ABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Coronary Sinus/physiopathology , Coronary Sinus/radiation effects , Coronary Sinus/surgery , Heart Failure/therapy , Catheter Ablation/methods , Electrodes, Implanted , Ventricular Dysfunction/complications , Ventricular Dysfunction/diagnosis , Angiography , Catheter Ablation/trends , Electrodes, Implanted/trends , Ventricular Dysfunction/physiopathology , Ventricular Dysfunction/therapyABSTRACT
Los desfibriladores automáticos modernos incluyen entre sus funciones la estimulación antibradicardia, la cardioversión de baja energía y la desfibrilación de alta energía. Tienen, además, criterios adicionales de detección para discriminar en lo posible las arritmias ventriculares de las de origen supraventricular. Son multiprogramables y pueden ser programados para actuar en diferentes zonas de frecuencia de taquicardia, lo que permite tratar de forma diferente cada taquicardia ventricular (TV) que pueda tener un paciente. Esto es particularmente útil en pacientes que presentan TV con ciclos diferentes. La estimulación antitaquicardia disminuye la necesidad de cardioversión o desfibrilación en pacientes con TV. Se han comparado diferentes algoritmos de estimulación con resultados similares. En este capítulo de la monografía se analizan dichos algoritmos y su mejor programación, la necesidad de estimulación antibradicardia y la selección del modo de estimulación, y cómo evitar en lo posible las terapias inapropiadas debidas a arritmias supraventriculares (AU)
Among other functions, modern implantable cardioverter-defibrillators (ICDs) are able to perform antibradycardia pacing, low-energy cardioversion, and highenergy defibrillation. In addition, they can implement a range of different arrhythmia detection criteria that enable them to discriminate, when possible, between ventricular and supraventricular tachycardias. The devices can be programmed in a range of different ways. They can be set to respond differently according to specific tachycardia frequency ranges, thereby enabling each form of tachycardia experienced by the patient to be treated differently. This capability is particularly useful in patients who present with ventricular tachycardias with a number of different cycle lengths. Antitachycardia pacing reduces the need for cardioversion or defibrillation in patients with ventricular tachycardias. Comparison of different pacing algorithms has shown that they give similar results. This part of the monograph contains reviews of the efficacy of these algorithms and how they can be better programmed, of the need for antibradycardia pacing and selection of the most appropriate pacing mode, and of how the administration of inappropriate shocks in response to supraventricular arrhythmias can be avoided (AU)
Subject(s)
Humans , Health Services Programming/methods , Defibrillators, Implantable , Cardiac Electrophysiology/methods , Electric Stimulation/methods , Tachycardia/epidemiology , Tachycardia/prevention & control , Electrophysiologic Techniques, Cardiac/methods , Electrophysiologic Techniques, Cardiac/standardsABSTRACT
Since the development of radiofrequency catheter ablation for the treatment of atrial fibrillation, electrophysiology laboratories have experienced a significant rise in the number of transseptal catheterization procedures. Traditionally, the procedure requires the presence of a interventional cardiologist who carries out transseptal catheterization following arterial puncture and placement of a reference pigtail catheter in the aortic root. Use of His bundle and coronary sinus catheters to provide anatomical and electrophysiological landmarks enables transseptal catheterization to be carried out without the need for arterial puncture or intracavity pressure measurement. We report our experience with transseptal catheterization in an electrophysiology laboratory using only electrophysiological landmarks. The procedure was carried out on 68 occasions and was successful in all patients except one, in whom catheterization could not be performed for anatomical reasons and because the patient had previously received anticoagulation therapy. One other patient developed transient ST elevation, which was probably due to an air embolism.
Subject(s)
Bundle of His/physiology , Cardiac Catheterization/methods , Catheter Ablation/methods , Sinoatrial Node/physiology , Cardiac Catheterization/instrumentation , HumansABSTRACT
Desde el desarrollo de la ablación con radiofrecuencia para el tratamiento curativo de la fibrilación auricular, los laboratorios de electrofisiología han experimentado un incremento considerable en el número de cateterismos transeptales. Tradicionalmente, el procedimiento requería la intervención de un hemodinamista que procedía a realizar el cateterismo transeptal previa punción arterial y colocación de un catéter pigtail de referencia en la raíz aórtica. Utilizando el catéter del His y el del seno coronario como referencias anatomo-electrofisiológicas se puede llevar a cabo el cateterismo transeptal sin necesidad de realizar punción arterial ni medición de presiones intracavitarias. Presentamos nuestra experiencia en cateterización transeptal en el laboratorio de electrofisiología utilizando referencias puramente electrofisiológicas. Hemos realizado el procedimiento en 68 ocasiones, con resultado exitoso en todos los casos salvo en uno, en el que la punción no pudo llevarse a cabo por dificultades en el acceso anatómico y porque el paciente se encontraba previamente anticoagulado. Un paciente presentó elevación transitoria del segmento ST, probablemente debida a un embolismo aéreo
Since the development of radiofrequency catheter ablation for the treatment of atrial fibrillation, electrophysiology laboratories have experienced a significant rise in the number of transseptal catheterization procedures. Traditionally, the procedure requires the presence of a interventional cardiologist who carries out transseptal catheterization following arterial puncture and placement of a reference pigtail catheter in the aortic root. Use of His bundle and coronary sinus catheters to provide anatomical and electrophysiological landmarks enables transseptal catheterization to be carried out without the need for arterial puncture or intracavity pressure measurement. We report our experience with transseptal catheterization in an electrophysiology laboratory using only electrophysiological landmarks. The procedure was carried out on 68 occasions and was successful in all patients except one, in whom catheterization could not be performed for anatomical reasons and because the patient had previously received anticoagulation therapy. One other patient developed transient ST elevation, which was probably due to an air embolism
