Should all patients with unexplained paroxysmal palpitations undergo diagnostic electrophysiologic study [EPS]

This study was performed on 40 patients for the evaluation of palpitations. There were 17 patients with inappropriate sinus tachycardia diagnosed with an elevated resting heart rate and an exaggerated heart rate response to exercise in the absence of organic illness, they were excluded from the study. The other 23 patients [16 females and 7 males] were diagnosed as paroxysmal unexplained palpitations. All patients had careful history taking, cardiac exam and baseline labs including complete blood count and thyroid functions. Also, they had regular 12-lead ECG, echocardiography, 24-Holter monitoring and exercise test. All patients underwent baseline electrophysiologic studies in a drug- free state of anti- arrhythmic medicine. Atrial and ventricular stimulation protocol using up to three extrastimuli was done as well as using Isuprel infusion if no tachycardia was induced at baseline. The study concluded that palpitation is a common symptom that needs a careful work-up to assess the etiological diagnosis. Electrophysiological studies in these patients have a low yield and should be only considered in patients with documented sustained arrhythmia or highly suspicious for rhythm disorder

Anatomical distribution of manifest and concealed accessory pathways in the Egyptian population as documented by electrophysiologic studies

Patients with Wolff-Parkinson-White [WPW] syndrome [group 1] referred for the evaluation and ablation of drug refractory PSVT and patients with concealed accessory pathway [group 2] were included in this study. The anatomical site of accessory pathways [Ap] was classified into left lateral [LL], left posterior [LP], left posteroseptal [LPS], right posteroseptal [RPS], right midseptal [RMS], right anteroseptal [RAS] and right free wall [RL]. Multiple Aps defined as more than one Ap with at least 1 cm difference between each Ap. It was concluded that septal Aps are the most prevalent Ap in patients with WPW in the Egyptian population than LLAP. The latter is more frequent in patients with concealed Ap. This difference in the frequency of location of different Ap in Egyptian population vs the Western population might be due to the genetic etiology

Radiofrequency ablation of chronic atrial fibrillation in patients undergoing mitral valve surgery

In this study, 11 patients affected by rheumatic mitral valve disease and chronic atrial fibrillation underwent mitral valve surgery and radiofrequency [RF] ablation. The mean duration of atrial fibrillation [AF] was 3.6 +/- 1.2 years. A control group [no RF] included 11 patients underwent mitral valve surgery only during the same period. RF endocardial ablation was performed under temperature control after left atriotomy. RF pulses were delivered in order to obtain a circumferential isolation of each pulmonary vein alone without any additional lines. Firstly, all patients received a loading dose of amiodarone in the early postoperative period, followed by a maintenance dose of 200 mg/day for three months. It was concluded that circumferential isolation of each pulmonary vein [PV] in patients with chronic AF undergoing mitral valve surgery is a feasible, safe and effective procedure in restoring sinus rhythm [SR] at an average follow-up period of six months

Radiofrequency catheter ablation of septal accessory pathway: effect of selected mode on outcome

Forty patients with a single septal accessory pathway were included in this study and divided into two equal groups. Ablation for group I patients was done in the power controlled mode using the RF generator [3-D, Radioncics] that allows continuous measurements of current, voltage, power, time and impedance. Ablation for group II was done in the temperature controlled mode using the RF generator [3-E, Radioncics], where the power supply automatically modulates the amount of power delivered to that the tip temperature approaches, but does not exceed that selected temperature >5C. The initial target temperature was set at 70C. After ablation, patients of both groups were followed for three months. It was concluded that temperature monitoring incorporating closed loop feedback control is a valuable tool during RF ablation of septal accessory pathways as it provides important information regarding the adequacy of tissue heating, reduces the RF pulses application and prevents coagulum formation with a temperature of 70C, thus reducing the time of harmful radiation exposure as well as the procedure time