Project description:A 73-year-old woman was admitted for atrial tachycardia (AT) ablation. The activation map and pacing study indicated that the AT propagated around the left pulmonary vein and that the Marshall bundle (MB) bypassed the scar area of the left pulmonary vein ridge and mitral isthmus. The Rhythmia Mapping System revealed double potentials propagated along the assumed position of the MB. The mapping system includes a confidence mask that can be used to visually identify low-confidence areas of the map based upon extremely low-voltage signals. Given the low-voltage area in the endocardial side, the epicardial conduction was emphasized.

| S-EPMC6009767 | biostudies-literature

A variant of pulmonary vein-gap reentrant atrial tachycardia with multiple epicardial conduction gaps.

Project description:A 66-year-old male had an atrial tachycardia (AT) during a first extensive pulmonary vein (PV) isolation (PVI) of persistent atrial fibrillation. Activation mapping during the AT using Rhythmia (Boston Scientific, Marlborough, MA, USA) exhibited a centrifugal pattern with the earliest activation at the left-sided carina, and conduction towards the inferior left atrium (LA) over the left PVI line. The post-pacing interval was similar to the tachycardia cycle length (TCL) upon entrainment from the LA roof, left-sided carina, and anterior, inferior, and septal LA, but was longer than the TCL upon entrainment from the left superior PV and lateral and posterior LA. These findings suggested the presence of a macroreentrant AT circuit with epicardial conduction from the roof toward the inferior LA via the left-sided carina over the PVI line and propagation to the anterior LA through the septum. A radiofrequency application at the left-sided carina terminated the AT. This case suggested a rare type of PV-gap reentrant AT with multiple epicardial conduction gaps by high-resolution activation mapping and entrainment pacing, which may have been associated with non-transmural radiofrequency lesions along the PVI line. Further, the origin of the residual epicardial gaps may have been subepicardial myocardial strands or the Marshall ligament. <Learning objective: Pulmonary vein (PV)-gap reentrant atrial tachycardias (ATs) generally have conduction gaps on the previous PV isolation lines. However, this case had a variant of PV-gap reentrant AT with multiple epicardial conduction gaps, without any endocardial gaps on the PV isolation line. High-resolution activation mapping during PV pacing and the AT in combination with entrainment pacing may facilitate an identification of residual epicardial connections associated with the PV-gap reentrant AT circuits.>.

| S-EPMC7718528 | biostudies-literature

Marked conduction time prolongation observed during atrial tachycardia originating from a giant left atrial appendage

Project description: Not available

| S-EPMC11632257 | biostudies-literature

Impact of technical aspects of vein of Marshall ethanol infusion on mitral isthmus block for persistent atrial fibrillation ablation.

Project description:AimsEthanol infusion into the VOM (EIVOM) adjunctive to radiofrequency catheter ablation (RFCA) was a novel approach facilitating mitral isthmus (MIth) block for persistent atrial fibrillation (PeAF); However, there were remarkable disparities in its technical aspects. This study aimed to evaluate the impact of EIVOM technical aspects on acute MIth block.MethodsEighty consecutive patients (63 males, average age 66.4 ± 8.6 years) undergoing de novo PeAF ablation were assigned to different groups. The procedural parameters in "EIVOM first" (n = 13) or "RFCA first" (n = 13) as well as small dose ([SD], ≤4 ml, n = 26) or big dose ([BD], >4 ml, n = 54) approaches were analyzed to identify the predictors for acute MIth block.ResultsCompared with the "EIVOM first" approach, the "RFCA first" approach was associated with longer procedural and MIth ablation time (134 ± 27 min vs. 112 ± 17 min; 14.9 ± 5.5 min vs. 9.3 ± 5.1 min, both P < 0.05, respectively), but with comparable success of MIth block. The ethanol dose was 6.3 ± 1.5 ml in BD group vs. 3.1 ± 1.0 ml in SD group (P < 0.001) and was correlated significantly with the size of Δlow voltage area (r = 0.66, P < 0.001). The success of MIth block was 92.6% in BD group vs. 73.1% in SD group, P = 0.03. The ethanol dose >5.75 ml independently predicted successful MIth block (OR: 0.428, 95% CI: 0.219-0.839, P = 0.01).ConclusionsDespite the comparable effectiveness on MIth block, the "EIVOM first" approach was associated with shorter procedural and MIth ablation time than the "RFCA first" approach. The ethanol dose in EIVOM was an independent predictor for MIth block.

| S-EPMC9576952 | biostudies-literature

Clinical effect of vein of Marshall ethanol infusion on mitral isthmus ablation.

Project description:PurposeThis study aimed to investigate the effect of Marshall ethanol infusion (VOM-Et) in the vein on mitral isthmus (MI) ablation.MethodsPatients with persistent atrial fibrillation (AF) were grouped into vein of VOM-Et combined with radiofrequency (RF) ablation (VOM-Et-RF) and RF groups. The primary outcome was MI block immediate block rate after surgery. Stratified analysis was also performed for factors affecting the outcome measures.ResultsA total of 118 consecutive patients underwent AF ablation at Taizhou Hospital of Zhejiang Province from January 2018 to December 2021. Successful bidirectional perimitral block was achieved in 96% of patients in VOM-Et-RF (69 of 72) and in 76% of patients in the RF group (35 of 46) (P < 0.01). In the subgroup analysis, male sex, elder than 60 years, Left atrial diameter <55 mm, and AF duration <3 years were associated with the benefits of VOM-Et in AF Patients.ConclusionThe vein of Marshall ethanol infusion for catheter ablation can improve the MI block rate. Male sex, elder age, smaller Left atrial diameter and shorter AF duration may have significant benefits for VOM-Et.

| S-EPMC10875083 | biostudies-literature

Left atrial roof-dependent atrial tachycardia via the Marshall bundle.

Project description: Not available

| S-EPMC8377269 | biostudies-literature

Double-Orifice Mitral Valve in an Adult with Atrioventricular Reentrant Tachycardia.

Project description: Not available

| S-EPMC6058762 | biostudies-literature

Left atrial anterolateral linear ablation for biatrial tachycardia via Bachmann's bundle, interatrial septum, and left atrial anterior wall under mitral isthmus block.

Project description:Biatrial tachycardia via Bachmann's bundle, interatrial septum, and left atrial anterior wall can be treated by left atrial anterolateral linear ablation without left atrial appendage isolation, even under mitral isthmus block.

| S-EPMC10264756 | biostudies-literature

Focal Atrial Tachycardia Originating From the Right Atrial Appendage Masquerading as Inappropriate Sinus Tachycardia.

Project description:Focal atrial tachycardia arising from the right atrial appendage (RAAT) may be misdiagnosed as sinus tachycardia. The electrocardiogram from this case demonstrates a negative notched P-wave in leads V1 and V2 during RAAT compared with a beat of sinus rhythm. RAAT was confirmed and eliminated with mapping and ablation. (Level of Difficulty: Advanced.).

| S-EPMC8414541 | biostudies-literature

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