ABSTRACT
PURPOSE: To evaluate nature of AV nodal activation in patients with AVNRT using high density electro-anatomic mapping (HD-EAM). METHODS: HD-EAM was created in 30 patients with AVNRT from the triangle of Koch (ToK) in sinus rhythm (SR). Isochronal late activation maps (ILAM) were created. EAMs were analyzed for slow pathway (SPW) and fast pathway (FPW) activation. A pivot point (PP) was defined where FPW and SPW collided and pivoted back to the AV node (AVN). Conduction was assessed with programmed extrastimulus (PES) in 9 patients until FPW refractory period (ERP). The change in PP distance from the HIS (ΔPP) was measured in SR and PES. The ΔPP was compared to ΔAH. The PP was ablated and SR re-mapped. RESULTS: The FPW activates the His and moves inferiorly toward the coronary sinus (CS). Activation also enters the ToK near the CS and collides with the FPW which then pivots around a functional line of block (LOB) within the ToK and moves superiorly along the septal tricuspid annulus. PP electrograms are fractionated, low amplitude, and consistent with SPW potentials (Haissaguerre et al. in Circulation 85:2162-2175, 1992). During PES the PP moved superiorly until FPW ERP when only SPW activation occurs. Normalized ΔAH and ΔPR vs ΔPP was highly correlated p < 0.0001. Ablation at the PP was successful and associated with loss of SPW fusion and pivot. CONCLUSION: We conclude HD-EAM/ILAM provide a novel method for localizing the SPW in SR. This study provides further understanding of dual AV nodal physiology and may aid in targeting the SPW for ablation of AVNRT.
Subject(s)
Catheter Ablation , Tachycardia, Atrioventricular Nodal Reentry , Ventricular Septum , Atrioventricular Node , Bundle of His , Catheter Ablation/methods , Heart Rate , Humans , Tachycardia, Atrioventricular Nodal Reentry/surgeryABSTRACT
Conduction system damage is the most common complication of transcatheter aortic valve replacement (TAVR), which frequently requires placement of a permanent pacemaker. Bundle branch reentry (BBR) is a well-recognized mechanism of ventricular tachycardia (VT) in the setting of abnormal intraventricular conduction. We describe a case of a patient with post-TAVR intraventricular conduction abnormalities who presented with intermittent advanced atrioventricular block and BBR VT and discuss the potential risks, diagnosis, and management of BBR after TAVR.
ABSTRACT
BACKGROUND: Current guidelines recommend anticoagulation using warfarin with bridging parenteral anticoagulation or one of the non-vitamin K antagonist oral anticoagulants (NOACs) to prevent thromboembolic events in patients undergoing cardioversion for atrial fibrillation (AF). We aimed to compare by meta-analytical techniques, the safety and efficacy of NOACs versus warfarin in patients undergoing cardioversion. METHODS: PUBMED, EMBASE, Cochrane CENTRAL and CINAHL were searched electronically in addition to manual search for randomized controlled trials (RCTs) comparing NOACs and warfarin in patients undergoing cardioversion for AF. Mortality, major bleeding and ischemic and hemorrhagic stroke were compared between the two agents. RESULTS: A total of 7 trials with 7588 total patients were included in the meta-analysis. NOACs, as compared to warfarin, resulted in similar risk of ischemic stroke [odds ratio (OR): 0.49 (95% confidence interval (CI): 0.20-1.19; Pâ¯=â¯0.12], major bleeding [0.71 (0.37-1.38), Pâ¯=â¯0.32], mortality [0.73 (0.32-1.67); Pâ¯=â¯0.45], and hemorrhagic stroke [0.96 (0.11-8.70); Pâ¯=â¯0.97]. The results were consistent across subgroup analyses. CONCLUSIONS: Based on the current meta-analysis, NOACs and warfarin have comparable efficacy and safety in patients with atrial fibrillation undergoing cardioversion.
Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/therapy , Electric Countershock/methods , Vitamin K/antagonists & inhibitors , Warfarin/administration & dosage , Administration, Oral , Anticoagulants/adverse effects , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Electric Countershock/adverse effects , Hemorrhage/chemically induced , Humans , Randomized Controlled Trials as Topic/methods , Treatment Outcome , Warfarin/adverse effectsABSTRACT
Coarctation of the aorta, virtually always a congenital malformation, is characterized by localized aortic narrowing, usually in the arch opposite to the ductus arteriosus and just distal to the left subclavian artery. The condition occasionally goes undiagnosed until adulthood. We report a case of a 55-year-old man who presented with uncontrolled hypertension, pulmonary edema, and non-ST-segment elevation myocardial infarction due to multi-vessel coronary artery disease. He underwent successful simultaneous coronary artery bypass grafting and coarctation repair using an ascending-to-descending aortic bypass graft.
Subject(s)
Aortic Coarctation/diagnostic imaging , Aortic Coarctation/surgery , Coronary Artery Bypass , Pulmonary Edema/diagnostic imaging , Aorta, Thoracic/surgery , Computed Tomography Angiography , Electrocardiography , Humans , Male , Middle Aged , Non-ST Elevated Myocardial Infarction/etiology , Pulmonary Edema/etiology , Radiography, ThoracicABSTRACT
Acute coronary syndrome (ACS) due to embolic phenomenon in the setting of peripartum cardiomyopathy (PPCM) and left ventricular mural thrombus is a rare occurrence. There have been two known cases described in medical literature. We present a unique case in which catheter-based aspiration thrombectomy was used to successfully treat a patient with ACS due to coronary emboli in the setting of PPCMand left ventricular mural thrombus. We believe this to be the first report of the use of aspiration thrombectomy in such a clinical case.
