Asunto(s)
Fibrilación Atrial , Accidente Cerebrovascular , Administración Oral , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Dabigatrán/uso terapéutico , Humanos , Indicadores y Reactivos/uso terapéutico , Tiempo de Protrombina , Piridonas/uso terapéutico , Rivaroxabán/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológicoRESUMEN
BACKGROUND: Pulmonary vein (PV) isolation is an established treatment strategy for paroxysmal atrial fibrillation (PAF). However, the recurrence rate of PAF is 8% to 37%, despite repeated procedures, and the catheter ablation strategy for PAF with non-PV foci is unclear. OBJECTIVE: The purpose of this study was to assess the PAF ablation strategy for non-PV foci. METHODS: The study included 304 consecutive patients undergoing PAF ablation (209 males, age 63.0 ± 10.4 years) divided into 3 groups: group 1 (245 patients) with no inducible non-PV foci; group 2 (34 patients) with atrial fibrillation (AF) originating from non-PV foci and all the foci successfully ablated; and group 3 (25 patients) with AF originating from non-PV triggers, but without all foci being ablated or with persistently inducible AF. RESULTS: Mean follow-up period was 26.9 ± 11.8 months, and AF recurrence rates since the last procedure were 9.8%, 8.8%, and 68.0% in groups 1, 2, and 3, respectively. There was no statistically significant difference in recurrence rate between groups 1 and 2 (P = .89); however, there were statistically significant differences between groups 3 and 1 (P <.0001) and groups 3 and 2 (P <.0001). The patients in group 2 had an AF-free outcome to equivalent to those who had PV foci in group 1 (P = .83). CONCLUSION: Success rates can be improved for PAF ablation if non-PV foci are detected and eliminated.
Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Técnicas Electrofisiológicas Cardíacas/métodos , Sistema de Conducción Cardíaco/cirugía , Venas Pulmonares/cirugía , Taquicardia Paroxística/cirugía , Fibrilación Atrial/fisiopatología , Femenino , Estudios de Seguimiento , Sistema de Conducción Cardíaco/fisiopatología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Taquicardia Paroxística/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Idiopathic left ventricular aneurysms and diverticula (LVA/Ds) are rare cardiac malformations that can be detected using certain imaging techniques. Although most patients with these malformations are clinically asymptomatic, some patients exhibit cardiac arrhythmias and other clinical manifestations. In electrophysiological studies, it is often difficult to establish the relationship between clinical manifestations of cardiac arrhythmias and those of LVA/Ds due to anatomical complexities. We herein report the case of a 67-year-old man who was successfully diagnosed with ventricular tachycardia originating from an idiopathic LVA that was clearly demonstrated on a three-dimensional electroanatomical mapping system integrated with CT imaging.