RESUMO
BACKGROUND: The aim of this study was to evaluate the long-term success rates of pulmonary vein isolation (PVI) using only first-generation cryoballoon (CB-1) and second-generation CB (CB-2) in patients with paroxysmal atrial fibrillation (PAF). PATIENTS AND METHODS: A total of 114 drug-refractory patients with PAF (mean age: 62 ± 10 years; 62.3 % males) were enrolled. All index ablation procedures were performed using a 28-mm CB. All patients were scheduled for outpatient clinic visits, followed by 24-h or 7day Holter electrocardiogram (EGC) evaluation. RESULTS: All PVs in the CB-1 group and 367 of 368 (99.7 %) PVs in the CB-2 group were completely isolated during the index procedure. The most commonly observed complication was phrenic nerve palsy in four (4.3 %) patients with CB-2. The mean follow-up period for CB-1 and CB-2 was 33.4 ± 14.9 and 27.2 ± 10.6 months, respectively. Freedom from AF was 42.9 % for CB-1 and 74.2 % for CB-2 at the end of the follow-up period. The European Heart Rhythm Association score improved in patients without AF recurrence after the procedure (2.8 ± 0.4 vs. 1.2 ± 0.5, p < 0.001), whereas no significant improvement was observed in the symptomatic status of patients with recurrence (2.8 ± 0.4 vs. 2.2 ± 0.9, p = 0.149). CONCLUSION: Second-generation CB provided significantly better clinical outcomes than its predecessor and was associated with low peri- and postprocedural complications.
Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/instrumentação , Criocirurgia/instrumentação , Veias Pulmonares/cirurgia , Paralisia Respiratória/prevenção & controle , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia Respiratória/etiologia , Resultado do TratamentoRESUMO
Cardiac resynchronization therapy by multisite biventricular pacing presents an additive therapeutic option in the treatment of severe heart failure. Biventricular pacemaker implantation is challenging in patients with persistent left superior vena cava. We describe in this case report the implantation of a biventricular pacemaker using a left-sided approach in a patient with persistent left superior vena cava.