ABSTRACT
Resumen La ruptura de la vena cava inferior durante los procedimientos de intervencionismo percutáneo es una complicación infrecuente que se asocia con alta tasa de mortalidad aunque sea detectada a tiempo y se realice reparo quirúrgico, el cual es hoy el estándar de manejo. No existen hasta el momento casos reportados de manejo percutáneo de perforación de la vena cava durante procedimientos de electrofisiología. Se describe el caso de una paciente llevada a aislamiento eléctrico de venas pulmonares para el manejo de fibrilación auricular paroxística, en quien, durante el procedimiento, se produjo perforación accidental de la vena cava inferior con la sonda de ecocardiografía intracardiaca, la cual fue tratada exitosamente mediante el uso de un balón de alta distensibilidad con lo que se logró adecuada hemostasia sin necesidad de intervención quirúrgica. Se considera que el uso de un balón de alta distensibilidad puede ser una herramienta útil en el control del sangrado asociado a lesiones vasculares iatrogénicas, y que por consiguiente todo intervencionista debería tener presente.
Abstract Rupture of the inferior vena cava during percutaneous intervention procedures is an uncommon complication. It is associated with a high rate of mortality, even when it is detected at the time and the current standard management, surgical repair is performed. At present there are no cases reported of the percutaneous management of a vena cava perforation during electrophysiology procedures. The case is described of a patient subjected to electric ablation of pulmonary veins for the management of paroxysmal atrial fibrillation. During the procedure there was an accidental rupture of the inferior vena cava with the echocardiography cardiac catheter. She was successfully treated using a high-compliance balloon, with adequate haemostasis being achieved without surgical intervention. The use of a high-compliance balloon is considered as a useful tool in the control of bleeding associated with iatrogenic vascular injuries, and for this reason all interventionist should be aware of it.
Subject(s)
Humans , Female , Aged , Pulmonary Veins/abnormalities , Rupture , Vena Cava, Inferior , Wounds and Injuries , Venae Cavae , Echocardiography , Electrophysiology , Vascular System InjuriesABSTRACT
Resumen: La ablación de la fibrilación auricular mediante el aislamiento de las venas pulmonares, es una estrategia ampliamente utilizada en la actualidad. La recurrencia posablación es un problema frecuente. Se han investigado varios predictores de recurrencia con el fin de optimizar la elección del paciente que más se beneficia del procedimiento. Actualmente la evidencia es controvertida, siendo necesarios más estudios al respecto.
Summary: The ablation of atrial fibrillation based on pulmonary veins isolation, is a widely used strategy nowadays. Post ablation recurrence is a frequent problem. Several recurrence predictors have been researched, with the purpose of choosing the patient that would benefit the most from this procedure. Current evidence is controversial and more research is needed.
ABSTRACT
Resumen La terapia de ablación con catéter de arritmias cardiacas ha revolucionado el manejo de estos padecimientos en las úl timas décadas. La fibrilación atrial, que es una de las arritmias más frecuentes también ha sido susceptible a este tipo de abordaje. La complejidad de sus mecanismos y diferentes formas de manifestación ha hecho que las técnicas para realizar la ablación hayan requerido de un perfeccionamiento progresivo. También la selección de los pacientes que ten drán mayor beneficio del procedimiento lo tenemos más claro hoy en día. En el presente artículo se hace una revisión de estos aspectos y los resultados de los últimos estudios que sustentan las guías actuales para su manejo con esta forma de tratamiento.
Abstract Clinical application of catheter ablation for the treatment of Atrial Fibrillation Cardiac catheter ablation therapy has revolutionized the management of these conditions in the latest decades. Atrial fibrillation, which is one of the most frequent arrhythmias, has also been susceptible to this type of approach. The complexity of its mechanisms and different forms of manifestation has made the techniques to perform the ablation necessary for a progressive improvement. Also the selection of the patients that will have greater benefit of the procedure it is clearer nowadays. In this article we present a review of these aspects and the results of the latest studies that support the current guidelines for their management with this form of treatment.
Subject(s)
Humans , Arrhythmias, Cardiac , Atrial Fibrillation , Catheter Ablation , Costa Rica , CryosurgeryABSTRACT
OBJECTIVE:To observe the effect of rosuvastatin on prognostic of patients with paroxysmal atrial fibrillation (AF) after circumferential pulmonary vein ablation. METHODS:75 patients with paroxysmal AF were divided into observa-tion group(n=39)and control group(n=36)according to the admission single. All patients underwent circumferential pulmo-nary vein ablation antiarrhythmic treatment. Control group orally received warfarin sodium,amiodarone,metoprolol,and sub-cutaneous injected low molecular weight heparin. Observation group additionally received 10 mg Rosuvastatin tablet,qd on the basic of contol group. Changes of cardiac function,inflammatory factors,lipid levels in 2 groups before and after treat-ment were observed,and follow-up results were compared. RESULTS:There was no significant difference in left atrial diame-ter and left ventricular ejection fraction in 2 groups before and after treatment (P>0.05);atrial effective refractory periods (AERP)in 2 groups significantly prolorged,and observation group prolorged more significantly than control group,the differ-ence was statistically significant(P0.05). Triglyceride and low density lipoprotein cholesterol in observation group 1 month after operation significantly decreased, HDL-C significantly increased, there were significant differences (P0.05). CONCLUSIONS:Rosuvastatin can effectively inhibit the inflammatory reaction and prolong the AERP,thereby reducing the recurrence rate of AF,with good efficacy and safety.
ABSTRACT
Objective Using CT three-dimensional image technique to observe the pulmonary vein stenosis of circumferential pulmonary vein ablation (CPVA) for atrial ifbrillation (AF) on the structure of pulmonary vein before and after radiofrequency ablation. Methods 28 patients with AF who underwent CPVA were followed-up for a mean (6.5±3.9) months.The results of Pulmonary vein morphology study was compared with analysis of preablation, after following up radiofrequency catheter alation (6.5±3.9) months. Pulmonary vein diameters, cross-sectional area and left atrial volume were measured before and after CPVA using 64-slice multidector computed tomography (CT). Results Mild stenosis of pulmonary vein maximum diameter and pulmonary minimum diameter were 61.6%and 56.3%after CPVA. Moderate stenosis of pulmonary vein maximum diameter and pulmonary minimum diameter were 3.6%and 5.4%. All patients does not present symptoms of pulmonary vein stenosis at rest on during excercise during follow up. Conclusions Mild and moderate asymptomatic pulmonary vein stenosis may present in some patients after CPVA.
ABSTRACT
Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.