Transseptal approach for ablation of left sided pathways

To highlight our experience of transseptal approach for arrhythmias for the left side pathways. Electrophysiology [EP] studies and ablation conducted in electrophysiology laboratory Lady Reading Hospital Peshawar from September 2006 to May 2009. The study was conducted on Bard EP Lab, Bloom stimulator and Cordes EP shuttle. After explaining the procedure to the patient, beta- blockers were stopped 5 days and patients were fasted for six hours before the procedure. Five standard wires passed two from left femoral that is for coronary sinus and His and three from right femoral side that is for high right atrium, right ventricle and ablation. Pigtail catheter was placed in aortic root from left femoral artery. Septal puncture was done in the left lateral projection. Ablation catheter was passed in the sheath after withdrawing the needle, pathway was identified and ablated. Total 295 consecutive patients underwent electrophysiological studies and ablation. Out of which pathways were 131 [124 patients were having Wolff-Parkinson-White [WPW] and orthodromic reciprocating tachycardia 7].Among pathways Left sided pathways were 70. In all cases successful septal puncture and ablation was done. Overall success rate for atrial septal puncture and ablation was 100%. No complication was seen during and after the procedure. Average time for procedure of ablating left sided pathways was 25 minutes. Trans-septal approach is safe and is well approachable for far lateral pathways ablation

Radiofrequency catheter ablation for supraventricular tachycardias: experience at Peshawar

Drug therapy is mostly employed in the management of supraventricular tachycardias [SVTs]. However, radiofrequency catheter ablation has been found to be highly effective and safe in the treatment of SVTs. The current study is aimed at sharing our experience of 320 patients who presented with SVTs, and were treated with radiofrequency catheter ablation. This descriptive study was carried out in the Cardiac Electrophysiology Laboratory of Lady Reading Hospital, Peshawar from October 2006 to December 2009. Standard 4-wire electrophysiological study was carried out to identify the mechanism of SVT in 320 consecutive patients. Radiofrequency catheter ablation was used to interrupt the tachycardia circuit. Out of a total 320 patients who underwent electrophysiologic study, 168 were found to have atrioventricular nodal re-entry as underlying mechanism; 121 patients were having accessory pathway responsible for re-entry [of these 95 presented with orthodromic reciprocating tachycardia and 26 as antidromic reciprocating tachycardia]; 19 patients were having focal atrial tachycardia, 4 atrial fibrillation and 8 atrial flutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with an overall success of 94% and a complication risk of complete AV block in 0.3% and recurrence rate of 3%. Radiofrequency catheter ablation is safe and highly effective mode of treatment of SVTs

Efficacy of short course anti TB chemotherapy A study in Iran

This study was started in March 1983 to treat all the cases of Mycobacterial Tuberculosis with the combination of four bactericidal drugs Rifampin..RIF; Isoniazid. INH; Pyrazinamide..PYZ; and Streptomycin..STR. for a short duration of six months. The four drugs were given for two months and then the two drugs RIF and INH were given for the rest of the four months. Out of 36 patients 20 were males. 16 were females. Age extended from 14- 64 averaging 39 years. 14 were pulmonary TB. 3 were Pulm.TB with cavity.3 were pulmonary TB with Lymphadenopathy. 4 were TB meningitis. 3 were TB empyema. 2 were pulmonary TB with pleural effusion.l was TB abdomen. 2 were TB spine and 4 were TB cervical lymphadenopathy. Socioeconomic status was from poor to middle class; educational level ranged from illitrate to higher secondary level. 11 were treated totally on ambulatory basis and 25 were admitted for a few days to weeks for initial assessment and treatment. Ethnic origin was 21 Irani. 10 Afghani. 2 Pakistani. 3 Indian, Follow up period has been less than 12 months to more than 40 months; During treatment follow up was monthly and after the treatment on yearly basis. Compliance has been excelent. 1 pt. dropped out due to emigration and 1 pt. died during operation for constrictive pericarditis, 1 pt. with meningitis needetd shunt for hydrocephalus. This study once again shows that for Mycobacterial Tuberculous infection whether pulmonary/ extra pulmonary, primary / secondary; cavitory / non cavitory. focal / systemic; ambulatory / hospitallized, the four drugs-six months therapy is quite effective irrespective of economical,educational, age, sex, INH resistance or racial background. Due to good response no extra effort was made to do sensitivity tests. MOTT were not included in the study for which further trials are strongly suggested