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1.
Card Electrophysiol Clin ; 12(3): 313-319, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32771185

RESUMO

Catheter ablation can effectively reduce the frequency of ventricular tachycardia in ischemic cardiomyopathy by ablating sites of reentry within complex regions of myocardial scar. In cases of near transmural infarction, this arrhythmia substrate may be nearer the epicardium than the endocardium, and epicardial ablation may be necessary. An epicardial substrate location can potentially be predicted by imaging that suggests transmural infarction. Percutaneous epicardial ablation improves outcomes in selected patients, but is higher risk and avoided in patients with prior coronary artery bypass grafting.

2.
J Cardiovasc Electrophysiol ; 30(10): 1994-2001, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31328298

RESUMO

INTRODUCTION: Subclinical atrial fibrillation (AF), in the form of cardiac implantable device-detected atrial high rate episodes (AHREs), has been associated with increased thromboembolism. An implantable cardioverter-defibrillator (ICD) lead with a floating atrial dipole may permit a single lead (DX) ICD system to detect AHREs. We sought to assess the utility of the DX ICD system for subclinical AF detection in patients, with a prospective multicenter, cohort-controlled trial. METHODS AND RESULTS: One hundred fifty patients without prior history of AF (age 59 ± 13 years; 108 [72%] male) were enrolled into the DX cohort and implanted with a Biotronik DX ICD system at eight centers. Age-, sex-, and left ventricular ejection fraction-matched single- and dual-chamber ICD cohorts were derived from a Cornell database and from the IMPACT trial, respectively. The primary endpoint were AHRE detection at 12 months. During median 12 months follow-up, AHREs were detected in 19 (13%) patients in the DX, 8 (5.3%) in the single-chamber, and 19 (13%) in the dual-chamber cohorts. The rate of AHRE detection was significantly higher in the DX cohort compared to the single-chamber cohort (P = .026), but not significantly different compared to the dual-chamber cohort. There were no inappropriate ICD therapies in the DX cohort. At 12 months, only 3.0% of patients in the DX cohort had sensed atrial amplitudes less than 1.0 mV. CONCLUSION: Use of a DX ICD lead allows subclinical AF detection with a single lead DX system that is superior to that of a conventional single-chamber ICD system.

3.
Pacing Clin Electrophysiol ; 42(7): 965-969, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31045260

RESUMO

BACKGROUND: Boston Scientific (Marlborough, MA, USA) implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) manufactured between 2008 and 2014 are potentially subject to premature battery depletion through a low-voltage capacitor malfunction occurring as a result of hydrogen buildup within the device. Although some of these devices are currently under advisory, other devices manufactured during this timeframe carry a lower risk of the same malfunction. These same devices are known to have superior longevity in general, and the overall mean lifespan of the devices remains long. METHODS: All patients implanted or followed at our two centers who experienced premature battery depletion and had a Boston Scientific ICD or CRT-D potentially at risk for low-voltage capacitor malfunction were studied retrospectively. RESULTS: Nineteen out of 838 patients (2.3%) with devices potentially at risk have had premature battery depletion: 5.7% of those under advisory and 1.1% of those not under advisory. None of our patients had compromised therapy, and all had >27 days of projected battery longevity remaining. CONCLUSIONS: Undetected premature battery depletion in this population of ICDs has the potential to expose a patient to an interval of time where the device is unable to provide therapy. However, with enrollment in remote monitoring, regular follow-up, and attention to audible alerts, the risk of therapy loss due to low-voltage state can be effectively mitigated. For these reasons, prophylactic generator replacement is not recommended.

4.
Cardiol Clin ; 37(2): 241-249, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926025

RESUMO

Atrial fibrillation is common in patients with congestive heart failure (CHF). Due to reduced left atrial appendage (LAA) emptying velocities and increased sludge formation, a higher rate of stroke and embolism are seen with CHF. Up to 50% of CHF patients are inadequately covered for stroke protection with anticoagulation, and, even while on therapy, CHF patients are at risk for failure to clear LAA or left ventricular (LV) thrombus. Device-based LAA closure (LAAC) alternatives exist. Following intracardiac device closure, an increased rate of device-related thrombus is seen in heart failure patients, which warrants further study to optimize LAAC benefits.


Assuntos
Anticoagulantes/uso terapêutico , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Ecocardiografia Transesofagiana/métodos , Insuficiência Cardíaca/terapia , Trombose/prevenção & controle , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Comorbidade , Saúde Global , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/prevenção & controle , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Prognóstico , Trombose/diagnóstico , Trombose/etiologia
8.
Heart Rhythm ; 15(1): 56-62, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28917558

RESUMO

BACKGROUND: Catheter ablation is now a mainstay of therapy for ventricular arrhythmias (VAs). However, there are scenarios where either physiological or anatomical factors make ablation less likely to be successful. OBJECTIVE: The purpose of this study was to demonstrate that cardiac sympathetic denervation (CSD) may be an alternate therapy for patients with difficult-to-ablate VAs. METHODS: We identified all patients referred for CSD at a single center for indications other than long QT syndrome and catecholaminergic polymorphic ventricular tachycardia who had failed catheter ablation. Medical records were reviewed for medical history, procedural details, and follow-up. RESULTS: Seven cases of CSD were identified in patients who had failed prior catheter ablation or had disease not amenable to ablation. All patients had VAs refractory to antiarrhythmic drugs, with a median arrhythmia burden of 1 episode of sustained VA per month. There were no acute complications of sympathectomy. One of 7 patients (14%) underwent heart transplant. No patient had sustained VA after sympathectomy at a median follow-up of 7 months. CONCLUSION: Because of anatomical and physiological constraints, many VAs remain refractory to catheter ablation and remain a significant challenge for the electrophysiologist. While CSD has been described as a therapy for long QT syndrome and catecholaminergic polymorphic ventricular tachycardia, data regarding its use in other cardiac conditions are sparse. This series illustrates that CSD may be a viable treatment option for patients with a variety of etiologies of VAs.


Assuntos
Ablação por Cateter/efeitos adversos , Gerenciamento Clínico , Eletrocardiografia , Simpatectomia/métodos , Taquicardia Ventricular/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/fisiopatologia , Toracoscopia , Falha de Tratamento , Resultado do Tratamento
11.
J Cardiovasc Electrophysiol ; 27(1): 120-4, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26511459

RESUMO

We present three cases within 11 months at a single institution of sustained VT that fell below the programmed detection rate of the patients' implantable cardioverter-defibrillators (ICDs), two of which continued until converting to an agonal VF that did not meet criteria for detection, and a third case that could not be successfully defibrillated after a prolonged period of VT. These episodes may be under-recognized due to the dependence of device diagnostic storage on programming and the post-mortem effort that is often required to review these events. Some patients, likely those with the most advanced heart failure, may not tolerate sustained ventricular tachycardia (VT) and may even die from ventricular arrhythmias without ever having a rhythm that meets detection criteria in a ventricular fibrillation (VF) zone.


Assuntos
Morte Súbita Cardíaca/etiologia , Cardioversão Elétrica/instrumentação , Taquicardia Ventricular/terapia , Idoso , Causas de Morte , Desfibriladores Implantáveis , Eletrocardiografia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Falha de Tratamento
12.
Circ Arrhythm Electrophysiol ; 6(1): 39-47, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23243191

RESUMO

BACKGROUND: One operative approach to the mitral valve, the superior transseptal incision, is proarrhythmic because of extensive atriotomies. The objective of this study is to describe complex atrial tachycardias (ATs) that occur after this approach and propose methods to verify lines of block as an end point for catheter ablation. METHODS AND RESULTS: Of the 69 patients who had electrophysiological studies for AT after mitral valve surgery, 20 patients had prior superior transseptal incisions. Of these, 14 had complex ATs involving the lateral right atrium (RA). There were 9 dual-loop, 4 single-loop, and 1 focal tachycardias. Lateral wall ablation was performed either by creating a linear lesion from the lateral atriotomy to the inferior vena cava, superior vena cava, or tricuspid annulus or by ablating focally in the lateral RA. After a single ablation procedure, conduction block in the lateral wall was verified in 10 of 14 patients using 1 of 2 distinct patterns of block. One pattern consisted of late activation in an anterolateral corridor of the RA, and a second pattern consisted of wide-spaced double potentials. Recurrent conduction through the lateral wall lesions was associated with intraprocedural and late recurrences of ATs. CONCLUSIONS: The optimal end point for ablating ATs after mitral valve surgery with the superior transseptal approach is to establish lines of block that can be recognized by characteristic patterns of activation in the lateral RA. A novel criterion for lateral conduction block after catheter ablation is identification of a late-activated corridor in the anterolateral RA.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ablação por Cateter , Bloqueio Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Taquicardia Supraventricular/cirurgia , Potenciais de Ação , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Distribuição de Qui-Quadrado , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/etiologia , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Imagens com Corantes Sensíveis à Voltagem
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