Subject(s)
Long QT Syndrome/diagnosis , Adolescent , Adrenergic beta-Antagonists/therapeutic use , Death, Sudden, Cardiac/prevention & control , Electrocardiography, Ambulatory/drug effects , Female , Humans , Long QT Syndrome/drug therapy , Long QT Syndrome/genetics , Male , Risk Factors , Syncope/etiology , Young AdultSubject(s)
Electrophysiology/methods , Heart Defects, Congenital/diagnosis , Adult , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/surgery , Catheter Ablation/methods , Child , Electrophysiology/instrumentation , Heart Defects, Congenital/physiopathology , Heart Defects, Congenital/surgery , HumansABSTRACT
OBJECTIVE: To investigate the feasibility of catheter ablation as a treatment for symptomatic patients with longstanding permanent atrial fibrillation (AF). METHODS: Radiofrequency ablation was applied to encircle all pulmonary veins (PVs) and create lines from the left inferior PV to the mitral valve, along the roof of the left atrium between the PVs, and along the tricuspid valve-inferior vena cava isthmus. A seven day Holter was recorded at discharge and at follow up to assess arrhythmia burden. If patients developed a symptomatic, sustained atrial arrhythmia a repeat ablation procedure was advised. RESULTS: 42 patients underwent the procedure that took a mean of five hours with 50 minutes of fluoroscopy. After a median follow up of 8.4 months, 31 of 41 surviving patients (76%) were in sinus rhythm. Of these, 29 patients were no longer taking any antiarrhythmic drugs but 22 (52%) required more than one procedure. During follow up 49% experienced a sustained atrial tachycardia. Twenty six repeat procedures were performed. Maintenance of sinus rhythm after the first, second, or third procedure was 36% (15 of 42), 58% (11 of 19), and 71% (5 of 7), respectively. From a total of 68 procedures there were two serious complications (2.9%): a stroke from which a full recovery was made, and a PV stenosis. CONCLUSION: Catheter ablation can be used to cure longstanding permanent AF; however, there is a significant complication rate. Whether this is offset by a mortality benefit associated with sinus rhythm is unknown. Many patients will need more than one procedure to achieve success.
Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/methods , Feasibility Studies , Female , Humans , Male , Middle Aged , Recurrence , Reoperation , Tachycardia, Ectopic Atrial/surgery , Treatment OutcomeABSTRACT
We report the prenatal diagnosis of a fetus with a de novo Robertsonian translocation: 45,XY,der(15;15)(q10;q10). Although Robertsonian translocations are common chromosomal rearrangements, those involving homologous chromosomes are infrequent. Since chromosome 15 is imprinted, uniparental disomy (UPD) is a concern when chromosomal rearrangements involving chromosome 15 are identified. In the present case, UPD studies showed normal biparental inheritance. In contrast to the fact that most homologous acrocentric rearrangements are isochromosomes, these results indicate postzygotic formation of a Robertsonian translocation between biparentally inherited chromosomes 15.
