Pulmonary hemorrhage after cryoballoon ablation for pulmonary vein isolation in the treatment of atrial fibrillation.

Pulmonary vein isolation has evolved over the past years as an alternative for the treatment of symptomatic recurrences of atrial fibrillation refractory to antiarrhythmic drug treatment. Both radiofrequency energy and cryoballoon ablation have proven useful in this setting. We present the case of a 55-year-old male patient undergoing cryoballoon ablation complicated with pulmonary hemorrhage. The cause of this rare complication may be found in the damage of vascular venous structures near the ablation zone or, alternatively, in hemorrhagic damage of the pulmonary vein surrounding tissue (or less probably to direct injury of the lingular bronchus). The extremely low temperatures achieved in this case (which are often associated with deep balloon position inside the veins) are alarming and should alert the physician about the possibility of an excessively intrapulmonary vein deployment of the cryoablation balloon.

Nuevos predictores de evolución a bloqueo auriculoventricular en pacientes con bloqueo bifascicular / Novel predictors of progression of atrioventricular block in patients with chronic bifascicular block

Introducción y objetivos. Los pacientes con bloqueo bifascicular (BBF) pueden evolucionar a bloqueo auriculoventricular (BAV) avanzado, especialmente en presencia de síncope o intervalo HV prolongado. Otras variables podrían ayudar a definir qué pacientes se beneficiarán de un marcapasos (MP) profiláctico. Métodos. Desde 1998 hasta 2006, hemos estudiado prospectivamente a 263 pacientes consecutivos con BBF en un solo centro. Se analizaron variables clínicas, electrocardiográficas y electrofisiológicas predictoras de evolución a BAV significativo (segundo y tercer grado). Se implantaron dispositivos de estimulación siguiendo las guías de la Sociedad Europea de Cardiología. Los MP fueron programados en modo VVI con frecuencia mínima de 40 lat/min. Se definió necesidad de MP la presencia de BAV significativo o de estimulación ventricular > 10%. Resultados. Se incluyó a 249 pacientes (media de edad, 73,4 ± 9,3 años; 82 mujeres). Tras una mediana de seguimiento de 4,5 (2,16-6,41) años, se observó necesidad de MP en 102 pacientes, 45 por estimulación > 10% y 57 por BAV significativo. Las variables que predijeron la necesidad de MP fueron presencia de síncope o presíncope (hazard ratio [HR] = 2,06; intervalo de confianza [IC] del 95%, 1,03-4,12), anchura QRS > 140 ms (HR = 2,44; IC del 95%, 1,59-3,76), la insuficiencia renal (HR = 1,86; IC del 95%, 1,22-2,83) y un intervalo HV > 64 ms (HR = 6,6; IC del 95%, 4,04-10,80). La asociación de los cuatro factores mostró una probabilidad de necesitar el MP del 95% al año de seguimiento. Conclusiones. La clínica sincopal/presincopal, el QRS > 140 ms, la insuficiencia renal y el intervalo HV > 64 ms son predictores independientes de evolución a BAV en pacientes con BBF (AU)

Introduction and objectives. Patients with chronic bifascicular block (BFB) can progress to advanced atrioventricular block (AVB), especially when syncope or a prolonged HV interval is present. It is possible that other variables could help identify patients who would benefit from prophylactic pacemaker implantation. Methods. The study involved 263 consecutive BFB patients seen at a single center between 1998 and 2006. Clinical, electrocardiographic and electrophysiologic variables were analyzed to identify predictors of progression to significant AVB (i.e. second or third grade). Cardiac pacemakers were implanted in accordance with European Society of Cardiology guidelines. Pacemakers were programmed in the VVI mode with a minimum frequency of 40 beats/min. A pacemaker was required if there was significant AVB or a ventricular pacing percentage >10%. Results. In total, the study included 249 patients (mean age, 73.4±9.3 years, 82 female). After a median follow-up period of 4.5 years (2.16-6.41 years), a pacemaker was required by 102 patients: 45 had a ventricular pacing percentage >10% and 57 had significant AVB. Factors predictive of the need for a pacemaker were: the presence of syncope or presyncope (hazard ratio [HR]=2.06; 95% confidence interval [CI], 1.03-4.12), QRS width >140 ms (HR=2.44; 95% CI, 1.59-3.76), renal failure (HR=1.86; 95% CI, 1.22-2.83), and an HV interval >64 ms (HR=6.6; 95% CI, 4.04-10.80). The presence of all four risk factors was associated with a 95% probability of needing a pacemaker within 1 year of follow-up. Conclusions. The presence of syncope or presyncope, a QRS width >140 ms, renal failure, and an HV interval >64 ms were independent predictors of progression to AVB in patients with BFB (AU)

[Novel predictors of progression of atrioventricular block in patients with chronic bifascicular block]. / Nuevos predictores de evolución a bloqueo auriculoventricular en pacientes con bloqueo bifascicular.

INTRODUCTION AND OBJECTIVES: Patients with chronic bifascicular block (BFB) can progress to advanced atrioventricular block (AVB), especially when syncope or a prolonged HV interval is present. It is possible that other variables could help identify patients who would benefit from prophylactic pacemaker implantation. METHODS: The study involved 263 consecutive BFB patients seen at a single center between 1998 and 2006. Clinical, electrocardiographic and electrophysiologic variables were analyzed to identify predictors of progression to significant AVB (i.e. second or third grade). Cardiac pacemakers were implanted in accordance with European Society of Cardiology guidelines. Pacemakers were programmed in the VVI mode with a minimum frequency of 40 beats/min. A pacemaker was required if there was significant AVB or a ventricular pacing percentage >10%. RESULTS: In total, the study included 249 patients (mean age, 73.4+/-9.3 years, 82 female). After a median follow-up period of 4.5 years (2.16-6.41 years), a pacemaker was required by 102 patients: 45 had a ventricular pacing percentage >10% and 57 had significant AVB. Factors predictive of the need for a pacemaker were: the presence of syncope or presyncope (hazard ratio [HR]=2.06; 95% confidence interval [CI], 1.03-4.12), QRS width >140 ms (HR=2.44; 95% CI, 1.59-3.76), renal failure (HR=1.86; 95% CI, 1.22-2.83), and an HV interval >64 ms (HR=6.6; 95% CI, 4.04-10.80). The presence of all four risk factors was associated with a 95% probability of needing a pacemaker within 1 year of follow-up. CONCLUSIONS: The presence of syncope or presyncope, a QRS width >140 ms, renal failure, and an HV interval >64 ms were independent predictors of progression to AVB in patients with BFB.