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A report on feasibility and efficacy
14. Chierchia GB, de Asmundis C, Namdar M, Westra S, Kuniss M, Sarkozy A et al. Pulmonary vein isolation during cryoballoon ablation using the novel Achieve inner lumen mapping catheter: a feasibility study. Europace 2012;14:962 – 7. 15. Rosso R, Halkin A, Michowitz Y, Belhassen B, Glick A, Viskin S. Radiofrequency ablation of paroxysmal atrial fibrillation with the new irrigated multipolar nMARQ ablation catheter. Verification of intracardiac signals with a second circular mapping catheter. Heart Rhythm 2014;11:559–65. 16. Shin D-I, Kirmanoglou K, Eickholt C, Schmidt J, Clasen L, Butzbach B et al. Initial results of using a novel irrigated multielectrode mapping and ablation catheter for pulmonary vein isolation. Heart Rhythm 2014;11:375–83. 17. Deneke T, Schade A, Mu¨ller P, Schmitt R, Christopoulos G, Krug J et al. Acute safety and efficacy of a novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation. J Cardiovasc Electrophysiol 2014;25:339 –45. 18. Herrera Siklo´dy C, Deneke T, Hocini M, Lehrmann H, Shin D-I, Miyazaki S et al. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation:
19.
20.
21.
22.
comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol 2011;58:681 – 8. Zellerhoff S, Ritter MA, Kochha¨user S, Dittrich R, Ko¨be J, Milberg P et al. Modified phased radiofrequency ablation of atrial fibrillation reduces the number of cerebral microembolic signals. Europace 2014;16:341 –6. Haines DE, Stewart MT, Ahlberg S, Barka ND, CONDIE C, Fiedler GR et al. Microembolism and catheter ablation I: a comparison of irrigated radiofrequency and multielectrode phased radiofrequency catheter ablation of pulmonary vein ostia. Circ Arrhythm Electrophysiol 2013;6:16 –22. Deneke T, Schade A, Diegeler A, Nentwich K. Esophago-pericardial fistula complicating atrial fibrillation ablation using a novel-irrigated radiofrequency multipolar ablation catheter. J Cardiovasc Electrophysiol 2014;25:442 –3. Saad EB, Rossillo A, Saad CP, Martin DO, Bhargava M, Erciyes D et al. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation 2003;108:3102 –7.
doi:10.1093/europace/euu177 Online publish-ahead-of-print 10 July 2014
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Speech-triggered atrial tachycardia originating from the superior vena cava Akira Ueno*, Norishige Morita, and Yoshinori Kobayashi Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji-shi, Tokyo 1920032, Japan
* Corresponding author. Tel: +81 42 639 1111; fax: +81 42 639 1144. E-mail address: [email protected]
A 63-year-old male was referred due to frequent episodes of palpitations during conversation. An incessant form of atrial tachycardia (AT) triggered by premature atrial complexes could be reproducibly induced by starting to speak, and terminated over time after cessation of the conversation. In an electrophysiological study, a short duration AT was reproducibly induced by a single word verbal reply and three-dimensional electroanatomical mapping (Biosense Webster) revealed that the earliest focal activation site of the AT was on the septal side of the superior vena cava (SVC) (Figure). When the ablation catheter was placed at that site, the AT became no longer inducible even by speech manoeuvers, and then radiofrequency energy was applied. After 1 year of follow-up, he has been free of any palpitations during conversations. It may be inferred that central modulation acting on the pharyngeal muscles via the vagus nerve for a voice production also stimulates the cardiac vagus nerve elements, and the discharges of the sympathetic nervous system simultaneously occur by the initiation of speech. Both autonomic nerve elements collaboratively promote the formation of abnormal triggered activity, and subsequently lead to an occurrence of speech-triggered AT. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/ Documents/Speech-triggered-atrial-tachycardia.pdf. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from http://europace.oxfordjournals.org/ by guest on November 14, 2015
EP CASE EXPRESS
A report on feasibility and efficacy
14. Chierchia GB, de Asmundis C, Namdar M, Westra S, Kuniss M, Sarkozy A et al. Pulmonary vein isolation during cryoballoon ablation using the novel Achieve inner lumen mapping catheter: a feasibility study. Europace 2012;14:962 – 7. 15. Rosso R, Halkin A, Michowitz Y, Belhassen B, Glick A, Viskin S. Radiofrequency ablation of paroxysmal atrial fibrillation with the new irrigated multipolar nMARQ ablation catheter. Verification of intracardiac signals with a second circular mapping catheter. Heart Rhythm 2014;11:559–65. 16. Shin D-I, Kirmanoglou K, Eickholt C, Schmidt J, Clasen L, Butzbach B et al. Initial results of using a novel irrigated multielectrode mapping and ablation catheter for pulmonary vein isolation. Heart Rhythm 2014;11:375–83. 17. Deneke T, Schade A, Mu¨ller P, Schmitt R, Christopoulos G, Krug J et al. Acute safety and efficacy of a novel multipolar irrigated radiofrequency ablation catheter for pulmonary vein isolation. J Cardiovasc Electrophysiol 2014;25:339 –45. 18. Herrera Siklo´dy C, Deneke T, Hocini M, Lehrmann H, Shin D-I, Miyazaki S et al. Incidence of asymptomatic intracranial embolic events after pulmonary vein isolation:
19.
20.
21.
22.
comparison of different atrial fibrillation ablation technologies in a multicenter study. J Am Coll Cardiol 2011;58:681 – 8. Zellerhoff S, Ritter MA, Kochha¨user S, Dittrich R, Ko¨be J, Milberg P et al. Modified phased radiofrequency ablation of atrial fibrillation reduces the number of cerebral microembolic signals. Europace 2014;16:341 –6. Haines DE, Stewart MT, Ahlberg S, Barka ND, CONDIE C, Fiedler GR et al. Microembolism and catheter ablation I: a comparison of irrigated radiofrequency and multielectrode phased radiofrequency catheter ablation of pulmonary vein ostia. Circ Arrhythm Electrophysiol 2013;6:16 –22. Deneke T, Schade A, Diegeler A, Nentwich K. Esophago-pericardial fistula complicating atrial fibrillation ablation using a novel-irrigated radiofrequency multipolar ablation catheter. J Cardiovasc Electrophysiol 2014;25:442 –3. Saad EB, Rossillo A, Saad CP, Martin DO, Bhargava M, Erciyes D et al. Pulmonary vein stenosis after radiofrequency ablation of atrial fibrillation: functional characterization, evolution, and influence of the ablation strategy. Circulation 2003;108:3102 –7.
doi:10.1093/europace/euu177 Online publish-ahead-of-print 10 July 2014
.............................................................................................................................................................................
Speech-triggered atrial tachycardia originating from the superior vena cava Akira Ueno*, Norishige Morita, and Yoshinori Kobayashi Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji-shi, Tokyo 1920032, Japan
* Corresponding author. Tel: +81 42 639 1111; fax: +81 42 639 1144. E-mail address: [email protected]
A 63-year-old male was referred due to frequent episodes of palpitations during conversation. An incessant form of atrial tachycardia (AT) triggered by premature atrial complexes could be reproducibly induced by starting to speak, and terminated over time after cessation of the conversation. In an electrophysiological study, a short duration AT was reproducibly induced by a single word verbal reply and three-dimensional electroanatomical mapping (Biosense Webster) revealed that the earliest focal activation site of the AT was on the septal side of the superior vena cava (SVC) (Figure). When the ablation catheter was placed at that site, the AT became no longer inducible even by speech manoeuvers, and then radiofrequency energy was applied. After 1 year of follow-up, he has been free of any palpitations during conversations. It may be inferred that central modulation acting on the pharyngeal muscles via the vagus nerve for a voice production also stimulates the cardiac vagus nerve elements, and the discharges of the sympathetic nervous system simultaneously occur by the initiation of speech. Both autonomic nerve elements collaboratively promote the formation of abnormal triggered activity, and subsequently lead to an occurrence of speech-triggered AT. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/ Documents/Speech-triggered-atrial-tachycardia.pdf. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from http://europace.oxfordjournals.org/ by guest on November 14, 2015
EP CASE EXPRESS
