ABSTRACT
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
Subject(s)
Atrial Fibrillation , Catheter Ablation , Humans , Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Latin America , Treatment Outcome , Catheters , Asia , Catheter Ablation/adverse effects , Catheter Ablation/methodsABSTRACT
The epicardial outflow tract can be a site of origin of idiopathic ventricular arrhythmias. These arrhythmias are most commonly perivalvular and can be targeted from within the coronary venous system or from other adjacent structures, such as the right ventricular and left ventricular outflow tracts or the coronary cusp region. The authors report a case of an epicardial idiopathic outflow tract premature ventricular contraction originating from the midseptal epicardial left ventricle. In this case, direct epicardial access was crucial to identify early local activation and achieve successful catheter ablation.
Subject(s)
Catheter Ablation , Pericardium , Ventricular Premature Complexes , Adult , Female , Humans , Electrocardiography , Heart Ventricles/surgery , Heart Ventricles/physiopathology , Pericardium/surgery , Pericardium/physiopathology , Ventricular Premature Complexes/surgery , Ventricular Premature Complexes/physiopathologyABSTRACT
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Consensus , Societies, Medical , Atrial Fibrillation/surgery , Catheter Ablation/methods , Humans , Europe , Latin America , AsiaABSTRACT
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
ABSTRACT
BACKGROUND: Venous ethanol ablation (VEA) can be effective for ventricular arrhythmias from the left ventricular summit (LVS); however, there are concerns about excessive ablation by VEA. OBJECTIVES: The purpose of this study was to delineate and quantify the location, extent, and evolution of ablated tissue after VEA as an intramural ablation technique in the LVS. METHODS: VEA was performed in 59 patients with LVS ventricular arrhythmias. Targeted intramural veins were selected by electrograms from a 2F octapolar catheter or by guide-wire unipolar signals. Median ethanol delivered was 4 mL (IQR: 4-7 mL). Ablated areas were estimated intraprocedurally as increased echogenicity on intracardiac echocardiography (ICE) and incorporated into 3-dimensional maps. In 44 patients, late gadolinium enhancement cardiac magnetic resonance (CMR) imaged VEA scar and its evolution. RESULTS: ICE-demonstrated increased intramural echogenicity (median volume of 2 mL; IQR: 1.7-4.3) at the targeted region of the 3-dimensional maps. Post-ethanol CMR showed intramural scar of 2.5 mL (IQR: 2.1-3.5 mL). Early (within 48 hours after VEA) CMR showed microvascular obstruction (MVO) in 30 of 31 patients. Follow-up CMR after a median of 51 (IQR: 41-170) days showed evolution of MVO to scar. ICE echogenicity and CMR scar volumes correlated with each other and with ethanol volume. Ventricular function and interventricular septum remained intact. CONCLUSIONS: VEA leads to intramural ablation that can be tracked intraprocedurally by ICE and creates regions of MVO that are chronically replaced by myocardial scar. VEA scar volume does not compromise septal integrity or ventricular function.
Subject(s)
Catheter Ablation , Tachycardia, Ventricular , Ventricular Septum , Humans , Cicatrix , Contrast Media , Tachycardia, Ventricular/surgery , Catheter Ablation/methods , Gadolinium , Arrhythmias, Cardiac/surgeryABSTRACT
BACKGROUND: Post-surgical infections of the spine occur in from 0% to 18% of cases. Postoperative spine infections due to Clostridium Perfringens (CP) resulting in necrotizing fasciitis are extremely rare. However, since they may be fatal, early and definitive treatment is critical. CASE DESCRIPTION A: 62-year-old male with a T8-T9 Type C fracture, in ASIA Grade "E" (neurologically intact) underwent a posterior T6-T10 arthrodesis. However, 2 weeks postoperatively, he developed a postoperative thoracic wound infection; the cultures were positive for CP. As the patient developed necrotizing fasciitis, emergent debridement, negative pressure continued drainage, and initiation of appropriate antibiotic therapy were critical. CONCLUSION: Postoperative spinal infections due to CP with accompanying necrotizing fasciitis are extremely rare. As these infections may be fatal, they must be rapidly diagnosed and treated.
ABSTRACT
Resumen El implante percutáneo de un electrodo de estimulación ventricular izquierdo a través del seno coronario para resincronización cardiaca siempre ha implicado un reto y más aún en pacientes con anatomía venosa coronaria compleja. Este caso demuestra cómo una técnica de doble canulación del seno coronario con uso de catéter multi-snare permite la colocación exitosa de un electrodo de estimulación ventricular izquierdo mediante acceso retrógrado a una vena posterolateral estenótica.
Abstract The percutaneous implantation of a left ventricular pacing electrode through the coronary sinus for cardiac resynchronization has always been a challenge, especially in patients with a complex coronary venous anatomy. This case shows how double cannulation of the coronary sinus using a multisnare catheter allows a left ventricular pacing electrode to be placed through retrograde access to a stenotic posterolateral vein, with a good clinical outcome.
ABSTRACT
INTRODUCTION: Spinal simple bone cysts, also known as solitary cysts, are extremely unusual benign primary bone tumors with few cases reported in the literature. CASE PRESENTATION: Incidental Magnetic Resonance Imaging (MRI) finding of a C2 Simple bone cyst in a 13-year-old female patient is reported. Complementary studies suggested the benign nature of the lesion. Patient underwent cervical curettage followed by tumor excision. A lateral submandibular approach to the upper cervical spine was used and careful bone resection was possible with a radiofrequency assisted burr and no instrumentation or fixation was required. The stability of the defect was ensured by filling it with bone allograft and by prescribing a postsurgical plastic cervical collar to maintain neck immobilization. Histological examination supported the diagnosis of simple bone cyst. At 6-12-month follow-up the patient presented no recurrence or symptomatology. CONCLUSIONS: Solitary bone cysts are infrequent entities in the cervical vertebrae and preservation of spine stability without instrumentation to avoid neurological complications is often challenging. In this case, the proximity of the cyst to the right vertebral artery and the risk of injury were high; however the surgical approach used was successful and no recurrence or instability was evidenced on postoperative MRI.
ABSTRACT
BACKGROUND: Autonomic modulation is a valuable therapeutic option for the management of ventricular arrhythmias. Bilateral cardiac sympathetic denervation (BCSD) has shown promising results in the acute, intermediate, and long-term management of polymorphic and monomorphic ventricular tachycardia (VT) in patients with structural heart disease. Cardiomyopathy (CM) due to Chagas disease (CD), and associated VT, is thought to be in part due to autonomic neuronal destruction and dysfunction. OBJECTIVE: The purpose of this study was to assess whether BCSD is a safe and effective treatment modality in patients with CD and VT storm or refractory VT. METHODS: A retrospective analysis of data from patients with chagasic CM who underwent BCSD between 2009 and 2015 at 2 international centers was performed. RESULTS: Of 75 patients who underwent BCSD for VT storm or refractory VT in the setting of CM, 7 (9.3%) patients had CD as the etiology of CM. All patients had monomorphic VT. Median follow-up was 7 months (range 1-46 months). All patients either underwent previous unsuccessful catheter ablation or were not candidates for ablation. The median number of implantable cardioverter-defibrillator (ICD) shocks 1 month before BCSD was 4 (range 2-30) and decreased to 0 (range 0-2) during available follow-up after BCSD. When antitachycardia pacing therapies were included in the analysis, the median number of ICD therapies (shocks + antitachycardia pacing) still decreased to 1 (range 0-3). CONCLUSION: In patients with chagasic CM presenting with refractory monomorphic VT, early evidence suggests that BCSD reduces appropriate ICD therapy and may represent a valuable treatment option.
Subject(s)
Chagas Cardiomyopathy , Sympathectomy , Tachycardia, Ventricular/prevention & control , California/epidemiology , Chagas Cardiomyopathy/complications , Chagas Cardiomyopathy/diagnosis , Chagas Cardiomyopathy/physiopathology , Colombia/epidemiology , Female , Follow-Up Studies , Heart Conduction System/physiopathology , Humans , Male , Middle Aged , Recurrence , Retrospective Studies , Sympathectomy/adverse effects , Sympathectomy/methods , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/physiopathology , Treatment OutcomeABSTRACT
Resumen Paciente de 48 años con historia de fibrilación auricular paroxística, dislipidemia y antecedente de ablación de vía accesoria (2013). Anti coagulado con Rivaroxaban 20 mg PO. Paciente es llevado a aislamiento percutáneo de venas pulmonares (AVP) con sistema de navegación tridimensional Carto 3. 48 horas post AVP inicia con cuadro de distrés respiratorio agudo que requiere hospitalización en unidad de cuido intensivo, que resuelve con manejo diurético y antiinflamatorio. Describimos la importancia del manejo hídrico en relación al AVP.
Abstract 48 years old male, previous history of paroxysmal atrial fibrillation, hiperlipemia and previous accesory pathway ablation an 2013. Anticoagulated with Rivaroxaban 20mg PO. Patient underwent pulmonary vein insolation (PVI) with Carto 3 tridimensional navigation and mapping system. Discharged on day 1 after PVI, readmitted with acute respiratory distress that required intensive care unit admission that resolves with diuretics and anti-inflammatory management. We describe the role of hydric management related with PVI procedure.
Subject(s)
Humans , Male , Middle Aged , Arrhythmias, Cardiac , Pulmonary Veins , Respiratory Distress Syndrome , Atrial Fibrillation , Rivaroxaban/therapeutic use , Heart FailureABSTRACT
Resumen Introducción: El cuidado de los pacientes con infecciones asociadas al dispositivo sin endocarditis, incluye: la extracción completa y la realización de capsulectomía para evitar la reinfección. El uso de nuevos elementos como el sistema de la presión negativa es una terapia novedosa que ha demostrado disminuir: los tiempos de recuperación, el tiempo de estancia intrahospitalaria, la necesidad de nuevas intervenciones por sangrado o lavado y el tiempo de espera para un nuevo implante. Nuestro objetivo es describir la experiencia de un centro de cuarto nivel, en el manejo de las infecciones asociadas a los dispositivos sin endocarditis, con el uso de la terapia de presión negativa como parte del manejo. Metodología: Se realizó una descripción retrospectiva de la experiencia en el manejo de la terapia de presión negativa en pacientes con infecciones asociadas a dispositivo, en un centro de cuarto nivel. Se exponen cinco casos, a los que se les realizó: la extracción completa del dispositivo, la capsulectomía anterior y posterior, el lavado quirúrgico y el implante de la terapia con presión negativa. Conclusión: La experiencia presentada demuestra que el uso de la terapia de presión negativa es un protocolo de tratamiento novedoso, que en nuestros pacientes con infección asociada a dispositivo sin endocarditis, es segura y de fácil utilización.
Abstract Introduction: Care for patients with infections associated to the device without endocarditis include complete extraction and performing a capsulectomy to avoid reinfection. The use of new elements, such as the negative pressure system, is a new therapy that has shown to reduce recovery time, inpatient stay, need of new interventions due to bleeding or washing and waiting time for a new implant. The goal is to describe the experience of a fourth level centre for managing infections associated with devices without endocarditis using a negative pressure system as part of the therapy. Methods: Descriptive retrospective study of the experience of negative pressure therapy for managing patients with device-related infections at a fourth level centre. Five cases are exposed where complete removal of the device, anterior and posterior capsulectomy, surgical washing and negative pressure therapy were performed. Conclusion: Presented experience shows that the use of negative pressure therapy is a new therapy protocol that is safe and easy for managing our patients with an infection associated to the device without endocarditis.
Subject(s)
Humans , Male , Female , Adult , Endocarditis , Biological Clocks , Joint Capsule , Equipment and SuppliesABSTRACT
BACKGROUND: In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. METHODS AND RESULTS: Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, n = 23) and endo-epicardial ablation (group 2, n = 26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of "scar" or "abnormal" myocardium. All critical sites responsible for VTs and points with "abnormal" potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2% (12/23) in group 1 and 84.6% (22/26) in group 2 (P = 0.029), with 21.7% (5/23) and 69.2% (18/26) patients off antiarrhythmic drugs (P < 0.001), respectively. Compared with patients with no premature ventricular contractions after ablation, patients with frequent premature ventricular contractions after ablation were more likely to have VA recurrence/ICD therapy [3/33 (9%) versus 12/16 (75%); log-rank P<0.001]. CONCLUSIONS: An endo-epicardial-based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of ≥ 10 premature ventricular contractions per minute after ablation is associated with more VA recurrence.
Subject(s)
Arrhythmogenic Right Ventricular Dysplasia/complications , Catheter Ablation/methods , Electrophysiologic Techniques, Cardiac , Endocardium/surgery , Pericardium/surgery , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/surgery , Adult , Arrhythmogenic Right Ventricular Dysplasia/therapy , Defibrillators, Implantable , Disease-Free Survival , Electrocardiography , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Prospective Studies , Recurrence , Tachycardia, Ventricular/epidemiology , Treatment OutcomeABSTRACT
This article discusses how ventricular tachycardia ablation should be used, discusses which patients may derive benefit from this treatment, and highlights the best means of implementing it.
ABSTRACT
BACKGROUND: Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation. METHODS AND RESULTS: Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 (P<0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2) (40.6+/-1 degrees C versus 39.6+/-0.8 degrees C; P< 0.003). The time to peak temperature was 9+/-7 seconds in group 1 and 21+/-9 seconds in group 2, and this difference was statistically significant (P<0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination. CONCLUSIONS: The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.
Subject(s)
Anesthesia, General , Atrial Fibrillation/surgery , Capsule Endoscopy , Catheter Ablation/adverse effects , Conscious Sedation , Esophagus/injuries , Aged , Burns, Electric/etiology , Burns, Electric/pathology , Burns, Electric/prevention & control , Capsule Endoscopes , Esophageal Fistula/etiology , Esophageal Fistula/pathology , Esophageal Fistula/prevention & control , Esophagus/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/pathology , Postoperative Complications/prevention & control , Risk Factors , TemperatureABSTRACT
Objetivos: 1. Revisar las implicaciones dentro de la biomecánica de hombro, de la integridad y de la lesión del complejo capsuloligamentoso de la articulación acromio clavicular. 2. Elaborar un protocolo para el diagnóstico preciso, clínico y radiológico, y el seguimiento de pacientes con luxación acromioclavicular G III tratados quirúrgicamente. 3. Evaluar los resultados clínicos y radiológicos en pacientes con luxación acromio-clavicular G III tratados quirúrgicamente mediante reducción abierta, reparación de los ligamentos y cerclaje coracoclavicular con cinta de dacrón (Cervi-set ). Materiales y métodos: De 1985 a 1987, se operaron 23 paciente con luxación acromio clavicular, en el servicio de ortopedia y traumatología del Hospital Clínica San Rafael de Bogotá, de los cuales se lograron seguir 15. De los 23 pacientes, 21 son hombres y 2 mujeres, cuyas edades variaron entre los 23 y los 65 años con un promedio de 43 años, sin encontrar diferencia notable en cuanto al hombro comprometido. La mayoría de las lesiones se debieron a accidentes de tránsito y deportivos. Todos los pacientes ingresaron por el servicio de urgencias siendo avaluados según parámetros clínicos y radiológicos establecidos dentro del protocolo que se expone a continuación...
Subject(s)
Acromioclavicular Joint/surgery , Acromioclavicular Joint/injuries , Shoulder DislocationABSTRACT
Siendo testigos del aumento desproporcionado del numero de atentados terroristas mediante detonacion de explosivos en lugares publicos el ultimo ano, y del problema de tipo medico que ello conlleva, por la gran afluencia de politraumatizados remitidos a nuestros hospitales no siempre preparados para resolver tales situaciones hemos querido en este trabajo analizar la fisiopatologia de la lesion producida por explosion y la experiencia en tres de los hospitales universitarios de la capital (Hospital Militar Central, Hospital San Rafael, y Hospital de Kennedy) como muestra representativa se recolectaron 107 casos, victimas del atentado terrorista perpretado contra las instalaciones del DAS, el 6 de dicimebre de 1989, variedad de lesiones encontradas y de su magnitud, cuyos resultados se exponen en el presente estudio