ABSTRACT
Objective To investigate the risk factors that may induce pneumothorax resulted from subclavian vein puncture during interventional therapy for arrhythmia.Methods The clinical data of 4 351 patients with heart disease,who were admitted to Wuhan Asia Heart Disease Hospital,China,during the period from January 2010 to January 2014 to receive subclavian vein puncture for the performance of radiofrequency catheter ablation or pacemaker implantation,were retrospectively analyzed.The gender,age,presence of chronic obstructive pulmonary disease (COPD) and the shape of clavicle of patients who developed pneumothorax were analyzed,and their relationships with the occurrence of pneumothorax were evaluated.Results Of the 4 351 patients,47 patients developed pneumothorax(1.08％),their age was 12-72 years old with a mean of (47.1±18.4) years old.Among the 47 patients,37 patients were females (78.7％).The angle between clavicle and sternum ＜60°(oblique clavicle) was seen in 27 patients,coexisting COPD was seen in 2 patients.The occurrence of pneumothorax was strikingly higher in females than that in males (OR=2.7,95％ CI=1.4-5.2).In patients with oblique clavicle the risk of pneumothorax was obviously increased (OR=3.5,95％ CI=1.6-7.9) and in patients with COPD the probability of pneumothorax was remarkably increased (OR=2.3,95％CI=1.2-4.7).No special treatment was employed in 5 pneumothorax patients,and the pneumothorax was absorbed by itself.In 19 patients,the pneumothorax was relieved through thoracic puncture and suction.Closed drainage of thoracic cavity was employed in 23 patients.All patients were discharged from hospital with complete rehabilitation.Conclusion Clinically,pneumothorax has been an important clinical problem in interventional therapy.In female patients and in patients who have oblique clavicle or coexisting COPD,pneumothorax is more likely to occur when they receive subclavian vein puncture.
ABSTRACT
Objective To investigate the electrophysiological characteristics of atrial tachycardia (AT) originating from the side of the bundle of His, and to analyze the efficacy and safety of transcatheter radiofrequency ablation via the right side of the bundle of His and left noncoronary sinus of aorta for the treatment of AT. Methods A total of 12 patients with AT originating from the side the bundle of His, which was confirmed by conventional electrophysiological study and atrial activation patterns, were included in this study. The patient’s age ranged from 12 to 64 years old with a mean of (47.4±14.6) years. The mapping was carried out at the right side of the bundle of His and radiofrequency ablation was performed. When the ablation procedure failed, or the junction zone rhythm or atrioventricular block occurred, ablation via the left noncoronary sinus of aorta was employed. Results Atrial stimulation could repeatedly induce and terminate AT in all the 12 patients, the average cycle length was (327±76) ms. TA was terminated within 10 seconds after the start of ablation in 10 patients during their AT attacks. Ablation was unsuccessful in 2 patients. Ablation via the right side of His bundle was successfully accomplished in 2 patients, and the ablation via the left noncoronary sinus of aorta was successfully carried out in 8 patients. The average follow-up time was 1-6 years, and no recurrence of AT was observed. Conclusion Atrial tachycardia originating from the side of the bundle of His has certain electrophysiological characteristics, and transcatheter radiofrequency ablation is safe and effective for its treatment. Ablation via the left noncoronary sinus of aorta should be considered as a strategy of priority.
ABSTRACT
ObjectiveTo study electrophysiological characteristics and catheter ablation left-sided accessory pathways of Mahaim fiber.MethodsTwenty-eight patients underwent catheter ablation for Mabaim fiber and 3 patients was left-sided accessory pathways.All of them were male with 34,20,38 years old.The tachycardia history was1-5years. Electrophysiological characteristics,target sitesand electrocardiogram(ECG,12 leads) were recorded through catheter from coronary sinus(CS),high right atrium(HRA),His bundle and ablation.ResultsOne patient's ECG showed little preexcitation,the other two were normal. Atrial stimulation could be easily induced tachycardia.Their ECG showed wide QRS waves (right bundle branch block or similar right bundle branch block).The characteristics of accessory pathways were slow and anterograde decremental conduction as well as blocked by adenosine triphosphate injection.Ventricular-atrial conduction was via atrioventricular node with centripetal decreasing transmission during ventricular pacing.During tachycardia,the His bundle electrogram resulted in a V-H-A pattern,the retrograde A in His bundle was pioneer.The atriofascicular pathways of 2 patients were completely ablated respectively in left posterior lateral and before the free wall of mitral valve ring.The nodoventricular pathway of 1 patient was successfully ablated in left middle posterior lateral of mitral valve ring.ConclusionsThe left-sided accessory pathways of Mahaim fiber is an uncommon accessory pathway,which has specific electrophysiological characteristics.It is effective and safe to ablate accessory pathway with radiofrequency.