Hong Euy Lim

Electrocardiographic and electrophysiological characteristics of premature ventricular complexes associated with left ventricular dysfunction in patients without structural heart disease

AIMSnThe mechanism responsible for premature ventricular complex (PVC)-mediated left ventricular (LV) dysfunction remains unclear. We sought to determine the electrocardiographic and electrophysiological characteristics of PVC-mediated LV dysfunction.nnnMETHODS AND RESULTSnOne hundred and twenty-seven patients who underwent radiofrequency catheter ablation (RFCA) for frequent PVCs (PVCs burden ≥10%/24 h) and had no significant structural heart disease were investigated. Left ventricular dysfunction (ejection fraction < 50%) was present in 28 of 127 patients (22.0%). The mean PVC burden (31 ± 11 vs. 22 ± 10%, P < 0.001), the presence of non-sustained ventricular tachycardia (53.6 vs. 33.3%, P = 0.05), and the presence of a retrograde P-wave following a PVC (64.3 vs. 30.3%, P = 0.001) were significantly greater in those with LV dysfunction than in those with normal LV function. The cut-off PVC burden related to LV dysfunction was 26%/day, with a sensitivity of 70% and a specificity of 78%. The PVC morphology, QRS axis, QRS width, coupling interval, the presence of interpolation, and PVC emergence pattern during exercise electrocardiogram were not significantly different between the two groups. The origin sites of PVCs, the acute success rate, and the recurrence rate during follow-up after RFCA were similar. In a multivariate analysis, the PVC burden (odds ratio 2.94, 95% confidence interval 0.90-3.19, P = 0.006) and the presence of retrograde P-waves (odds ratio 2.79, 95% confidence interval 1.08-7.19, P = 0.034) were independently associated with PVC-mediated LV dysfunction.nnnCONCLUSIONnA higher PVC burden (>26%/day) and the presence of retrograde P-waves were independently associated with PVC-mediated LV dysfunction.

Clinical Significance of Early Recurrences of Atrial Tachycardia After Atrial Fibrillation Ablation

Early Recurrence After AF Ablation.u2002Background: Atrial tachycardia (AT) commonly recurs within 3 months after radiofrequency catheter ablation for atrial fibrillation (AF). However, it remains unclear whether early recurrence of atrial tachycardia (ERAT) predicts late recurrence of AF or AT.

Catheter Ablation of Atrial Fibrillation in Patients With Chronic Lung Disease

Background— Chronic lung disease (CLD) is one of the important underlying diseases of atrial fibrillation (AF). The outcomes after radiofrequency catheter ablation of AF in patients with CLD have not yet been reported. We investigated the electroanatomic alterations in pulmonary veins (PVs) in CLD patients with AF and assessed their effect on the outcomes of radiofrequency catheter ablation of AF. Method and Results— We assessed 15 patients who had CLD and underwent radiofrequency catheter ablation of AF. CLD included chronic obstructive pulmonary disease, a tuberculosis-destroyed lung, and interstitial lung disease. For controls, we selected 60 sex-, age-, and procedure era–matched non-CLD patients who received radiofrequency catheter ablation for AF (4 controls for each CLD patient). Eight patients had chronic obstructive pulmonary disease, 6 had a tuberculosis-destroyed lung, and 1 had interstitial lung disease. PV morphology in the affected lung was altered significantly, ie, obliteration, pulling of the PVs toward the destroyed lung, or compensatory bulging of the PV antrum. These alterations were related to arrhythmogenicity in 6 (40%) of 15 patients with CLD. Non-PV foci were more common in the CLD group (4/15, 26.7%) than in the control group (3/60, 5.0%; P=0.025). All non-PV foci were located in the right atrium. The AF recurrence rate in the CLD group (26.7%, 4/15) was similar to that in the control group (18.3%, 11/60; P=0.45). Conclusions— Significant alteration of PV anatomy was related to arrhythmogenicity, and non-PV foci from the right atrium were commonly observed in the CLD group. Radiofrequency catheter ablation can be performed safely for AF in CLD patients with a comparable success rate to that in patients with normal lungs.

Prediction of Long‐Term Outcomes of Catheter Ablation of Persistent Atrial Fibrillation by Parameters of Preablation DC Cardioversion

Prediction of Long‐Term Outcomes of Catheter Ablation of Persistent Atrial Fibrillation.u2003Aim: It has been demonstrated that atrial fibrillation (AF) frequently recurred after cardioversion (CV) using direct current (DC) or radiofrequency catheter ablation (RFCA) in patients with persistent (PeAF) or longstanding persistent AF (LPAF). We hypothesized that the atrial substrate impeding successful CV would also produce difficulty in catheter ablation, and therefore, the outcomes of RFCA for PeAF and LPAF could be predicted by the parameters determined at the time of DC CV.

Clinical significance of induced atrial tachycardia after termination of longstanding persistent atrial fibrillation using a stepwise approach.

Induced Atrial Tachyarrhythmia During Atrial Fibrillation Ablation.u2003Introduction: The utility of inducibility test of atrial tachycardia (AT) in patients with longstanding persistent atrial fibrillation (AF; LPAF) is unclear. This study aimed to evaluate the significance of induced AT and the impact of their ablation on the clinical outcome.

Atrial activation time and pattern of linear triple-site vs. single-site atrial pacing after cardioversion in patients with atrial fibrillation.

AIMSnMultisite atrial pacing has been suggested to be effective in suppressing atrial fibrillation (AF), however, the effect of linear triple-site atrial pacing (LTSP) in humans has not been evaluated. We compared the effects of LTSP to single-site atrial pacing (SSP) on the atrial activation and wavefront propagation pattern in patients with persistent AF.nnnMETHODS AND RESULTSnIn 10 patients with persistent AF, the effects of LTSP and SSP were evaluated by left atrial (LA) endocardial non-contact multielectrode array mapping and multipolar catheters. LTSP and SSP were delivered from the high right atrium (HRA), the distal coronary sinus (CS), and within the LA at the site showing maximal overlay of low-voltage zones during sinus rhythm and pacing at HRA and CS. Atrial activation time and pattern, P wave duration, and the prevention of AF induced by burst pacing were assessed with these pacing interventions. Compared with SSP, LTSP at the HRA, CS, and LA shortened atrial activation times (183 +/- 24 vs. 174 +/- 24 ms, 186 +/- 29 vs. 166 +/- 28 ms, and 171 +/- 40 vs. 163 +/- 39 ms; P < 0.05, respectively). P wave duration was shorter with LTSP than SSP at all three sites (141.7 +/- 35.1 vs. 146.9 +/- 38.5 ms, 138.1 +/- 34.6 vs. 145.7 +/- 33.7 ms, and 142.7 +/- 33.4 vs. 151.3 +/- 35.1 ms; P < 0.05, respectively). LTSP initially depolarized a larger area than SSP, and produced more uniform and planar wavefront propagation. LTSP prevented the burst-induction of AF during LA pacing in 3 of 10 patients, while SSP was never successful.nnnCONCLUSIONnIn patients with persistent AF, LTSP provided more rapid and uniform activation of the atria compared with SSP, which was associated with prevention of burst-induction of AF in some patients. Further study is required to determine whether LTSP can modify the substrate of chronic AF, leading to frank AF suppression.

Idiopathic ventricular arrhythmia originating from the para-Hisian area: Prevalence, electrocardiographic and electrophysiological characteristics

We investigated the prevalence and the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs) originating from the para‐Hisian area.

Intra-procedural imaging of the left atrium and pulmonary veins with rotational angiography: a comparison of anatomy obtained by pre-procedural cardiac computed tomography and trans-thoracic echocardiography

This study evaluated the feasibility and accuracy of three-dimensional rotational angiography (3DRA) to determine the anatomy of the left atrium (LA) and pulmonary veins (PVs) compared with cardiac computed tomography (CCT) and trans-thoracic echocardiography (TTE). One hundred two patients (56.1xa0±xa09.9xa0years, 86 males) with an indication for atrial fibrillation ablation were prospectively enrolled. Intra-procedural 3DRA was performed with power injected contrast medium (20xa0cc/s for 4xa0s, 240°) in the LA. 3DRA images of the LA and PVs were assessed qualitatively and then compared quantitatively. LA volume measured by 3DRA, CCT and TTE were compared. The majority of 3DRA acquisitions were optimal in delineating the right-side LA–PV (95xa0% for right superior PV and 96xa0% for right inferior PV) and left inferior PV anatomy (91xa0%), whereas it was optimal in only 63xa0% of left superior PV and 73xa0% of the LA appendage. The circumferences of PV ostia identified by 3DRA and CCT were correlated in four PVs (rxa0=xa00.57 for right superior PV, rxa0=xa00.67 for right inferior PV, rxa0=xa00.60 for left superior PV, and rxa0=xa00.52 for left inferior PV, pxa0<xa00.001). The mean LA volume measured by 3DRA (120xa0±xa032xa0mL) was greater than that found by CCT (109xa0±xa035xa0mL) or TTE (64xa0±xa023xa0mL), but the 3DRA LA volume measurements correlated well with those of CCT (rxa0=xa00.83, pxa0<xa00.001) and TTE (rxa0=xa00.69, pxa0<xa00.001). Intra-procedural 3DRA provided anatomical accuracy of LA and PVs comparable to those of CCT. However, optimal delineation of the left superior PV and LA appendage was limited. The LA volume determined by 3DRA was well correlated with those of CCT and TTE, despite different absolute values of each.

Relationship Between Complex Fractionated Atrial Electrograms During Atrial Fibrillation and the Critical Site of Atrial Tachycardia That Develops After Catheter Ablation for Atrial Fibrillation

Complex fractionated atrial electrograms (CFAEs) are a substrate modification target in patients with atrial fibrillation (AF). However, whether CFAEs can be also arrhythmogenic grounds of atrial tachycardia (AT) presenting after AF ablation remains to be determined. We investigated the relationship between CFAEs and the critical site of AT after CFAE‐guided AF ablation.

Does type D personality impact on the prognosis of patients who underwent catheter ablation for atrial fibrillation? A 1-year follow-up study

Objective Although Type D personality has been associated with the prognosis of various cardiac diseases, few studies have investigated the influence of Type D personality on the cardiac and psychiatric prognoses of patients with atrial fibrillation (AF). Methods Depression, anxiety, and quality of life were measured at baseline and 6 months. The recurrence of AF was measured during 1-year following radiofrequency catheter ablation (RFCA) for AF. The Kaplan-Meier method with log-rank tests were used to compare the cumulative recurrence of AF. ACox proportional hazard model was conducted to identify factors that contribute to the recurrence of AF. Results A total of 236 patients admitted for RFCA were recruited. Patients with a Type D personality had higher levels of depression and anxiety and a poorer quality of life compared to controls. Although depression, anxiety, and quality of life had improved 6 months after RFCA, significant differences in psychiatric symptoms remained between patients with and without Type D personality. In the Cox models, the type of AF was the only factor that influenced the recurrence of AF. Conclusion Our results suggest that Type D personality predominately influences psychological distress in patients with AF, but not the recurrence of AF.