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1.
J Cardiovasc Electrophysiol ; 31(4): 860-867, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32048776

RESUMO

INTRODUCTION: The need for transvenous lead extractions due to cardiac implantable electronic device (CIED)-related infections continues to rise. Current guidelines recommend complete device removal in the setting of an active infection, which can be challenging in pacemaker-dependent patients. METHODS: We retrospectively reviewed all leadless pacemaker implants between January 2018 and November 2019 and identified a subset of patients who had undergone a concomitant CIED extraction in the setting of an active infection. Baseline characteristics, procedural details, and clinical follow-ups were recorded. RESULTS: Seventeen patients received a leadless pacemaker during the same procedure as the CIED extraction. There were no procedural complications. All patients were being treated for an active CIED infection at the time of the procedure. Fourteen patients (82.4%) were completely pacemaker-dependent and four patients (23.5%) had positive blood cultures at the time of the leadless pacemaker implantation. During a median follow-up of 143 days (interquartile range: 57, 181 days), there were no recurrent infections. CONCLUSION: Simultaneous leadless pacemaker implantation and CIED extraction are safe and feasible in the setting of an active infection. This strategy may be particularly useful in patients that are pacemaker-dependent.


Assuntos
Arritmias Cardíacas/terapia , Remoção de Dispositivo , Marca-Passo Artificial/efeitos adversos , Implantação de Prótese/instrumentação , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Masculino , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
2.
J Interv Card Electrophysiol ; 57(1): 67-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650458

RESUMO

BACKGROUND: Early recurrence (ER) of atrial fibrillation (AF) within 90 days post-ablation is observed in up to 50% of patients and has been attributed to transient inflammation. The importance of ER in current era of pulmonary vein isolation (PVI) with cryoballoon ablation (CBA) and contact-force catheter radiofrequency ablation (cfRFA) has not been clearly reported. In addition, it is not known whether there are differences between types of ablation energy used during PVI. METHODS: Study population was drawn from a prospective multicenter database of AF ablation. Consecutive patients undergoing first-time ablation with PVI alone, using either second-generation CBA or cfRFA catheters were included. Patients were followed at 0.5, 3, 6, and 12 months to assess recurrence. Predictors of late recurrence (LR), defined as recurrence outside the blanking period, were assessed by Cox proportional hazards regression models. Freedom from LR was calculated and compared between two groups using the Kaplan-Meier method and log-rank test. RESULTS: Study cohort included 300 patients (1:1 CBA:RFA, age 63.6 ± 10.3 years, 67% male). There were no baseline characteristic differences between the CBA and cfRFA groups. ER occurred in 23.3% and 16.7% of patients in the CBA and cfRFA groups, respectively (p = 0.149). One-year freedom from LR was similar for both groups (72.7% CBA vs. 78% cfRFA, p = 0.287). Fifty-two patients (25 CBA and 27 cfRFA) underwent repeat ablation and no difference in durability of PVI was found. ER was the only common independent predictor of LR for either group and for the entire cohort (HR 2.3). CONCLUSIONS: In our series of AF ablation using second-generation cryoballoon and contact-force RFA catheters, recurrence in the "blanking period" is seen in 20% and remains predictive of late recurrence irrespective of the energy used.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Veias Pulmonares/cirurgia , Ablação por Radiofrequência/métodos , Fibrilação Atrial/diagnóstico por imagem , Feminino , Humanos , Inflamação/complicações , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
3.
J Innov Card Rhythm Manag ; 9(2): 3006-3013, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32477795

RESUMO

The discovery, characterization, and ablation of the papillary muscles have evolved rapidly since the initial description in 2008. New innovations in pacemapping, intracardiac imaging, ablation catheters, and ablation methodologies have dramatically impacted the approach to the treatment of papillary muscle ventricular arrhythmias. This review provides an up-to-date summary of these methods, as well as guidance on how to integrate them into clinical practice.

4.
Pacing Clin Electrophysiol ; 36(5): e143-5, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22670720

RESUMO

The definition of a successful ablation of atrial fibrillation can vary among electrophysiologists. A commonly described endpoint is bidirectional block of the four pulmonary veins. A case is described in which entrance block into a pulmonary vein was achieved early during pulmonary vein isolation. However, triggers from the pulmonary vein continued to conduct into the atrium, revealing the block was only unidirectional. Further ablation resulted in true electrical isolation and highlights the importance of achieving bidirectional block.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Sistema de Condução Cardíaco/cirurgia , Veias Pulmonares/cirurgia , Ablação por Cateter , Feminino , Humanos , Pessoa de Meia-Idade , Reoperação , Falha de Tratamento , Resultado do Tratamento
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