1	RADIOFREQUENCY ABLATION OF CARDIAC ARRHYTHMIAS פרופ' ברנרד בלאסן מרכז רפואי ת"א Posgraduate, TAU 04/11/2008
2	CARDIAC ARRHYTHMIAS AV NODAL REENTRY TACHYCARDIA ACCESSORY PATHWAYS ATRIAL FLUTTER ATRIAL FIBRILLATION VENTRICULAR ARRHYTHMIAS
3	AV NODAL REENTRY TACHYCARDIA
4	AV nodal reentry tachycardia Clinical features The most frequently encountered regular SVT (70%) Female predominance (2/3) Most common in the elderly Age (at ablation): 9-91 (48 + 17) yrs Sporadic familial cases No obvious heart disease (>95%)
5	AV nodal reentry tachycardia Mechanism Reentry mechanism: > 2 extranodal pathways with different conduction velocity and refractoriness 93%: slow/fast AVNRT (“common”) 7%: “uncommon” - fast/slow; slow/intermediate; F/S+S/F - various involving slow pathway
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13	AV Nodal Reentry Tachycardia Indications: - Recurrent supraventricular arrhythmias - 1 single episode of PSVT ? - Undocumented palpitations and + ATP test
14	AV Nodal Reentry Tachycardia Results: (n=901 pts) - Success: 97% - Failure: 1.1% - Discontinued procedure: 1.6% Recurrence: 2.8%
15	AV Nodal Reentry Tachycardia
16	AV Nodal Reentry Tachycardia Mechanical trauma to FP/SP: 13.4% FP: 71%; SP: 2.4%; FP + SP: 26.4% <1 min: 72%; 1-30min: 19%; > 30min: 9% Lower success rate: 93.4% (vs 97.9%) Higher discontinuation rate: 5.8% (vs 0.9%)
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20	AV Nodal Reentry Tachycardia Complications - None: 96% - > 2^nd AV block: 3.4% (pacemaker: 0.9%) - Miscellaneous: 0.7% In young patients (<34 yrs) - No significant complications
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25	ACCESSORY PATHWAYS
26	AV reentry tachycardia Clinical features The second most frequently encountered regular SVT (20%) Male predominance (60%) Most common in the young Age (at ablation): 9-82 (27 + 17) yrs Sporadic familial cases No obvious heart disease (>95%)
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30	Accessory Pathways Indications: Recurrent supraventricular tachyarrhythmias 1 single episode of PSVT or PAF + WPW High risk asymptomatic WPW Undocumented palpitations and + ATP test
31	Accessory Pathways (534 AP’s) Acute success rate: - 93% (1^st procedure); 96% ≥ 1 procedure)
32	Accessory Pathways Recurrence rate after 1^st procedure:9.9%
33	Accessory Pathways
34	Accessory Pathways Mechanical trauma: 10.5% - RAF 43.8% - RAS 38.1% - RFA 9.1% - PS 8.1% - LFW 6.3% - MS 5.6%
35	Accessory Pathways (complications) Complications: AV block requiring PM: 2 pts 1 pt RAS (2.3%) 1 pt PS (0.8%)
36	Accessory Pathways (complications) Pericardial effusion (7 pts; 1.2%; 6/7 F) - Pericardiocenthesis: 2 pts - LFW (5 pts); all retrograde approach - RFW (1 pt) - PS AP (1 pt)
37	Accessory Pathways (complications) Mitral valve damage (2 pts) - Both LFW AP’s and retrograde approach - Acute severe MR (1 pt) - Late (11.5 yrs) severe MR (1 pt) - Both requiring MV surgery
38	Accessory Pathways (complications) Acute myocardial ischemia(4 pts; 0.8%) - All LFW AP’s treated with retrograde approach - Suspected coronary spasm
39	Left Free Wall AP’s
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52	Septal AP’s
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76	Right free wall AP’s
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81	Atrio-fascicular AP’s
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87	PERMANENT JUNCTIONAL RECIPROCATING TACHYCARDIA (PJRT)
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92	ATRIAL FLUTTER
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100	ATRIAL FIBRILLATION
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118	POST-MI VENTRICULAR TACHYCARDIA
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130	IDIOPATHIC VENTRICULAR ARRHYTHMIAS
131	Idiopathic Right VT Right ventricular outflow tract VT Right His bundle VT Right free wall VT
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134	Idiopathic Left VT Fascicular VT 1) left posterior fascicular VT: RBBB-LAD +++ (“Belhassen VT”) 2) left anterior fascicular VT: RBBB-RAD 3) upper septal fascicular VT Left ventricular outflow tract VT 1) endocardial origin 2) coronary cusp origin 3) epicardial origin
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151	BUNDLE BRANCH REENTRY VENTRICULAR TACHYCRDIA
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