Abstract:
:The intrinsic cardiac autonomic nervous system (ganglionated plexuses [GP]) plays a significant role in the initiation and maintenance of atrial fibrillation (AF) in both experimental models and AF patients. Left atrial GP, located in epicardial fat pads and the ligament of Marshall, contain afferent neurons from the atrial myocardium and the central autonomic nervous system, efferent neurons (cholinergic and adrenergic neurons), and interconnecting neurons, which allow communication between GP. Stimulation of the GP produces both parasympathetic stimulation (markedly shortens action potential duration) and sympathetic stimulation (increases calcium transient) in the pulmonary vein (PV) myocardium and atrial myocardium. In a canine model, GP stimulation resulted in early afterdepolarizations, and calcium transient triggered firing in the adjacent PV and initiated AF. Fractionated atrial potentials (FAP) were consistently located in the left atrium close to the stimulated GP. Ablation of the stimulated GP eliminated the FAP surrounding the GP. In patients with paroxysmal AF, epicardial and endocardial high-frequency stimulation produced a positive vagal response (transient AV block during AF and hypotension), allowing the identification and localization of five major left atrial GP (superior left GP, inferior left GP, Marshall tract GP, anterior right GP, inferior right GP). High-density electroanatomic maps of the left atrium and PVs obtained during AF showed the FAP are located in four main left atrial areas (left atrial appendage ridge FAP area, superior-left FAP area, inferoposterior FAP area, anterior-right FAP area). All five GP are located within one of the four FAP areas. In 63 patients with paroxysmal AF, GP ablation alone (before PV antrum isolation) significantly decreased the occurrence of PV firing (47/63 patients before ablation vs 9/63 patients after ablation, P <.01). GP ablation also decreased the inducibility of sustained AF (43/63 patients vs 23/63 patients, P <.01) and markedly reduced or eliminated the left atrial FAP areas.
journal_name
Heart Rhythmjournal_title
Heart rhythmauthors
Nakagawa H,Scherlag BJ,Patterson E,Ikeda A,Lockwood D,Jackman WMdoi
10.1016/j.hrthm.2009.07.029subject
Has Abstractpub_date
2009-12-01 00:00:00pages
S26-34issue
12 Suppleissn
1547-5271issn
1556-3871pii
S1547-5271(09)00800-5journal_volume
6pub_type
杂志文章相关文献
HEART RHYTHM文献大全abstract:BACKGROUND:Recognition of the creation of transmural lesions (TLs) during atrial ablation procedures is important. OBJECTIVE:The purpose of this study was to characterize local unipolar electrograms (UEs) and bipolar electrograms (BEs) recorded from a TL at different catheter orientations. METHODS:In 13 porcines, 125...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2010.06.014
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:Class 1 antiarrhythmic drugs are highly effective in restoring and maintaining sinus rhythm in atrial fibrillation patients but carry a risk of ventricular tachyarrhythmia. The antianginal agent ranolazine is a prototypic atrial-selective voltage-gated Na+ channel blocker but the mechanisms underlying its at...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2017.06.012
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:More sustained forms of atrial fibrillation (AF) are less amenable to treatment and associated with worse outcomes, but the incidence and predictors of AF progression are not well defined. OBJECTIVE:The purpose of this study was to perform a systematic review and meta-analysis assessing the incidence and pr...
journal_title:Heart rhythm
pub_type: 杂志文章,meta分析
doi:10.1016/j.hrthm.2018.10.022
更新日期:2019-04-01 00:00:00
abstract::Atrial fibrillation is a marker for worse outcomes in patients with heart failure and requires careful, individualized management. Anticoagulation and rate control are important. Routine use of antiarrhythmic drug therapy for maintenance of sinus rhythm carries concerns of risk and limited efficacy. Catheter ablation ...
journal_title:Heart rhythm
pub_type: 杂志文章,评审
doi:10.1016/j.hrthm.2006.12.003
更新日期:2007-03-01 00:00:00
abstract::Electrocardiographic (ECG) screening in infants and children who may be at risk of sudden cardiac death (SCD) is controversial, and both rational and emotional arguments have often been given equal weight. We all have direct experience in this field, but have different backgrounds and have expressed divergent views on...
journal_title:Heart rhythm
pub_type: 杂志文章,评审
doi:10.1016/j.hrthm.2014.09.047
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:Good catheter-tissue contact force (CF) is critical for transmural and durable lesion formation during radiofrequency (RF) ablation but is difficult to assess in clinical practice. Tissue heating during RF application results in an impedance decrease at the catheter tip. OBJECTIVE:The purpose of this study ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2013.10.048
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) reduces mortality, improves functional status, and induces reverse left ventricular remodeling in selected populations with heart failure (HF). The magnitude of reverse remodeling predicts survival with many HF medical therapies. However, there are few studies assessin...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.hrthm.2014.11.014
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:With the increasing use of implantable cardioverter-defibrillators (ICDs), device complications are becoming more common. Fungal-related ICD infections have rarely been reported, and little is known about the presentation, prevalence, and treatment options for these morbid infections. OBJECTIVES:The purpose...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2006.04.012
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:Left atrial appendage (LAA) ligation with the Lariat device is a therapeutic option to prevent thromboembolic stoke in patients with nonvalvular atrial fibrillation (AF) at high risk for systemic thromboembolization and bleeding related to use of anticoagulation. In rare cases, this procedure could leave the...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.06.035
更新日期:2014-11-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the efficacy of a totally subcutaneous, anteroposterior defibrillation shock pathway using a long time-constant shock waveform that emulates a proposed device having approximately twice the capacitance and thus twice the available energy of traditional transvenous de...
journal_title:Heart rhythm
pub_type: 临床试验,杂志文章
doi:10.1016/j.hrthm.2007.08.030
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Standard electroanatomic mapping systems use a single catheter to perform left ventricular substrate mapping. A new mapping system uses a 64-electrode mini-basket catheter to perform rapid automated acquisition of chamber geometry, voltage, and activation. OBJECTIVE:The aim of this study was to compare the ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.08.036
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Therapeutic hypothermia (TH) may increase the susceptibility to ventricular arrhythmias by decreasing ventricular conduction velocity (CV) and facilitating arrhythmogenic spatially discordant alternans (SDA). OBJECTIVE:The purpose of this study was to test the hypothesis that rotigaptide, a gap junction enh...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2015.07.023
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:Predictors of risk of lethal arrhythmic events (LAE) is poorly understood and may differ from adults in children with hypertrophic cardiomyopathy (HCM). OBJECTIVE:The purpose of this study was to determine predictors of LAE in children with HCM. METHODS:A retrospective data collection was performed on 446 ...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2019.04.040
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Complex fractionated electrograms (CFAEs) detected during substrate mapping for atrial fibrillation (AF) reflect etiologies that are difficult to separate. Without knowledge of local refractoriness and activation sequence, CFAEs may represent rapid localized activity, disorganized wave collisions, or far-fie...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2010.10.020
更新日期:2011-02-01 00:00:00
abstract:BACKGROUND:The origin of outflow tract ventricular tachycardia (OTVT) can be predicted from a surface electrocardiogram: indexes of R-wave amplitudes in leads V(1) and V(2) are used to differentiate a right origin from a left origin, while the axis of lead I differentiates an anterior origin from a posterior origin. In...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.12.007
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Ventricular arrhythmias (VAs) in cardiac sarcoidosis (CS) are frequently refractory to both antiarrhythmic drug (AAD) therapy and catheter ablation (CA). Cardiac sympathetic denervation (CSD) has been shown to reduce VA burden and implantable cardioverter-defibrillator (ICD) shocks in patients with nonischem...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2019.02.025
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Battery longevity is an important factor that may influence the selection of cardiac implantable electronic devices (CIEDs). However, there remains a lack of industry-wide standardized reporting of predicted CIED longevity to facilitate informed decision-making for implanting physicians and payers. OBJECTIV...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2018.07.029
更新日期:2018-12-01 00:00:00
abstract::Cardiac K+ channelopathies account for a significant proportion of arrhythmias and sudden cardiac death (SCD) in subjects without structural heart disease. It is well recognized that genetic defects are key factors in many cases, and in practice, the term cardiac channelopathies currently coincides with inherited card...
journal_title:Heart rhythm
pub_type: 杂志文章,评审
doi:10.1016/j.hrthm.2019.02.017
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Atrial tachyarrhythmias (AT) are considered progressive diseases. Several rhythm control therapies for treatment of AT have been proposed. OBJECTIVES:The Italian AT500 Registry was designed to prospectively study long-term AT evolution in patients paced for the brady-tachy form of sinus node disease (BT-SND...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2005.07.011
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:Interleukin 1β (IL-1β) is a key regulator of the inflammatory response after myocardial infarction (MI) by modulating immune cell recruitment, cytokine production, and extracellular matrix turnover. Elevated levels of IL-1β are associated with adverse remodeling, and inhibition of IL-1 signaling after MI res...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2017.01.027
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:The reported complication rate of catheter ablation of atrial fibrillation (AF) varies. OBJECTIVE:Our goal was to assess temporal trends and the effect of both institutional and individual operators' experience on the incidence of complications. METHODS:All patients undergoing AF ablation at Johns Hopkins ...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.07.025
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Vernakalant inhibits several potassium currents and causes a rate- and voltage-dependent inhibition of the sodium current. OBJECTIVE:The aim of this study was to evaluate the antiarrhythmic mechanism of vernakalant in normal and electrically remodeled atria. METHODS:Fourteen goats were instrumented with el...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2015.12.009
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited. OBJECTIVE:The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease. METHODS:Patients with structural heart disease undergoing VT RFA at 12 cent...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2017.03.008
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) has been demonstrated to lead to restoration of oxygen consumption homogeneity throughout the left ventricle (LV), which is important for long-term reverse remodeling of the ventricles. However, research has focused exclusively on identifying the LV pacing sites that l...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2014.03.021
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:The pulmonary veins (PVs) and the PV-LA (left atrium) junction are established sources of triggers initiating atrial fibrillation. In addition, they have been implicated in the maintenance of arrhythmia. OBJECTIVE:To undertake high-density electrophysiological characterization of the right superior PV-LA ju...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2011.09.010
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:Pulmonary vein isolation (PVI) is a cornerstone ablation strategy in the management of patients with atrial fibrillation (AF). Consensus guidelines and statements recommend PVI during the index catheter ablation procedure in patients with paroxysmal and persistent AF. OBJECTIVE:The objective of this analysi...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2017.10.038
更新日期:2018-03-01 00:00:00
abstract:OBJECTIVE:The purpose of this study is to ascertain the effects of spatially variable ACh distributions on arrhythmogenesis in a morphologically realistic computer model of canine atria. BACKGROUND:Vagal stimulation releases acetylcholine (ACh), which causes a dose-dependent reduction in action potential duration (APD...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2004.03.077
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Areas of conduction delay (CD) or conduction block (CB) are associated with higher recurrence rates after ablation therapy for atrial fibrillation (AF). OBJECTIVE:Thus far, there are no reports on the quantification of the extensiveness of CD and CB at the pulmonary vein area (PVA) and their clinical releva...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2018.10.027
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:Indications for pulmonary vein isolation for the treatment of atrial fibrillation (AF) have expanded over the years. OBJECTIVE:We aimed to describe trends in demographic and clinical characteristics of patients undergoing ablation, with a particular focus on sex differences. METHODS:Patients who underwent ...
journal_title:Heart rhythm
pub_type: 杂志文章,多中心研究
doi:10.1016/j.hrthm.2015.06.029
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Antitachycardia pacing (ATP) can reduce implantable cardioverter-defibrillator shocks, but its use in children and patients with congenital heart disease (CHD) is not well described. OBJECTIVE:To review the efficacy of ATP in children and patients with CHD. METHODS:We reviewed implantable cardioverter-defi...
journal_title:Heart rhythm
pub_type: 杂志文章
doi:10.1016/j.hrthm.2012.06.042
更新日期:2012-11-01 00:00:00