ABSTRACT
Introducción: La ablación de la fibrilación auricular (FA) es un tratamiento potencialmente curativo para esta arritmia, siendo su principal objetivo el aislamiento o desconexión eléctrica de las venas pulmonares (VP). El aislamiento de las 4 VP ha demostrado mayor beneficio que solo el aislamiento de la VP culpable del inicio de la FA (ablación focal). Para aislar las VP se realizan líneas de ablación alrededor de ellas, éstas se pueden efectuar en la unión veno-auricular (circunferencial antral) o en su ostium (ostial). El objetivo de este estudio es describir estas estrategias de aislamiento de las VP en un grupo de pacientes sometidos a ablación de FA. Métodos: Los criterios de selección fueron pacientes con FA paroxística sintomática recurrente a pesar de tratamiento antiarrítmico y FA persistente sintomática sin cardiopatía estructural significativa, además, con un seguimiento mínimo de 3 meses post ablación. Se analizaron las estrategias de ablación focal versus aislamiento de las 4 VP y se evaluaron las líneas de ablación antral y ostial. El éxito fue definido como ausencia de FA, según síntomas y holter de arritmias de 24 horas, sin necesidad de tratamiento antiarrítmico. Resultados: Se analizaron 50 procedimientos en 42 pacientes, por recurrencia de FA se reintervinieron 6 pacientes por una vez y un paciente 2 veces. Durante un seguimiento de 19 +/- 15 meses se alcanzo el éxito en 30 pacientes (71.4 por ciento). En 19 pacientes la estrategia inicial de ablación fue focal y en 23 pacientes fue en las 4 VP, alcanzándose el éxito en 12 pacientes (63.1 por ciento) y en 20 pacientes (87 por ciento) respectivamente (p=0.14). Se realizo ablación antral en las VP izquierdas en 22 casos y en las VP derechas en 14 casos, logrando la desconexión eléctrica en 3 casos (13.6 por ciento) y ningún caso respectivamente. En los restantes casos se complemento con ablación ostial para alcanzar su aislamiento, en 4 VP este objetivo no se alcanzo. Un paciente ...
Introduction: Ablation of pulmonary veins is a potentially curative procedure for atrial fibrillation (AF). The objective is to electrically isolate the pulmonary veins from the left atrium. Ablation of all pulmonary veins (PVs) has been more effective than the isolation of the PV responsible for the initiation of AF (focal ablation). Ablation lines to isolate PVs can be performed around the PV-LA junction (circumferential) or at the PV os-tium. Aim: to describe circumferential and ostium ablation strategies in a group of patients with AF Methods: Patients with recurrent paroxistic AF unresponsive to anti arrhythmic therapy or patients with persistent symptomatic lone AF were included. Focal vs 4 PV ablation as well as circumferential vs ostial techniques were compared. Success was defined as being free from AF, as judged by symptoms and Holter recordings. Results: 50 procedures were performed in 42 patients. 6 patients had a repeat ablation procedure and one had 2 additional ablation procedures, due to recurrence of AF. 30 patients (71.4 percent) were AF free after 19 +/- 15 months of follow-up. 12 of 19 patients (63.1 percent) with focal ablation were AF free as compared to 20 of 23 submitted to 4PV ablation (87 percent) (pNS) . Three of 22 patients (13.6 percent) had successful AF ablation while none of right PVs ablation succeeded. Ostial ablation was performed after failure of circumferential ablation in unsuccessful cases. One patient developed stenosis in a left PV, which was successfully treated with stent-less angioplasty. Conclusion: Ablation is an effective therapy to prevent recurrence of AF. Focal ablation is generally needed to achieve effective electrical isolation of PVs.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Catheter Ablation/methods , Atrial Fibrillation/therapyABSTRACT
Heart transplantation is a therapeutic alternative for selected patients with refractory heart failure. Acute allograft rejection is one of the main causes of early death after transplantation. The cellular rejection is characterized by cellular infiltrates with or without miocyte necrosis. However, some patients develop left ventricular dysfunction due to rejection without evidence of cellular infiltration. In these patients, the rejection is mediated by antibodies and complement. Humoral rejection is a relative rare but potentially fatal form of acute allograft rejection. We report two patients with left ventricular dysfunction secondary to humoral rejection, shortly after cardiac transplantation. Both patients were treated with methylprednisolone, and azathioprine was substituted by cyclophosphamide. One patient underwent plasmapheresis. The clinical outcome was satisfactory and the left ventricular function returned to normal in both cases. The diagnostic and therapeutic strategies for the management of humoral rejection are reviewed