RESUMEN
Cardiac magnetic resonance (CMR) imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolution anatomy, arrhythmia substrate, and ablation lesion visualization in the absence of ionizing radiation. Over the last decade, technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed. However, performing procedures outside the conventional fluoroscopic laboratory posed technical, practical and safety concerns. The development of magnetic resonance imaging compatible ablation systems, the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors. The first human reports, in order to establish a procedural workflow, have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation. Potential expansion to other more complex arrhythmias, especially ventricular tachycardia and atrial fibrillation, would be of essential impact, taking into consideration the widespread use of substrate-based strategies. Importantly, all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.
RESUMEN
Background: Cavotricuspid isthmus pulsed-field ablation has been recently described to be safely performed despite initial reports on coronary arterial spasm while conduction disturbances as a complication of cavotricuspid isthmus ablation are rare and have been reported exclusively for radiofrequency catheter ablation. Case summary: A 64-year-old female patient with mechanical prosthetic valves underwent atrial fibrillation ablation using the pentaspline pulsed-field ablation catheter. At the end of the uneventful pulmonary vein isolation, an atrial tachycardia depended to the cavotricuspid isthmus occurred. A single pulsed-field application at the cavotricuspid isthmus resulted in right bundle branch block combined with posterior fascicular hemiblock and PR prolongation that resolved spontaneously within 12â h. Discussion: This is the first report of transient conduction disturbances as a complication of cavotricuspid isthmus pulsed-field ablation. Although the underlying mechanism, either single or miscellaneous, was not verified, this case highlights that caution should be taken when the pentaspline pulsed-field ablation catheter is used for cavotricuspid isthmus ablation.
RESUMEN
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes. We present the case of a young woman with an acute coronary syndrome caused by SCAD, where grey-scale intravascular ultrasound (IVUS) and ChromaFlo were instrumental in deciding against interventional treatment. The patient's urgent angiogram gave the impression of a spiral dissection in the right coronary artery. IVUS confirmed the presence of an intimal flap and the ChromaFlo study showed unobstructed flow throughout the dissected segments. No atherosclerotic plaques or intramural hematomas were imaged on the IVUS pullback. In this case, grey-scale IVUS was used to confirm the absence of atherosclerotic coronary artery disease and ChromaFlo to assess flow in the true and the false lumen, excluding the presence of no-flow intramural hematomas. Based on these findings, it was decided to adopt a conservative treatment strategy.