Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure.

BACKGROUND: Finding the conduction gaps in redo PV isolation procedures is challenging, and several maneuvers have been described. In the present study, we analyze the pace and map (P&M) maneuver [atrial mapping during pulmonary vein (PV) pacing] to locate the gaps in redo PV isolation procedures. METHODS: Consecutive patients undergoing a second PV isolation procedure at a single institution over a 4-year period were included. For the last 2 years, all the patients (n = 38) studied underwent PV isolation based on the P&M maneuver and were compared to the previous patients (n = 45). The atrial side of the ablation line was mapped with the ablation catheter during PV pacing, and the earliest site was considered a gap site. RESULTS: Shorter radiofrequency time was required to obtain PV isolation in the P&M group (485 ± 374 vs. 864 ± 544 s; p < 0.001), which remained significant after adjusting for the number of reconnected PVs (p = 0.01). We did not find significant differences in the procedure duration (106 ± 46 vs. 112 ± 53 min; p = 0.57) and arrhythmia recurrence during 1-year follow-up (26.6 vs. 28.9%; p = 0.82) after adjusting for several confounding factors (HR 1.32; 95% CI 0.5-3.4; p = 0.57). CONCLUSIONS: P&M is a simple maneuver to identify the gaps in ablation lines around the PV. It remains efficacious in redo procedures despite the difficulties in localizing the ablation lines performed in the first procedure. The P&M maneuver reduced the radiofrequency time required to isolate the PV without compromising the efficacy.

Cardiac imaging in prosthetic paravalvular leaks.

Prosthetic paravalvular leaks (PVL) is an uncommon but serious complication after surgical valve replacement. Although surgery has been the traditional treatment of choice in hemodynamically significant PVL, percutaneous transcatheter closure is emerging as a novel and less invasive option for patients with high operative risk. Cardiac imaging, especially two- and three-dimensional transoesophageal echocardiography, plays an essential role in the diagnosis, guidance of intervention and subsequently in the evaluation of the outcomes of the procedure. The aim of this manuscript is to review the role of cardiac imaging techniques in the interventional management of patients with symptomatic PVL.

Frequency of chromosomal aberrations in peripheral lymphocytes of tannery workers in Brazil.

To evaluate the incidence of chromosomal aberrations (CA) in peripheral lymphocytes of workers chronically exposed to chemical hazards in a tannery in Franca, São Paulo, Brazil. The exposed group consisted of 10 male workers employed in the same tannery. The duration of work in the tannery ranged from 5 months to 14 years. The control group consisted of 10 males without a history of exposure to chemicals or other potentially genotoxic substances. A total of 100 well-spread metaphases were analyzed per subject. The frequency of CA was higher in the exposed group than in the control group. Smoking had a significant effect on the frequency of CA in both the control and the exposed groups. Chronic occupational exposure of tannery workers represents a relevant risk factor for the development of diseases associated with genetic damage.