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.

Atrial mapping during pulmonary vein pacing: a novel maneuver to detect and close residual conduction gaps in an ablation line.

BACKGROUND: Location of residual conduction gaps on ablation lines around pulmonary veins (PV) is challenging, and several maneuvers have been described. Atrial mapping during PV pacing-the "pace and map" maneuver-could localize gaps. METHODS AND RESULTS: We prospectively studied 209 patients undergoing PV isolation at a single institution over a 25-month period. In 24 (11.4 %) patients, 26 PV remained connected after an ablation line and an initial conventional gap closure protocol. 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. Ablation at these gap sites resulted in bidirectional PV conduction block in 22 PV (85 %) in 21 patients (88 %), after 2.2 ± 1.6 radiofrequency applications and 8.2 ± 4.8 min. Early PV reconnection (≥20 min) occurred in 0 PV (0 %). During a mean follow-up of 12 ± 6 months, eight patients (33 %) had arrhythmia recurrences. CONCLUSIONS: The "pace and map" maneuver is a relatively simple and efficacious means to identify gaps in ablation lines around PV, focusing on the atrial rather than the PV side of the line. It could be considered among the ways to eliminate residual conduction gaps.

Leishmaniasis, sarcoma de kaposi y strongyloidiasis en pacientes con SIDA / Leishmaniasis, kaposi' sarcoma and strongyloidiasis in patient with AIDS

La leismaniasis, el sarcoma de Kaposi y la strongyloidiasis, son patolog¡as que pueden aparecer en pacientes HIV, como infecciones oportunistas, especialmente si el número de CD4+ es menor a 200, implicando una mayor morbi-mortalidad para el paciente. La leishmaniasis se ha hecho más frecuente, como infección oportunista principalmente en áreas endémicas. El sarcoma de Kaposi es la patología maligna más frecuentemente asociada al HIV, pero desde que se ha extendido el tratamiento antirretrovial, los casos han disminuido de forma importante. La strongyloidiasis es una infección causada por helminto, que podría ocasinar en este tipo de pacientes inmunosuprimidos, el síndrome de superinfección, causando complicaciones difusas que pueden manifestarse a nivel cutáneo, gastrointestinales y pulmonar, y es muy frecuente en pacientes HIV con diarrea crónica. Se presenta el caso de un paciente masculino de 47 años de edad, con clínica de tres meses de evolución de diarrea, fiebre y pérdida de peso. Al examen físico: máculas y placas violáceas generalizadas en la piel, síndrome adenomegálico incluyendo mediastino y retroperitoneo, hepatoesplenomegalia, y en los exámenes complementarios; pancitopenia, hiperglobulinemia y serología positiva para el virus de inmunodeficiencia humana.