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1.
Heart Rhythm ; 19(5): 807-811, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35501106

RESUMO

BACKGROUND: Cardiac electrophysiology (EP) has few women physicians. OBJECTIVE: The purpose of this study was to determine temporal and geographical trends in the proportion of women EP operators in the United States. METHODS: We extracted data from the Medicare Provider Utilization and Payment Database from 2013 to 2019 using procedure codes for atrial fibrillation (AF) ablation, supraventricular tachycardia/atrial flutter (SVT/AFL) ablation, and cardiac device implantation. The Medicare Provider Utilization and Payment Database excludes operators who perform ≤10 procedures annually for a given individual procedure code. The proportion of women operators was compared across the 7-year period. RESULTS: On average annually between 2013 and 2019, 5% (n = 187) of the 3524 EP operators were women. Procedure-specific analyses demonstrated a similarly low proportion of women EP operators across each procedure type. Despite a 137% increase in the total number of AF ablationists over the 7-year period, the proportion of women remained unchanged (P = .3966). The number of SVT/AFL ablationists and device operators remained constant over time as did the proportion of women operators (P = .9709 and .3583, respectively). In 2019, 10 states (20%) had no women EP operators who performed >10 of any given EP procedure annually, 20 states (39%) had no women who performed >10 of either AF or SVT/AFL ablation procedures annually, and 10 states (20%) had no women device operators who performed >10 of any given type of device implantation annually. CONCLUSION: Women EP operators remain underrepresented, and the proportion of women is stagnant even in areas of major clinical growth such as AF ablation. One-fifth of states had no women operators who performed >10 of any given EP procedure annually.


Assuntos
Fibrilação Atrial , Flutter Atrial , Taquicardia Paroxística , Taquicardia Supraventricular , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Flutter Atrial/epidemiologia , Flutter Atrial/cirurgia , Eletrofisiologia Cardíaca , Feminino , Humanos , Masculino , Medicare , Taquicardia Supraventricular/cirurgia , Estados Unidos/epidemiologia
3.
J Int Med Res ; 50(3): 3000605221081727, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35264051

RESUMO

Ivabradine is an effective treatment for focal atrial tachycardia. However, it may also be effective for re-entrant atrial arrhythmia. An 85-year-old woman with a history of underlying ischaemic cardiomyopathy complained of worsening symptoms of heart failure because of rapid atrial tachycardia that was resistant to several rate-controlling drugs, but responded well to ivabradine. An electrophysiology study demonstrated a roof-dependent macro-re-entrant tachycardia of the left atrium. Linear ablation of the left atrial roof resulted in termination of the tachycardia. Thus, ivabradine can be an effective treatment for re-entrant atrial tachycardia.


Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Idoso de 80 Anos ou mais , Ablação por Cateter/métodos , Feminino , Frequência Cardíaca , Humanos , Ivabradina/farmacologia , Ivabradina/uso terapêutico , Taquicardia/tratamento farmacológico , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/tratamento farmacológico , Taquicardia Supraventricular/cirurgia
4.
BMC Cardiovasc Disord ; 22(1): 98, 2022 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-35282836

RESUMO

PURPOSE: The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy (ZF) catheter ablation (CA) for supraventricular tachycardias (SVT). METHODS: 584 consecutive patients referred to our institution for CA of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. The ZF group was further divided into two subgroups (adults and paediatric). Patient characteristics, procedural information, and follow-up data were compared. RESULTS: The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0%; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators' preferences. CONCLUSION: The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.


Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Adolescente , Adulto , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criança , Fluoroscopia , Humanos , Pessoa de Meia-Idade , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
J Cardiovasc Electrophysiol ; 33(5): 943-952, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35199408

RESUMO

INTRODUCTION: Atrial tachycardias (AT) in patients with congenital heart disease (CHD) are significantly contributing to morbidity and mortality. Aim of this study was to evaluate the long-term course of CHD patients requiring repeat ablation procedures (RAP) of AT. PATIENTS AND METHODS: All 144 patients with CHD who had undergone ablation of AT at our center between January 2003 and October 2018 were enrolled. Patients were classified according to the complexity of CHD: complex CHD (cCHD), moderate CHD (mCHD), and simple CHD (sCHD). RESULTS: A total of 101 RAP were performed in 64 patients. One RAP was performed in n = 40, two in n = 13, three in n = 10, and five in n = 1. Acute success rate was 82% (83/101) and was not associated with the complexity of CHD (p = 1.0). Number of procedures was lower in patients with sCHD than in patients with mCHD and cCHD (sCHD 1.3 ± 0.6, mCHD 1.8 ± 1.0, and cCHD 1.8 ± 1.1, p = .04). RAP were most frequent in patients after Fontan palliation or Atrial switch procedure (2.0 ± 1.1 [n = 41] vs. 1.6 ± 0.9 all others, p = .016) and in patients with multiple unstable AT's (2.5 ± 1.1 [n = 11] vs. 1.7 ± 1.0, p = .008). Major complications occurred in 4/101 procedures. Complete follow-up was available in 125 patients. Since last RAP 73% of the patients were in sinus/atrial rhythm and 34/125 patients (27%) with AT recurrence did not require re-ablation with mean follow-up of 52 ± 40 months. CONCLUSIONS: Recurrences after ablation of AT in CHD patients were frequent. After RAP promising long-term results could be achieved. Data encourage repetitive ablation procedures in this patient population.


Assuntos
Técnicas de Ablação , Ablação por Cateter , Técnica de Fontan , Cardiopatias Congênitas , Taquicardia Supraventricular , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia , Humanos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/cirurgia , Resultado do Tratamento
6.
BMC Cardiovasc Disord ; 22(1): 57, 2022 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-35172730

RESUMO

BACKGROUND: Left atrial roof-dependent tachycardias (LARTs) are common macroreentrant atrial tachycardias (ATs). We sought to characterize clinical LARTs using an ultra-high resolution mapping system. METHODS: This study included 22 consecutive LARTs in 21 patients who underwent AT mapping/ablation using Rhythmia systems. RESULTS: Three, 13, 4, and 2 LART patients were cardiac intervention naïve (Group-A), post-roof line ablation (Group-B), post-atrial fibrillation ablation without linear ablation (Group-C), and post-cardiac surgery (Group-D), respectively. The mean AT cycle length was 244 ± 43 ms. Coronary sinus activation was proximal-to-distal or distal-to-proximal in 16 (72.7%) ATs. The activation map revealed 13 (59.1%) clockwise and 9 (40.9%) counter-clockwise LARTs. A 12-lead synchronous isoelectric interval was observed in 10/19 (52.6%) LARTs. The slow conduction area was identified on the LA roof, anterior/septal wall, and posterior wall in 18, 6, and 2 ATs, respectively. Twenty concomitant ATs among 13 procedures were also eliminated, and peri-mitral AT coexisted in 7 of 9 non-group-B patients. In group-B, the conduction gap was predominantly located on the mid-roof. Sustained LARTs were terminated by a single application and linear ablation in 6 (27.3%) and 9 (40.9%), while converting to other ATs in 7 (31.8%) LARTs. Complete linear block was created without any complications in all, however, ablation at the mid-posterior wall was required to achieve block in 4 (18.2%) procedures. During 14.0 (6.5-28.5) months of follow-up, 17 (81.0%) and 19 (90.5%) patients were free from any atrial tachyarrhythmias after single and last procedures. CONCLUSIONS: The LART mechanisms were distinct in individual patients, and elimination of all concomitant ATs was required for the management.


Assuntos
Potenciais de Ação , Ablação por Cateter , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Átrios do Coração/cirurgia , Taquicardia Supraventricular/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Feminino , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
9.
Heart Vessels ; 37(5): 840-853, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34708268

RESUMO

Focal activation is believed to be an atrial fibrillation (AF) driver; however, little is known about whether all focal activations are necessary for AF persistence. The purpose of this study was to assess the electrical nature of focal activation and identify high-priority focal activations using a novel mapping system (CARTOFINDER). Thirty-five patients with persistent AF who underwent catheter ablation were assessed. Cycle length (CL) and CL standard deviation (CLSD) on unipolar recordings and voltage amplitude and electrogram morphologies on bipolar recordings were evaluated at all points of interest. The most frequent CL at each mapping site was defined as the dominant CL. We identified dominant focal activations (DFAs) that had a shorter dominant CL on the integrated CARTOFINDER map. The effect of elimination of DFAs on AF maintenance was assessed by the composite endpoint (termination to sinus rhythm, organization of the rhythm to atrial tachycardia, and AF CL slowing). In all, 450 focal activations were identified among 10,868 points, and 50.4% of focal activations were DFAs. Focal activations showed relatively long CL and regularity with short CLSD. Most focal activations showed an isoelectric baseline and were located outside of the fractionated electrogram area. Both DFAs and non-DFAs were typically observed in the normal voltage range. Elimination of DFAs was achieved in 19 (54.3%) patients, with a remarkable impact on AF maintenance (68.4% vs. 25.0%, p = 0.018). In conclusion, DFAs may play an important role in AF maintenance and could be an attractive therapeutic target for AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Taquicardia Supraventricular , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Técnicas Eletrofisiológicas Cardíacas , Humanos , Taquicardia Supraventricular/cirurgia , Resultado do Tratamento
10.
Pacing Clin Electrophysiol ; 45(1): 157-159, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34679213

RESUMO

Smartwatch allows easy detection of arrhythmia. Such an approach is widely used for detecting atrial fibrillation. However, there has been no consensus on the diagnostic power of smartwatch-detected supraventricular tachycardia (SVT). We reported three patients of SVT presenting with infrequent palpitations. Their SVTs were not documented with single-lead or standard ECG in hospital before, but only recorded by the single-lead ECG on smartwatches. Electrophysiological studies confirmed the mechanisms of these SVTs and led to successful catheter ablations. In conclusion, in patients with recurrent symptomatic tachycardia and a smartwatch-detected SVT, an electrophysiological study is indicated rather than to wait for a standard ECG for clinical decision. This approach might prevent the delay for successful treatment.


Assuntos
Ablação por Cateter , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/cirurgia , Dispositivos Eletrônicos Vestíveis , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade
12.
Herzschrittmacherther Elektrophysiol ; 33(1): 77-80, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34669032

RESUMO

Atrial arrhythmias after heart transplantation are common and usually originate from reentrant circuits inside the donor and recipient atria. A case is presented of macroreentrant atrial tachycardia with a reentry circuit incorporating preserved electrical conduction from the donor and recipient right atria. An invasive electrophysiological study including high-density electroanatomical mapping with a multipolar catheter was performed during tachycardia. A reentry circuit with an area of slow conduction at the supero-lateral aspect of the surgical anastomosis could be demonstrated. Catheter ablation at the site of slow conduction successfully terminated and permanently suppressed the tachycardia.


Assuntos
Ablação por Cateter , Transplante de Coração , Taquicardia Supraventricular , Ablação por Cateter/métodos , Átrios do Coração , Transplante de Coração/efeitos adversos , Humanos , Taquicardia/cirurgia , Taquicardia Supraventricular/cirurgia
13.
Heart Rhythm ; 19(2): 272-280, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34628040

RESUMO

BACKGROUND: Catheter ablation outcomes for adults with congenital heart disease (ACHD) are described, but recurrence mechanisms remain largely unknown. OBJECTIVE: The purpose of this study was to identify the electrophysiological characteristics of atrial tachycardia (AT) recurrence in ACHD. METHODS: ACHD atrial tachycardia procedures over a 10-year period were explored for AT or atrial fibrillation (AF) recurrence. RESULTS: At 299 procedures in 250 ACHD (mean age 39 ± 15 years; 130 [52%] male), 464 ATs (360 intra-atrial reentrant tachycardia, 104 focal AT; median 2 [IQR 1-3] ATs per procedure) were targeted. Complete (n = 256 [86%]) or partial (n = 37 [12%]) success was achieved in 98% of procedures. Over a median of 3.0 (IQR 1.4-5.3) years of follow-up, 67 patients (27%) developed AT/AF recurrence after the index procedure. Repeat vs index tachycardias were more often focal AT (26/69 [38%] vs 73/378 [19%]; P < .001), demonstrated longer cycle length (325 ms vs 280 ms; P = .003), required isoproterenol (34/69 [50%] vs 121/378 [32%]; P = .03), and involved the pulmonary venous atrium (PVA)/septum (26/69 [38%] vs 67/378 [18%]; P < .001). AF history (hazard ratio [HR] 2.0; interquartile range [IQR] 1.2-3.4; P = .01), incomplete success (HR 3.6; IQR 2.1-6.4; P < .001), and PVA substrate (HR 2.1; IQR 1.2-3.5; P = .006) were independently associated with AT/AF recurrence. With complete index procedure success and no AF history, 5-year actuarial freedom from AT/AF and AT alone were 77% and 80%. CONCLUSION: After catheter ablation in ACHD, repeat ATs were more frequently focal, required isoproterenol administration, or involved intra-atrial reentrant tachycardia within the PVA or atrial septum. Negative factors were partial success, index PVA substrate, and remote history of AF. These data support aggressive pharmacological provocation to eliminate all inducible tachycardias and coexisting PVA substrates at index procedures for ACHD.


Assuntos
Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Cardiopatias Congênitas/complicações , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgia , Agonistas Adrenérgicos beta/administração & dosagem , Adulto , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Isoproterenol/administração & dosagem , Masculino , Recidiva
14.
Pediatr Cardiol ; 43(1): 218-224, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34510237

RESUMO

Sudden cardiac arrest in pediatric patients is a rare occurrence. Supraventricular tachycardia without the presence of ventricular preexcitation in pediatric patients with a structurally normal heart is generally considered benign. Previous literature in adults reported a subset of patients in whom SVT was suspected to be the primary trigger of sudden cardiac arrest. We performed a single-center, retrospective cohort study of pediatric patients without known heart disease, 1-21 years of age, presenting with aborted SCA between 2009 and 2019. We collected diagnostic studies in all patients to identify the etiology of the aborted SCA. Thirty patients met the inclusion criteria. The median age at the time of SCA was 15.2 years. The etiology of SCA was identified in 23 (77%) patients. Of the seven patients with unknown diagnosis after initial diagnostic studies, three patients subsequently developed fast SVT that was presumed to be the etiology of the initial SCA. These three patients had varying diagnoses of atrioventricular nodal reentry tachycardia, ectopic atrial tachycardia, and a concealed accessory pathway with atrioventricular reentrant tachycardia. After ablation or medical treatment of the SVT substrate, no further tachyarrhythmias were observed. Pediatric patients presenting with an aborted SCA of unknown etiology ought to be considered for electrophysiology testing to elicit occult SVT substrates that may lead to a malignant ventricular tachyarrhythmia.


Assuntos
Ablação por Cateter , Taquicardia por Reentrada no Nó Atrioventricular , Taquicardia Supraventricular , Adulto , Criança , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Humanos , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/cirurgia
15.
Pacing Clin Electrophysiol ; 45(1): 50-58, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34792208

RESUMO

BACKGROUND: The Singapore Cardiac Databank was designed to monitor the performance and outcomes of catheter ablation. We investigated the outcomes of paroxysmal supraventricular tachycardia (PSVT)-ablation in a prospective, nationwide, cohort study. METHODS: Atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT), or atrial tachycardia (AT)-ablations in Singapore from 2010 to 2018 were studied. Outcomes include acute success, periprocedural-complications, postoperative pacing requirement, arrhythmic recurrence and 1-year all-cause mortality. RESULTS: Among 2260 patients (mean age 45 ± 18 years, 50% female, 57% AVNRT, 37% AVRT, 6% AT), overall acute success rates of PSVT-ablation was 98.4% and increased in order of AT, AVRT, and AVNRT (p < .001). Periprocedural cardiac tamponade occurred in two AVRT patients. A total of 15 pacemakers (6 within first 30-days, 9 after 30-days) were implanted (seven AV block, eight sinus node dysfunction [SND]), with the highest incidence of pacemaker implantation after AT-ablation (5% vs. 0.6% AVNRT vs. 0.1% AVRT, p < .001). Repeat ablations (0.9% AVNRT, 7% AVRT, 4% AT, p < .001) were performed in 78 (3.5%) patients and 13 (0.6%) patients died within a year of ablation. Among outcomes considered adjusting for age, sex, PSVT-type and procedure-time, AT was independently associated with 6-fold increased odds of total (adjusted odds ratio [AOR] 6.32, 95% confidence interval [CI] 1.95-20.53) and late (AOR 6.38, 95% CI 1.39-29.29) pacemaker implantation, while AVRT was associated with higher arrhythmic recurrence with repeat ablations (AOR 4.72, 95% CI 2.36-9.44) compared to AVNRT. CONCLUSIONS: Contemporary PSVT ablation is safe with high acute success rates. Long-term outcomes differed by nature of the PSVT.


Assuntos
Ablação por Cateter/métodos , Taquicardia Supraventricular/cirurgia , Estimulação Cardíaca Artificial/estatística & dados numéricos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Recidiva , Sistema de Registros , Singapura/epidemiologia , Taquicardia Supraventricular/epidemiologia , Taquicardia Supraventricular/mortalidade
16.
J Interv Card Electrophysiol ; 63(1): 39-47, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33515142

RESUMO

PURPOSE: Entrainment is a useful method for locating reentrant atrial tachycardia (AT) circuits, but alterations or termination of the AT can derail this process. We assessed whether resetting an upstream site of a neighboring electrode by a scanned extrastimulus at a downstream site (when the upstream tissue was refractory) could diagnose that site within the AT circuit. METHODS: The procedure was applied to 48 ATs with a cycle length (CL) of 238 ± 42 ms (26 common flutters, 8 perimitral flutters, 7 left atrial [LA] roof-dependent AT, 3 LA scar-related macroreentrant ATs, 2 pulmonary vein-gap reentry tachycardias, 1 right atrial scar-related macroreentrant AT, and 1 with an unidentified circuit). Entrainment and scanned extrastimulation were attempted at the cavotricuspid isthmus, LA roof, and mitral isthmus and/or critical AT isthmus. RESULTS: Within the circuit, the post-pacing interval minus the ATCL after entrainment was < 30 ms for all ATs and resetting of the AT cycle by ≥ 5 ms occurred in 94% of the ATs. No ATs were reset by extrastimulation outside the circuit. The positive predictive value of both maneuvers for locating the circuit was 100%, and the negative predictive value of the extrastimulation was similar to that of entrainment (96% vs. 100%, P = 0.25). The incidence of an AT alteration was lower with extrastimulation than with entrainment (1% vs. 9%, P = 0.01). For ATs with a CL < 210 ms, extrastimulation yielded a good diagnostic performance without any AT alterations. CONCLUSION: AT resetting by a scanned extrastimulus is diagnostic and avoids AT alterations.


Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Cateteres , Átrios do Coração/cirurgia , Humanos , Taquicardia , Taquicardia Supraventricular/diagnóstico por imagem , Taquicardia Supraventricular/cirurgia
17.
J Interv Card Electrophysiol ; 63(1): 29-37, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33506319

RESUMO

PURPOSE: Diagnosis of atrial tachycardia (AT) with 3D mapping system remains challenging due to fibrosis or previous ablation. This study aims to evaluate a new electroanatomical mapping annotation setting using a window of interest adjusted at the end of the P wave (WOIp wave) to identify the AT mechanism more accurately. METHODS: Twenty patients with successful ablation of left AT using navigation system CARTO3 were evaluated. Two maps for each patient were generated offline using either conventional settings of WOI (WOIconv.) or WOIp wave. Three investigators from two centres analysed the maps blindly. RESULTS: Mechanisms of AT were macroreentrant in 14/20 patients (70%) and focal in 6/20 (30%). WOIp wave resulted in a significant increase in the percentage of correct identification of the mechanism based on mapping alone (93.3 ± 13.7% vs 58.3 ± 33.9%; p = 0.0003) compared with WOIconv.. Diagnoses based on mapping were arrived at faster (27.8 ± 16.4 s vs 38.97 ± 13.64 s, respectively; p = 0.0231) and with a greater confidence in the diagnosis (confidence index 2.57 ± 0.45 vs 2.12 ± 0.45, respectively; p = 0.0024). With perimitral re-entry specifically "early meets late" was closer to the anatomical region of the mitral isthmus (15.9 ± 20.9 mm vs 48.77 ± 23.23 mm, respectively; p = 0.0028). CONCLUSIONS: This study found that electroanatomical mapping acquisition with a window of interest set at the end of the P wave improves the ability to diagnose the arrhythmia mechanism based on the initial map. It is particularly beneficial in identifying area of interest for ablation in perimitral AT.


Assuntos
Ablação por Cateter , Taquicardia Supraventricular , Átrios do Coração/cirurgia , Humanos , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/cirurgia
18.
Rev Esp Cardiol (Engl Ed) ; 75(2): 166-173, 2022 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33741288

RESUMO

INTRODUCTION AND OBJECTIVES: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. METHODS: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). RESULTS: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). CONCLUSIONS: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation.


Assuntos
Feixe Acessório Atrioventricular , Ablação por Cateter , Taquicardia Supraventricular , Criança , Feminino , Fluoroscopia , Humanos , Masculino , Taquicardia Supraventricular/cirurgia , Resultado do Tratamento
19.
Cardiol Young ; 32(3): 437-443, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34165064

RESUMO

INTRODUCTION: Accessory pathways are commonly seen due to delamination of tricuspid valve leaflets. In addition to accessory pathways, an enlarged right atrium due to tricuspid regurgitation and incisional scars creates substrates for atrial re-entries and ectopic tachycardia. We sought to describe our experience with catheter ablation in children with Ebstein's anomaly. METHODS AND RESULTS: During the study period, of 89 patients diagnosed with Ebstein's anomaly, 26 (30.9%) of them who underwent 33 ablation procedures were included in the study. Accessory pathways were observed in the majority of procedures (n = 27), whereas atrial flutter was observed in five, atrioventricular nodal reentrant tachycardia in five, and atrial tachycardia in two procedures. Accessory pathways were commonly localised in the right posteroseptal (n = 10 patients), right posterolateral (n = 14 patients), septal (n = two patients), and left posteroseptal (n = one patient) areas. Multiple accessory pathways and coexistent arrhythmia were observed in six procedures. All ablation attempts related to the accessory pathways were successful, but recurrence was observed in five (19%) of the ablations. Ablation for atrial flutter was performed in five patients; two of them were ablated successfully. One of the atrial tachycardia cases was ablated successfully. CONCLUSIONS: Ablation in patients with Ebstein's anomaly is challenging, and due to nature of the disease, it is not a rare occasion in this group of patients. Ablation of accessory pathways has high success, but also relatively high recurrence rates, whereas ablation of atrial arrhythmias has lower success rates, especially in operated patients.


Assuntos
Feixe Acessório Atrioventricular , Flutter Atrial , Ablação por Cateter , Anomalia de Ebstein , Taquicardia Supraventricular , Feixe Acessório Atrioventricular/cirurgia , Arritmias Cardíacas/complicações , Flutter Atrial/cirurgia , Ablação por Cateter/métodos , Criança , Anomalia de Ebstein/complicações , Anomalia de Ebstein/diagnóstico , Anomalia de Ebstein/cirurgia , Humanos , Taquicardia/cirurgia , Taquicardia Supraventricular/cirurgia
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