1256 22. Strik M, Rademakers LM, van Deursen CJ, van Hunnik A, Kuiper M, Klersy C et al. Endocardial left ventricular pacing improves cardiac resynchronization therapy in chronic asynchronous infarction and heart failure models. Circ Arrhythm Electrophysiol 2012;5:191 –200. 23. Wyman BT, Hunter WC, Prinzen FW, Faris OP, McVeigh ER. Effects of single- and biventricular pacing on temporal and spatial dynamics of ventricular contraction. Am J Physiol Heart Circ Physiol 2002;282:H372 – 9. 24. van Deursen CJ, Strik M, Rademakers LM, van Hunnik A, Kuiper M, Wecke L et al. Vectorcardiography as a tool for easy optimization of cardiac resynchronization therapy in canine left bundle branch block hearts. Circ Arrhythm Electrophysiol 2012; 5:544–52. 25. Verbeek XA, Vernooy K, Peschar M, Van Der Nagel T, Van Hunnik A, Prinzen FW. Quantification of interventricular asynchrony during LBBB and ventricular pacing. Am J Physiol Heart Circ Physiol 2002;283:H1370 –8. 26. Tamargo J, Capucci A, Mabo P. Safety of flecainide. Drug Saf 2012;35:273 –89. 27. Roy D, Rowe BH, Stiell IG, Coutu B, Ip JH, Phaneuf D et al. A randomized, controlled trial of RSD1235, a novel anti-arrhythmic agent, in the treatment of recent onset atrial fibrillation. J Am Coll Cardiol 2004;44:2355 –61. 28. Allison B, Yang Y, Pourrier M, Gibson JK. Comparison of the in vivo hemodynamic effects of the antiarrhythmic agents vernakalant and flecainide in a rat hindlimb perfusion model. J Cardiovasc Pharmacol 2011;57:463 –8.
L. B. van Middendorp et al.
29. Harmer AR, Valentin JP, Pollard CE. On the relationship between block of the cardiac Na(+) channel and drug-induced prolongation of the QRS complex. Br J Pharmacol 2011;164:260 –73. 30. Bechard J, Pourrier M. Atrial selective effects of intravenously administered vernakalant in conscious beagle dogs. J Cardiovasc Pharmacol 2011;58:49–55. 31. Mao Z, Wheeler JJ, Townsend R, Gao Y, Kshirsagar S, Keirns JJ. Population pharmacokinetic-pharmacodynamic analysis of vernakalant hydrochloride injection (RSD1235) in atrial fibrillation or atrial flutter. J Pharmacokinet Pharmacodyn 2011;38: 541 –62. 32. Vernooy K, Cornelussen RN, Verbeek XA, Vanagt WY, van Hunnik A, Kuiper M et al. Cardiac resynchronization therapy cures dyssynchronopathy in canine left bundlebranch block hearts. Eur Heart J 2007;28:2148 –55. 33. Peschar M, de Swart H, Michels KJ, Reneman RS, Prinzen FW. Left ventricular septal and apex pacing for optimal pump function in canine hearts. J Am Coll Cardiol 2003;41: 1218 –26. 34. Vernooy K, Verbeek XA, Peschar M, Crijns HJ, Arts T, Cornelussen RN et al. Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion. Eur Heart J 2005;26:91 –8. 35. Lynch JJ Jr, Regan CP, Beatch GN, Gleim GW, Morabito CJ. Comparison of the intrinsic vasorelaxant and inotropic effects of the antiarrhythmic agents vernakalant and flecainide in human isolated vascular and cardiac tissues. J Cardiovasc Pharmacol 2012;61:226 –32.
doi:10.1093/europace/eut362 Online publish-ahead-of-print 4 December 2013
.............................................................................................................................................................................
Real-time assessment of bidirectional block during pulmonary vein cryoablation Serge Boveda*, Rui Provideˆncia, and Jean-Paul Albenque De´partement de Rythmologie, Clinique Pasteur, 43 –45 avenue de Lombez, 31076 Toulouse, BP 27617 Cedex 3, France
* Corresponding author. Tel: +33 5 62 21 16 45; fax: +33 5 62 21 16 41, Email: [email protected]
Real-time assessment of the occurrence of bidirectional block during balloon cryoablation is not routinely performed. We paced continuously inside the pulmonary vein (PV) at high amplitude (12 mA/1.0 ms) with the Achievew catheter (lasso 7–8). These tracings illustrate the left superior PV before and during the beginning of balloon cryoablation. The left atrium (LA) was constantly captured (change in P-wave morphology—*) at a rate slightly faster than the spontaneous sinus rhythm (preserved exit conduction). Observe that the first intracardiac electrograms clearly shows a sharp PV potential (e.g. lasso 2–3 and 7– 8) in spontaneous sinus rhythm (preserved entrance conduction). An ectopic beat is shown (†) (also demonstrating preserved exit conduction because originated within the PV), followed by loss of LA capture (V—exit block). Immediate stopping of pacing after loss of LA capture allowed the demonstration of the entrance block (loss of PV potentials within the Achievew). The bidirectional block was confirmed by the presence of a dissociated PV potential (black arrow) and an atrial fibrillation spontaneously induced inside this very active vein (dotted arrow) without conduction to the LA (Figure). Real-time assessment of exit block may be of interest, as an alternative to entrance block evaluation, when PV potentials are not very clear or when the presence of far-field from the LA appendage impairs the analysis of the potentials. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/ Documents/real-time-assessment-of-bidirectional.pdf. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: [email protected].
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EP CASE EXPRESS
L. B. van Middendorp et al.
29. Harmer AR, Valentin JP, Pollard CE. On the relationship between block of the cardiac Na(+) channel and drug-induced prolongation of the QRS complex. Br J Pharmacol 2011;164:260 –73. 30. Bechard J, Pourrier M. Atrial selective effects of intravenously administered vernakalant in conscious beagle dogs. J Cardiovasc Pharmacol 2011;58:49–55. 31. Mao Z, Wheeler JJ, Townsend R, Gao Y, Kshirsagar S, Keirns JJ. Population pharmacokinetic-pharmacodynamic analysis of vernakalant hydrochloride injection (RSD1235) in atrial fibrillation or atrial flutter. J Pharmacokinet Pharmacodyn 2011;38: 541 –62. 32. Vernooy K, Cornelussen RN, Verbeek XA, Vanagt WY, van Hunnik A, Kuiper M et al. Cardiac resynchronization therapy cures dyssynchronopathy in canine left bundlebranch block hearts. Eur Heart J 2007;28:2148 –55. 33. Peschar M, de Swart H, Michels KJ, Reneman RS, Prinzen FW. Left ventricular septal and apex pacing for optimal pump function in canine hearts. J Am Coll Cardiol 2003;41: 1218 –26. 34. Vernooy K, Verbeek XA, Peschar M, Crijns HJ, Arts T, Cornelussen RN et al. Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion. Eur Heart J 2005;26:91 –8. 35. Lynch JJ Jr, Regan CP, Beatch GN, Gleim GW, Morabito CJ. Comparison of the intrinsic vasorelaxant and inotropic effects of the antiarrhythmic agents vernakalant and flecainide in human isolated vascular and cardiac tissues. J Cardiovasc Pharmacol 2012;61:226 –32.
doi:10.1093/europace/eut362 Online publish-ahead-of-print 4 December 2013
.............................................................................................................................................................................
Real-time assessment of bidirectional block during pulmonary vein cryoablation Serge Boveda*, Rui Provideˆncia, and Jean-Paul Albenque De´partement de Rythmologie, Clinique Pasteur, 43 –45 avenue de Lombez, 31076 Toulouse, BP 27617 Cedex 3, France
* Corresponding author. Tel: +33 5 62 21 16 45; fax: +33 5 62 21 16 41, Email: [email protected]
Real-time assessment of the occurrence of bidirectional block during balloon cryoablation is not routinely performed. We paced continuously inside the pulmonary vein (PV) at high amplitude (12 mA/1.0 ms) with the Achievew catheter (lasso 7–8). These tracings illustrate the left superior PV before and during the beginning of balloon cryoablation. The left atrium (LA) was constantly captured (change in P-wave morphology—*) at a rate slightly faster than the spontaneous sinus rhythm (preserved exit conduction). Observe that the first intracardiac electrograms clearly shows a sharp PV potential (e.g. lasso 2–3 and 7– 8) in spontaneous sinus rhythm (preserved entrance conduction). An ectopic beat is shown (†) (also demonstrating preserved exit conduction because originated within the PV), followed by loss of LA capture (V—exit block). Immediate stopping of pacing after loss of LA capture allowed the demonstration of the entrance block (loss of PV potentials within the Achievew). The bidirectional block was confirmed by the presence of a dissociated PV potential (black arrow) and an atrial fibrillation spontaneously induced inside this very active vein (dotted arrow) without conduction to the LA (Figure). Real-time assessment of exit block may be of interest, as an alternative to entrance block evaluation, when PV potentials are not very clear or when the presence of far-field from the LA appendage impairs the analysis of the potentials. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/ Documents/real-time-assessment-of-bidirectional.pdf. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2013. For permissions please email: [email protected].
Downloaded from by guest on November 15, 2015
EP CASE EXPRESS
