ABSTRACT
OBJECTIVES: The aim of this study was to investigate the prevalence and severity of left atrial (LA) edema after pulmonary vein (PV) ablation and its effect on the cardiac function. BACKGROUND: Though extensive LA catheter ablation has been demonstrated to be more effective in curing paroxysmal atrial fibrillation (PAF) than segmental ostial pulmonary vein isolation (S-PVI), it might cause life-threatening complications, including congestive heart failure associated with LA edema. METHODS: Fifty patients underwent S-PVI (Group S) and 27 underwent circumferential PV antrum ablation (Group C) for drug-refractory PAF. Enhanced electron beam tomography (EBT) was performed before, 1 or 2 days after, and 1 month after the PV ablation, and transthoracic ultrasound cardiography (UCG) was performed 1 month after the PV ablation in all patients. RESULTS: The EBT assessment revealed LA edema immediately after the PV ablation in 47 Group S patients and all Group C patients. The severity of the LA edema, number of radiofrequency applications, and amount of radiofrequency energy delivered during the PV ablation was significantly greater in Group C than in Group S. One month after the PV ablation, in all patients, the EBT assessment revealed that those edematous changes had disappeared, and the UCG assessment showed no reduction in the cardiac function. CONCLUSIONS: Left atrial edema was observed in a large portion of the patients immediately after the PV ablation, and the severity of the LA edema depended on the extent and amount of the radiofrequency energy delivered in the PV ablation. The LA edema soon disappeared naturally and did not reduce the cardiac function.
Subject(s)
Catheter Ablation , Edema, Cardiac/diagnosis , Edema, Cardiac/epidemiology , Heart Atria , Pulmonary Veins/surgery , Tomography, X-Ray Computed , Atrial Fibrillation/surgery , Edema, Cardiac/diagnostic imaging , Female , Humans , Male , Middle Aged , Prevalence , Severity of Illness Index , Time Factors , UltrasonographyABSTRACT
We report a case of polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) storm associated with ischemic cardiomyopathy (ICM). The electrocardiogram (ECG) monitor revealed frequent premature ventricular contractions (PVCs) initiated PVT/VF. Electroanatomic mapping revealed the plausible origins of PVCs were located in the scar border zone at the posterior septum of the left ventricle. Purkinje-like potentials (PLPs) always preceded PVCs and a decremental property for the PLPs and infarcted myocardium junction was observed. Ablation at these sites eliminated both PVCs and PVT/VF.
