ABSTRACT
BACKGROUND: The precise reasons for failure to cannulate the coronary sinus during biventricular device implantation are unknown. Visualization of the coronary sinus ostium during electrophysiology procedures may enhance understanding of how unusual anatomy can affect successful cannulation of the coronary sinus. OBJECTIVES: The aim of this study was to describe the morphology of valves at the coronary sinus ostium (CSO) visualized directly with an illuminated fiberoptic endoscope during implantation of biventricular devices. METHODS: The coronary sinus anatomy of one hundred consecutive patients undergoing implantation of biventricular devices was investigated using a fiberoptic endocardial visualization catheter (EVC). RESULTS: The CSO was clearly visualized in 98 patients using the EVC. A Thebesian valve was seen in 54% of these. Almost all Thebesian valves were positioned at the inferior (61%) or posterior (33%) aspect of the CSO. Only six patients had Thebesian valves that covered more than 70% of the CSO, but all were successfully implanted with a transvenous left ventricular pacing lead after cannulating the coronary sinus under direct visualization. CONCLUSIONS: Over half of patients undergoing biventricular device implantation have identifiable Thebesian valves. Even valves covering the majority of the ostial area may be traversed using direct visualization and modern catheterization techniques.
Subject(s)
Angioscopes , Angioscopy/methods , Heart Failure/therapy , Heart Valves , Pacemaker, Artificial , Aged , Catheterization/instrumentation , Equipment Design , Female , Fiber Optic Technology , Humans , MaleSubject(s)
Bundle-Branch Block/complications , Bundle-Branch Block/diagnosis , Electrocardiography/methods , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/etiology , Bundle-Branch Block/therapy , Chronic Disease , Humans , Male , Middle Aged , Rare Diseases/complications , Rare Diseases/diagnosis , Rare Diseases/therapy , Tachycardia, Supraventricular/therapySubject(s)
Cardiac Pacing, Artificial , Cardiomyopathies/therapy , Defibrillators, Implantable/adverse effects , Tachycardia, Ventricular/physiopathology , Adult , Cardiomyopathies/physiopathology , Electrocardiography , Equipment Design , Heart Conduction System/physiopathology , Humans , Male , Tachycardia, Ventricular/etiologyABSTRACT
We present a case of a 44 year-old man with medically refractory symptomatic paroxysmal atrial fibrillation in whom the initial attempt at left atrial catheter ablation was complicated by coronary and cerebral arterial air embolization during transseptal catheter exchange. The manifestations, management, and long term outcomes are detailed. Following the case report is a review of published reports and contemporary management strategies for treatment of acute air embolization. Dramatic clinical consequences can be aborted by prompt intervention including volume loading, oxygenation, lidocaine, and hyperbaric oxygen therapy.
Subject(s)
Catheter Ablation/adverse effects , Electrophysiologic Techniques, Cardiac/adverse effects , Embolism, Air/etiology , Hyperbaric Oxygenation , Intracranial Embolism/etiology , Intraoperative Complications/therapy , Paresis/etiology , Paresis/therapy , Adult , Atrial Fibrillation/therapy , Electrophysiologic Techniques, Cardiac/methods , Embolism, Air/therapy , Humans , Intracranial Embolism/therapy , MaleSubject(s)
Coronary Vessel Anomalies/complications , Death, Sudden, Cardiac/prevention & control , Heart Arrest/etiology , Sports , Tachycardia, Ventricular/etiology , Adult , Cardiac Catheterization/methods , Coronary Angiography/methods , Coronary Artery Bypass/methods , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Electric Countershock , Electrocardiography/methods , Exercise Test/adverse effects , Heart Arrest/therapy , Humans , Male , Tachycardia, Ventricular/therapy , Tomography, X-Ray Computed/methodsABSTRACT
A 70-year-old woman presented with acute pancreatitis and new-onset QT prolongation with subsequent torsades de pointes. Coronary catheterization was performed and was unremarkable. After persistent QT prolongation, despite temporary atrial pacing, a permanent dual chamber cardioverter defibrillator was implanted. In addition to the QT prolongation, significant depression in the left ventricular function was noted. Both resolved once the pancreatitis abated.
