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   Table of Contents - Current issue
July-December 2021
Volume 6 | Issue 2
Page Nos. 77-107

Online since Tuesday, December 28, 2021

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The interpretation of cryoballoon ablation of atrial fibrillation: Consensus of Chinese experts (English version) p. 77
Zulu Wang, Congxin Huang, Dejia Huang, Shu Zhang
Atrial fibrillation (AF) is the most common tachycardia arrhythmia in clinical practice. Catheter ablation has been one of the most effective established therapies for AF. In recent years, cryoballoon ablation (CBA) is a novel technique of AF treatment. Much experience in the operations, therapeutic parameters, and the prevention against complications has been gained during the process of clinical application and promotion. Chinese Society of Pacing and Electrophysiology and Chinese Society of Arrhythmias organized experts, jointly initiated, and compiled “The interpretation of CBA of AF: Consensus of Chinese experts,” aiming to standardize and promote the clinical application of CBA. Based on the real-world situation in China, this article interprets and reviews the important contents of this consensus, combined with the domestic and overseas guidelines, consensus, and recent literature on AF management.
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Feasibility of the transseptal approach for mapping and ablation in patients with ventricular aneurysm-related ventricular tachycardia with a steerable sheath: A retrospective study p. 85
Lian Chen, Min Tang, Xiaoqing Ren, Pihua Fang, Jingtao Zhang, Tianjie Feng, Zhengqin Zhai, Xiaonan Dong, Shu Zhang
Background: A retrograde transaortic access might be limited in mapping and ablation for some left ventricular (LV) arrhythmias. We examined the feasibility and safety of a transseptal approach for catheter ablation of LV aneurysm (LVA)-related ischemic ventricular tachycardia (VT). Subjects and Methods: Five consecutive patients with postinfarction LVA-related VT were selected for catheter ablation at Fuwai Hospital from April 2011 to October 2015 in this retrospective study. After a routine transaortic LV-mapping approach was failed, a transseptal approach with a steerable sheath was performed in all these cases. The study was approved by the Ethics Committee of Fuwai Cardiovascular Hospital (approval No. 2016-768) on May 24, 2016. Results: In these five patients, four had LVAs located in the LV apical area, and one in the septum. Acute ablation successes were all failed to achieve through the transaortic route. Two were due to aortic stenosis and tortuous peripheral arteries and the others were due to failure to target the effective sites. While all ablation procedures succeeded through the sequent transseptal approach with a steerable sheath, and no major complications related to the transseptal approach were reported. During the 12-month (10–12 months) follow-up, no electrical storm or episode of VT was documented. One VT recurrence occurred, yet acute success was obtained again through the transseptal approach. Conclusions: Transseptal approach appears a feasible, safe, and effective method in catheter ablation for VT with LVA and could be considered as an elective approach.
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A decremental response seen to a his refractory premature ventricular complex in a patient with short ventriculoatrial interval: A case report p. 90
Khalil Kanjwal, Asim Kichloo, Muzaffar Ali, Abdul Qadir Haji
We report on a patient with supraventricular tachycardia, mediated through a left posterior concealed accessory pathway (AP). During an electrophysiology study, the His refractory premature ventricular complex (PVC) delayed in the next atrial signal and was suggestive of the decremental pathway; however, further maneuvers and tachycardia features were suggestive of a nondecremental AP. In this paper, we discuss possible mechanisms of this interesting observation of decremental response to PVC in an otherwise nondecremental AP.
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Case report: A regular wide QRS complex tachycardia with fusion beats? p. 93
Haiyang Xie
A patient suffered from recurrent episodes of palpitations and documented wide QRS complex tachycardia. Echocardiography revealed no obvious abnormal heart structure. A diagnostic electrophysiological study was performed and fast-slow atrioventricular nodal reentrant tachycardia with aberrancy was diagnosed. Successful slow pathway ablation rendered the tachycardia noninducible.
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Persistent bradycardia in post-COVID-19: Possible dysautonomia? A case report Highly accessed article p. 95
Olivia Handayani
The impact of coronavirus disease 2019 (COVID-19) infection is immeasurable. As we continue to learn about the presentation and complications of this infection, we begin to understand that COVID-19 is associated with multiorgan involvement. Bradycardia is one of cardiac complications that occur frequently in patients with COVID-19 infection. This clinical case is one approach to further understand the mechanism of COVID-19–induced dysautonomia causing bradycardia, through overstimulation of parasympathetic nervous system. Routine physical rehabilitation had improved the symptoms.
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Demonstration of double-wave-like reentry using activation and propagation map in a patient with atrial flutter and previous atrial septal defect surgery: A case report p. 98
Khalil Kanjwal, Asim Kichloo, Abdul Qadir Haji
Three-dimensional electroanatomic maps have revolutionized the management of complex arrhythmia. By providing a visual display of various arrhythmia mechanisms these maps have not only helped with the mechanism of the tachycardia but also allowed for precise localization of the critical isthmus. Herein, we present an interesting propagation map of a 55-year-old female with scar-related right-sided atrial flutter. The propagation map helped in localizing the critical isthmus and subsequent successful ablation.
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A case report of tachycardia-dependent right bundle branch block during cardiac resynchronization therapy: A factor for nonresponse p. 101
Chendi Cheng, Lei Sun, Xiang Gu
Cardiac resynchronization therapy (CRT) has been shown to improve symptoms and mortality in a suitably selected population with systolic heart failure and prolonged QRS duration. Various factors have been reported to be associated with poor response to CRT. A 67-year-old man with CRT implantation experienced response, nonresponse, and response in turn. The new-onset right tachycardia-dependent bundle branch block was considered to be an exclusive cause. More attention should be paid to the possible changes of paced-QRS morphology, resulting from tachycardia-dependent aberrancy during CRT, ensuring a high percentage of effective biventricular pacing.
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Significantly high serum cardiac troponin level with supraventricular tachyarrhythmia in the absence of coronary artery disease p. 104
Lian Chen, Yigang Zhong, Yizhou Xu, Liuying Chen, Faming Yu
Although elevated cardiac troponin is considered to be the gold standard biomarker for the identification of acute coronary syndrome, it may also occur in other clinical situations as supraventricular tachyarrhythmia (SVT) and acute coronary syndrome. We reported the case of a 77-year-old patient with a highly elevated cTn after the onset of SVT. Normal coronary arteries were detected through coronary angiography and intravenous ultrasound. It seems that the association of the cardiac troponin elevation in SVT patients with future cardiovascular events is very low. Meanwhile, more attention should be paid to those patients with high cardiovascular risk factors.
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