RESUMO
INTRODUCTION: There is a lack of studies in the literature directly investigating the relationship between atrial tachycardia (AT) and left atrial (LA)/left atrial appendage (LAA) thrombus, and current guidelines do not provide strong recommendations regarding the use of transesophageal echocardiography (TEE) before AT catheter ablation. This study aims to elucidate the relationship between AT and the presence of LA/LAA thrombus and contribute to the literature on the use of TEE before AT catheter ablation. METHODS: This single-center retrospective observational study screened patients who underwent TEE between February 10, 2019, and February 10, 2023. Patients were assigned to the AT patient and control groups. TEE was conducted to exclude thrombus in the AT ablation group. The control group included patients who underwent TEE for interatrial septum evaluation and had LA imaging during TEE but did not have atrial arrhythmia. To mitigate bias between the AT patient group and the control group, they were randomized 1:1 using propensity-score matching (PSM). Following randomization, each group consisted of 49 patients. RESULTS: All analyses were conducted after PSM. There were no statistically significant differences between the AT patient and control groups in terms of baseline clinical characteristics and echocardiographic features. Additionally, no significant differences were found between the blood viscosities calculated at low and high shear rates in both groups. The study revealed a significant difference between the two groups in the presence of LA spontaneous echo contrast (SEC) (24.5% in AT group vs 0% in Control group, p = .001), but not in the presence of thrombi (8.2% in AT group vs 0% in Control group, p = .117). CONCLUSION: Compared to the control group, the presence of SEC was significantly higher in the AT patient group. The increased frequency of SEC in AT patients suggests the hypothesis that AT may contribute to LA stasis. The routine use of TEE before AT catheter ablation remains controversial, despite the presence of LA thrombus and SEC in the AT patient group. The clinical assessment of thrombus presence before the procedure must be conducted on a patient-specific basis.
Assuntos
Apêndice Atrial , Ablação por Cateter , Ecocardiografia Transesofagiana , Valor Preditivo dos Testes , Taquicardia Supraventricular , Trombose , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Taquicardia Supraventricular/cirurgia , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/diagnóstico , Resultado do Tratamento , Idoso , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/fisiopatologia , Apêndice Atrial/cirurgia , Trombose/diagnóstico por imagem , Adulto , Cardiopatias/diagnóstico por imagem , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Frequência Cardíaca , Potenciais de Ação , Fatores de RiscoRESUMO
PURPOSE: The echocardiography parameters may predict the maintenance of sinus rhythm after cardioversion of a supraventricular arrhythmia (SVA). MATERIALS AND METHODS: Patients in septic shock with onset of an SVA, normal to moderately reduced LV systolic function (EF_LVË̳35%) and on a continuous noradrenaline of <1.0 µg/kg.min were included. Echocardiography was performed at the arrhythmia onset, 1 h and 4 h post cardioversion on an infusion of propafenone or amiodarone. RESULTS: Cardioversion was achieved in 96% of the 209 patients within a median time of 6(1.8-15.6)h, 134(64.1%) patients experienced at least one SVA recurrence after cardioversion. At 4 h the left atrial emptying fraction (LA_EF, cut-off 38.4%, AUC 0.69,pË0.001), and transmitral A wave velocity-time-integral (Avti, cut-off 6.8 cm, AUC 0.65,p = 0.001) showed as limited predictors of a single arrhythmia recurrence. The LA_EF 44(36,49)%, (p = 0.005) and the Avti 8.65(7.13,9.50)cm, (p < 0.001) were associated with sustained sinus rhythm and decreased proportionally to increasing numbers of arrhythmia recurrences (p < 0.001 and p = 0.007, respectively). The enlarged left atrial end-systolic diameter at the arrhythmia onset (p = 0.04) and elevated systolic pulmonary artery pressure at 4 h (p = 0.007) were weak predictors of multiple(Ë3) recurrences. CONCLUSION: The LA_EF and Avti are related to arrhythmia recurrences post-cardioversion suggesting potential guidance to the choice between rhythm and rate control strategies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03029169, registered on 24th of January 2017.
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Ecocardiografia , Cardioversão Elétrica , Choque Séptico , Humanos , Masculino , Feminino , Choque Séptico/terapia , Choque Séptico/fisiopatologia , Choque Séptico/complicações , Idoso , Pessoa de Meia-Idade , Antiarrítmicos/uso terapêutico , Recidiva , Amiodarona/uso terapêutico , Amiodarona/administração & dosagem , Propafenona/uso terapêutico , Propafenona/administração & dosagem , Taquicardia Supraventricular/terapia , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/diagnóstico por imagem , Estudos ProspectivosRESUMO
BACKGROUND: Catheter ablation (CA) has become a well-established first-line therapy for a broad spectrum of arrhythmias, including atrial tachycardias (ATs). In this study we aimed to assess the performance of the integrated novel high-resolution new generation noncontact mapping system (AcQMap) with robotic magnetic navigation (RMN) system in CA procedures for patients with ATs including comparing patient subgroups based on the utilized mapping modality, arrhythmia mechanism, localization and type of procedure. METHODS: All patients undergoing CA for AT using the AcQMap-RMN system were included. Procedural safety and efficacy were characterized by intra- and post-procedural complications. Acute procedural success and the long-term outcome were assessed in the overall group and in the subgroups. RESULTS: A total number of 70 patients were referred for CA with atrial arrhythmias including 67 AT/AFL (mean age 57.1 ± 14.4 years), and 3 additional patients with inappropriate sinus tachycardia. Thirty-eight patients had de novo AT, 24 had post-PVI AT including 2 patients with perinodal AT, and 5 had post-MAZE AT. Two patients (2.9%) suffered post-procedural complications including 1 patient with groin hematoma and 1 patient with a transient ischemic attack. Acute success was achieved in 63/67 (94.0%) procedures. Thirteen patients (19.4%) had documented recurrence at the end of the 12-months follow-up period. The performance of AcQMap was equally good in focal vs. reentry mechanisms (p = 0.61, acute success), in the left and right atrium (p = 0.21). CONCLUSIONS: AcQMap-RMN integration might improve success rates in CA of ATs with low number of complications.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Procedimentos Cirúrgicos Robóticos , Taquicardia Supraventricular , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Fibrilação Atrial/etiologia , Resultado do Tratamento , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Ablação por Cateter/métodos , Fenômenos MagnéticosRESUMO
BACKGROUND: Short runs of atrial tachycardias (ATs) and infrequent premature atrial contractions (PACs) are difficult to map and ablate using sequential electrophysiology mapping techniques. The AcQMap mapping system allows for highly accurate mapping of a single atrial activation. OBJECTIVES: We aimed to test the value of a novel dipole charge density-based high-resolution mapping technique (AcQMap) in the treatment of brief episodes of ATs and PACs. METHODS: Data of all patients undergoing catheter ablation (CA) using the AcQMap mapping system were reviewed. RESULTS: Thirty-one out of 219 patients (male n = 8; female n = 23) had short runs of ATs (n = 23) and PACs (n = 8). The mean procedural time was 155.3 ± 46.6 min, with a mean radiation dose of 92.0 (IQR 37.0-121.0) mGy. Total radiofrequency application duration 504.0 (271.0-906.0) s. Left atrial localization of ATs and PACs was identified in 45.1% of the cases, right atrium localization in 45.1%, and septal origins in 9.8% of the cases. Acute success was achieved in 30/31 (96.8%), and recurrence during the follow-up developed in six patients (19.4%), including four patients with PACs and two patients with short-lived ATs. One patient presented procedure-related groin hematoma as minor complication. CONCLUSION: Brief episodes of highly symptomatic ATs and infrequent PACs can be mapped using charge density mapping and successfully ablated with high acute and long-term success rates.
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Fibrilação Atrial , Complexos Atriais Prematuros , Ablação por Cateter , Taquicardia Supraventricular , Humanos , Masculino , Feminino , Complexos Atriais Prematuros/cirurgia , Resultado do Tratamento , Técnicas Eletrofisiológicas Cardíacas/métodos , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Ablação por Cateter/métodos , Fibrilação Atrial/cirurgiaRESUMO
BACKGROUND: The management of symptomatic gestational supraventricular tachycardia (SVT) is challenging and requires a multidisciplinary approach for optimal management. Catheter ablation during pregnancy has traditionally been considered a last option due to procedural safety and ionizing radiation risks. Recent advances including intracardiac echocardiography and multi-electrode electroanatomic mapping have greatly enhanced the safety and efficacy profile to successfully perform ablations with minimal to no fluoroscopy even during pregnancy. This is the first review to compare the efficacy, safety, and aggregate outcomes of purely zero-fluoroscopic and minimal fluoroscopic approaches in gestational SVT. METHODS: A literature search was performed for catheter ablations in the past 15 years for gestational arrhythmias that used minimal or no fluoroscopy. Sixteen cases describing catheter ablations with zero-fluoroscopy were compared to twenty-four cases using minimal fluoroscopy, defined as total documented exposure time of less than 10 min. RESULTS: Analysis of both groups demonstrated that zero-fluoroscopic approaches have comparable efficacy and procedural safety outcomes with the utilization of earlier trimester ablations and in older maternal ages. The utilization of electroanatomic mapping with or without concomitant intracardiac echocardiography in the zero-fluoroscopy group further demonstrated equal efficacy rates of successful ablation when compared to the control group. Furthermore, there were no reported immediate or long-term periprocedural complications in either group, including delivery outcomes. CONCLUSION: Our review demonstrates that zero-fluoroscopy catheter ablation for SVT in pregnancy is both effective and safe when compared to minimal fluoroscopy ablations while eliminating the theoretical risks of ionizing radiation.
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Ablação por Cateter , Cirurgia Assistida por Computador , Taquicardia Supraventricular , Humanos , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/cirurgia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do Tratamento , Feminino , GravidezRESUMO
AIMS: Interventional cardiology procedures may expose patients and staff to considerable radiation doses. We aimed to assess whether exposure to ionizing radiation during catheter ablation of supraventricular tachycardia (SVT) can be completely avoided. METHODS AND RESULTS: In this prospective randomized study, patients with SVT (atrioventricular re-entrant tachycardia n = 94, typical atrial flutter n = 29) were randomly assigned in a 1:1 ratio to catheter ablation with conventional fluoroscopic guidance (CF group) or with the EnSite Precision mapping system [zerofluoro (ZF) group]. Acute procedural parameters, increased stochastic risk of cancer incidence and 6-month follow-up data were assessed. Between May 2019 and August 2020, 123 patients were enrolled. Clinical parameters were comparable. Median procedural time was 60.0 and 58.0â min, median fluoroscopy time and estimated median effective dose were 240â s vs. 0 and 0.38â mSv vs. 0 and arrhythmia recurrence was 5% and 7.9% in the CF and ZF groups, respectively. The acute success rate was 98.4% in both groups. No procedure-related complications were reported. At an average age of 55.5 years and median radiation exposure of 0.38â mSv, the estimate of increased incidence was approximately 1 in 14 084. The estimated mortality rate was 1 per 17 857 exposed persons. CONCLUSIONS: The procedural safety and efficacy of the zero-fluoroscopic approach are similar to those of conventional fluoroscopy-based ablation for atrioventricular nodal re-entrant tachycardia and atrial flutter. Under the assumption of low radiation dose, the excessive lifetime risk of malignancy in the CF group due to electrophysiology procedure is reasonably small, whilst totally reduced in zero fluoroscopy procedures.
Assuntos
Flutter Atrial , Ablação por Cateter , Taquicardia por Reentrada no Nó Atrioventricular , Taquicardia Supraventricular , Arritmias Cardíacas/cirurgia , Flutter Atrial/diagnóstico por imagem , Flutter Atrial/cirurgia , Nó Atrioventricular , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Fluoroscopia/métodos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico por imagem , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy (ZF) catheter ablation (CA) for supraventricular tachycardias (SVT). METHODS: 584 consecutive patients referred to our institution for CA of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. The ZF group was further divided into two subgroups (adults and paediatric). Patient characteristics, procedural information, and follow-up data were compared. RESULTS: The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0%; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators' preferences. CONCLUSION: The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.
Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Adolescente , Adulto , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criança , Fluoroscopia , Humanos , Pessoa de Meia-Idade , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Utilizing a three-dimensional (3-D) mapping system and intracardiac echocardiography (ICE) has allowed ablation procedures with less or without fluoroscopy; however, there is limited data for patients with cardiac electronic implantable device (CIED) leads regarding the suspected risk of lead injury. Therefore, we sought to explore technics to perform safe trans-septal approach and catheter manipulation technique in patients with CIED leads. METHODS AND RESULTS: This study comprised 49 consecutive patients (59% males, median 73 years old) with CIED who underwent catheter ablation for supraventricular tachycardia requiring the trans-septal approach, 15 without fluoroscopy (zero-fluoro group), and 34 with fluoroscopy (conventional-fluoro group), between July 2019 and April 2021. All procedures were performed under a 3-D mapping system and ICE guidance. We compared the differences in treatment and development of complications between the two groups. The procedures were for atrial fibrillation (82%) and atrial tachycardia (76%). Coronary sinus catheter insertion and the trans-septal procedure were successfully performed in all patients. The median time from venipuncture to trans-septal procedure (zero-fluoro vs. conventional-fluoro group: 28 [18-37] min vs. 24 [21-31] min, p = .70), total procedure time (231 [142-274] min vs. 175 [163-225] min, p = .63), and the acute procedural success rate (100% vs. 97%, p = 1.00) did not differ between both groups. No patient showed lead-related complications in both groups. CONCLUSION: This is the first study to show zero-fluoro ablation for supraventricular arrhythmia using 3-D mapping and ICE in patients with CIED leads was feasible under careful catheter manipulation.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Taquicardia Supraventricular , Idoso , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Eletrônica , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do TratamentoAssuntos
Ablação por Cateter , Taquicardia Supraventricular , Feminino , Fluoroscopia , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Gravidez , Gestantes , Punções , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/etiologia , Resultado do TratamentoRESUMO
PURPOSE: Entrainment is a useful method for locating reentrant atrial tachycardia (AT) circuits, but alterations or termination of the AT can derail this process. We assessed whether resetting an upstream site of a neighboring electrode by a scanned extrastimulus at a downstream site (when the upstream tissue was refractory) could diagnose that site within the AT circuit. METHODS: The procedure was applied to 48 ATs with a cycle length (CL) of 238 ± 42 ms (26 common flutters, 8 perimitral flutters, 7 left atrial [LA] roof-dependent AT, 3 LA scar-related macroreentrant ATs, 2 pulmonary vein-gap reentry tachycardias, 1 right atrial scar-related macroreentrant AT, and 1 with an unidentified circuit). Entrainment and scanned extrastimulation were attempted at the cavotricuspid isthmus, LA roof, and mitral isthmus and/or critical AT isthmus. RESULTS: Within the circuit, the post-pacing interval minus the ATCL after entrainment was < 30 ms for all ATs and resetting of the AT cycle by ≥ 5 ms occurred in 94% of the ATs. No ATs were reset by extrastimulation outside the circuit. The positive predictive value of both maneuvers for locating the circuit was 100%, and the negative predictive value of the extrastimulation was similar to that of entrainment (96% vs. 100%, P = 0.25). The incidence of an AT alteration was lower with extrastimulation than with entrainment (1% vs. 9%, P = 0.01). For ATs with a CL < 210 ms, extrastimulation yielded a good diagnostic performance without any AT alterations. CONCLUSION: AT resetting by a scanned extrastimulus is diagnostic and avoids AT alterations.
Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Catéteres , Átrios do Coração/cirurgia , Humanos , Taquicardia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgiaRESUMO
Background The lateral left atrium (LA) is often associated with atrial tachycardia (AT) because of its complex anatomy. We sought to characterize ATs associated with the lateral LA, including the posterolateral mitral isthmus (MI) and left atrial ridge. Methods and Results Twenty-eight lateral LA-associated ATs were mapped with high-resolution mapping systems and entrainment pacing. The vein of Marshall was mapped with a 1.8-Fr mapping catheter when possible. ATs were associated with the posterolateral MI in 18 ATs (14 perimitral, 3 small reentry, and 1 focal AT). All patients had undergone MI area ablation, and all ATs were successfully eliminated. During 27.0 (interquartile range, 10.5-40.0) months of follow-up, all were free from any atrial tachyarrhythmias, with 3 patients on antiarrhythmics. Of 10 ATs involving the ridge or Marshall bundle, 3 were ridge related, 3 were Marshall bundle related based on vein of Marshall mapping, and 1 was a persistent left superior vena cava related AT. All 7 patients had undergone MI linear ablation. The critical isthmus was in the LA-ridge junction or the LA-Marshall bundle junction. Bidirectional conduction block between the LA and ridge or Marshall bundle was created. Two patients had the critical isthmus in the other area. The remaining patient had micro-reentry in the ridge. All 10 ATs were terminated during ablation at the critical isthmus. During 12.0 (5.2-31.7) months of follow-up, all were free from any atrial tachyarrhythmias, with 7 patients on antiarrhythmics. Conclusions Most ATs occurred after MI area ablation. An high resolution mapping-guided approach is highly effective for identifying the mechanism.
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Ablação por Cateter , Átrios do Coração , Taquicardia Supraventricular , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Humanos , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do TratamentoAssuntos
Ablação por Cateter , Taquicardia Supraventricular , Trombose , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Humanos , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/etiologia , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/cirurgiaRESUMO
PURPOSE: Atrioventricular nodal reentry tachycardia (AVNRT) is the most common supraventriculer arrhythmia in daily clinical practice. Comorbidity of AVNRT and atrial fibrillation (AF) has been well documented in some patients and AF development has been observed more frequently in AVNRT patients during their long-term follow-up. This study was conducted in order to investigate the left atrial two-dimensional-speckle-tracking echocardiographic (STE) parametres as the predictors of the occurence of AF in long-term follow-up in patients with spontaneously developed AF during AVNRT ablation. METHODS: Two hundred and thirty two consecutive AVNRT patients who developed spontaneous AF during ablation procedure were included in the study. The patients were followed up for a mean follow-up period of 6.2 ± 2.1 years. All patients were evaluated using the 2D-STE method. AF was developed in 34 patients during the follow-up period. Cox regression analysis was performed in order to identify the independent predictors of AF occurence. RESULTS: Left atrial LA-res, LA-pump, LA-SRs, LA-SRe, and LA-SRa values were found to be significantly decreased in the group of patients that developed AF during the follow-up period (p < .001 for all aforementioned values). Multivariate cox regression analysis revealed that LA-res (hazard ratio [HR], 0.367; 95% confidence interval [CI], 0.161-0.0.683, p < .001) and SRe (HR, 0.472; 95% CI, 0.346-0.825, p = .006) were independent risk factors associated with the occurrence of AF. CONCLUSION: In conclusion, it was demonstrated for the first time with this study that 2D-STE can effectively predict the development of AF in long-term follow-up in patients with spontaneously developed AF during AVNRT ablation.
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Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/etiologia , Ablação por Cateter , Ecocardiografia/métodos , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
BACKGROUND: No data exist on the ability of the novel Rhythmia 3-D mapping system to minimize fluoroscopy exposure during transcatheter ablation of arrhythmias. We report data on the feasibility and safety of a minimal fluoroscopic approach using this system in supraventricular tachycardia (SVT) procedures. METHODS: Consecutive patients were enrolled in the CHARISMA registry at 12 centers. All right-sided procedures performed with the Rhythmia mapping system were analyzed. The acquired electroanatomic information was used to reconstruct 3-D cardiac geometry; fluoroscopic confirmation was used whenever deemed necessary. RESULTS: Three hundred twenty-five patients (mean age = 56 ± 17 years, 57% male) were included: 152 atrioventricular nodal reentrant tachycardia, 116 atrial flutter, 41 and 16 right-sided accessory pathway and atrial tachycardia, respectively. Overall, 27 481 s of fluoroscopy were used (84.6 ± 224 s per procedure, equivalent effective dose = 1.1 ± 3.7 mSv per patient). One hundred ninety-two procedures (59.1%) were completed without the use of fluoroscopy (zero fluoroscopy, ZF). In multivariate analysis, the presence of a fellow in training (OR = 0.15, 95% CI: 0.05-0.46; p = .0008), radiofrequency application (0.99, 0.99-1.00; p = .0002), and mapping times (0.99, 0.99-1.00; p = .042) were all inversely associated with ZF approach. Acute procedural success was achieved in 97.8% of the cases (98.4 vs. 97% in the ZF vs. non-ZF group; p = .4503). During a mean of 290.7 ± 169.6 days follow-up, no major adverse events were reported, and recurrence of the primary arrhythmia was 2.5% (2.1 vs. 3% in the ZF vs. non-ZF group; p = .7206). CONCLUSIONS: The Rhythmia mapping system permits transcatheter ablation of right-sided SVT with minimal fluoroscopy exposure. Even more, in most cases, the system enables a ZF approach, without affecting safety and efficacy.
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Ablação por Cateter , Taquicardia Supraventricular , Adulto , Idoso , Ablação por Cateter/efeitos adversos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do TratamentoRESUMO
AIM: To evaluate systolic and diastolic cardiac function in children who had cardiomyopathy induced by ectopic atrial tachycardia (EAT). METHODS: Twenty-two pediatric patients who had cardiomyopathy induced by EAT and 25 age-matched controls were recruited in this case-control study. The patients were examined after rhythm control and normalization of their left ventricular systolic function. Different echocardiographic modalities including tissue Doppler imaging and two-dimension speckle tracking echocardiography were utilized to assess the ventricular and atrial function. RESULTS: The patients' median age was 51 months (interquartile range: 28.5-84 months). The median time interval required for normalization of left ventricular ejection fraction (EF) among patients was 1.5 months (interquartile range: 1.5-2.12 months). Compared to controls, patients had a significantly higher median left ventricular myocardial performance index (MPI) at the interventricular septum (0.44 vs. 0.38, p = .001) and left ventricular lateral wall (0.46 vs. 0.32, p = .0001). The median right ventricular MPI of the patients' group was significantly higher when compared to the control group (0.34 vs. 0.26, p = .0001). The median right atrial (RA) reservoir function in patients was significantly reduced compared to controls (30% vs. 36.63%, p = .007). CONCLUSIONS: Shortly after rhythm normalization and restoration of left ventricular EF, using tissue Doppler imaging and two-dimension speckle tracking echocardiography, children who had cardiomyopathy induced by EAT continue to have left ventricular diastolic dysfunction, right ventricular dysfunction, and reduced RA reservoir function.
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Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Recuperação de Função Fisiológica , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/fisiopatologia , Antagonistas Adrenérgicos beta/uso terapêutico , Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Cardiomiopatia Dilatada/tratamento farmacológico , Estudos de Casos e Controles , Criança , Pré-Escolar , Diástole , Digoxina/uso terapêutico , Quimioterapia Combinada , Ecocardiografia Doppler , Eletrocardiografia , Feminino , Humanos , Lactente , Masculino , Sístole , Taquicardia Supraventricular/tratamento farmacológicoRESUMO
PURPOSE: The purpose of this study was to evaluate the safety and feasibility of the new high-resolution mapping algorithm SuperMap (Acutus Medical, CA, USA) in identifying and guiding ablation in the setting of regular atrial tachycardias following index atrial fibrillation (AF) ablation. METHODS: Seven consecutive patients who underwent a radiofrequency catheter ablation guided by the novel noncontact charge density (CD) SuperMap for atrial tachycardia were prospectively enrolled in our study. RESULTS: Arrhythmogenic substrate was identified in all seven patients. Mean number of EGM per map was 5859.7 ± 4348.5 points. Three patients (43%) exhibited focal tachycardia mechanisms in the left atrium, alternating from anteroseptal right superior pulmonary vein (RSPV), posterior in proximity of left inferior pulmonary vein (LIPV), and interarial septum in proximity of fossa ovalis, respectively. Four patients exhibited macroreentrant mechanism. In 3 of these patients, SuperMap detected mitral isthmus-dependent flutters with tachycardia cycle lengths of 240, 270 and 420 ms, respectively. In one patient, the mechanism was a macroreentrant tachycardia with the critical isthmus located between the crista terminalis and atriotomy. The mean ablation time (min) was 18.2 ± 12.5 and the mean procedural duration time was 56.4 ± 12.1 min. No minor or major complications occurred. CONCLUSION: The novel high-resolution mapping algorithm SuperMap proved to be safe, fast, and feasible in identifying and guiding ablation in the setting of regular atrial tachycardias following index AF ablation.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Taquicardia Supraventricular , Algoritmos , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Humanos , Taquicardia/cirurgia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: With CARTO HD COLORING, a new enhanced software-based map visualization is available to highlight among others potential areas of conduction block in complex arrhythmias (extended early meets late (EEML)). The ideal settings of thresholds are still unclear and are examined here by studying 12 left atrial arrhythmias. METHODS: Ten patients with left atrial tachycardia underwent high-density activation mapping of the left atrium. Areas of local conduction block were visualized with different extended early meets late (EEML) thresholds (75/25%; 80/20%; 85/15%; 90/10%) and compared with ripple maps for verification. RESULTS: Settings of 80/20% or 85/15% were more accurate than the default settings of 75/25% in displaying the actual amount of conduction block as assessed by ripple maps. CONCLUSION: HD COLORING leads to further insights into complex tachycardias through a new Voxel Map Surface Concept and color-based visualization of local conduction block. It can be assumed that individual adaption of extended early meets late (EEML) thresholds should be applied for a more accurate visualization of local conduction block.
Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Técnicas Eletrofisiológicas Cardíacas , Átrios do Coração , Humanos , Software , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgiaRESUMO
BACKGROUND: High-density automated mapping of complex atrial tachycardias (ATs) requires accurate assessment of activation maps. A new local activation display module (HD coloring, Biosense Webster®) provides higher map resolution, a better delineation of potential block reducing color interpolation, and a new propagation display. We evaluated the accuracy of a dedicated local activation display compared with standard algorithm. METHODS: High-density maps from 10 AT were collected with a multipolar catheter and were displayed with standard activation or HD coloring. Six expert operators retrospectively analyzed activation maps and were asked to define (1) the tachycardia mechanism, (2) ablation target, and (3) level of difficulty to interpret those maps. RESULTS: Using HD coloring, operators were able to reach a correct diagnosis in 93% vs. 63%, p < 0.05 compared to standard activation maps. Time to diagnosis was shorter 1.9 ± 1.0 min vs. 3.9 ± 2.1 min, p < 0.05. Confidence level would have allowed ablation without necessity for entrainment maneuvers in 87% vs. 53%, p < 0.05. Operators would have needed to remap or proceed with multiple entrainments in 3% vs. 13% of cases, p < 0.05. Finally, ablation strategy was more accurately identified in 97% vs. 67%, p < 0.05. CONCLUSION: Activation mapping with the new HD coloring module allowed a more accurate, reliable, and faster interpretation of complex ATs mechanisms compared to standard activation maps.
Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Técnicas Eletrofisiológicas Cardíacas , Humanos , Estudos Retrospectivos , Taquicardia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgiaRESUMO
PURPOSE: To investigate the learning curve for atrial fibrillation (AF), supraventricular tachycardia (SVT), and premature ventricular contraction (PVC) radiofrequency ablation (RFA) using zero fluoroscopy. METHODS: This is a retrospective, single-center study of 167 patients undergoing ablation between 2016 and 2019. Minimal fluoroscopy approach was initiated after the first 20 cases of PVI and SVT RFA. Procedures were divided consecutively into increments of 10 cases to determine operator learning curve. RESULTS: A total of 64 (38%) had SVT ablations, 26 (16%) had PVC ablations, and 77 (46%) had AF and underwent PVI. For SVT RFA, fluoroscopy time improved from 4.1 ± 3.5 min during the first 10 cases to 0.8 ± 1.2 min after 50 cases (p = 0.0001). Sixty-two out of 64 (97%) of cases were successful. In PVC RFA, fluoroscopy time was 7.7 ± 5.5 min for the first 5, 2.3 ± 3.4 min after 15, and 0 min after 20 cases (p = 0.0008). Twenty-four out of 26 (92%) of cases were acutely successful with recurrence in 2/26 (8%) of patients over 9 ± 9 months. In PVI, fluoroscopy time was 9.9 ± 3.3 min over the first 20 cases, 2.6 ± 2.3 min after 40 cases, and 0.1 min after 50 cases (p < 0.0001). PVI procedure time was 170 ± 34 min after 60 cases from 235 ± 41 min initially (p 0.001). Six out of 77 (8%) had AF recurrence at 12 months. CONCLUSIONS: Zero fluoroscopy ablation for AF, SVT, and PVC can be safely achieved without increasing procedure time. The steepest learning curve occurs over the first 20, 15, and 40 cases for SVT, PVC, and PVI ablation respectively.