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1.
Europace ; 25(11)2023 11 02.
Article in English | MEDLINE | ID: mdl-37851513

ABSTRACT

AIMS: The optimal interlesion distance (ILD) for 90 and 50 W radiofrequency applications with low ablation index (AI) values in the atria has not been established. Excessive ILDs can predispose to interlesion gaps, whereas restrictive ILDs can predispose to procedural complications. The present study sought, therefore, to experimentally determine the optimal ILD for 90 W-4 s and 50 W applications with low AI values to optimize catheter ablation outcomes in humans. METHODS AND RESULTS: Posterior intercaval lines were created in eight adult sheep using CARTO and the QDOT-MICRO catheter in a temperature-controlled mode. In four animals, the lines were created with 50 W applications, a target AI value ≥350, and ILDs of 6, 5, 4, and 3 mm, respectively. In the other four animals, the lines were created with 90 W-4 s applications and ILDs of 6, 5, 4, and 3 mm, respectively. Activation maps were created immediately after ablation and at 21 days to assess linear block prior to gross and histological analyses. All eight lines appeared transmural and continuous on histology. However, for 50 W-only applications with an ILD of 3 mm resulted in durable linear electrical block, whereas for 90 W applications, only the lines with ILDs of 4 and 3 mm were blocked. No complications were detected during ablation procedures, but all power and ILD combinations except 50 W-6 mm resulted in asymptomatic shallow lung lesions. CONCLUSION: In the intercaval region in sheep, for 50 W applications with an AI value of ∼370, the optimal ILD is 3 mm, whereas for 90 W-4 s applications, the optimal ILD is 3-4 mm.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Lung Diseases, Interstitial , Pulmonary Veins , Humans , Adult , Animals , Sheep , Pulmonary Veins/surgery , Heart Atria/surgery , Heart Atria/pathology , Catheter Ablation/adverse effects , Catheter Ablation/methods , Catheters , Lung Diseases, Interstitial/pathology , Lung Diseases, Interstitial/surgery , Atrial Fibrillation/surgery , Atrial Fibrillation/pathology , Treatment Outcome
2.
Pacing Clin Electrophysiol ; 46(10): 1235-1238, 2023 10.
Article in English | MEDLINE | ID: mdl-36811180

ABSTRACT

Left ventricular (LV) summit premature ventricular contractions (PVCs) are often unresponsive to radiofrequency (RF) ablation. Retrograde venous ethanol infusion (RVEI) can be a valuable alternative in this scenario. A 43-year-old woman without structural heart disease presented with LV summit PVCs unresponsive to RF ablation because of their deep-seated origin. Unipolar pace mapping performed through a wire inserted into a branch of the distal great cardiac vein (GCV) demonstrated 12/12 concordance with the clinical PVCs thus indicating close proximity to PVCs' origin. RVEI abolished the PVCs without complications. Subsequently, magnetic resonance imaging (MRI) evidenced an intramural myocardial scar produced by ethanol ablation. In conclusion, RVEI effectively and safely treated PVC arising from a deep site in the LVS. The scar provoked by chemical damage was well characterized by MRI imaging.


Subject(s)
Catheter Ablation , Ventricular Premature Complexes , Female , Humans , Adult , Ventricular Premature Complexes/surgery , Cicatrix/surgery , Ethanol , Catheter Ablation/methods , Magnetic Resonance Imaging , Treatment Outcome
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