ABSTRACT
Rotors of two different left atrial flutters were mapped using focal impulse and rotor modulation and 3D-MRI overlayed on live fluoroscopy and were successfully ablated in a patient with two prior left-atrium ablation procedures for recurrent atrial fibrillation.
Subject(s)
Atrial Flutter/diagnosis , Atrial Flutter/surgery , Body Surface Potential Mapping/methods , Catheter Ablation/methods , Fluoroscopy/methods , Magnetic Resonance Imaging/methods , Surgery, Computer-Assisted/methods , Heart Conduction System/surgery , Humans , Imaging, Three-Dimensional/methods , Male , Middle Aged , Subtraction Technique , Treatment OutcomeABSTRACT
BACKGROUND: Rotational angiography of the left atrium with 3-dimensional reconstruction (3DATG) is a new imaging tool to guide atrial fibrillation (AF) ablation. Its role as part of a complex imaging strategy with NavX has not yet been evaluated. OBJECTIVE: To determine the feasibility of using 3DATG fusion with NavX in guiding AF ablation. METHODS: 3DATG was performed in 24 consecutive patients undergoing AF ablation by using the Philips Allura Xper FD 10 system. The 3DATG anatomical shell was fused with NavX data (fusion group). Procedural characteristics of the fusion group were compared to 12 patients (control group) who underwent AF ablation guided by NavX only during the preceding 6 months. RESULTS: 3DATG/NavX fusion was successful in all patients and required 12 ± 2 fiducial points. Total radiation dose, fluoroscopy, and procedural times were significantly lower in the fusion group despite additional time and radiation exposure from 3DATG (total radiation dose of 20.4 mSv in the fusion group vs 34.0 mSv in the control group; P = .04; fluoroscopy time 50.5 minutes vs 69.7 minutes; procedural time 4.3 hours vs 5.1 hours). Ablation was successful acutely in 35 of 36 patients. At follow-up, 14 of 24 (58.3%) patients in the fusion group and 6 of 12 (50%) patients in the control group were in sinus rhythm. There was 1 complication in each group. CONCLUSIONS: AF ablation guided by 3DATG/NavX fusion is associated with reduced procedural time and radiation exposure and similar clinical outcomes when compared with NavX mapping only. 3DATG/NavX fusion may provide a lower radiation alternative to NavX only or preprocedural cardiac computed tomography as part of complex imaging strategies.
Subject(s)
Angiography/methods , Atrial Fibrillation/surgery , Catheter Ablation/methods , Surgery, Computer-Assisted/methods , Atrial Fibrillation/diagnostic imaging , Feasibility Studies , Female , Fluoroscopy , Follow-Up Studies , Humans , Imaging, Three-Dimensional/methods , Male , Middle Aged , Reproducibility of Results , Retrospective StudiesABSTRACT
We report a case of severe deep venous thrombosis (DVT) treated with multimodality therapy that was complicated by sepsis due to thrombus likely infected by Salmonella virchow. We review the current therapeutic options in the therapy of severe DVT and cardiovascular pathology associated with non-typhoid Salmonella.
Subject(s)
Salmonella Infections/microbiology , Sepsis/therapy , Thrombectomy , Thrombolytic Therapy , Thrombophlebitis/therapy , Venous Thrombosis/complications , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Combined Modality Therapy , Humans , Male , Middle Aged , Phlebography , Salmonella Infections/therapy , Sepsis/microbiology , Severity of Illness Index , Thrombophlebitis/microbiology , Thrombophlebitis/pathology , Treatment Outcome , Ultrasonography, Doppler , Venous Thrombosis/pathology , Venous Thrombosis/therapyABSTRACT
We describe a case of instent restenosis in a femoral-distal saphenous vein bypass graft successfully treated with brachytherapy. A 45-year-old insulin-requiring diabetic woman underwent an in-situ femoral-anterior tibial bypass graft for a non-healing ischemic ulcer. Despite a technically successful percutaneous transluminal angioplasty and endovascular stenting of a retained valve within the threatened graft, the wound failed to heal. At the 1-month follow-up, instent restenosis was documented and successful cutting balloon angioplasty, complemented by adjunctive beta-irradiation was successfully performed. Clinical and hemodynamic success was achieved, with prompt ulcer healing and intermediate-term graft patency maintained on surveillance duplex ultrasound follow-up. We review the literature on radiation therapy in the management of peripheral arterial disease and discuss therapeutic options in the management of restenosis.
