RESUMEN
Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.
Asunto(s)
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cardiología , Infecciones por Coronavirus/epidemiología , Atención a la Salud , Técnicas Electrofisiológicas Cardíacas , Neumonía Viral/epidemiología , Atención Ambulatoria , American Heart Association , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Toma de Decisiones Conjunta , Personal de Salud , Humanos , Tamizaje Masivo , Política Organizacional , Pandemias/prevención & control , Selección de Paciente , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Reinserción al Trabajo , Medición de Riesgo , SARS-CoV-2 , Telemedicina , Estados Unidos/epidemiologíaAsunto(s)
Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/terapia , Cardiopatías Congénitas/epidemiología , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/prevención & control , Terapia de Resincronización Cardíaca , Ablación por Catéter , Comorbilidad , Desfibriladores Implantables , Técnicas Electrofisiológicas Cardíacas , Accesibilidad a los Servicios de Salud , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/cirugía , Humanos , Marcapaso ArtificialAsunto(s)
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Adulto , American Heart Association/organización & administración , Canadá , Electrofisiología Cardíaca/organización & administración , Terapia de Resincronización Cardíaca , Cardiología/organización & administración , Ablación por Catéter , Niño , Desfibriladores Implantables , Técnicas Electrofisiológicas Cardíacas , Europa (Continente) , Humanos , Marcapaso Artificial , Estados UnidosRESUMEN
INTRODUCTION: Radiofrequency ablation of some right-sided accessory pathways continues to be challenging. The purpose of this study was to evaluate the efficacy of introducing a multielectrode microcatheter in the right coronary artery to localize accessory pathways when conventional mapping was unsuccessful. METHODS AND RESULTS: A retrospective study was conducted of all right-sided accessory pathway radiofrequency ablation procedures in which a multielectrode microcatheter as a reference in the right coronary artery was used to assist mapping. Between January 1998 and January 2002, 10 patients (5 males) underwent mapping of 11 accessory pathways with this technique at mean age of 12.3 +/- 3.8 years. Five patients had Ebstein's anomaly of the tricuspid valve. Accessory pathways were identified in the following locations: right anterior 3, right anterolateral 2, right lateral 1, right posterolateral 2, and right posterior 3. Mean procedure time was 285 +/- 70.3 minutes, and fluoroscopy time was 68.7 +/- 21 minutes. Average mapping duration prior to microcatheter insertion in the right coronary artery was 136 +/- 40 minutes. After microcatheter placement in the right coronary artery, the time to successful ablation of accessory pathways was 38 +/- 11 minutes. All 11 (100%) accessory pathways were successfully ablated. CONCLUSION: Mapping in the right coronary artery with a microcatheter is an effective method to improve localization and successful ablation of difficult right-sided accessory pathways.