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Papers by Melvin Scheinman
The American Journal of Cardiology, 1983
Journal of the American College of Cardiology, 1993
San Francisco, (al{fornia Obiectfves. The purpose of this study was to compare success rates, pro... more San Francisco, (al{fornia Obiectfves. The purpose of this study was to compare success rates, procedure and fluoroscopy times and complications for the transseptal and retrograde aortic approaches in a consecutive series of patients undergoing catheter ablation of left free wall accessory pathways. Background. Radiofrequency catheter ablation of left-sided accessory pathways can be performed either by a retrograde, transaortic approach or by means of a transseptal puncture. Methods. A total of 106 patients (mean age 33 years, range 4 to 79) underwent attempted catheter ablation of a single left-sided accessory pathway by either the retrograde or the transseptal approach, or both. In the fist 65 patients, the retrograde aortic approach was the preferred initial method. In the most recent 51 patients, we first attempted the transseptal approach whenever a physician trained in the technique was available. Ultimately, 102 (96.2%) of 106 patients bad successful ablation. Results. Of 89 retrograde procedures, 85% resulted in elimination of accessory pathway conduction. Four retrograde procedures performed after failure of the transseptal approach were successful. Of the 13 Patients with a failed retrograde procedure, 11 later underwent ablation using the transseptal approach. Twenty-six (85%) of 33 transseptal procedures were successful. All four patients with unsuccessful Initial transseptal attempts were successfully treated with the retrograde method during the same session In the electrophysiotogy laboratory. Ten of 11 transseptal procedures after unsuccessful retrograde procedures were vaccessful. Crossover from the retrograde to the transseptal Radiofrequency catheter ablation has gained wide acceptance in the treatment of adults (1-5) and children (6) with symptomatic supraventricular tachycardia involving an accessory atrioventricular (AV) connection .
Pacing and Clinical Electrophysiology, 1981
vulnerability in a palient with the Woljj-Parkinson-W'hile syndrome. An electrophysjoiogic study ... more vulnerability in a palient with the Woljj-Parkinson-W'hile syndrome. An electrophysjoiogic study was carried out in a patient with the Woljj-Parkinson-White syndrome and a history of sponfuneous atrial fibrillafion but with no evidence oj organic cardiac disease. A singJe induced premature ventricular depoiarizalion resulted in ventricular tachycardia joUowed by ventricular fibrillation. Similarly, airial pacing or premature atrial siimulation resulted in frequent episodes of airial fibrillation or flutter. The atrial and ventricular effective refractory periods were 180 ms and < 160 ms. respectively, al a driven cycle length of 480 ms. Intravenous adminislralion of procainamide resulted in lengthening of the refractory periods and failure to induce either atriai or venlricular arrhythmias with pacing. In most patients with enhanced atrioventricular nodal or accessory atrioventricular nodal bypass, Ihe mechanism of ventricular tachycardia is related to an inordinately rapid ventricular response during supraventricular arrhythmias. In our patient, a unique mechonism was apparent; atrial and venlricular vulnerability to fibrillation was associated with extremely short myocardial effective refraclory periods. The relationship of this finding to sudden cardiac death bears further study. (PACE. Vol. 4, January-February, 1981} atrial vulnerability, ventricular vulnerability, Wolff-ParJiinson-White syndrome. ventricular fibrillation, atrial fibrillation, atrial flutter Atrial fibrillation is a well-documenled complication in palients with the Wolff-Parkinson-White syndrome and its occurrence has been related to increased citrial vulnerability during reciprocating atrioventricular tachycardia or to delayed atrial conduction.'"^ Less clear, however, is the relationship between ventricular arrhythmias and preexcitation. This uncer
Journal of The American College of Cardiology, 1987
© 1987 by the American College of Cardiology free wall Kent connection. Two patients had fascicul... more © 1987 by the American College of Cardiology free wall Kent connection. Two patients had fasciculoventricular connections that were associated with either septal (one patient) or left free wall (one patient) Kent connections. The latter also had evidence of enhanced AV node conduction. This report is unique in that it describes in detail two patients with left nodoventricular connections (Mahaim) inserting in or near the left posterior fascicle. Combined Kent and Mahaim connections, present in the six patients, appear to occur in approximately 5% of patients with the WolfT-Parkinson-White syndrome. Precise identification of bypass connections critical for reentrant circuits is essential for intelligent application of treatment options.
The American Journal of Cardiology, 1992
ABSTRACT
Pacing and Clinical Electrophysiology, 1992
BHARATI, S., ET AL.: Histologic Findings of the Heart and the Conduction System in the First Pati... more BHARATI, S., ET AL.: Histologic Findings of the Heart and the Conduction System in the First Patient Who Underwent Catheter Ablation. This is a detailed pathological examination of the heart including the conduction system (CS} from a 64'year-old maJe who had catheter ablation of the atrfoventricular (AV} junction for intractable atriaJ fibrillation. This is the world's first human who had this procedure, and who survived 3 years and 8 months, and later died of congestive heart failure. Pathoiogically, the heart was hypertrophied and enlarged. HistoJogically, there were chronic inflammatory cells, marked fatty metamorphosis with fibrosis of the atria, the approaches to the AV node, and the AV node, with almost isolation of the node from the atria, and considerable fibrosis of the bundle and bundie branches. In addition, there was fibrosis of the summit of the ventricular septum with chronic inflammatory ceils. These represent the sequelae of the ablation procedures. It is not known how much of the pathological findings contributed to the cardiac hypertrophy and impairment of cardiac function.
Journal of the American College of Cardiology, 1991
Journal of the American College of Cardiology, 1991
Journal of the American …, 1988
The abitity to locate cslbeter pesUimt in the kR ventrick with resp~t to endo~srdlal tmutmartw mt... more The abitity to locate cslbeter pesUimt in the kR ventrick with resp~t to endo~srdlal tmutmartw mtgbt rnhsnrr tbe accursey of venlrictdar txhycardis mapping. An eehatrarusponder system (Teleetrotdes, Inc.) was rompered with biplane tluomseopy far lell ventricular endeardial mapping. A 6F eketmde catheter was maditled with the addition of a pRzwleetrtc crystal 5 mm from the tip. Thts eryrtat WBS connected to P transponder that received and trsnmittfd ultrmaund, resulting in a discrete prtibcl on the twedbnensionel eehoeardiogrsphic image correspond. ing to the pmitien of the catheter tip. Catheters were introduced percutene~ttsly ittto the left ventricle of nine anertbettzed dogr. Two~dimensionPI echo. MI viirotnp with the catheter at n&ipk&dacsrdisl dtrs. Catheter locsttw was marked by deltvertng rsdiofrequeney current to the distal rlodrcde, mating a small mdwardial ksion. Catheter lecatiae by echo-tipocldrr and by fbm. Msnwi~t received December 7. 1987. revird manurcript ,e~eived the exact location of the catheter tip. We compared the
American Heart Journal, 1983
His bundle ablation by means of pulsed synchronized electrical shocks delivered between an electr... more His bundle ablation by means of pulsed synchronized electrical shocks delivered between an electrode catheter adjacent to the His bundle and a metal plate behind the dog's back. Detailed histologic studies were performed 3 months after induction of stable complete atrioventricular (AV) block in nine dogs. The ventricular response ranged from 35 to 51 beats/min (bpm). Graded increases in overdrive ventricular pacing resulted in graded increases in pacemaker suppression up to a paced cycle length of 450 msec. All dogs showed extensive damage to the approaches to the AV node, the AV node, and the penetrating portion of the common bundle. This technique resulted in complete AV block with typical features of an infranodal pacemaker and correlated with the histologic findings of severe damage to the AV junction. The minimal myocardial damage suggests that this technique may be applicable for control of drug refractory supraventricular arrhythmias in
The American Journal of Cardiology, 1983
Journal of the American College of Cardiology, 1993
The purpose of this study was to compare success rates, procedure and fluoroscopy times and compl... more The purpose of this study was to compare success rates, procedure and fluoroscopy times and complications for the transseptal and retrograde aortic approaches in a consecutive series of patients undergoing catheter ablation of left free wall accessory pathways. Radiofrequency catheter ablation of left-sided accessory pathways can be performed either by a retrograde, transaortic approach or by means of a transseptal puncture. A total of 106 patients (mean age 33 years, range 4 to 79) underwent attempted catheter ablation of a single left-sided accessory pathway by either the retrograde or the transseptal approach, or both. In the first 65 patients, the retrograde aortic approach was the preferred initial method. In the most recent 51 patients, we first attempted the transseptal approach whenever a physician trained in the technique was available. Ultimately, 102 (96.2%) of 106 patients had successful ablation. Of 89 retrograde procedures, 85% resulted in elimination of accessory pathway conduction. Four retrograde procedures performed after failure of the transseptal approach were successful. Of the 13 patients with a failed retrograde procedure, 11 later underwent ablation using the transseptal approach. Twenty-six (85%) of 33 transseptal procedures were successful. All four patients with unsuccessful initial transseptal attempts were successfully treated with the retrograde method during the same session in the electrophysiology laboratory. Ten of 11 transseptal procedures after unsuccessful retrograde procedures were successful. Crossover from the retrograde to the transseptal approach was performed during a separate session in 9 of these 11. There was no difference in total procedure time (220 +/- 12.8 vs. 205 +/- 12.5 min) (mean +/- SEM) or fluoroscopy time (44.1 +/- 4.4 vs. 44.7 +/- 5.1 min) between the retrograde and transseptal methods. Ablation time was longer for the retrograde method (69.2 +/- 10.5 vs. 43.4 +/- 9.3 min) (p < 0.01). Of patients > or = 65 or < or = 16 years old, technical factors requiring crossover to the other technique or complications occurred in 7 (42%) of 17 patients undergoing the retrograde and 1 (11%) of 9 patients undergoing the transseptal approach (p < 0.01). The overall rate of complications was the same for both (6.7% for retrograde and 6.1% for transseptal). The most serious complication involved dissection of the left coronary artery with myocardial infarction during a retrograde procedure. The retrograde and transseptal approaches are complementary; if one method fails, the other should be attempted, yielding an overall success rate close to 100%. Because patients undergo heparinization immediately after the arterial system is entered during a retrograde procedure, failure of that approach requires crossover to the transseptal method during a separate session or reversal of heparin; if the transseptal method is tried first, crossover to the retrograde approach can be accomplished easily during the same session. To avoid complications related to access, the transseptal method should be the first used in children, the elderly and those with arterial disease or hypertrophic ventricles.
The American Journal of Cardiology, 1983
Journal of the American College of Cardiology, 1993
San Francisco, (al{fornia Obiectfves. The purpose of this study was to compare success rates, pro... more San Francisco, (al{fornia Obiectfves. The purpose of this study was to compare success rates, procedure and fluoroscopy times and complications for the transseptal and retrograde aortic approaches in a consecutive series of patients undergoing catheter ablation of left free wall accessory pathways. Background. Radiofrequency catheter ablation of left-sided accessory pathways can be performed either by a retrograde, transaortic approach or by means of a transseptal puncture. Methods. A total of 106 patients (mean age 33 years, range 4 to 79) underwent attempted catheter ablation of a single left-sided accessory pathway by either the retrograde or the transseptal approach, or both. In the fist 65 patients, the retrograde aortic approach was the preferred initial method. In the most recent 51 patients, we first attempted the transseptal approach whenever a physician trained in the technique was available. Ultimately, 102 (96.2%) of 106 patients bad successful ablation. Results. Of 89 retrograde procedures, 85% resulted in elimination of accessory pathway conduction. Four retrograde procedures performed after failure of the transseptal approach were successful. Of the 13 Patients with a failed retrograde procedure, 11 later underwent ablation using the transseptal approach. Twenty-six (85%) of 33 transseptal procedures were successful. All four patients with unsuccessful Initial transseptal attempts were successfully treated with the retrograde method during the same session In the electrophysiotogy laboratory. Ten of 11 transseptal procedures after unsuccessful retrograde procedures were vaccessful. Crossover from the retrograde to the transseptal Radiofrequency catheter ablation has gained wide acceptance in the treatment of adults (1-5) and children (6) with symptomatic supraventricular tachycardia involving an accessory atrioventricular (AV) connection .
Pacing and Clinical Electrophysiology, 1981
vulnerability in a palient with the Woljj-Parkinson-W'hile syndrome. An electrophysjoiogic study ... more vulnerability in a palient with the Woljj-Parkinson-W'hile syndrome. An electrophysjoiogic study was carried out in a patient with the Woljj-Parkinson-White syndrome and a history of sponfuneous atrial fibrillafion but with no evidence oj organic cardiac disease. A singJe induced premature ventricular depoiarizalion resulted in ventricular tachycardia joUowed by ventricular fibrillation. Similarly, airial pacing or premature atrial siimulation resulted in frequent episodes of airial fibrillation or flutter. The atrial and ventricular effective refractory periods were 180 ms and < 160 ms. respectively, al a driven cycle length of 480 ms. Intravenous adminislralion of procainamide resulted in lengthening of the refractory periods and failure to induce either atriai or venlricular arrhythmias with pacing. In most patients with enhanced atrioventricular nodal or accessory atrioventricular nodal bypass, Ihe mechanism of ventricular tachycardia is related to an inordinately rapid ventricular response during supraventricular arrhythmias. In our patient, a unique mechonism was apparent; atrial and venlricular vulnerability to fibrillation was associated with extremely short myocardial effective refraclory periods. The relationship of this finding to sudden cardiac death bears further study. (PACE. Vol. 4, January-February, 1981} atrial vulnerability, ventricular vulnerability, Wolff-ParJiinson-White syndrome. ventricular fibrillation, atrial fibrillation, atrial flutter Atrial fibrillation is a well-documenled complication in palients with the Wolff-Parkinson-White syndrome and its occurrence has been related to increased citrial vulnerability during reciprocating atrioventricular tachycardia or to delayed atrial conduction.'"^ Less clear, however, is the relationship between ventricular arrhythmias and preexcitation. This uncer
Journal of The American College of Cardiology, 1987
© 1987 by the American College of Cardiology free wall Kent connection. Two patients had fascicul... more © 1987 by the American College of Cardiology free wall Kent connection. Two patients had fasciculoventricular connections that were associated with either septal (one patient) or left free wall (one patient) Kent connections. The latter also had evidence of enhanced AV node conduction. This report is unique in that it describes in detail two patients with left nodoventricular connections (Mahaim) inserting in or near the left posterior fascicle. Combined Kent and Mahaim connections, present in the six patients, appear to occur in approximately 5% of patients with the WolfT-Parkinson-White syndrome. Precise identification of bypass connections critical for reentrant circuits is essential for intelligent application of treatment options.
The American Journal of Cardiology, 1992
ABSTRACT
Pacing and Clinical Electrophysiology, 1992
BHARATI, S., ET AL.: Histologic Findings of the Heart and the Conduction System in the First Pati... more BHARATI, S., ET AL.: Histologic Findings of the Heart and the Conduction System in the First Patient Who Underwent Catheter Ablation. This is a detailed pathological examination of the heart including the conduction system (CS} from a 64'year-old maJe who had catheter ablation of the atrfoventricular (AV} junction for intractable atriaJ fibrillation. This is the world's first human who had this procedure, and who survived 3 years and 8 months, and later died of congestive heart failure. Pathoiogically, the heart was hypertrophied and enlarged. HistoJogically, there were chronic inflammatory cells, marked fatty metamorphosis with fibrosis of the atria, the approaches to the AV node, and the AV node, with almost isolation of the node from the atria, and considerable fibrosis of the bundle and bundie branches. In addition, there was fibrosis of the summit of the ventricular septum with chronic inflammatory ceils. These represent the sequelae of the ablation procedures. It is not known how much of the pathological findings contributed to the cardiac hypertrophy and impairment of cardiac function.
Journal of the American College of Cardiology, 1991
Journal of the American College of Cardiology, 1991
Journal of the American …, 1988
The abitity to locate cslbeter pesUimt in the kR ventrick with resp~t to endo~srdlal tmutmartw mt... more The abitity to locate cslbeter pesUimt in the kR ventrick with resp~t to endo~srdlal tmutmartw mtgbt rnhsnrr tbe accursey of venlrictdar txhycardis mapping. An eehatrarusponder system (Teleetrotdes, Inc.) was rompered with biplane tluomseopy far lell ventricular endeardial mapping. A 6F eketmde catheter was maditled with the addition of a pRzwleetrtc crystal 5 mm from the tip. Thts eryrtat WBS connected to P transponder that received and trsnmittfd ultrmaund, resulting in a discrete prtibcl on the twedbnensionel eehoeardiogrsphic image correspond. ing to the pmitien of the catheter tip. Catheters were introduced percutene~ttsly ittto the left ventricle of nine anertbettzed dogr. Two~dimensionPI echo. MI viirotnp with the catheter at n&ipk&dacsrdisl dtrs. Catheter locsttw was marked by deltvertng rsdiofrequeney current to the distal rlodrcde, mating a small mdwardial ksion. Catheter lecatiae by echo-tipocldrr and by fbm. Msnwi~t received December 7. 1987. revird manurcript ,e~eived the exact location of the catheter tip. We compared the
American Heart Journal, 1983
His bundle ablation by means of pulsed synchronized electrical shocks delivered between an electr... more His bundle ablation by means of pulsed synchronized electrical shocks delivered between an electrode catheter adjacent to the His bundle and a metal plate behind the dog's back. Detailed histologic studies were performed 3 months after induction of stable complete atrioventricular (AV) block in nine dogs. The ventricular response ranged from 35 to 51 beats/min (bpm). Graded increases in overdrive ventricular pacing resulted in graded increases in pacemaker suppression up to a paced cycle length of 450 msec. All dogs showed extensive damage to the approaches to the AV node, the AV node, and the penetrating portion of the common bundle. This technique resulted in complete AV block with typical features of an infranodal pacemaker and correlated with the histologic findings of severe damage to the AV junction. The minimal myocardial damage suggests that this technique may be applicable for control of drug refractory supraventricular arrhythmias in
The American Journal of Cardiology, 1983
Journal of the American College of Cardiology, 1993
The purpose of this study was to compare success rates, procedure and fluoroscopy times and compl... more The purpose of this study was to compare success rates, procedure and fluoroscopy times and complications for the transseptal and retrograde aortic approaches in a consecutive series of patients undergoing catheter ablation of left free wall accessory pathways. Radiofrequency catheter ablation of left-sided accessory pathways can be performed either by a retrograde, transaortic approach or by means of a transseptal puncture. A total of 106 patients (mean age 33 years, range 4 to 79) underwent attempted catheter ablation of a single left-sided accessory pathway by either the retrograde or the transseptal approach, or both. In the first 65 patients, the retrograde aortic approach was the preferred initial method. In the most recent 51 patients, we first attempted the transseptal approach whenever a physician trained in the technique was available. Ultimately, 102 (96.2%) of 106 patients had successful ablation. Of 89 retrograde procedures, 85% resulted in elimination of accessory pathway conduction. Four retrograde procedures performed after failure of the transseptal approach were successful. Of the 13 patients with a failed retrograde procedure, 11 later underwent ablation using the transseptal approach. Twenty-six (85%) of 33 transseptal procedures were successful. All four patients with unsuccessful initial transseptal attempts were successfully treated with the retrograde method during the same session in the electrophysiology laboratory. Ten of 11 transseptal procedures after unsuccessful retrograde procedures were successful. Crossover from the retrograde to the transseptal approach was performed during a separate session in 9 of these 11. There was no difference in total procedure time (220 +/- 12.8 vs. 205 +/- 12.5 min) (mean +/- SEM) or fluoroscopy time (44.1 +/- 4.4 vs. 44.7 +/- 5.1 min) between the retrograde and transseptal methods. Ablation time was longer for the retrograde method (69.2 +/- 10.5 vs. 43.4 +/- 9.3 min) (p < 0.01). Of patients > or = 65 or < or = 16 years old, technical factors requiring crossover to the other technique or complications occurred in 7 (42%) of 17 patients undergoing the retrograde and 1 (11%) of 9 patients undergoing the transseptal approach (p < 0.01). The overall rate of complications was the same for both (6.7% for retrograde and 6.1% for transseptal). The most serious complication involved dissection of the left coronary artery with myocardial infarction during a retrograde procedure. The retrograde and transseptal approaches are complementary; if one method fails, the other should be attempted, yielding an overall success rate close to 100%. Because patients undergo heparinization immediately after the arterial system is entered during a retrograde procedure, failure of that approach requires crossover to the transseptal method during a separate session or reversal of heparin; if the transseptal method is tried first, crossover to the retrograde approach can be accomplished easily during the same session. To avoid complications related to access, the transseptal method should be the first used in children, the elderly and those with arterial disease or hypertrophic ventricles.