ABSTRACT
PURPOSE: Radiofrequency ablation (RF) of atrioventricular reentrant tachycardia (AVNRT) is an effective method for treating this arrhythmia. However, inadverted AV block requiring implantation of permanent pacemaker is a worrisome side effect. Although permanent AV block seems to be rare nowadays, patients are by no means spared from this severe complication. Catheter cryoablation is emerging as an alternative technology with an excellent safety profile, but limited data exist regarding its efficacy. METHODS: We conducted a randomized study among patients with AVNRT remitted to our center for EP study and ablation between January 2008 and June 2010. After giving a written consent, patients were randomized to conventional RF or cryoablation, unless specific preference of patient was stated. Primary outcomes were acute success, SVT recurrence, and complications, including AV block. RESULTS: One hundred nineteen patients were included (60 cryoablation and 59 conventional RF). There were no differences in demographic and clinical baseline data between groups. Acute procedural success was achieved in 59 patients (98 %) in cryoablation group and 59 (100 %) in RF. One patient in RF group underwent complete AV block and pacemaker implantation. Over a mean follow-up period of 256.6 days, there was a significant difference in AVNRT recurrence between cryoablation and RF patients (15 versus 3.4 %, p = 0.03). CONCLUSION: Catheter cryoablation of AVNRT is a clinically effective alternative to RF ablation, with excellent acute success rate. Despite a slightly higher rate of recurrence during long-term follow-up, these results suggest that cryoablation may be considered as first-line approach, especially in younger people, where the risk of permanent pacing because of inadvertent AV block may be relevant.
Subject(s)
Catheter Ablation/methods , Cryosurgery/methods , Tachycardia, Atrioventricular Nodal Reentry/surgery , Adult , Aged , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Postoperative Complications , Prospective Studies , Recurrence , Statistics, Nonparametric , Survival AnalysisABSTRACT
Objetivo. Conocer las posibles modificaciones en la calidad de vida (CV) e identificar diferencias asociadas a variables clínicas y sociodemográficas tras la implantación de un desfibrilador automático implantable (DAI). Método. Estudio transversal descriptivo. Se eligió a 157 pacientes de forma consecutiva, que cumplieron los criterios de inclusión, de los 241 a los que se implantó un DAI subpectoral o subcutáneo. Se les envió por correo una carta de presentación junto con el instrumento de valoración: el EuroQol-5D (EQ5D) en versión validada para la población española, que describe el estado de salud en cinco dimensiones: movilidad (MO), cuidado personal (CP), actividades cotidianas (AC), dolor/malestar (DM) y ansiedad/depresión (AD). Se incorporó una escala visual analógica (EVA), cuyos extremos con rótulos indican 0, peor estado de salud imaginable y 100, mejor estado de salud imaginable; una antes y otra posterior al implante. Resultados. Recibimos 90 encuestas válidas: 80 hombres, edad media de 61,2 años (DE=13,1). Presentaron problemas de MO 25 pacientes (27,7%), en CP 8 (8,8%), en AC 32 (35,5%), de DM 22 (24,4%) y de AD 29 (32,2%). Los pacientes con descargas mostraron mayor porcentaje de problemas en las cinco dimensiones del EQ5D, resultando significativos en DM y AD. Según la EVA, 54 pacientes (60%) puntuaron mejor la percepción de su estado de salud, pasando de una puntuación mediana de 50 (antes) a 75 (después) (p<0,001). Conclusión. La gran mayoría de pacientes portadores de DAI ganan CV tras el implante, siendo esta ganancia más limitada en los más jóvenes y en los que han recibido descargas(AU)
Objectives. To describe possible changes in the quality of life (QL) and to identify possible differences associated to sociodemographic and clinical variables after being given an implantable cardioverter-defibrillator (ICD). Method. Descriptive cross-sectional study, selecting 241 consecutive patients for a subcutaneous or subpectoral ICD implantation. One-hundred and fifty-seven patients met inclusion criteria. Introduction letter along with the assessment tool was mailed to them. Assessment tool used was the Euroqol-5D (EQ5D), validated and translated for a Spanish population. EQ5D describes health status in 5 domains: mobility (MO), self-care (SC), usual activity (UA), pain/discomfort (PD) and anxiety/depression (AD). It included a visual analogue scale (VAS) where the endpoints are labelled Best imaginable health state and Worst imaginable health state; one before and another after ICD implantation. Results. Ninety valid assessments were received: 80 males, mean age 61.2±13.1 years. Patients with EQ5D problems: MO 25 (27.7%), SC 8 (8.8%), UA 32 (35.5%), PD 22 (24.4%) and AD 29 (32.2%). Patients with ICD discharges had a higher percentage of problems in all EQ5D domains, being significant in PD and AD. Fifty four patients (60%) experienced a significant improvement in QL after ICD implant using the visual analogue scale score (75 points after vs. 50 points before; P<0.001). Conclusions. The majority of ICD patients gain QL after implantation, but this gain is more limited in younger patients and those who have received discharges(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Defibrillators, Implantable , Quality of Life , Cross-Sectional StudiesABSTRACT
OBJECTIVES: To describe possible changes in the quality of life (QL) and to identify possible differences associated to sociodemographic and clinical variables after being given an implantable cardioverter-defibrillator (ICD). METHOD: Descriptive cross-sectional study, selecting 241 consecutive patients for a subcutaneous or subpectoral ICD implantation. One-hundred and fifty-seven patients met inclusion criteria. Introduction letter along with the assessment tool was mailed to them. Assessment tool used was the Euroqol-5D (EQ5D), validated and translated for a Spanish population. EQ5D describes health status in 5 domains: mobility (MO), self-care (SC), usual activity (UA), pain/discomfort (PD) and anxiety/depression (AD). It included a visual analogue scale (VAS) where the endpoints are labelled 'Best imaginable health state' and 'Worst imaginable health state'; one before and another after ICD implantation. RESULTS: Ninety valid assessments were received: 80 males, mean age 61.2+/-13.1 years. Patients with EQ5D problems: MO 25 (27.7%), SC 8 (8.8%), UA 32 (35.5%), PD 22 (24.4%) and AD 29 (32.2%). Patients with ICD discharges had a higher percentage of problems in all EQ5D domains, being significant in PD and AD. Fifty four patients (60%) experienced a significant improvement in QL after ICD implant using the visual analogue scale score (75 points after vs. 50 points before; P<0.001). CONCLUSIONS: The majority of ICD patients gain QL after implantation, but this gain is more limited in younger patients and those who have received discharges.
