ABSTRACT
AIMS: Cryoballoon pulmonary vein isolation (CB-PVI) offers similar efficacy to point-by-point radiofrequency PVI for patients with atrial fibrillation (AF), but generally with higher X-ray exposure. Strategies aimed at reducing fluoroscopy mostly rely on other costly imaging techniques, limiting their applicability. We designed a Systematic Workflow and Electrogram guidance to reduce X-ray Exposure Time during CB-PVI (SWEET-Cryo) strategy and analysed its impact on fluoroscopy use and acute procedural and clinical outcomes. METHODS AND RESULTS: We enrolled 100 patients with paroxysmal or persistent AF undergoing CB-PVI by two operators with different levels of expertise. Patients treated with the SWEET-Cryo strategy (prospective cohort; n = 50) or conventional fluoroscopy (retrospective control cohort; n = 50) were compared. When applied by the senior operator, the SWEET-Cryo strategy significantly reduced the mean fluoroscopy time (FT) (2.6 ± 1.25 vs. 20.3 ± 10.8â min) and mean dose area product (DAP) (5.1 ± 3.8 vs. 35.3 ± 22.3 Gy cm2) compared with those of the control group, respectively (P < 0.001). Significant reductions in FT (6.4 ± 2.5â min vs. 32.5 ± 10.05) and DAP (13.9 ± 7.7 vs. 92.3 ± 63.8) were also achieved by the less experienced operator (P < 0.001). No difference was observed in acute and long-term complications or freedom from AF between fluoroscopy strategies during a 33-month median follow-up. Mean FT was maintained below 3â min in randomly selected cases performed during the follow-up period. CONCLUSION: In contrast to conventional protocols and regardless of the operator's experience, the optimized SWEET-Cryo strategy dramatically reduced fluoroscopy exposure during CB-PVI. The efficacy, safety, or added costs of the ablation procedure were not compromised.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Cryosurgery , Pulmonary Veins , Humans , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/surgery , Retrospective Studies , Prospective Studies , X-Rays , Workflow , Cryosurgery/adverse effects , Cryosurgery/methods , Treatment Outcome , Pulmonary Veins/diagnostic imaging , Pulmonary Veins/surgery , Catheter Ablation/adverse effects , Catheter Ablation/methods , RecurrenceABSTRACT
Immune checkpoint inhibitors are associated with a myriad of autoimmune adverse events. We present a 70-year-old patient with renal-cell carcinoma treated with nivolumab/ipilimumab complicated with myocarditis and encephalitis in which gradual impairment of the His-Purkinje system progressed to complete atrioventricular block. Full recovery was achieved after treatment with corticosteroids and immunoglobulins. (Level of Difficulty: Intermediate.).
ABSTRACT
Catheter ablation has become the cornerstone of the treatment of ventricular arrythmias. Nevertheless, it is crucial to recognize the adverse effects of such treatment. We present a case of an incidental diagnosis of ventricular pseudoaneurysms after catheter ablation for treatment of drug-refractory nonsustained runs of ventricular tachycardia. (Level of Difficulty: Advanced.).
ABSTRACT
Type II diabetes mellitus is a known cardiovascular risk factor and its prevalence continues to increase. A revolution in the Type II diabetes mellitus treatment has occurred with the arrival of new antidiabetic drugs, which are thought to compromise metformin place. We aim to review the pharmacology, available evidence and clinical aspects of metformin use in the era of new antidiabetics.
Subject(s)
Diabetes Mellitus, Type 2 , Metformin , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Humans , Hypoglycemic Agents/therapeutic use , Metformin/therapeutic useABSTRACT
No disponible
Subject(s)
Humans , Female , Aged, 80 and over , Chest Pain/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Electrocardiography/methods , Diagnosis, Differential , Postoperative Complications/diagnosisABSTRACT
No disponible
