Zero fluoroscopy atrioventricular node ablation and left bundle branch pacing guided by electroanatomic tridimensional mapping system.

Recent publications have reported the feasibility of atrioventricular node ablation (AVNA) and concomitant His-bundle pacing guided by an electroanatomic tridimensional mapping system (ETMS). We report the case of a 65-year-old female patient in which zero fluoroscopy left bundle branch pacing and AVNA were performed guided just by ETMS. Optimal device functioning, electrical parameters stability, and correct lead location were observed 24 h and 30 days after the procedure. In selected cases, in which ionizing radiation is not recommended, this technique may represent an alternative for performing both interventions in the same procedure. .

Remarkable oxygen consumption improvement after auricular flutter ablation in a patient with constrictive pericarditis and severe mitral stenosis.

Atrial function is a key factor in cardiac output and oxygen consumption (VO2). Substantial improvements in VO2 have been reported after restoring sinus rhythm (SR) in patients with atrial fibrillation. However, there are no published data on how atrial function affects VO2 in patients with both constrictive pericarditis (CP) and severe mitral stenosis (MS). A 53-year-old caucasian patient consulted for exacerbated heart failure (EHF). His medical record lists ischemic heart disease, severe MS, and CP after thoracic radiotherapy. The electrocardiogram showed atrial flutter (AFL) with controlled ventricular rate. Normal left ventricular ejection fraction was observed. Ergospirometry showed an impaired maximum VO2 (VO2 max) of 6 ml/kg/min. On the electrophysiological study typical AFL was diagnosed and ablated achieving a great exercise capacity improvement, correlated with an increase of VO2 max to 16 ml/kg/min a week after ablation, and disappearance of EHF symptoms. This case illustrates how restoration of SR resulted in a clinical substantial improvement. Radiofrequency catheter ablation is warranted as the most effective option in this context. .

Ivabradina como alternativa a la ablación del nódulo AV para un paciente con fibrilación auricular permanente / Ivabradine as an alternative to AV node ablation in a patient with permanent atrial fibrillation

No disponible