Efficacy and safety of zero-fluoroscopy approach for ablation of atrioventricular nodal reentry tachycardia: experience from more than 1000 cases.

BACKGROUND: Radiofrequency catheter ablation (RFCA) of the slow pathway in atrioventricular nodal reentry tachycardia (AVNRT) is associated with high efficacy and low risk of total perioperative or late atrioventricular block. This study aimed to evaluate the efficacy, safety, and feasibility of slow-pathway RFCA for AVNRT using a zero-fluoroscopy approach. METHODS: Data were obtained from a prospective multicenter registry of catheter ablation from January 2012 to February 2018. Consecutive unselected patients with the final diagnosis of AVNRT were recruited. Electrophysiological and 3-dimensional (3D) electroanatomical mapping systems were used to create 3D maps and to navigate only 2 catheters from the femoral access. Acute procedural efficacy was evaluated using the isoproterenol and/or atropine test, with 15-min observation after ablation. Each case of recurrence or complication was consulted at an outpatient clinic during long-term follow-up. RESULTS: Of the 1032 procedures, 1007 (97.5%) were completed without fluoroscopy. Conversion to fluoroscopy was required in 25 patients (2.5%), mainly due to an atypical location of the coronary sinus (n = 7) and catheter instability (n = 7). The mean radiation exposure time was 1.95 ± 1.3 min for these cases. The mean fluoroscopy time for the entire study cohort was 0.05 ± 0.4 min. The mean total procedure time was 44.8 ± 18.6 min. There were no significant in-hospital complications. The total success rate was 96.1% (n = 992), and the recurrence rate was 3.9% (n = 40). CONCLUSION: Slow-pathway RFCA can be safely performed without fluoroscopy, with a minimal risk of complications and a high success rate.

Association between the geographic region and the risk of familial atrioventricular nodal reentrant tachycardia in the Polish population.

Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common regular supraventricular arrhythmias referred for catheter ablation (CA). In Poland, several families with familial AVNRT (FAVNRT) were reported in Podkarpacie Province (PP). Objectives: We aimed to determine the frequency of FAVNRT in PP compared with other south-eastern provinces of Poland. Patients and methods: Clinical data of 1544 patients with AVNRT diagnosed by invasive electrophysiological study between 2010 and 2019 were screened for FAVNRT. From January 2017 to June 2019, patients were asked to provide details on family history and origin to obtain 3-generation pedigrees. Families with at least 2 members with previous CA of AVNRT were divided into those from south-eastern provinces (SEPs; including PP and bordering provinces [BPs]) and the remaining parts of Poland (RPP). Results: There were 932 patients from SEPs and 612 from RPP. FAVNRT was reported in 45 patients (2.91%) from 27 families, with a higher frequency in SEPs than RPP (4.02% vs 1.17%; P = 0.002) and the highest frequency in PP (6.33% vs 2.47% in BPs; P = 0.004). The risk of FAVNRT was higher in PP compared with BPs (odds ratio, 2.67; 95% CI, 1.36­5.23; P = 0.004) and similar in BPs compared with RPP (odds ratio, 2.14; 95% CI, 0.86­5.34; P = 0.1). Conclusions: A relationship exists between the geographic region and frequency of FAVNRT. A greater distance from PP was associated with less frequent FAVNRT. International cooperation and genetic testing are needed to confirm the genetic impact of FAVNRT in this part of Central Europe.

Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach.

Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without fluoroscopy (No-X-Ray [NXR]). The aim of this study was to evaluate the feasibility and effectiveness of CTI RFCA during implementation of the NXR approach and the maximum voltage-guided (MVG) technique for ablation of AFL.Data were obtained from prospective standardized multicenter ablation registry. Consecutive patients with the first RFCA for CTI-dependent AFL were recruited. Two navigation approaches (NXR and fluoroscopy based as low as reasonable achievable [ALARA]) and 2 mapping and ablation techniques (MVG and pull-back technique [PBT]) were assessed. NXR + MVG (n  =  164; age: 63.7 ±â€Š9.5; 30% women), NXR + PBT (n  =  55; age: 63.9 ±â€Š10.7; 39% women); ALARA + MVG (n  =  36; age: 64.2 ±â€Š9.6; 39% women); and ALARA + PBT (n  =  205; age: 64.7 ±â€Š9.1; 30% women) were compared, respectively. All groups were simplified with a 2-catheter femoral approach using 8-mm gold tip catheters (Osypka AG, Germany or Biotronik, Germany) with 15 min of observation. The MVG technique was performed using step-by-step application by mapping the largest atrial signals within the CTI.Bidirectional block in CTI was achieved in 99% of all patients (P  =  NS, between groups). In NXR + MVG and NXR + PBT groups, the procedure time decreased (45.4 ±â€Š17.6 and 47.2 ±â€Š15.7 min vs. 52.6 ±â€Š23.7 and 59.8 ±â€Š24.0 min, P < .01) as compared to ALARA + MVG and ALARA + PBT subgroups. In NXR + MVG and NXR + PBT groups, 91% and 98% of the procedures were performed with complete elimination of fluoroscopy. The NXR approach was associated with a significant reduction in fluoroscopy exposure (from 0.2 ±â€Š1.1 [NXR + PBT] and 0.3 ±â€Š1.6 [NXR + MVG] to 7.7 ±â€Š6.0 min [ALARA + MVG] and 9.1 ±â€Š7.2 min [ALARA + PBT], P < .001). The total application time significantly decreased in the MVG technique subgroup both in NXR and ALARA (P < .01). No major complications were observed in either groups.Complete elimination of fluoroscopy is feasible, safe, and effective during RFCA of CTI in almost all AFL patients without cardiac implanted electronic devices. The most optimal method for RFCA of CTI-dependent AFL seems to be MVG; however, it required validation of optimal RFCA's parameters with clinical follow-up.

Sepsis and multiorgan failure following TVT procedure.

Tension-free vaginal tape (TVT), is a commonly performed, low risk procedure for treatment of stress urinary incontinence (SUI). Severe complications are rare, but can be potentially life threatening. We present a case of 66 year old patient who sustained bladder perforation at the time of TVT procedure and subsequently developed sepsis rapidly leading to multi-organ failure and triggering sequence of serious complications. During her inpatient stay she required ITU admission, emergency laparotomy, TVT mesh removal, bowel resection due to ischemic colitis and anticoagulation for pulmonary embolism. Despite of clinical picture of sepsis her microbiology tests were almost consistently negative. This case emphasise importance of awareness and quick recognition of TVT related complications. Patient ultimately survived and recovered thanks to timely and coordinated management by the multidisciplinary team of doctors.

Infertility information on the World Wide Web: a cross-sectional survey of quality of infertility information on the internet in the UK.

BACKGROUND: The internet is a frequently used source of information for infertile couples. Previous studies suggested that the quality of health information on the internet is poor. The aim of this study was to assess the quality of websites providing information on infertility and its management in the UK. Differences between website types and affiliations were assessed. METHODS: A Google search for the keyword 'infertility' was performed and 107 relevant websites were identified and categorized by type. Websites were assessed for credibility, accuracy and ease of navigation using predefined criteria. RESULTS: The total scores for all types of websites were low, particularly in the accuracy category. Websites affiliated to the UK National Health Service (NHS) scored higher than those affiliated to private fertility clinics and other clinics providing non-conventional fertility treatment. Specifically, NHS websites were more likely to report success rates (92.9% versus 60% and 0%, P < or = 0.05) and display information about their sources of funding (85.7% versus 15% and 14.8%, P < or = 0.0001). CONCLUSIONS: Internet resources available to infertile patients are variable. Differences in the quality of infertility information exist between the different types of websites.