Primary percutaneous coronary intervention in acute myocardial infarction at Siriraj Hospital: the improvement over time.

OBJECTIVE: To evaluate the efficacy of the acute ST segment elevation treatment guidelines in reducing the door-to-balloon time at Siriraj Hospital. MATERIAL AND METHOD: Retrospective analysis of the data and records obtained from one hundred and twenty eight patients who underwent primary percutaneous intervention for acute ST segment elevation myocardial infarction at Siriraj Hospital between June 2002 and February 2006. Control chart analysis was applied to evaluate the efficacy of the guidelines. RESULTS: The mean door-to-balloon time was consistently reduced from 243.23 minutes before to 137.13 minutes after the guidelines implementation. Control chart analysis showed that this reduction in door-to-balloon time reached statistical significance. CONCLUSION: The guidelines developed by a multidisciplinary approach could effectively reduce the door-to-balloon time.

An abnormal systemic and regional hypercoagulable state in patients with mitral stenosis.

Mitral stenosis still remains a major problem in Southeast Asia including Thailand. It contributes to the morbidity and mortality related to thromboembolism which was associated with the left atrial thrombus. However, the pathogenesis of left atrial thrombus in these patients is not completely understood. Therefore, the objective of this study was to investigate the coagulation and platelet activity including the function of the endocardium in the left atrium and peripheral circulation in patients with mitral stenosis who were free of left atrial thrombus and to compare those hematologic markers activity in the peripheral venous blood between the patients with mitral stenosis and the control. Thirty-six patients with moderate to severe mitral stenosis were included in the study. Most of the patients were in functional class II and 50 per cent had atrial fibrillation. Blood was obtained from the femoral vein, femoral artery, pulmonary artery and left atrium of these patients before heparin was administered to determine the value of various hematologic markers. In the control group, blood for determining the hematologic markers was collected only from the antecubital vein. The results of this study demonstrated that the levels of prothrombin activation fragment 1+2 (F1+2), thrombin-antithrombin III complex (TAT) and Beta-thromboglobulin (beta-TG) in the left atrium of the patients with mitral stenosis were significantly higher than those in the femoral vein and femoral artery, whereas the level of thrombomodulin was significantly lower in the left atrium compared with the femoral artery and vein. When comparing with the control group, the levels of TAT, plasminogen activator inhibitors-1 (PAI-1) from the peripheral vein were significantly higher and the level of thrombomodulin was also significantly lower in the patients with mitral stenosis. In conclusion, the present study demonstrated an abnormal hypercoagulable state of the left atrium and systemic circulation related to the abnormalities of coagulation, platelets and the endocardium which may cause the formation of left atrial thrombus in patients with mitral stenosis.

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.

Successful implantation of transveneous biventricular permanent pacemaker for refractory congestive heart failure: the first case-report in Thailand.

Biventricular pacemaker is a pacemaker that can pace both the right and left ventricle at the same time. There have been progression in the development of biventricular pacemaker from thoracotomy system to fully transveneous system. The benefit in improving quality of life in selected medical refractory congestive heart failure patients of this device had been shown in randomized controlled trials. The authors reported successful implantation fully transveneous biventricular pacemaker in Thailand.

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.

Efficacy and safety of percutaneous metallic mitral valvuloplasty in rheumatic mitral stenosis at Siriraj Hospital.

Mitral stenosis is an important problem that leads to heart failure and stroke in Thailand. The options of treatment at present are either surgical or balloon mitral commissurotomy. However, the cost of balloon is very expensive. To reduce the expense of the procedure, the authors prospectively did a study using a new device called the metallic valvulotome in symptomatic severe mitral stenosis to assess the safety, feasibility and immediate outcomes. Fifty-seven patients were included in the study. The successful outcome achieved by the metallic valvulotome was 96.2 per cent in patients in whom the procedure was actually performed. The mean transmitral gradient, left atrial pressure and pulmonary artery pressure were significantly decreased and the mitral valve area was also significantly increased. Three cases failed the procedure due to inappropriate position of the septal puncture. No death occurred in the study and complications of the procedure included only two cases of hemopericardium. In the future, it is believed that this new innovative device will provide improvement and reduce the cost of the procedure in patients with severe mitral stenosis.