patterns, similar sites of earliest activation, and typical occurrence of a His bundle deflection before the atrial and ventricular electrograms. Slow pathway (SP) modification has evolved as the first-line treatment for AVNRT with acute success rates of 95% to 98% 3,4 ; however, catheter ablation of JT has lower success rates and a higher rate of atrioventricular block.5 Previous studies have suggested that premature atrial contractions (PACs) or atrial overdrive pacing can rapidly differentiate AVNRT from JT. 2,6Editor's Perspective see p 236 Case PresentationA 72-year-old woman with a history of paroxysmal supraventricular tachycardia that was refractory to medical therapy underwent catheter ablation. During the procedure, baseline AA interval during sinus rhythm, AH interval, and HV interval were 610, 80, and 38 ms ( Figure 1A), respectively. Narrow QRS tachycardia was induced by atrial burst pacing (320 ms; Figure 1B), which was felt to be most consistent with slow/ fast AVNRT (cycle length, 380 ms; AH, 340 ms; HA, 40 ms) based on the characteristics of induction with a critically long AH interval and the response to right ventricular overdrive pacing ( Figure 1B and 1C). SP modification was performed and guided by intracardiac electrograms and fluoroscopic landmarks. After SP modification, a tachycardia spontaneously initiated during infusion of isoproterenol with a dosage of 1 μg/min at a cycle length of 540 ms, with HA and AH intervals of 40 and 500 ms, respectively, as illustrated in Figure 2A. The tachycardia could be terminated by rapid atrial pacing or PACs and would spontaneously initiate after a few sinus tachycardia beats (Figure 2A). Figure 2B demonstrates the spontaneous onset of tachycardia at faster sweep speed with initial shortening of the HH interval to 450 ms, followed by tachycardia with the HH interval of 540 ms.PACs were introduced throughout the diastolic interval beginning at 10 ms shorter than the tachycardia cycle length until the loss of atrial capture or tachycardia was terminated ( Figure 2C). A PAC that advanced the immediate His by 50 ms resulted in delaying the subsequent His by 50 ms ( Figure 2D). However, a later PAC advanced the immediate His by 40 ms, and there was no change in the following HH interval ( Figure 2E). A later PAC delivered during His refractoriness advanced the following His by 15 ms, indicating that the mechanism of tachycardia was AVNRT ( Figure 2F). This was confirmed multiple times with late-coupled PACs advancing the subsequent His activation without affecting the immediate His. Further ablation at the SP region was performed, and subsequently, no ta...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Differentiating Atrioventricular Nodal Re-Entrant Tachycardia From Junctional Tachycardia

Chen

Shehata

Cingolani

et al. 2015

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9] Hamdan et al applied RF current at the site of the earliest retrograde atrial activation during sinus rhythm in 9 patients with JET, and successful ablation without AV block was achieved in 7 of them. 9 However, in patients with JET lacking retrograde atrial activation, 1,4,10 the optimal site for ablation is determined (1) empirically, 9 (2) by observing the termination of JET by mechanical manipulation of the ablation catheter, 6 or (3) by observing the rate acceleration during a low-dose RF energy application. 8 We decided on the para-Hissian region as the ablation site in the present patient for the following reasons: (1) there was no evidence of retrograde atrial activation during JET, (2) it was considered to be safer to apply RF current in a region where a relatively small atrial potential and a large ventricular potential (small A/V ratio) could be recorded, because the His bundle is protected by the central fibrous body, 11,12 and (3) it has been reported that the paraHissian accessory pathway can be ablated successfully by RF current with preservation of normal AV conduction.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 However, these therapies may result in the need for permanent cardiac pacing. Recently, selective ablation of the JET focus while preserving normal AV conduction was reported, [5][6][7][8][9] suggesting that the junctional focus is usually perinodal and that ablative lesions created over the anterior, mid or posterior septum, avoiding the His bundle, may be effective. However, in the present patient we believed that the automatic focus of the JET existed at a site ajacent to the His bundle.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Atrial Pacing During Radiofrequency Ablation of Junctional Ectopic Tachycardia

2001

View full text Add to dashboard Cite

ecause of its refractoriness to medical therapy and the high mortality rate, 1,2 junctional ectopic tachycardia (JET) has been treated by ablation of the atrioventricular (AV) junction using either direct 1 or radiofrequency (RF) current. 3,4 However, these therapies may result in the need for permanent cardiac pacing. Recently, selective ablation of the JET focus while preserving normal AV conduction was reported, [5][6][7][8][9] suggesting that the junctional focus is usually perinodal and that ablative lesions created over the anterior, mid or posterior septum, avoiding the His bundle, may be effective. However, in the present patient we believed that the automatic focus of the JET existed at a site ajacent to the His bundle. Case ReportThe patient was a 5-year-old boy with a tachyarrhythmia that had been present since birth and had been well controlled with propranolol and digoxin. For the 6 months prior to admission, he had recurrent episodes of tachycardia accompanied by signs of congestive heart failure, including vomiting, appetite loss, and cyanosis. Pharmacologic management with multiple antiarrhythmic drugs (excluding amiodarone) failed, and the patient was referred for catheter ablation. The 24-h Holter monitoring showed an incessant irregular narrow QRS tachycardia with a rate of 180 beats/min. Echocardiography showed a reduced left ventricular shortening fraction (22%).Two 5Fr quadripolar electrode catheters were introduced via the left femoral vein into the high right atrium and the right ventricle. A steerable 7Fr 20-pole catheter with a 2-mm interelectrode distance was placed across the tricuspid valve to record the AV junctional electrograms via a left femoral transvenous approach. A 6Fr 8-pole catheter was inserted from the right internal jugular vein into the coronary sinus. A baseline electrophysiologic study confirmed the diagnosis of JET based on the following observations: (1) during tachycardia, ventriculoatrial (VA) dissociation was present with a His potential always preceding the ventricular depolarization at an His-ventricular (HV) interval of 36 ms, (2) the earlier His potential recording was obtained by the more proximal electrode of the 20-pole catheter in the region expected to produce a His electrogram, (3) sinus beats that occasionally captured the ventricle caused a sudden shortening of the HH interval with subtle aberrancy in the QRS configuration, but the HV intervals were the same as those during tachycardia, (4) there was no evidence of retrograde atrial activation in the His bundle or the coronary sinus during tachycardia, (5) atrial overdrive pacing during tachycardia caused temporary suppression of the tachycardia, confirming normal AV nodal conduction, (6) with the termination of atrial overdrive pacing, the tachycardia immediately resumed with a warming-up of the HH interval and subtle changes in the QRS configuration (Fig 1), and (7) the tachycardia could not be terminated with either atrial or ventricular programmed pacing. A 7Fr ablation catheter (Medtronic CardioR...

show abstract

Supraventricular Tachycardia

Penny‐Peterson,

Naccarelli

2009

Evidence‐Based Cardiology

View full text Add to dashboard Cite

Selective catheter ablation of the tachycardia focus in patients with nonreentrant junctional tachycardia

Cited by 58 publications

References 10 publications

Differentiating Atrioventricular Nodal Re-Entrant Tachycardia From Junctional Tachycardia

Differentiating Atrioventricular Nodal Re-Entrant Tachycardia From Junctional Tachycardia

Atrial Pacing During Radiofrequency Ablation of Junctional Ectopic Tachycardia

Supraventricular Tachycardia

Contact Info

Product

Resources

About