Radiofrequency catheter ablation for various tachyarrhythmias: experience in the Bangkok Heart Institute.

Radiofrequency catheter ablation (RFCA) is the first-line therapy for various tachyarrhythmias. The authors reports experience of RFCA for various types of tachyarrhythmia in 80 consecutive patients, 85 tracts of ablation, from May 2001 to October 2002. The mean age was 40 years, range 6-81 years. Seventy four and 13 tracts of ablation were supraventricular and ventricular arrhythmia, respectively. The results are shown below. [table: see text] Conclusion: RFCA is an effective method to cure various types tachyarrhythmia. Long-term follow-up should be evaluated in patients with paroxysmal atrial fibrillation.

Lasso catheter guided ablation for paroxysmal atrial fibrillation: the first experience in Thailand.

The authors used the 10-pole pulmonary vein sized loop-shaped, lasso, catheter via a transatrial septal long sheath in 10 patients who had symptomatic refractory paroxysmal atrial fibrillation (PAF) in order to map and guide for catheter ablation. The radiofrequency current was delivered at the junction between atrial tissue and the pulmonary vein which was the earliest endocardial activation time of the premature atrial contraction (PAC) initiating the PAF and at the pulmonary vein potential during sinus rhythm. Twenty two foci of PAC, 10 and 7, 4 and 1 from left and right superior and left and right inferior pulmonary veins, respectively, and 5 pulmonary vein potentials, 2 and 3 from left and right superior pulmonary veins, respectively, were ablated. After AF ablation, classical atrial flutter (AFl) could be induced in 9 patients. Isthmus line of block for AFl was performed in all patients. Two patients had atrial tachycardia at the high right atrium and also successfully ablated. The mean fluoroscopic and procedure times were 87 and 300 minutes, respectively. One patient had deep vein thrombosis which resolved after anticoagulant therapy. One patient had recurrent PAF which was successfully reablated but he still had very mild symptoms. During the mean follow-up period of 5.8 months, 9 patients remained free of symptoms. Conclusion: Lasso catheter is an effective tool for mapping and guiding of ablation for PAF. However, more experience and long-term follow-up are required.

Early atherosclerosis in children in familial hypercholesterolemia: A 2 case report.

Familial hypercholesterolemia (FH) is inherited as an autosomal dominant. It is an important clinical condition leading to hypertension, atherosclerosis, and premature coronary artery disease. Atherosclerosis is rarely reported in children. We report here 2 children with familial hypercholesterolemia and early atherosclerosis. The first case is a 4 year-old Thai boy who presented with yellowish papules in the skin creases which had been present for 2 years. His grandfather and father had been diagnosed with diabetes mellitus and hypercholesterolemia, respectively. Physical examination revealed his weight for height to be 125% and planar xanthomas. The remaining examination was unremarkable. Plasma lipid profiles showed a total cholesterol level of 674 mg/dl, a triglyceride level of 261 mg/dl, a high-density lipoprotein cholesterol (HDL-C) level of 39 mg/dl, and a low-density lipoprotein cholesterol (LDL-C) level of 583 mg/dl. The results of a carotid duplex scan showed atherosclerotic plaques in both carotid arteries. The second case is a 10 year-old Thai boy who had no symptoms, but hismother and uncle had been diagnosed with coronary heart disease and diabetes mellitus,respectively. Physical examination revealed a weight for height of 112%, but the remaining examination was unremarkable. Plasma lipid profiles showed a total cholesterol level of 328 mg/dl, a triglyceride level of 59 mg/dl, an HDL-C level of 54 mg/dl, and an LDL-C level of 262 mg/dl. A carotid duplex scan showed atherosclerotic plaques in both carotid arteries. Atherosclerosis is rarely reported in children and it usually correlates with ischemic heart disease. The finding of atherosclerotic plaques in the large arteries may reflect deposition of atheroma in their coronary arteries. We suggest that this investigation is an important procedure in the screening of early atherosclerosis in order to primarily and secondarily.