Subject(s)
Connective Tissue Diseases , Occupational Exposure , Australia , Humans , Silicon DioxideSubject(s)
Connective Tissue Diseases/chemically induced , Construction Industry , Construction Materials/adverse effects , Occupational Diseases/chemically induced , Occupational Exposure/adverse effects , Silicon Dioxide/adverse effects , Aged , Australia , Humans , Male , Middle Aged , Silicosis/diagnosis , Silicosis/etiologyABSTRACT
PURPOSE: Cryothermal ablation (CTA) for atrioventricular nodal reentrant tachycardia (AVNRT) is considered safer than radiofrequency ablation (RFA) since it eliminates the risk of inadvertent AV block. However, it has not been widely adopted due to high late recurrence rate (LRR). In an effort to improve LRR, we evaluated a new approach to cryothermal mapping (CTM): "time to tachycardia termination" (TTT). METHODS: This single-center study had 88 consecutive patients who underwent CTA using TTT for AVNRT. The CTA catheter was positioned in sinus rhythm at the posteroseptal tricuspid annulus, and then AVNRT was induced. The CTA target site was identified by prompt tachycardia termination in ≤20 s during CTM. Procedural success was defined as no inducible AVNRT and ≤1 single AV nodal echoes. RESULTS: Acute procedural success was achieved in 87 of 88 patients (98.9 %) and was similar to prior studies for both CTA and RFA. No permanent AV block was observed. LRR was 3.7 % at a mean follow-up of 19.7 months. LRR was equivalent to that commonly reported for RFA and improved when compared to conventional CTA. CONCLUSION: TTT for CTA of AVNRT provides enhanced safety and similar long-term efficacy when compared to RFA. Based upon this experience, TTT provides an enhancement to conventional CTA that appears to result in improved long-term outcomes. In light of these findings, it seems reasonable to undertake additional randomized trials to determine whether RFA or CTA using TTT is the optimal approach for the catheter ablation of AVNRT.
Subject(s)
Body Surface Potential Mapping/methods , Cryosurgery/methods , Surgery, Computer-Assisted/methods , Tachycardia, Atrioventricular Nodal Reentry/diagnostic imaging , Tachycardia, Atrioventricular Nodal Reentry/surgery , Female , Humans , Longitudinal Studies , Male , Middle Aged , Recurrence , Treatment OutcomeABSTRACT
BACKGROUND: Ultrasound is a well-validated adjunct to central venous cannulation; however, previous reviews of ultrasound-guided radial artery cannulation have been inconclusive. The aim of this study was to assess the use of ultrasound in radial artery cannulation in adult and paediatric populations. METHODS: A systematic search of five major databases for all relevant articles published until November 2015 was conducted. Randomized controlled trials of radial artery cannulation with and without ultrasound guidance were included. All studies were assessed for level of evidence and risk of bias. Studies were grouped in adult and paediatric populations for each outcome. A meta-analysis was performed to analyse the data. RESULTS: Eleven randomized controlled trials (six adult and five paediatric) were found. In both the adult and paediatric populations, there was high-level evidence for significantly improved first-attempt success rate and number of attempts with the use of ultrasound guidance. CONCLUSIONS: This is the first level one systematic review to demonstrate strong evidence for the use of ultrasound guidance in radial artery cannulation in adult and paediatric populations. In the adult population, ultrasound use significantly increased first-attempt success rate, which subsequently resulted in a significant reduction in the number of attempts. The benefits of ultrasound were also shown in the paediatric population, with a significant increase in first-attempt success rate and reduction in the number of attempts. The use of ultrasound as an adjunct to radial arterial cannulation should now be considered best practice.
Subject(s)
Catheterization, Peripheral/methods , Radial Artery/diagnostic imaging , Ultrasonography, Interventional/methods , Adult , Child , Evidence-Based Medicine/methods , HumansABSTRACT
BACKGROUND: Catheter ablations are traditionally performed using fluoroscopic guidance, exposing both patients and medical staff to the risks of radiation. Nonfluoroscopic catheter ablation has been used successfully to treat limited types of arrhythmias in children, but whether this approach has broad application in adults is uncertain. The purpose of this study was to evaluate the feasibility, safety, and efficacy of fluoroless catheter ablation in adults being treated for a range of arrhythmias. METHODS AND RESULTS: Retrospective analysis was performed in 2 patient groups (both n = 60): (1) the nonfluoroscopy (NF) group consisting of consecutive adult patients, in which catheter positioning was accomplished exclusively with intracardiac electrograms (IE), electroanatomic mapping (EAM), and intracardiac echocardiography (ICE); and (2) the fluoroscopy (F) group, in which catheter positioning was additionally guided by fluoroscopy. The patients in the F group were selected to match the types of arrhythmias in the NF group. All ablation procedures were performed by one operator. The total procedure time did not differ between groups for any specific type of arrhythmia ablated. Acute procedural success was similar in both groups (NF, 59/60 [98%] and F, 60/60 [100%]). The complications were limited to a groin pseudoaneurysm in the NF group, and pericardial effusion and groin hematoma in the F group. CONCLUSION: Catheter ablations were efficiently and effectively performed in adults with a variety of arrhythmias using only IE, EAM, and ICE for catheter guidance. This nonfluoroscopic technique was feasible, posed no additional safety concerns, and should be readily implementable in most electrophysiology laboratories.
