Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares / Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias

Introducción y objetivos: La exposición a radiación ionizante en los procedimientos de ablación conlleva riesgos para la salud, sobre todo en pacientes pediátricos. Nuestro objetivo es comparar la seguridad y la eficacia de la ablación guiada por un sistema de navegación intracardiaca no fluoroscópica (SNINF) con las de la ablación guiada exclusivamente por fluoroscopia en pacientes pediátricos. Métodos: Se analizaron los resultados de la ablación con catéter en pacientes pediátricos con vías accesorias de riesgo o taquicardias supraventriculares remitidos a nuestro centro en un periodo de 6 años. Se compararon los procedimientos guiados solo por fluoroscopia (grupo A) y los guiados por SNINF (grupo B). Resultados: Se analizaron 120 procedimientos de ablación en 110 pacientes (edad, 11±3,2 años; el 70% varones), 62 procedimientos en el grupo A y 58 en el grupo B. No se encontraron diferencias significativas entre ambos grupos en éxito del procedimiento (el 95% del grupo A y el 93,5% del grupo B; p=0,53), complicaciones (el 1,7 frente al 1,6%; p=0,23) y recurrencia (el 7,3 frente al 6,9%; p=0,61). Sin embargo, el tiempo de fluoroscopia (mediana, 1,1 frente a 12 min; p<0,0005) y el tiempo de ablación (mediana, 96,5 frente a 133,5 s; p=0,03) fueron menores en el grupo B. La presencia de cardiopatía se comportó como un predictor independiente de recurrencia (p=0,03). Conclusiones: El SNINF para guiar los procedimientos de ablación en pacientes pediátricos reduce el tiempo de exposición a la radiación ionizante. Su empleo generalizado en las ablaciones pediátricas podría reducir el riesgo atribuido a la radiación (AU)

Introduction and objectives: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. Methods: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). Results: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). Conclusions: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation (AU)

Manejo de los pacientes con fibrilación auricular en los servicios de urgencias hospitalarios (actualización 2012) / Atrial fibrillation management in the hospital emergency department: 2012 update

La fibrilación auricular (FA) es la arritmia sostenida de mayor prevalencia en los servicios de urgencias (SHU), que presentan una frecuentación elevada y creciente en España. La FA es una enfermedad grave, que incrementa la mortalidad y asocia una relevante morbilidad e impacto en la calidad de vida de los pacientes y en el funcionamiento de los servicios sanitarios. La diversidad de aspectos clínicos a considerar y el elevado número de opciones terapéuticas posibles justifican la implementación de estrategias de actuación coordinadas entre los diversos profesionales implicados, con el fin de incrementar la adecuación del tratamiento y optimizar el uso de recursos. Este documento recoge las recomendaciones para el manejo de la FA, basadas en la evidencia disponible, y adaptadas a las especiales circunstancias de los SUH. En él se analizan con detalle las estrategias de tromboprofilaxis, control de frecuencia y control del ritmo, y los aspectos logísticos y diagnósticos relacionados (AU)

Atrial fibrillation is the most frecuently sustained arrhythmia managed in emergency departments, and accounts for a high and increasing prevalence in Spain. Atrial fibrillation is increases mortality, is associated with substantial complications and, therefore, has a relevant impact in running of the health care system. Management requires consideration of diverse clinical variables and a large number of possible therapeutic approaches, justifying action plans that coordinate the work of medical staff in the interest of providing appropriate care and optimizing resources. These evidence-based guidelines contain recommendations for managing atrial fibrillation in the special circumstances of hospital emergency departments. Stroke prohylaxis, rate control, rhtyhm control, and related diagnostic and logistic issues are discussed in detail (AU)

Guías para el manejo de la fibrilación auricular en los servicios de urgencias hospitalarios / Guidelines for the managment of atrial fibrillation in hospital emergency services

No disponible

[Wolff-Parkinson-White syndrome cured with diagnostic electrode catheter]. / Curación del síndrome de Wolff-Parkinson-White con electrocatéter diagnóstico.

Catheter-induced mechanical trauma to accessory pathways is an infrequent, usually transitory phenomenon related to manipulation of the ablation catheter. We describe a patient with Wolff-Parkinson-White syndrome due to a midseptal accessory pathway with recurrent episodes of paroxysmal tachycardias under antiarrhythmic treatment. During the diagnostic electrophysiological study coinciding with manipulation of the His catheter (5 French), mechanical trauma to the accessory pathways occurred, with preexcitation not being recovered in the midterm follow up (28 months). This is a exceptional case demonstrating the complexity of the decision making (expectant or rescue ablation) following accidental catheter-induced mechanical trauma.

[Usefulness of the Doppler index delta P/delta t in the evaluation of left ventricular systolic dysfunction]. / Utilidad del índice Doppler delta P/delta t en la evaluación de la disfunción sistólica ventricular izquierda.

INTRODUCTION AND OBJECTIVES: It has been shown that the delta P/delta t index, derived from the continuous Doppler mitral regurgitation signal correlates strongly with dP/dt. This study evaluates the feasibility, reproducibility and correlation of the index with ejection fraction and other conventional echocardiographic parameters. MATERIAL AND METHODS: One hundred and ten patients with mitral regurgitation demonstrated by colour Doppler were studied. delta P/delta t were calculated by the ratio between the interval of pression between two points of the Doppler signal (-1 and -3 m/s; 32 mmHg, applying the modified Bernouilli equation) and the interval of time (s) which separates both. Ejection fraction was measured in 70 patients by non-echocardiographic methods (isotopic ventriculography, n = 52, and angiography, n = 18). RESULTS: The index was feasible in 91 cases, the variability of intra and interobserver was 5% and 7% respectively. The correlation between delta P/delta t and ejection fraction was significant although weak (r = 0.59; p < 0.001; n = 70). It was better in the group of dilated idiopathic myocardiopathy (r = 0.72; p < 0.001; n = 18) than in the group of myocardial infarction (r = 0.54; p < 0.01; n = 25). No significant correlation was founded in the cases with mitral rheumatic valvulopathy. Regarding to the echocardiographic parameters, the best correlation was obtained with end systolic diameter (r = -0.64; p < 0.001; n = 49). Finally, a value of delta P/delta t < 1,000 mmHg/s predicted the existence of left ventricular systolic dysfunction with high accuracy (84%), sensitivity (80%) and specificity (92%). CONCLUSIONS: High feasibility when mitral regurgitation exists, adequate reproducibility and heightened precision in diagnosing left ventricular systolic dysfunction, are characteristics which make delta P/delta t useful in the echocardiographic routine practice.