RESUMO
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.
Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cardiologia , Infecções por Coronavirus/epidemiologia , Atenção à Saúde , Técnicas Eletrofisiológicas Cardíacas , Pneumonia Viral/epidemiologia , Assistência Ambulatorial , American Heart Association , Betacoronavirus , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Tomada de Decisão Compartilhada , Pessoal de Saúde , Humanos , Programas de Rastreamento , Política Organizacional , Pandemias/prevenção & controle , Seleção de Pacientes , Equipamento de Proteção Individual/provisão & distribuição , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Retorno ao Trabalho , Medição de Risco , SARS-CoV-2 , Telemedicina , Estados Unidos/epidemiologiaAssuntos
Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Cardiopatias Congênitas/epidemiologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/prevenção & controle , Terapia de Ressincronização Cardíaca , Ablação por Cateter , Comorbidade , Desfibriladores Implantáveis , Técnicas Eletrofisiológicas Cardíacas , Acessibilidade aos Serviços de Saúde , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Marca-Passo ArtificialAssuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Adulto , American Heart Association/organização & administração , Canadá , Eletrofisiologia Cardíaca/organização & administração , Terapia de Ressincronização Cardíaca , Cardiologia/organização & administração , Ablação por Cateter , Criança , Desfibriladores Implantáveis , Técnicas Eletrofisiológicas Cardíacas , Europa (Continente) , Humanos , Marca-Passo Artificial , Estados UnidosRESUMO
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.