Electrophysiological identification of superior vena cava: Novel insight into slow conduction or conduction block.
ablation
conduction block
isolation
slow conduction
superior vena cava
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
29
08
2020
revised:
23
10
2020
accepted:
28
10
2020
pubmed:
20
11
2020
medline:
29
7
2021
entrez:
19
11
2020
Statut:
ppublish
Résumé
It has not been clarified how to identify the electrophysiological junction between right atrium (RA) and superior vena cava (SVC). The aim of this study was to identify the electrophysiological RA-SVC junction according to slow conduction or conduction bock and to examine the electrophysiological SVC isolation procedure. Seventy-three consecutive atrial fibrillation patients who underwent SVC mapping using a CARTO 3 system were enrolled in this study. Slow conduction or conduction block between the RA and SVC was identified by adjusting the lower threshold criteria of the early meets late function and was described as a white line. The SVC isolation was performed along the white line and with pacing maneuvers to confirm direct SVC capture. Activation mapping (1296 ± 631 points) was obtained in 66 patients (90%) in 4.6 ± 1.8 min. Slow conduction or conduction block was observed in all patients. The threshold for detecting slow conduction or conduction block was 24 ± 8 ms. The location of the electrophysiological RA-SVC junction was higher in the anterior portion (anterior-septal, anterior, and anterior-lateral) than in the posterior portion (posterior-septal, posterior, and posterior-lateral) (-2.3 ± 6.2 mm vs. 7.1 ± 6.3 mm, p < .001). The SVC isolation at the electrophysiological RA-SVC junction was successful in all patients without any injury to the sinus node function. Asymptomatic phrenic nerve injury was observed in three patients (4.5%). In all patients, the electrophysiological RA-SVC junction determined by slow conduction or conduction block was identified and the electrophysiological SVC isolation was performed successfully and safely.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
58-66Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-666.
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275-e444.
Goya M, Ouyang F, Ernst S, Volkmer M, Antz M, Kuck KH. Electroanatomic mapping and catheter ablation of breakthroughs from the right atrium to the superior vena cava in patients with atrial fibrillation. Circulation. 2002;106(11):1317-1320.
Santangeli P, Marchlinski FE. Techniques for the provocation, localization, and ablation of non-pulmonary vein triggers for atrial fibrillation. Heart Rhythm. 2017;14(7):1087-1096.
Arruda M, Mlcochova H, Prasad SK, et al. Electrical isolation of the superior vena cava: an adjunctive strategy to pulmonary vein antrum isolation improving the outcome of AF ablation. J Cardiovasc Electrophysiol. 2007;18(12):1261-1266.
Yamashita S, Tokuda M, Isogai R, et al. Spiral activation of the superior vena cava: the utility of ultra-high-resolution mapping for caval isolation. Heart Rhythm. 2018;15(2):193-200.
Miyazaki S, Yamao K, Hasegawa K, et al. SVC mapping using an ultra-high resolution 3-dimensional mapping system in patients with and without AF. JACC Clin Electrophysiol. 2019;5(8):958-967.
Tanaka Y, Takahashi A, Takagi T, et al. Novel ablation strategy for isolating the superior vena cava using ultra high-resolution mapping. Circ J. 2018;82(8):2007-2015.
Tsai CF, Tai CT, Hsieh MH, et al. Initiation of atrial fibrillation by ectopic beats originating from the superior vena cava: electrophysiological characteristics and results of radiofrequency ablation. Circulation. 2000;102(1):67-74.
Ho SY, Anderson RH, Sánchez-Quintana D. Atrial structure and fibres: morphologic bases of atrial conduction. Cardiovasc Res. 2002;54(2):325-336.
Ho SY, Sanchez-Quintana D. The importance of atrial structure and fibers. Clin Anat. 2009;22(1):52-63.
Nishiyama N, Hashimoto K, Yamashita T, et al. Visualization of the electrophysiologically defined junction between the superior vena cava and right atrium. J Cardiovasc Electrophysiol. 2020;31:1964-1969.
Porta-Sánchez A, Jackson N, Lukac P, et al. Multicenter study of ischemic ventricular tachycardia ablation with decrement-evoked potential (DEEP) mapping with extra stimulus. JACC Clin Electrophysiol. 2018;4(3):307-315.
Jaïs P, Maury P, Khairy P, et al. Elimination of local abnormal ventricular activities: a new end point for substrate modification in patients with scar-related ventricular tachycardia. Circulation. 2012;125(18):2184-2196.
Shah DC, Haïssaguerre M, Jaïs P, Clémenty J. High-resolution mapping of tachycardia originating from the superior vena cava: evidence of electrical heterogeneity, slow conduction, and possible circus movement reentry. J Cardiovasc Electrophysiol. 2002;13(4):388-392.
Schuessler RB, Boineau JP, Bromberg BI. Origin of the sinus impulse. J Cardiovasc Electrophysiol. 1996;7(3):263-274.
Miyazaki S, Hasegawa K, Kaseno K, Tada H. Protected channels can be formed by a functional line of block in human atrial tachycardia. Heart Rhythm. 2019;16(4):642-643.
Yamane T, Matsuo S, Date T, et al. Repeated provocation of time- and ATP-induced early pulmonary vein reconnections after pulmonary vein isolation. Circ: Arrhythmia Electrophysiol. 2011;4(5):601-608.
Sacher F, Monahan KH, Thomas SP, et al. Phrenic nerve injury after atrial fibrillation catheter ablation: characterization and outcome in a multicenter study. J Am Coll Cardiol. 2006;47(12):2498-2503.
Miyazaki S, Ichihara N, Nakamura H, et al. Prospective evaluation of electromyography-guided phrenic nerve monitoring during superior vena cava isolation to anticipate phrenic nerve injury. J Cardiovasc Electrophysiol. 2016;27(4):390-395.
Miyazaki S, Kusa S, Hachiya H, et al. Electrical superior vena cava isolation using a novel pace-and-ablate technique under diaphragmatic electromyography monitoring. Heart Rhythm. 2017;14(5):678-684.