ABSTRACT
Background : This study was conducted to compare the conventional retrograde arterial approach (RAA) with the transeptal approach (TSA) for radiofrequency catheter ablation (RFA) of left accessory pathways (AP). Materials and Methods: Sixty consecutive patients (44 male; mean age of 35.60 ± 11.63 years) with 60 left APs (39 overt and 21 concealed) underwent catheter ablation using the TS method (30 patients) and the RA method (30 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle. Results : The transeptal puncture was successfully performed in 29 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p = 0.103), fluoroscopy time (p = 0.565) and total time (p = 0.1917). Three patient in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.006) and smaller number of radiofrequency applications (p = 0.042) as compared to the conventional RAA. The patients who had unsuccessful ablation in the first session in each approach underwent with the opposite technique (cross-over), with a final ablation success rate of 100%. Conclusion : The TS and RA approaches showed similar efficacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the final efficacy of the ablation.
ABSTRACT
Introduction: Verapamil-sensitive, idiopathic left ventricular tachycardia (ILVT) with right bundle branch block configuration and left-axis deviation is known to be due to re-entry mechanism but the exact nature of reentrant circuit in ILVT is not fully elucidated. In this study we evaluate the results of long-term clinical outcome in patients who underwent radiofrequency catheter ablation of idiopathic fascicular ventricular tachycardia in National Institute of Cardiovascular Diseases. Methods: Electrophysiological studies and radiofrequency ablation were performed in 46 consecutive patients (42 men,04 women), age ranging from 16 to 36 years (mean 20±5 years) with verapamilsensitive ILVT and structurally normal hearts. VT could be terminated by the intravenous administration of verapamil in all patients. Mapping was performed using a Bard electrophysiology system. The target site for ablation was the mid-septum of left ventricle where the earliest Purkinje potentials were recorded during VT. RF current was applied to the target site with or without late diastolic potential during VT in all patients to meet the ablation endpoints which were termination of the VT and non-inducibility of the tachycardia. Results: All 46 patients had successful ablation of the ILVT. During 3 years follow up 02 patients had recurrence. Conclusion: Idiopathic left ventricle tachycardia occurs most commonly in young population. Prompt recognition of this arrhythmia is important since radiofrequency ablation can cure this rhythm problem. This can be achieved in a country like Bangladesh where resources are limited.
ABSTRACT
Objective: Recently; tubularized incised plate (TIP) urethroplasty (Snodgrass repair) has gained popularity for the primary repair of distal and proximal hypospadias. This study was carried out to evaluate TIP urethroplasty in the repair of failed and complicated hypospadias cases. Patients and Methods: This study was carried out in the pediatric surgery unit; Departments of General Surgery and Urology; Zagazig University Hospital. Twenty-four patients with failed and complicated hypospadias with an intact urethral plate were included in this work. Thirteen patients (54) were younger than 3 years; and 3 patients (13) older than 6 years. The original hypospadias was coronal in 4; midshaft in 11 and penoscrotal in 9 cases. Wide fistula was present in 8 cases (32) and dehiscence was found in 6 cases (26). Previous procedures included meatal advancement and glanuloplasty incorporated (MAGPI) in 5 (21) cases; Mathieu procedure in 4 (17); and preputial flaps in 13 (55) cases. Two patients (8) had been subjected to previous TIP urethroplasty. Twenty cases had had a single preceding procedure; while 4 cases had been subjected to two previous trials of correction. The time that had elapsed before re-operation was less than 6 months in 14 cases (58). Results: Fistula occurred in 3 cases; two of them had had preoperative fistula. Meatal and anastomotic strictures occurred in 2 cases each and were completely managed by dilatation for 3-6 months. Wound infection occurred in 5 cases. Good cosmetic and functional results were achieved in 15 cases (63). TIP urethroplasty was found to be suitable for re-operating previously failed hypospadias cases because it reconstructs the urethra entirely from the urethral plate which is the least affected part after all types of repair. Also; no relation was found between the morphology of the urethral plate and the success of TIP repair. Most of the cases had an intact urethral plate which had not been incised in the primary procedure. Further studies are needed to assess the possibility of using a urethral plate which was previously incised in a primary procedure. Conclusion: TIP urethroplasty could be a reasonable procedure in failed and complicated hypospadias cases. It provides good cosmetic and functional results and can be done using minimal residual tissues remaining after primary procedures