RÉSUMÉ
BACKGROUND: Since the early descriptions of large series of accessory atrioventricular pathway ablations in adults and adolescents over 20 years ago, there have been limited published reports based on more recent experiences of large referral centers. We aimed to characterize accessory pathway distribution and features in a large community-based population that influence ablation outcomes using a tiered approach to ablation. METHODS: Retrospective analysis of 289 patients (age 14-81) who underwent accessory ablation from 2015-2019 was performed. Pathways were categorized into anteroseptal, left freewall, posteroseptal, and right freewall locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters. RESULTS: Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. Accessory pathways were in left freewall (61.6%), posteroseptal (24.6%), right freewall (9.6%), and anteroseptal (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for left freewall pathways (97.1%) with lowest case times (144 ± 68 min) and fluoroscopy times (15 ± 19 min). Longest procedure time parameters were seen with anteroseptal, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. CONCLUSIONS: In this community-based adult and adolescent population, majority of the accessory pathways are in the left freewall and posteroseptal region and tend to be more easily ablated. A tiered approach with initial use of standard ablation equipment before the deployment of more advance tools, such as irrigated tips and 3D mapping, is cost effective without sacrificing overall efficacy.
Sujet(s)
Faisceau accessoire atrioventriculaire/chirurgie , Troubles du rythme cardiaque/chirurgie , Ablation par cathéter/tendances , Services de santé communautaires/tendances , Prestation intégrée de soins de santé/tendances , Types de pratiques des médecins/tendances , Irrigation thérapeutique/tendances , Faisceau accessoire atrioventriculaire/diagnostic , Faisceau accessoire atrioventriculaire/économie , Faisceau accessoire atrioventriculaire/physiopathologie , Potentiels d'action , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Troubles du rythme cardiaque/diagnostic , Troubles du rythme cardiaque/économie , Troubles du rythme cardiaque/physiopathologie , Ablation par cathéter/effets indésirables , Ablation par cathéter/économie , Prise de décision clinique , Services de santé communautaires/économie , Analyse coût-bénéfice , Prestation intégrée de soins de santé/économie , Femelle , Coûts des soins de santé/tendances , Rythme cardiaque , Humains , Mâle , Adulte d'âge moyen , Durée opératoire , Types de pratiques des médecins/économie , Études rétrospectives , Irrigation thérapeutique/effets indésirables , Irrigation thérapeutique/économie , Facteurs temps , Résultat thérapeutique , Jeune adulteRÉSUMÉ
Pain remains a tremendous burden on patients and for the health care system, with uncontrolled pain being the leading cause of disability in this country. There are a variety of medications that can be used in the treatment of pain, including ketorolac, oxymorphone, tapentadol, and tramadol. Depending on the clinical situation, these drugs can be used as monotherapy or in conjunction with other types of medications in a multimodal approach. A strong appreciation of pharmacologic properties of these agents and potential side effects is warranted for clinicians.