ABSTRACT
Usando el mapeo espectral endocárdio en ritmo sinusal nosotros podemos definir dos tipos de miocardio auricular: el fibrilar con espectro segmentado hacia la derecha - llamado Nido-FA (NFA) - y el compacto con espectro no segmentado hacia la izquierda. Al inducir FA nosotros hemos observado constantemente activación muy desorganizada sobre los Nidos-FA [tejido resonante reactivo] mientras el compacto mantiene una activación bien regular [ tejido pasivo]. Ambos son activados por una taquicardia protegida de alta frecuencia "Taquicardia de Background" (TB). Describir el tratamiento de la FA a través de la ablación - RF de los Nidos-FA y la TB. 92 p (76 H, 52,4 ± 11 a) con FA refractaria muy frecuente, 56 paroxístina, 25 persistente, 11 permanente sin cardiopatía significativa (AI 41, 9 ± 5mm). 1- Ablación- RF con catéter de los NFA [4/8 mm-60°/30-40J/30s] guiado por mapeo espectral en ritmo sinusal fuera de las venas pulmonares (VP); 2- Estimulación auricular (300 ppm); 3- Adicional ablación de los NFA cuando era inducida FA; 4- Ablación de TB focal o Flutter cuando eran inducidos; 4 - Seguimiento Clínico SC (EKG/Holter). Una media de 50 ± 18 nidos-FA / p fueron tratados. Después de SC 0 11,3 ± 8 meses 81p (88%) no tenía FA (28,3 % previamente utilizaban drogas AA no eficaces). Después de ablación los NFA: fue imposible reinducir FA en 61p (71 %); en 31p (29%) solo FA no sostenida (< 10s) fue inducida; TB fue inducida y tratada en 24p (26%). Dos derrames pericárdicos ocurrieron (tratada en 24p (26%). Dos derrames pericárdicos ocurrieron (tratada en 24p (26%). Dos derrames pericárdicos ocurrieron (tratados 1 clínicamente y 1 quirúrgicamente) descrito utilizando una específica y no más usada vaina. El mapeo espectral de los Nidos - FA fue fácil de hallar y ablacionar; Durante la FA los Nidos _ FA juegan un papel resonante reactivo mientras el compacto juega un papel pasivo, uno o ambos son activados por la TB de elevada frecuencia; Después de la ablación de los...
Using endocardial spectral mapping in sinus rhythm we found two kinds of atrial myocardium: fibrillar with a rightward - segmented spectrum - named AF - Nest (AFN) - and compact with a leftward non - segmented spectrum. Inducing AF we have consistently observed very highly disorganized activation only in the AF - Nest [reactive resonant tissue] while the compact myocardium maintains well - organized, predominantly regular activation [passive tissue]. Both are activated by a high frequency protected tachycardia "Background Tachycardia" (BT). To describe treatment of AF by AF - Nests and BT catheter RF - ablation. 92 (76 males, 52.4 ± 11 y) with very frequent refractory AF, paroxysmal in 56, persistent in 25, and permanent in 11 without any significant cardiopathy (LA 41. 9 ± 5mm). 1 - AFN Catheter RF ablation [4/8mm - 60°/30-40J/30s] guided by spectral mapping in sinus rhythm outside the pulmonary veins (PV); 2 - Atrial stimulation (300ppm); 3 - AFN additional ablation if AF induced; 4 - BT focal or flutter ablation if induced; 4 - Clinical FU (EKG/Holter). A mean of 50 ± 18 AF nests/person were treated. After 11. 3 ± 8 months of follow up, 81 (88%) patients had no AF (28. 3 % previously on no effective AA drugs). After AFN ablations, it Was not possible to reinduce AF in 61 (71%) cases. In 31 patients (29 %) only non - sustained AF (< 10s) was induced; BT was induced and treated in 24 patientns (26%). Two pericardial effusions occurred (1 clinically and 1 surgically treated) related to an isolated cause and the other to a sheath no longer in use. Using spectral mapping, AF - Nests were easily found and ablated. During AF - Nests play a reactive resonant role while the compact myocardium plays a passive one, both activated by the high frequency BT. After AF - nest and BT ablations it was not possible to reinduce sustained AF; AF - nest and BT ablation around the PV is safe, feasible and very efficient for the cure or control of AF.
Subject(s)
Humans , Male , Female , Atrial Function , Catheter Ablation/methods , Arrhythmias, Cardiac/physiopathology , Atrial Fibrillation/diagnosis , Atrial Fibrillation/radiotherapy , CardiologyABSTRACT
FUNDAMENTO: Através de mapeamento espectral-(ME) endocárdico em ritmo sinusal, observam-se dois tipos de miocárdio atrial: o compacto de espectro liso e o fibrilar de espectro segmentado ("Ninho de FA" [NFA]). Durante a FA o compacto tem ativação organizada e baixa freqüência (passivo) enquanto o fibrilar apresenta ativação bastante desorganizada e alta freqüência (ativo/ressonante) sendo ambos ativados por uma taquicardia protegida de alta freqüência, taquicardia de background (TB). OBJETIVO: Descrever o tratamento da FA pela ablação dos NFA e da TB. MÉTODOS: 1) Ablação por cateter-RF [4/8mm-60°/30-40J/30s] dos NFA guiada por ME em ritmo sinusal, fora das veias pulmonares; 2) Estimulação atrial-300ppm; 3) Ablação adicional de NFA se induzida FA; 4) Ablação focal se induzida TB e/ou Flutter; 5) Seguimento clínico+ECG+Holter. RESULTADOS: Foram tratados 50±18 NFA/paciente. Após 11,3±8m 81p (88 por cento) estavam sem FA (28,3 por cento com antiarrítmico). Após a ablação dos NFA: a FA não foi reinduzida em 61p(71 por cento); TB foi induzida e tratada em 24p(26 por cento). Ocorreram 2 sangramentos pericárdicos (1 tratado clinicamente e 1 cirurgicamente) ocasionados por bainhas não mais utilizadas. CONCLUSÃO: O ME em ritmo sinusal ablaciona os NFA. Durante a FA os NFA apresentam um padrão reativo-ressonante e o miocárdio compacto apresenta-se passivo, estimulados pela alta freqüência da TB. Após a ablação dos NFA e da TB não foi possível reinduzir FA sustentada. A ablação dos NFA fora das VP se mostrou segura e altamente eficiente para a cura e/ou o controle clínico da FA.
BACKGROUND: Two types of myocardia can be observed through the endocardial spectral mapping (SM) in sinus rhythm: the compact type with a smooth spectrum and the fibrillar type with a segmented spectrum (atrial fibrillation nests). During the atrial fibrillation (AF), the compact type has an organized activation and low frequency (passive), whereas the fibrillar type has a rather disorganized activation and high frequency (active/resonant), with both being activated by high-frequency sustained tachycardia - the background tachycardia (BT). OBJECTIVE: To describe the treatment of AF by the ablation of the AF nests and BT. METHODS: 1) Catheter ablation of the AF nests with RF [4/8mm-60°/30-40J/30s] guided by SM in sinus rhythm, outside the pulmonary vein; 2) atrial stimulation -300ppm; 3) Additional ablation of the AF nests if AF is induced; 4) Focal ablation if BT and/or Flutter is induced; 5)Clinical follow-up+ ECG+ Holter. RESULTS: A total of 50±18 AF nests/patient were treated. After 11.3±8m, 81 patients (88 percent) did not present AF (28.3 percent with antiarrhythmic drugs). After the ablation of the AF nests, AF was not reinduced in 61 patients (71 percent) and BT was induced and treated in 24 patients (26 percent). There were two episodes of pericardial bleeding (1 treated clinically and 1 surgically), caused by sheaths that are no longer used CONCLUSION: The SM in sinus rhythm can be used in the ablation of AF nests. During the AF, the AF nests present a reactive-resonant pattern and the compact myocardium is passive, stimulated by the high frequency of the BT. After the ablation of the AF nests and the BT, it was not possible to reinduce the sustained AF. The Ablation of AF nests outside the pulmonary veins showed to be safe and highly effective in the cure and/or clinical control of the AF.
Subject(s)
Female , Humans , Male , Middle Aged , Atrial Fibrillation/surgery , Catheter Ablation/methods , Tachycardia/surgery , Atrial Fibrillation/physiopathology , Catheter Ablation/adverse effects , Catheter Ablation/standards , Electrocardiography , Electrophysiologic Techniques, Cardiac , Follow-Up Studies , Pulmonary Veins/surgery , Tachycardia/physiopathologyABSTRACT
Arritmias cardíacas de algum tipo ocorrem entre 10 por cento e 30 por cento nos exames de Holter nas crianças. Podem ser assintomáticas e benignas, porém em muitos casos produzem sintomas incapacitantes e risco de morte súbita. Frequentemente estão relacionadas a cardiopatias congênitas ou a cirurgias de correção, assim como à presença de feixes ou vias anômalas ou a cardiopatias adquiridas. A ablação por cateter por meio de radiofrequência mudou a história natural de muitas arritmias pediátricas, permitindo a cura definitiva na maioria dos casos. Adicionalmente, marcapassos especiais, desfibriladores e ressincronizadores estão cada vez mais estendendo seus benefícios ao pequeno paciente. Análises clínicas e laboratoriais...