ABSTRACT
A 24-year-old man presented with rapidly progressive dyspnea due to mixed aortic stenosis and insufficiency. Unicommissural unicuspid aortic valve, ascending aortic aneurysm, and a bovine arch were identified on computed tomography angiography. Uncomplicated surgical mechanical valve replacement and ascending aortic graft placement improved his symptoms. Aortopathy is common in unicuspid valve patients.
Subject(s)
Aortic Aneurysm , Aortic Valve Insufficiency , Aortic Valve Stenosis , Heart Valve Diseases , Adult , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/etiology , Aortic Aneurysm/surgery , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Humans , Male , Young AdultABSTRACT
PURPOSE OF REVIEW: Atrioventricular node reentrant tachycardia (AVNRT) is the most common mechanism of supraventricular tachycardia. Radiofrequency ablation has been the most prevalent method for slow pathway ablation but carries risk of atrioventricular node injury. Focal cryoablation has been utilized as an alternative ablation modality; however, there has been concern about decreased efficacy, resulting in a higher rate of recurrence postablation. We also report outcomes from two international centers using an 8-mm cryocatheter and complete a thorough comparison of existing data on ablation of AVNRT. RECENT FINDINGS: Previous reviews included studies from 2006 onward. These studies included use of the 4âmm focal cryocatheter, which has largely been abandoned in current adult practice. We will cite more contemporary studies within the past 10 years, which also includes use of the 6 and 8âmm cryocatheter. SUMMARY: The use of focal cryoablation allows for reversible injury during AVNRT ablation, providing safety from permanent atrioventricular node injury. With the appropriate ablation endpoints, 8âmm focal cryoablation is more effective for permanent lesion formation, leading to lower recurrences.
Subject(s)
Catheter Ablation , Cryosurgery , Tachycardia, Atrioventricular Nodal Reentry , Adult , Atrioventricular Node , Cryosurgery/adverse effects , Humans , Recurrence , Tachycardia, Atrioventricular Nodal Reentry/surgery , Treatment OutcomeABSTRACT
Patients with atrial fibrillation often undergo repeat catheter ablation for the recurrence of tachyarrhythmia. If the pulmonary veins were isolated in prior procedure, the operator should focus on substrate homogenization with identification and ablation of only arrhythmogenic areas.
