Catheter Ablation of Left Ventricular Summit Arrhythmias from Adjacent Anatomic Vantage Points.

Idiopathic ventricular arrhythmias (VA), particularly left ventricular outflow tract (LVOT) VA accounts for up to 10% of all VAs referred for ablative therapy. In addition to being infrequent, its intricate anatomy and its pathophysiology make catheter ablation (CA) of these arrhythmias a challenge even for experts. In this scenario, detailed right ventricular outflow tract as well as LVOT electroanatomic mapping including epicardial mapping are essential. In this article, we will emphasize our approach toward the CA technique used for LVOT VA, particularly IVS and/or LVS VA originating from intramural foci, along with its acute and long-term efficacy and safety.

Fluoroless Catheter Ablation of Left Ventricular Summit Arrhythmias: A Step-by-Step Approach.

Prolonged use of fluoroscopy during catheter ablation (CA) of arrhythmias is associated with a significant exposure to ionizing radiation and risk of orthopedic injuries given the need for heavy protective equipment. CA of ventricular arrhythmias (VAs) arising from the left ventricular (LV) summit is challenging, requiring a vast knowledge of the intricate cardiac anatomy of this area and careful imaging delineation of the different anatomical structures, which is frequently performed using fluoroscopic guidance. Certain techniques, including pericardial mapping and ablation, use of intracoronary wires, and mapping and ablation inside the coronary venous system have been proposed, further prolonging fluoroscopy time. Fluoroless CA procedures are feasible with currently available technology and appear to have similar safety and efficacy outcomes compared with conventional techniques. To successfully perform fluoroless CA of LV summit arrhythmias, it is important to be fully acquainted with intracardiac echocardiography (ICE) imaging and electroanatomic mapping (EAM). We will describe our approach to perform fluoroless CA in LV summit VAs.

Prevención de la preeclampsia con aspirina / Preeclampsia prevention with aspirin

Objetivo: revisar si la administración de dosis bajas de aspirina durante el embarazo reduce el riesgo de preeclampsia. Material y métodos: se realizó una búsqueda en PubMed, donde se incluyeron ensayos controlados aleatorios, revisiones sistemáticas y metaanálisis publicados entre 2003 y 2013 y escritos en inglés. El principal resultado de interés fue la preeclampsia. Resultados: la búsqueda identificó 174 artículos, pero solo 13 fueron seleccionados. El grupo control se hizo con placebo o sin tratamiento. Las dosis de aspirina fueron de entre 40-160 mg/día. La aspirina se administró antes o después de 20 semanas de gestación. También se comparó el efecto de la aspirina según si eran mujeres con factores de riesgo o si desarrollaban preeclampsia grave o preeclampsia pretérmino. Conclusión: se recomienda el uso de dosis bajas de aspirina en embarazadas de alto riesgo antes de las 16 semanas de gestación (AU)

Objective: To review whether the administration of low-dose aspirin during pregnancy reduces the risk of preeclampsia. Material and methods: We performed a PubMed search. We included randomized controlled trials, systematic reviews and meta-analyses published between 2003 and 2013 and written in English. The main outcome of interest was preeclampsia. Results: The search identified 174 articles, but only 13 were selected. The control group consisted of patients receiving placebo or no treatment. Aspirin doses were between 40 and 160 mg/day. Aspirin was administered before or after 20 weeks of pregnancy. The effect of aspirin was compared, depending on whether the women had risk factors or if they developed severe preeclampsia or preterm preeclampsia. Conclusion: We recommend the use of low-dose aspirin in high risk pregnancies before 16 weeks of pregnancy (AU)