Very high-power and short-duration radiofrequency ablation for atrial fibrillation in a Latin American low-volume private center.

BACKGROUND: Center volume and operator experience/training are important factors impacting outcomes in AFib CA. Setting for RF delivery (power, duration, and contact force) associated with better outcomes remains to be determined. METHODS: This is an observational, longitudinal, and retrospective study. All consecutive procedures performed between December 12, 2013, and March 9, 2023, in a low-volume private center in Latin America were analyzed. Procedure characteristics and outcomes were compared between STD and vHPSD. RESULTS: Two hundred ten procedures were performed on 194 patients. Median annual number of procedures was 19 (7-29). Median age was 62 (52-68), and majority were male (71%). Median procedure duration was 155 (125-195) min, mean fluoroscopy time 32.8 ± 15 min and mean fluoroscopy dose 373.5 ± 208.9 mGray. Median follow-up was 27 months, significantly longer in STD compared with vHPSD group (43 [31-68] vs. 13 [8-19], respectively; P ≤ 0.001). The recurrence rate was 33.2% and major complications 8.6%. Compared with STD, vHPSD resulted in a significantly shorter procedure duration (125 vs. 180 min, P ≤ 0.001), shorter fluoroscopy time (22.7 ± 9.5 vs. 39.2 ± 14.3 min, P ≤ 0.001), and lower fluoroscopy dose (283.8 ± 161.1 vs. 438.3 ± 216.1 mGray, P ≤ 0.001). No long-term recurrence difference was observed when the follow-up periods were comparable. No difference in complication rate was observed (8.5% vs. 8.6%, P = 0.988). CONCLUSIONS: Outcomes in AFib CA in a Latin American low-volume private center can be considered acceptable, with efficacy and safety similar to those reported in the literature. Compared with STD ablation, vHPSD showed higher efficiency with similar efficacy and safety.

Catheter ablation of frequent monomorphic ventricular arrhythmias in Andersen-Tawil syndrome: case report and focused literature review.

BACKGROUND/PURPOSE: Andersen-Tawil syndrome type 1 is a rare autosomal dominant disease caused by a KCNJ2 gene mutation and clinically characterized by dysmorphic features, periodic muscular paralysis, and frequent ventricular arrhythmias (VAs). Although polymorphic and bidirectional ventricular tachycardias are prevalent, PVCs are the most frequent VAs. In addition, a "dominant" morphology with RBBB pattern associated with either superior or inferior axis is seen in most of the patients. Due to the limited efficacy of most antiarrhythmic drugs, catheter ablation (CA) is an alternative in patients with monomorphic VAs. Based on our experience, we aimed to review the arrhythmogenic mechanisms and substrates for VAs, and we analyzed the potential reasons for CA failure in this group of patients. METHODS: Case report and focused literature review. RESULTS: Catheter ablation has been reported to be unsuccessful in all of the few cases published so far. Most of the information suggests that VAs are mainly originated from the left ventricle and probably in the Purkinje network. Although identifying well-established and accepted mapping criteria for successful ablation of a monomorphic ventricular arrhythmia, papillary muscles seem not to be the right target. CONCLUSIONS: More research is needed to understand better the precise mechanism and site of origin of VAs in Andersen-Tawil syndrome patients with this particular "dominant" monomorphic ventricular pattern to establish the potential role of CA.

Mejora en la reperfusión del infarto de miocardio en Argentina / Improvement in Reperfusion of Myocardial Infarction in Argenitna

INTRODUCCIÓN: No existe evidencia de que la conformación de redes de atención y procesos de mejora de la calidad en Argentina se relacionen con mejores resultados en el tratamiento del infarto agudo de miocardio. OBJETIVOS: Evaluar las principales causas de demora o no reperfusión en pacientes con infarto agudo de miocardio y supradesnivel del ST, determinando si la conformación de redes de atención, derivación precoz y mejora de la calidad produce mejores resultados. MÉTODOS: Se realizó un análisis de línea de base, con registro inicial de pacientes en seis centros. En aquellos pacientes que no recibieron tratamiento apropiado (demora o falta de reperfusión), se analizaron las causas raíz. En cada centro se implementaron intervenciones ajustadas a estas causas. En la segunda fase del registro se evaluaron los resultados de las intervenciones. RESULTADOS: En la primera etapa del registro se incluyó a 193 pacientes. El primer lugar de recepción fueron las guardias externas (55,4%), seguidas de las ambulancias (25,9%). Un total de 81 pacientes (41,2%) no recibieron un tratamiento apropiado. Las principales causas fueron el desconocimiento de los pacientes y las demoras en el traslado y diagnóstico. Una vez implementadas las intervenciones, en la segunda etapa (con 226 pacientes) la proporción con demora o sin tratamiento adecuado se redujo al 32,3% (n=73,p=0,04). CONCLUSIONES: Fue factible identificar las principales causas de demora en el tratamiento del infarto agudo de miocardio con supradesnivel del ST e implementar redes de atención y ciclos de mejora. Esto puede mejorar los resultados de la reperfusión, que tiene un gran impacto en la mortalidad.

INTRODUCTION: There is no evidence that networking for care and quality improvement process in Argentina brings better results in the treatment of acute myocardial infarction. OBJECTIVES: To assess the main causes of delay or non-reperfusion in patients with acute myocardial infarction and elevated ST segment, determining whether the networking for care, early referral and quality improvement brings better results. METHODS: A base lineanalysis was performed, including initial patient records in six centers. For those patients who had not received appropriate treatment (delay or lack of reperfusion), root causes were explored. Case-related interventions were implemented in each center. The second stage of the record assessed intervention results. RESULTS: The first stage of the record included 193 patients. The first place of reception were emergency departments (55.4 percent), followed by ambulances (25.9 percent). A total of 81 patients (41.2 percent) did not receive appropriate treatment. This was mainly due to lack of information about patients and delays for transfer and diagnosis. In the second stage (with 226 patients), after the implementation of interventions, the rate with delay or without appropriate treatment was reduced to 32.3 percent (n=73, p=0.04). CONCLUSIONS: It was possible to identify the main causes of delay in the treatment of acute myocardial infarction with elevated ST segment, and to implement networks for care and improvement cycles. This can improve reperfusion results, which have a big impact on mortality.