RESUMO
BACKGROUND: The impact of contact force (CF) monitoring in pulmonary vein (PV) isolation after a circumferential anatomic ablation (CAA) is unknown. We analyze the usefulness of CF monitoring in acute PV isolation and procedure parameters using a CAA. METHODS: Fifty patients with paroxysmal atrial fibrillation were randomized into CF-on (CF >10 grams; n = 25) or CF-off (CF blinded; n = 25) groups. We performed a first round of CAA with a ThermoCool(®) SmartTouch(®) catheter blinded to the LASSO(®) catheter (Biosense Webster, Diamond Bar, CA, USA), with radiofrequency (RF) lesions tagged with the VisiTag(™) Module. After the CAA, each PV was reviewed with the LASSO(®) catheter recording the segments with gaps. RESULTS: All the PVs were isolated with a CAA in 20 patients of the CF-on versus eight of the CF-off (P = 0.001). Of the 45 segments with gaps in the left PVs, 38 were from the CF-off (P = 0.0001). Of the eight segments with gaps in the right PVs, seven were from the CF-off (P = 0.06). The CF in the left PVs was higher in the CF-on (16.3 ± 3.2 grams vs 10.5 ± 4.3 grams; P = 0.0001) and similar in the right PVs (17.6 ± 3.6 grams vs 15.2 ± 5.3 grams; P = 0.08). All of the gaps were closed with additional RF LASSO(®) -guided touch-up. Procedure and fluoroscopy times were shorter in the CF-on (139 ± 24 minutes vs 157 ± 32 minutes and 20 ± 6 minutes vs 24 ± 7 minutes; both P = 0.039). At 12 months the patients free of AF recurrence was 84% CF-on versus 75% CF-off (log-rank P = 0.4) [corrected]. CONCLUSIONS: In paroxysmal atrial fibrillation, a CAA guided by CF reduces PV gaps and shortens the procedure parameters at the expense of the left PVs.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/instrumentação , Ablação por Cateter/métodos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Adolescente , Adulto , Idoso , Fibrilação Atrial/patologia , Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/instrumentação , Desenho de Equipamento , Feminino , Sistema de Condução Cardíaco/patologia , Sistema de Condução Cardíaco/cirurgia , Humanos , Masculino , Sistemas Homem-Máquina , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Monitorização Intraoperatória/métodos , Veias Pulmonares/patologia , Estresse Mecânico , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Adulto JovemRESUMO
Aunque la presencia de foramen oval permanente es una patología relativamente frecuente, la presencia de embolia paradójica es un cuadro clínico poco frecuente y constituye menos del 2% de las isquemias arteriales. Presentamos el caso de un varón de 55 años diagnosticado de tromboembolismo pulmonar masivo y embolia paradójica en el miembro superior derecho, secundario a foramen oval permeable. Además, pondremos de manifiesto algunas incertidumbres en cuanto al diagnóstico y tratamiento de los pacientes con embolia paradójica
Although patent foramen ovale is a relatively common disease, the presence of paradoxical embolismis a rare clinical condition, representing less than 2% of arterial ischemias. We report the case of a 55-year-old male diagnosed with massive pulmonary embolism and paradoxical embolism in the right arm, secondary to patent foramen ovale. We also highlight some uncertainties in the diagnosis and treatment of patients with paradoxical embolism
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Paradoxal/complicações , Forame Oval Patente/complicações , Fatores de RiscoRESUMO
Although patent foramen ovale is a relatively common disease, the presence of paradoxical embolism is a rare clinical condition, representing less than 2% of arterial ischemias. We report the case of a 55-year-old male diagnosed with massive pulmonary embolism and paradoxical embolism in the right arm, secondary to patent foramen ovale. We also highlight some uncertainties in the diagnosis and treatment of patients with paradoxical embolism.
