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Journal Card Electrophysiol Clin

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Fluoroless Catheter Ablation of Cardiac Arrhythmias.

Hany Demo, Cameron Willoughby, Mohammad-Ali Jazayeri, Mansour Razminia,

Fluoroless catheter ablation of all endocardial cardiac arrhythmias is feasible using current, and often standard, electrophysiology laboratory equipment. This article lays out a road map for performing fluoroless ablations, safely and efficaciously. We outline optimizing intracardiac echocardiography, performing complex ablations with radiofrequency and cryoballoon technology. ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):719-729]

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Mapping and Ablation of Arrhythmias from Uncommon Sites (Aortic Cusp, Pulmonary Artery, and Left Ventricular Summit).

Santhisri Kodali, Pasquale Santangeli, Fermin C Garcia,

Despite advances in our understanding of the relevant anatomy and mapping and catheter ablation techniques of idiopathic outflow tract ventricular arrhythmias, challenging sites for catheter ablation remain the aortic cusps, pulmonary artery, and notably the left ventricular summit. A systematic approach should be used to direct mapping efforts efficiently between ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):665-674]

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Mapping and Ablation of Ventricular Outflow Tract Arrhythmias.

Magdi M Saba, Anthony Li,

Arrhythmias arising from the ventricular outflow tracts are commonly encountered. Although largely benign, they can also present with heart failure and sudden cardiac death. Mapping and ablation of these arrhythmias is commonly performed in the electrophysiology laboratory with a high success rate, but occasionally can prove challenging to abolish. This ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):597-607]

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Challenges in Ablation of Complex Congenital Heart Disease.

George F Van Hare,

The field of congenital cardiac electrophysiology is growing rapidly due to the rapid growth in the population of survivors of childhood critical congenital heart disease surgery. Chronic arrhythmias pose one of the biggest challenges in this patient population, and catheter ablation, despite its challenges, is still the most desirable and ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):711-718]

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Substrate Mapping in Ventricular Arrhythmias.

Roderick Tung,

Ventricular tachycardia is typically hemodynamically unstable. Strategies to target the arrhythmogenic substrate during sinus rhythm are essential for therapeutic ablation. Electroanatomic mapping is the cornerstone of substrate-based strategies; ablation can be directed within a delineated scar region defined by low voltage. Bipolar voltage mapping has inherent limitations. Specific electrogram characteristics ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):657-663]

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Mapping and Ablation of Rotational and Focal Drivers in Atrial Fibrillation.

Junaid Zaman, Tina Baykaner, Sanjiv M Narayan,

Drivers are increasingly studied ablation targets for atrial fibrillation (AF). However, results from ablation remain controversial. First, outcomes vary between centers and patients. Second, it is unclear how best to perform driver ablation. Third, there is a lack of practical guidance on how to identify critical from secondary sites using ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):583-595]

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The Spectrum of Idiopathic Ventricular Fibrillation and J-Wave Syndromes: Novel Mapping Insights.

Michel Haïssaguerre, Wee Nademanee, Mélèze Hocini, Josselin Duchateau, Clementine André, Thomas Lavergne, Masa Takigawa, Frederic Sacher, Nicolas Derval, Thomas Pambrun, Pierre Jais, Rick Walton, Mark Potse, Ed Vigmond, Remi Dubois, Olivier Bernus,

Idiopathic ventricular fibrillation and J-wave syndromes are causes of sudden cardiac death (SCD) without any identified structural cardiac disease after extensive investigations. Recent data show that high-density electrophysiological mapping may ultimately offer diagnoses of subclinical diseases in most patients including those termed "unexplained" SCD. Three major conditions can underlie the ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):699-709]

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Mapping and Ablation of Ventricular Arrhythmias in Cardiomyopathies.

Henry H Hsia, Nanqing Xiong,

Mapping and ablation of ventricular arrhythmias in patients with nonischemic cardiomyopathies remain a major challenge. The electroanatomic abnormalities are frequently inaccessible to conventional endocardial ablations. Diagnostic diligence with a thorough understanding of the potential mechanisms/substrate, coupled with detailed electroanatomic mapping, is essential. Careful procedural planning, advanced imaging, and unipolar recordings ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):635-655]

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Postablation Atrial Arrhythmias.

Suraj Kapa,

Atrial arrhythmias, including atrial tachycardia and atrial flutter, are not uncommon after prior ablation. Mechanisms for arrhythmogenesis may vary and include recurrent conduction through sites of ablation, leading to recurrence of prior ablated arrhythmias and creation of new substrate. Incidence of postablation atrial arrhythmias varies across studies and may relate ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):573-582]

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Toward a Uniform Ablation Protocol for Paroxysmal, Persistent, and Permanent Atrial Fibrillation.

Domenico Giovanni Della Rocca, Carlo Lavalle, Carola Gianni, Marco Valerio Mariani, Sanghamitra Mohanty, Chintan Trivedi, Ugur Canpolat, Bryan MacDonald, Huseyin Ayhan, Agostino Piro, Mohamed Bassiouny, Amin Al-Ahmad, John David Burkhardt, Joseph G Gallinghouse, Rodney P Horton, Javier Sanchez, Nicola Tarantino, Luigi Di Biase, Andrea Natale,

Atrial fibrillation catheter ablation has emerged as the most effective strategy to restore and maintain sinus rhythm. The cornerstone of atrial fibrillation ablation is elimination of triggers from the pulmonary veins by pulmonary vein isolation. Nevertheless, some patients may experience atrial tachyarrhythmia recurrences even with permanent pulmonary vein antral isolation. ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):731-738]

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Mapping and Ablation of Unmappable Ventricular Tachycardia, Ventricular Tachycardia Storm, and Those in Acute Myocardial Infarction.

Josef Kautzner, Petr Peichl,

In stable ventricular tachycardia (VT), activation mapping and entrainment mapping are the most important strategies to describe the reentrant circuit and its critical components. In many patients, however, VT is noninducible or hemodynamically unstable and unmappable. Several technological advances have broadened ablation options in unmappable VTs. Preprocedural imaging and intraprocedural ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):675-688]

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Mapping and Ablation of Fascicular Tachycardias (Reentrant and Nonreentrant).

Ahmed Karim Talib, Mohammad Shenasa,

Fascicular ventricular tachycardia (FVT) usually involves the left fascicular system; namely the left posterior fascicle, anterior fascicle, and rarely the upper septal fascicle. It may also involve the right Purkinje arborization. This tachycardia can be seen in normal heart or in the setting of structural heart diseases. Monomorphic FVT can ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):609-623]

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The Ideal Cardiac Mapping System.

Mohammad Shenasa, Seyed-Mostafa Razavi, Hossein Shenasa, Amin Al-Ahmad,

Cardiac mapping has witnessed significant and unprecedented progress over more than a century. At present, several mapping/imaging technologies are commercially available, alone or in combination. This article briefly discusses the advantages and limitations (disadvantages) of each technique. ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):739-748]

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Ablation of Neuroaxial in Patients with Ventricular Tachycardia.

Yuhong Wang, Lilei Yu, Sunny S Po,

Ventricular tachycardia (VT) remains a common cause of sudden cardiac death. It is widely accepted that VTs are strongly associated with autonomic imbalance with reduced vagal and increased sympathetic activities. Pharmacologic therapy remains the first-line therapy, but antiarrhythmic agents may not be effective or carry significant side effects. Sympathetic denervation ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):625-634]

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New Findings in Atrial Fibrillation Mechanisms.

Dennis H Lau, Dominik Linz, Prashanthan Sanders,

This review focusses on novel findings in atrial fibrillation mechanisms derived from mapping studies. Recent panoramic mapping techniques have identified 2 arrhythmic mechanisms of interest, namely, rotational (rotors) and ectopic focal activations as drivers of atrial fibrillation. Epicardial adipose tissue and fatty infiltration into the myocardium have been described as ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):563-571]

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Advances in Cardiac Mapping Part 2.

Mohammad Shenasa, Amin Al-Ahmad,

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):xv]

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Mapping the Heart.

Ranjan K Thakur, Andrea Natale,

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):xiii]

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Mapping and Ablation of Ventricle Arrhythmia in Patients with Left Ventricular Assist Devices.

Subodh R Devabhaktuni, Jonathan T Shirazi, John M Miller,

Ventricular arrhythmias (VA) constitute well-known problems in patients with left ventricular assist devices (LVADs), with incidence ranging from 18% to as high as 52%. Catheter ablation has become a common therapeutic intervention to treat drug-refractory VA, particularly with the increase and more widespread use of durable LVADs to bridge patients ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(4):689-697]

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Fibrosis and Ventricular Arrhythmogenesis: Role of Cardiac MRI.

Mohammad Shenasa,

Cardiac fibrosis is a significant increase in collagen volume fraction of myocardial tissue. It plays an important role in the pathophysiology of many cardiovascular abnormalities. Electrophysiologically, myocardial fibrosis produces anisotropic conduction, inhomogeneity, and conduction delay. Several markers are available to detect myocardial fibrosis. CMRI is the most common imaging technique; ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(3):551-562]

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Optical Mapping.

Omer Berenfeld, Igor Efimov,

Optical mapping of electrical activity in the heart is based on voltage-sensitive and lipophilic fluorescence dyes. Optical signals recorded from cardiac cells correlate well with their transmembrane potentials. High spatiotemporal resolution, wide field mapping, and high sensitivity to transmembrane potential enable detailed characterization of action potential initiation and propagation. Optical ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(3):495-510]

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Fundamentals of Cardiac Mapping.

Thomas P Ladas, Alan Sugrue, John Nan, Vaibhav R Vaidya, Deepak Padmanabhan, K L Venkatachalam, Samuel J Asirvatham,

To characterize cardiac activity and arrhythmias, electrophysiologists can record the electrical activity of the heart in relation to its anatomy through a process called cardiac mapping (electroanatomic mapping, EAM). A solid understanding of the basic cardiac biopotentials, called electrograms, is imperative to construct and interpret the cardiac EAM correctly. There ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(3):433-448]

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Cardiac MRI and Fibrosis Quantification.

Eugene G Kholmovski, Alan K Morris, Mihail G Chelu,

Left atrial fibrosis plays an important role in the pathophysiology of atrial fibrillation. Left atrial ablation is an effective and increasingly used strategy to restore and maintain sinus rhythm in patients with atrial fibrillation. Late gadolinium enhancement (LGE) MRI and custom image analysis software have been used to visualize and ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(3):537-549]

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Noninvasive Cardioablation.

Marwan M Refaat, Patrick Zakka, Bassem Youssef, Youssef H Zeidan, Fadi Geara, Amin Al-Ahmad,

Stereotactic body radiotherapy uses the principle of 3-dimensional localization of a target to deliver a high dose of radiation to a precise location. The aim of this technique is to ablate tissue noninvasively. Because of its high precision and target conformity, it can deliver a high dose of radiation to ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(3):481-485]

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Anatomic Considerations Relevant to Atrial and Ventricular Arrhythmias.

John Nan, Alan Sugrue, Thomas P Ladas, Nandini Mehra, Samuel J Asirvatham,

Knowledge of relevant cardiac anatomy is crucial in understanding the pathophysiology and treatment of arrhythmias, and helps avoid potential complications in mapping and ablation. This article explores the anatomy, relevant to electrophysiologists, relating to atrial flutter and atrial fibrillation, ventricular tachycardia relating to the outflow tracts as well as endocardial ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(3):421-432]

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Contact Force and Ablation Index.

Sohaib A Virk, Richard G Bennett, Ivana Trivic, Timothy Campbell, Saurabh Kumar,

Radiofrequency ablation of arrhythmias depends on durable lesion formation. Catheter tip-tissue contact force (CF) is a key determinant of lesion quality; excessive CF is associated with major complications, whereas insufficient CF increases the risk of electrical reconnection and arrhythmia recurrence. In recent years, CF-sensing catheters have emerged with the ability ... Read more >>

Card Electrophysiol Clin (Cardiac electrophysiology clinics)
[2019, 11(3):473-479]

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