RESUMEN
Although ectopic atrial tachycardia (EAT) is common following surgery for congenital heart disease (CHD), there are limited data regarding this arrhythmia. This study assessed risk factors and outcomes for patients less than one year of age with post-operative EAT. This was a retrospective analysis of infants undergoing CHD surgery from 2007 to 2020. Patients and surgeries with EAT were compared to controls without EAT. Out of 5372 infant CHD surgeries, EAT developed in 129 (2.5%). Compared to controls, the EAT cohort was younger (median 7 vs 85 days, p < 0.01), weighed less at time of surgery (3.3 vs 4.2 kg, p < 0.01), and was more likely to have DiGeorge syndrome (7.7% vs 3.0%, p < 0.01). Multivariate analysis revealed total anomalous venous connection (TAPVC) repair (odds ratio [OR] 2.8; 95% confidence interval 1.5-5.2), DiGeorge syndrome (OR 2.4; 1.1-5.2), Society of Thoracic Surgeons-European Association for Cardio-Thoracic surgery (STAT) category ≥ 4 (OR 2.1; 1.0-4.4), and longer cardiopulmonary bypass times (OR 1.1; 1.0-1.2) as independent risk factors for EAT. The onset of EAT occurred a median of 9 days (IQR 5-14 days) after CHD surgery. Antiarrhythmic treatment was initiated in 109/129 patients (84%) with propranolol (71%) and amiodarone (24%) the most commonly used medications. Although 15 (11.6%) patients did not survive to hospital discharge, EAT was not directly implicated in any deaths. EAT occurred after 2.5% of infant CHD surgeries. In addition to TAPVC repair, longer and more complex surgeries were associated with an increased the risk for the development of post-operative EAT.
Asunto(s)
Síndrome de DiGeorge , Cardiopatías Congénitas , Taquicardia Atrial Ectópica , Taquicardia Supraventricular , Lactante , Humanos , Taquicardia Atrial Ectópica/etiología , Estudios Retrospectivos , Síndrome de DiGeorge/complicaciones , Taquicardia Supraventricular/tratamiento farmacológico , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/complicacionesRESUMEN
Atrial fibrillation and atrial tachycardias (AF/AT) have been reported as a common condition in patients with pulmonary hypertension (PH). As yet, limited data exists about the significance of the borderline post-capillary pressure component on the occurrence of AF / AT in patients with isolated pre-capillary PH. We retrospectively studied the prevalence of AF / AT in 333 patients (mean age 61 ± 15 years, 44% males) with pre-capillary idiopathic / familiar pulmonary arterial hypertension, and inoperable chronic thromboembolic pulmonary hypertension. The prevalence of AF / AT was analyzed in different categories of pulmonary artery wedge pressure (PAWP). In the study population overall, the mean PAWP was 10.5 ± 3 mmHg, median of 11 mmHg, range 2-15 mmHg. AF / AT was diagnosed in 79 patients (24%). The proportion of AF / AT among patients with PAWP below the median (?11 mmHg) was lower than in subjects with PAWP between 12 and 15 mmHg, 30 (16%) vs. 46 (35%), p = 0.0001. Compared to the patients with PAWP?11 mmHg, subjects with PAWP between 12 and 15 mmHg were older (65 ± 13 years vs. 58 ± 16), with more prevalent arterial hyperte\nsion [100 (70%) vs. 106 (55%)] and diabetes mellitus [50 (35%) vs. 48 (25%)], showed larger size of the left atrium (42 ± 7 vs. 40 ± 6 mm), and higher values of right atrium pressure (12 ± 5 vs. 8 ± 5 mm Hg), p < 0.05 in all comparisons. The prevalence of AF / AT in the group studied increased with the growing post-capillary component.
Asunto(s)
Fibrilación Atrial/epidemiología , Hipertensión Pulmonar/complicaciones , Presión Esfenoidal Pulmonar , Sistema de Registros , Taquicardia Atrial Ectópica/epidemiología , Adulto , Anciano , Fibrilación Atrial/etiología , República Checa/epidemiología , Femenino , Humanos , Hipertensión Pulmonar/fisiopatología , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Taquicardia Atrial Ectópica/etiologíaRESUMEN
Background High levels of supraventricular ectopy are associated with greater risk of atrial fibrillation, stroke, and death. Little information is available about differences by race/ethnicity in the extent of supraventricular ectopy, or about whether high levels of supraventricular ectopy are associated with impaired left atrial (LA) function and LA enlargement. Methods and Results In the MESA (Multi-Ethnic Study of Atherosclerosis), 1148 participants (47% men; mean age, 67 years) had cardiovascular magnetic resonance imaging in 2010 to 2012, followed by 14-day ambulatory electrocardiographic monitoring in 2016 to 2018. We analyzed participant characteristics and cardiovascular magnetic resonance measures of LA function and structure in relation to average count of premature atrial contractions (PACs) per hour and average number of runs per day of supraventricular tachycardia. In adjusted regression analyses, older age, male sex, White race, elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide), and a history of clinically detected atrial fibrillation were associated with more PACs/hour. Chinese and Hispanic participants had on average fewer PACs/hour than White participants (Chinese participants, 31% less [95% CI, 8%-49%]; Hispanic participants, 38% less [95% CI, 19%-52%]). Greater LA total emptying fraction was associated with fewer PACs/hour (per SD, 16% fewer PACs/hour [95% CI, 7%-25% fewer PACs/hour]). Larger LA minimum volume was associated with more PACs/hour (per SD, 7% more PACs/hour [95% CI, 2%-13% more PACs/hour]). Associations of LA volumes with runs of supraventricular tachycardia/day were similar in direction but were weaker. Conclusions Impaired LA function and LA enlargement were associated with more PACs/hour on extended ambulatory electrocardiographic monitoring. Measurement of supraventricular ectopy may provide information about the extent of atrial myopathy.
Asunto(s)
Aterosclerosis/etnología , Función del Atrio Izquierdo/fisiología , Electrocardiografía Ambulatoria/métodos , Etnicidad , Atrios Cardíacos/fisiopatología , Taquicardia Atrial Ectópica/fisiopatología , Anciano , Anciano de 80 o más Años , Aterosclerosis/complicaciones , Aterosclerosis/fisiopatología , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Incidencia , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Factores de Riesgo , Taquicardia Atrial Ectópica/etnología , Taquicardia Atrial Ectópica/etiología , Estados Unidos/epidemiologíaRESUMEN
Ripple mapping can make the visualization of activation conduction on a 3-dimensional voltage map and is useful tool for scar-related organized atrial tachycardia (AT). This study sought to assess the efficacy of ripple mapping for interpreting reentrant circuits and critical isthmus in postoperative ATs. 34 consecutive patients with a history of mitral valve surgery (mean age, 54.5 ± 12.4 years) underwent high density (HD) RM during ATs with CARTO3v4 CONFIDENSE system. The voltage activation threshold was determined by RM over a bipolar voltage map. The identification of underlying mechanisms and ablation setting was based on RM without reviewing activation mapping. A total of 41 ATs (35 spontaneous, 6 induced) were characterized. 39 reentry circuits were successfully mapped (cycle length, 256 ± 43 ms). Of the 41 ATs, 28 were confirmed by ripple mapping alone (68%), and 12 (29%) by ripple mapping and entrainment mapping. Of 12 ATs in the left atrium, 9 (75%) needed entrainment to confirm, compared with 5 (17.8%) in the right atrium. Primary endpoint after initial ablation set was achieved in 32 of the 34 patients (94.1%). Freedom from atrial arrhythmias was 79.4% after the follow-up of 12 ± 5 months. Of the seven patients with recurrence, three underwent the repeated catheter ablation. Ripple mapping precisely delineated reentrant circuits in post-cardiac surgery AT resulting in a high success rate of ablation. Entrainment maneuvers remain useful for elucidation of complex AT circuits.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ablación por Catéter/métodos , Técnicas Electrofisiológicas Cardíacas/métodos , Imagenología Tridimensional/métodos , Complicaciones Posoperatorias/cirugía , Cirugía Asistida por Computador/métodos , Taquicardia Atrial Ectópica/cirugía , Electrocardiografía Ambulatoria , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Periodo Posoperatorio , Estudios Prospectivos , Taquicardia Atrial Ectópica/diagnóstico , Taquicardia Atrial Ectópica/etiologíaRESUMEN
OBJECTIVE: The preferential sites for focal atrial tachycardia (FAT) are mainly in the right atrium in both sexes. However, a limited number of studies have indicated that sex differences in the localization of FAT. This study investigated possible sex differences in the distribution of FAT in a large cohort of patients referred for ablation. METHODS: From 2004 to 2019, 487 patients (298 women) were referred to our institution for ablation of FAT. A standard electrophysiological study was conducted, and isoproterenol or atropine was given when needed. Conventional catheter mapping, electroanatomic contact mapping, and noncontact mapping were used to assess the origin of ectopic atrial tachycardia. RESULTS: Overall, 451 foci were successfully ablated in 436 patients (90%). Although the foci located along the crista terminalis were more common in women than in men (42% vs. 29%; p=0.023), the opposite were found in the foci located along the tricuspid annulus (5% vs. 11%; p=0.032) and the right atrial appendage (RAA) (1% vs. 3%; p=0.032). Other locations were similarly distributed in men and women. In addition, the presence of persistent FAT was more frequent in men than in women (22% vs. 5%; p<0.001). Finally, the difference in the induction pattern of FAT was also remarkable between sexes. CONCLUSION: The distribution of FAT in women and men is different. In addition, persistent FAT seems more often in men than in women. The different distribution, persistency, and induction pattern of FAT should be considered in the successful management of this type of tachycardia.
Asunto(s)
Taquicardia Atrial Ectópica/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ablación por Catéter , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Suecia/epidemiología , Taquicardia Atrial Ectópica/etiología , Taquicardia Atrial Ectópica/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
The incidence of atrial tachycardia (AT) after rheumatic mitral valvular (RMV) surgery has been well described. However, there have been few reports on the characteristics, mechanism, and long-term ablation outcome of ATs after RMV surgery and concomitant Cox-MAZE IV procedure.The present study reviewed consecutive patients who underwent AT ablation between May 2008 and July 2013. All patients were refractory to antiarrhythmic drugs (AADs) and had a history of RMV surgery and Cox-MAZE IV procedure. A total of 34 patients underwent AT ablation after RMV surgery and concomitant Cox-MAZE IV procedure, and presented 57 mappable and 2 unmappable ATs. The 57 mappable ATs included 14 focal-ATs and 43 reentry-ATs. Ten of the 14 focal-like ATs were located at the pulmonary vein (PV) antrum and border of a box lesion. Of the 43 reentry-ATs, 16 were marco-reentrant around the mitral annulus (MA) and 16 around the tricuspid annulus. There were 41 atypical ATs (non-cavotricuspid isthmus related) including 16 ATs related to the box lesion and 21 ATs related to other Cox-MAZE IV lesions. The AT were successfully terminated in 33 (97.1%) patients. After mean follow-up of 46.9 ± 15.7 months, 25 (73.5%) patients maintained sinus rhythm without AADs after a single procedure and 28 (82.4%) patients after repeated procedures.The recurrent ATs after RMV surgery and concomitant Cox-MAZE IV were mainly reentry mechanism, and largely related to LA. An incomplete lesion or re-conductive gaps in a prior lesion might be the predominant mechanisms for these ATs. Catheter-based mapping and ablation of these ATs seems to be effective and safe during a long-term follow-up.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Válvula Mitral/cirugía , Cardiopatía Reumática/cirugía , Taquicardia Atrial Ectópica/epidemiología , Taquicardia Atrial Ectópica/cirugía , Adulto , Anciano , Ablación por Catéter , Mapeo Epicárdico/instrumentación , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Cardiopatía Reumática/fisiopatología , Taquicardia Atrial Ectópica/etiología , Taquicardia Atrial Ectópica/fisiopatología , Resultado del TratamientoAsunto(s)
Electrocardiografía , Sistema de Conducción Cardíaco/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Taquicardia Atrial Ectópica/etiología , Taquicardia por Reentrada en el Nodo Sinoatrial/etiología , Humanos , Masculino , Taquicardia Atrial Ectópica/diagnóstico , Taquicardia Atrial Ectópica/fisiopatología , Taquicardia por Reentrada en el Nodo Sinoatrial/diagnóstico , Taquicardia por Reentrada en el Nodo Sinoatrial/fisiopatología , Adulto JovenRESUMEN
Ectopic atrial tachycardia (EAT) is common in surgically repaired congenital heart disease (CHD) and carries the potential for significant hemodynamic compromise. Our objective was to determine the incidence, and risk factors of EAT after CHD surgery. Prospective study of patients that underwent surgery for CHD from February to October 2016 was performed. Demographic, perioperative and electrophysiologic data were collected. Sustained EAT (> 30 s) was documented by telemetry or electrocardiogram and confirmed by a pediatric electrophysiologist. All patients were followed through index hospitalization. During the study period, 17/204 (8%) of patients developed EAT with median time-to-event of 14 days. 15/17 (88%) received anti-arrhythmic therapy for sustained EAT. By univariate analysis, younger age (5 vs. 284 days, P < .001), lower weight (3.2 vs. 7.5 kg, P < .001), single ventricle physiology (P = .05), longer cardiopulmonary bypass time (176 vs. 94 min, P < .001), need for delayed sternal closure (P < .001), and higher STAT category (P < .001) were associated with EAT. Incidence among single ventricle patients was 7/44 (16%), and of those 7/13 (54%) were < 30 days of age. Multivariable Cox regression analysis confirmed age at surgery < 30 days (hazard ratio = 11.7, P = .002) and use of milrinone (hazard ratio = 4.4, P = .007) as independent predictors of EAT. Post-operative EAT is frequent following surgery for CHD especially in neonates. Further study is warranted, specifically in the single ventricle population, given the high potential risk for arrhythmia-induced hemodynamic compromise in this vulnerable population.
Asunto(s)
Cardiopatías Congénitas/cirugía , Complicaciones Posoperatorias/etiología , Taquicardia Atrial Ectópica/etiología , Antiarrítmicos/uso terapéutico , Preescolar , Electrocardiografía/métodos , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Factores de Riesgo , Análisis de Supervivencia , Taquicardia Atrial Ectópica/epidemiologíaRESUMEN
CLINICAL INTRODUCTION: A 2-month-old baby boy was referred to our centre due to tachycardia and acute heart failure. The ECG showed a narrow complex tachycardia with a heart rate of 300 beats per minute (Figure 1). Echocardiographically, a patent foramen ovale and a parachute mitral valve with mild regurgitation were diagnosed; cardiac function was highly impaired.heartjnl;104/6/467/F1F1F1Figure 1ECG (50 mm/s) showing the small complex tachycardia. QUESTION: Which of the following is the most likely diagnosis?Ectopic atrial tachycardiaAtrial flutterChaotic atrial tachycardiaFocal micro re-entrant tachycardiaAtrial fibrillation.
Asunto(s)
Electrocardiografía/métodos , Taquicardia Atrial Ectópica , Diagnóstico Diferencial , Ecocardiografía/métodos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico , Foramen Oval Permeable/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Lactante , Masculino , Válvula Mitral/anomalías , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Manejo de Atención al Paciente/métodos , Taquicardia Atrial Ectópica/diagnóstico , Taquicardia Atrial Ectópica/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: Prolonged ECG monitoring after stroke frequently reveals short paroxysmal atrial fibrillation (pAF) and supraventricular (SV) runs. The minimal duration of atrial fibrillation (AF) required to induce cardioembolism, the relevance of SV runs, and whether short pAF results from cerebral damage itself are currently being debated. We aimed to study the relevance of SV runs and short pAF detected by prolonged Holter ECG after cerebral ischemia during long-term follow-up. METHODS: Analysis is from the prospective Find-AF trial (ISRCTN46104198). We included patients with acute cerebral ischemia. Those without AF on admission received 7-day Holter ECG monitoring. We differentiated patients with AF on admission (AF-adm), with pAF (>30 seconds), with SV runs (>5 beats but <30 seconds in a 24-hour ECG interval), and without SV runs (controls). During follow-up, those with baseline pAF received another 7-day Holter ECG to examine AF persistence. RESULTS: A total of 254 of 281 initially included patients were analyzed (mean age 70.0 years, 45.3% female). Forty-three (16.9%) had AF-adm. A total of 211 received 7-day Holter ECG monitoring: 27 (12.8%) had pAF, 67 (31.8%) had SV runs, and 117 (55.5%) were controls. During a mean 3.7 years of follow-up, the SV runs group had more recurrent strokes (p = 0.04) and showed numerically more novel AF (12% vs 5%, p = 0.09) than the controls. Seventy-five percent of the patients with manifest pAF detected after cerebral ischemia still had AF during follow-up (50% paroxysmal, 50% persisting/permanent). CONCLUSIONS: Patients with cerebral ischemia and SV runs had more recurrent strokes and numerically more novel AF during follow-up and could benefit from further prolonged ECG monitoring. pAF detected after stroke is not a temporal phenomenon.
Asunto(s)
Fibrilación Atrial/etiología , Isquemia Encefálica/complicaciones , Taquicardia Atrial Ectópica/etiología , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/diagnóstico , Electrocardiografía , Electrocardiografía Ambulatoria , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Taquicardia Atrial Ectópica/diagnóstico , Factores de TiempoRESUMEN
A 63-year-old man presented with a 1-year history of atrial tachycardia (AT) 6 years after orthotopic heart transplantation with bicaval anastomosis. Twelve-lead electrocardiogram showed monomorphic AT with isoelectric intervals across all leads and strikingly irregular PP intervals. At electrophysiology study, the native left atrium's rhythm was atrial fibrillation (AF) while the donor atria exhibited centrifugal activation of irregular cycle length originating from a site along the left atrial anastomosis. Ablation at that site terminated AT to sinus rhythm. Recipient AF with recipient-to-donor conduction should be suspected in the presence of irregular monomorphic AT in orthotopic heart transplantation recipients. Catheter ablation of atrio-atrial conduction is safe and effective.
Asunto(s)
Fibrilación Atrial/etiología , Ablación por Catéter/métodos , Sistema de Conducción Cardíaco/fisiopatología , Trasplante de Corazón/efectos adversos , Taquicardia Atrial Ectópica/etiología , Donantes de Tejidos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Electrocardiografía , Sistema de Conducción Cardíaco/cirugía , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Taquicardia Atrial Ectópica/diagnóstico , Taquicardia Atrial Ectópica/cirugíaRESUMEN
BACKGROUND: During ablation for atrial fibrillation (AF), it is challenging to anticipate transitions to organized tachycardia (AT). Defining indices of this transition may help to understand fibrillatory conduction and help track therapy. OBJECTIVE: To determine the timescale over which atrial fibrillation (AF) organizes en route to atrial tachycardia (AT) using the ECG referenced to intracardiac electrograms. METHODS: In 17 AF patients at ablation (58.7±9.6years; 53% persistent AF) we analyzed spatial loops of atrial activity on the ECG and intracardiac electrograms over successive timepoints. Loops were tracked at precisely 15, 10, 5, 3 and 1min prior to defined transitions of AF to AT. RESULTS: Organizational indices reliably quantified changes from AF to AT. Spatiotemporal AF organization on the ECG was identifiable at least 15min before AT was established (p=0.02). CONCLUSIONS: AF shows anticipatory global organization on the ECG minutes before AT is clinically evident. These results offer a foundation to establish when AF therapy is on an effective path, and for a quantitative classification separating AT from AF.
Asunto(s)
Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Electroencefalografía/métodos , Técnicas Electrofisiológicas Cardíacas/métodos , Monitoreo Intraoperatorio/métodos , Taquicardia Atrial Ectópica/diagnóstico por imagen , Taquicardia Atrial Ectópica/cirugía , Fibrilación Atrial/complicaciones , Ablación por Catéter , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Taquicardia Atrial Ectópica/etiología , Resultado del TratamientoRESUMEN
BACKGROUND: Roof-dependent atrial tachycardia (roof AT) sometimes occurs after pulmonary vein isolation (PVI) of atrial fibrillation (AF). This study aimed to investigate the relationship between the anatomy of the residual left atrial posterior wall and occurrence of roof AT. METHODS: A total of 265 patients with AF who underwent PVI were enrolled. After the PVI, induced or recurrent roof AT was confirmed by an entrainment maneuver or activation mapping using a three-dimensional (3D) mapping system. To identify the predictors of roof AT, the minimum distance between both PVI lines (d-PVI) was measured by a 3D mapping system and the anatomical parameters, including the left atrial (LA) diameter, left atrial volume index (LAVi), and shape of the left atrial roof, were analyzed by 3D computed tomography. RESULTS: Roof AT was documented in 11 (4.2%) of 265 patients. A multivariable analysis demonstrated that the d-PVI, Deep V shape of the LA roof, and LAVi were associated with roof AT occurrences (d-PVI: odds ratio: 0.72, confidence interval [CI]: 0.61-0.86, P < 0.001; Deep V shape: odds ratio: 0.19, CI: 0.04-0.82, P = 0.03; LAVi: odds ratio: 1.05, CI: 1.02-1.07, P = 0.001). A receiver-operating characteristic curve analysis yielded an optimal cut-off value of 15.5 mm and 55.7 mL/m2 for the d-PVI and LAVi, respectively. CONCLUSION: The shorter d-PVI at the LA roof, greater LAVi, and Deep V shape were associated with the occurrence of a roof AT.
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Atrios Cardíacos/fisiopatología , Venas Pulmonares/cirugía , Taquicardia Atrial Ectópica/etiología , Ablación por Catéter , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Resultado del TratamientoRESUMEN
Atrial arrhythmias are frequently encountered in patients with congenital heart disease (CHD) with or without corrective surgery and respond to pharmacological therapies with only limited success. This review describes the technologies currently available for performing successful ablation procedures in this very complex patient cohort. In addition to an understanding of the underlying anatomy, which can be supplemented by 3D imaging with the aid of magnetic resonance imaging (MRI) or computed tomography (CT), the choice between the different 3D mapping systems (sequential versus simultaneous) is presented. Finally, conventional manual navigation is compared with magnetic navigation and then discussed with regard to the respective arrhythmias encountered with the different forms of CHD.
Asunto(s)
Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Taquicardia Atrial Ectópica/diagnóstico , Taquicardia Atrial Ectópica/terapia , Adulto , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/etiología , Mapeo del Potencial de Superficie Corporal/métodos , Técnicas de Imagen Cardíaca/métodos , Ablación por Catéter/métodos , Terapia Combinada/métodos , Medicina Basada en la Evidencia , Femenino , Cardiopatías Congénitas/complicaciones , Humanos , Imagenología Tridimensional/métodos , Masculino , Taquicardia Atrial Ectópica/etiología , Resultado del TratamientoRESUMEN
BACKGROUND: Whether adding cardiac resynchronization therapy (CRT-D) to an implanted cardioverter-defibrillator alters the risk of atrial fibrillation or other atrial tachyarrhythmias (AF/AT), or if postimplantation AF/AT modulate the benefits of CRT-D, remain unknown. METHODS AND RESULTS: We studied 972 Resynchronization/Defibrillation in Ambulatory Heart Failure Trial (RAFT) participants without permanent AF, who were randomized to CRT-D (n=495) versus nonresynchronization defibrillator (implanted cardioverter-defibrillator; n=477) within the predefined stratum eligible for an atrial lead. Occurrence of postrandomization AF/AT was prospectively assessed, and Cox models were used to test the independent association between the postrandomization AF/AT and the RAFT primary composite outcome of all-cause mortality or hospitalization for heart failure. Over 41 (±19) months, postrandomization AF/AT occurred in 216 (45.3%) patients randomized to implanted cardioverter-defibrillator and 249 (50.3%) randomized to CRT-D. After adjusting for competing risk of death, randomization to CRT-D increased risk of postrandomization AF/AT (hazard ratio, 1.20; 95% confidence interval, 1.00-1.42; P=0.045). Postrandomization AF/AT, which remained paroxysmal in 69.5%, did not reduce biventricular pacing percentage. In adjusted models, postrandomization AF/AT was not associated with the primary outcome (hazard ratio, 1.04; 95% confidence interval, 0.84-1.30). However, AF/AT was associated with a borderline decreased risk of mortality (hazard ratio, 0.75; 95% confidence interval, 0.58-1.00) but increased risk of heart failure hospitalization (hazard ratio, 1.43; 95% confidence interval, 1.08-1.90). CONCLUSIONS: In RAFT, nearly half of the patients developed postrandomization AF/AT, and those randomized to CRT-D had borderline significant higher risk. Postrandomization AF/AT was associated with risk of heart failure hospitalization, but not with the primary composite outcome. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.
Asunto(s)
Cardioversión Eléctrica/métodos , Electrocardiografía , Atrios Cardíacos/fisiopatología , Insuficiencia Cardíaca/terapia , Taquicardia Atrial Ectópica/epidemiología , Anciano , Canadá/epidemiología , Terapia de Resincronización Cardíaca/métodos , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Incidencia , Masculino , Pronóstico , Factores de Riesgo , Taquicardia Atrial Ectópica/etiología , Taquicardia Atrial Ectópica/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
We present the first reported case of totally video-assisted thoracoscopic surgery for combined ablation and external exclusion without appendectomy of the left atrial appendage. We encourage the use of video-assisted thoracoscopic surgery for a combined procedure of epicardial radiofrequency ablation and external exclusion without appendectomy to achieve a safe and complete electrical isolation of the left atrial appendage in children with focal atrial tachycardia. In our opinion, the external exclusion of the appendage has several advantages: it presents minimal risk of bleeding (especially in the pediatric population), and the clip can be retrieved if the circumflex artery is distorted.
Asunto(s)
Apéndice Atrial/cirugía , Ablación por Catéter/métodos , Taquicardia Atrial Ectópica/cirugía , Cirugía Torácica Asistida por Video/métodos , Apéndice Atrial/fisiopatología , Pérdida de Sangre Quirúrgica/prevención & control , Niño , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Instrumentos Quirúrgicos , Taquicardia Atrial Ectópica/etiologíaRESUMEN
The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds. To our knowledge, this is the first report of such findings in this circumstance.
Asunto(s)
Desfibriladores Implantables , Corazón Auxiliar , Miocarditis/terapia , Taquicardia Atrial Ectópica/prevención & control , Electrocardiografía , Fenómenos Electromagnéticos , Diseño de Equipo , Estudios de Seguimiento , Humanos , Masculino , Miocarditis/complicaciones , Miocarditis/fisiopatología , Taquicardia Atrial Ectópica/etiología , Taquicardia Atrial Ectópica/fisiopatología , Adulto JovenRESUMEN
The arterial switch operation has been the procedure of first choice for correction of transposition of the great arteries (TGA) for several decades now. However, a large number of adult patients with TGA nowadays were palliated previously by either a Mustard or a Senning procedure. Atrial tachyarrhythmias (ATs) are frequently observed during long-term follow-up of patients with TGA after these atrial switch corrections and are associated with both morbidity and mortality. Because of the complex postoperative anatomy in these patients, ablative therapy for these tachyarrhythmias can be challenging. The goals of this review are to discuss the most prevalent ATs in patients after the Mustard or Senning procedure and to summarize (long-term) outcomes of ablative therapy. In addition, recent developments in ablative therapy for ATs in this patient population are outlined.
Asunto(s)
Operación de Switch Arterial/efectos adversos , Atrios Cardíacos/fisiopatología , Taquicardia Atrial Ectópica/etiología , Transposición de los Grandes Vasos/cirugía , Humanos , Complicaciones Posoperatorias , Taquicardia Atrial Ectópica/fisiopatologíaRESUMEN
BACKGROUND: Repeat procedures after persistent atrial fibrillation (AF) ablation are frequently performed for secondary atrial tachycardias (AT). Predictors of AT recurrence after the first repeat ablation have not yet been studied. METHODS: We investigated predictors of AT recurrence in 117 patients who underwent ablation for secondary AT arising after a previous ablation for persistent AF using the Cox proportional hazards model. RESULTS: Acute ablation success rate was 94%. Over a follow-up period of 12 months, 61 patients (53%) were free from AT recurrence. Of the assessed predictors of AT recurrence, the number of ablated AT forms (>1 vs. 1) was significantly associated with AT recurrence (hazard ratio 2.01, 95% CI 1.18-3.43, P = 0.01). Other variables including left atrial diameter, AT mechanism, or the characteristics of previous AF ablation did not have significant influence on AT recurrence (P>0.05). Men had a tendency toward fewer AT recurrences than women (OR 0.60, 95% CI 0.34-1.05, P = 0.07). During a second AT ablation procedure, 19 (49%) patients were identified to have a recurrence of the previously ablated AT, whereas in 20 patients (51%) a new AT form was diagnosed. CONCLUSION: Ablation of atrial tachycardias following persistent AF ablation has a high acute success rate. However, a substantial number of patients develop new onset AT during follow-up. The occurrence of multiple AT forms during the repeat ablation procedure was the only predictive factor for AT recurrence.
Asunto(s)
Fibrilación Atrial/complicaciones , Fibrilación Atrial/terapia , Ablación por Catéter , Taquicardia Atrial Ectópica/etiología , Anciano , Función del Atrio Izquierdo , Supervivencia sin Enfermedad , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Venas Pulmonares , Recurrencia , Retratamiento , Caracteres SexualesRESUMEN
AIMS: Early atrial arrhythmia following atrial fibrillation (AF) ablation is associated with higher recurrence rates. Few studies explore the impact of early AF (EAF) and atrial tachycardia (EAT) on long-term outcomes. Furthermore, EAF/EAT have not been characterized after wide pulmonary vein isolation. We aimed to characterize EAF and EAT and its impact on late AF (LAF) and AT (LAT) after single ring isolation (SRI). METHODS AND RESULTS: We recruited 119 (females 21, age 58 ± 10 years) consecutive patients with AF (paroxysmal 76, persistent 43) undergoing SRI. Early atrial fibrillation/ early atrial tachycardia was defined as AF/AT within 3 months post-procedure (blanking period). Patients were followed for median 2.8[2.2-4] years. Early atrial fibrillation occurred in 28% (n = 33) and EAT in 25% (n = 30). At follow-up, 25% (n = 30) had LAF and 28% (n = 33) had LAT. Patients with EAF and EAT had higher rates of LAF (48 vs. 16%, P<0.0001) and LAT (60 vs. 16%, P < 0.0001), respectively. Independent predictors of LAF were EAF (3.53(1.72-7.29) P = 0.001); and of LAT were EAT (5.62(2.88-10.95) P < 0.0001) and procedure time (1.38/ h(1.07-1.78) P = 0.04). Importantly, EAF did not predict LAT and EAT did not predict LAF. Early atrial fibrillation late in the blanking period was associated with higher rates of LAF (73% for month 3 vs. 25% for Months 1-2, P = 0.004). However, EAT timing did not predict LAT. CONCLUSION: Early atrial fibrillation and EAT are predictive of LAF and LAT, respectively. Early atrial fibrillation late in the blanking period has greater predictive significance for LAF. This timing is not relevant for LAT. Early arrhythmia type and timing have important prognostic significance following SRI. CLINICAL TRIAL REGISTRATION: http://www.anzctr.org.au;ACTRN12606000467538.