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1.
Europace ; 19(12): 2023-2026, 2017 Dec 01.
Article in English | MEDLINE | ID: mdl-28340160

ABSTRACT

AIMS: The transseptal approach is used for left atrial access during the ablation of atrial fibrillation (AF) and other left-sided arrhythmia substrates. Transseptal puncture (TP) is commonly performed with fluoroscopic guidance, contrast injection, and pressure monitoring. In many centres, additional techniques [intracardiac echocardiography (ICE), transoesophageal echocardiography (TEE), radiofrequency needle] are used to facilitate TP but its use adds costs. In this retrospective study, we studied the safety and complication rate when TP was routinely done with fluoroscopic guidance, contrast injection, and pressure monitoring using ICE or TEE only in selected cases. METHODS AND RESULTS: This study analysed 4690 consecutive TP performed between 2000 and 2015: 3408 (72.6%) were ablation of AF, left-sided atrial flutter, or left-sided atrial tachycardia (non-AP group); 1153 (24.6%) were ablation of left-sided accessory pathway, AP group; and 129 (2.8%) were ablation of ventricular tachycardia. Transseptal puncture was done under fluoroscopy, pressure monitoring, and commonly using contrast media injection. In 27 procedures, ICE or TEE was used to guide the TP. We found 34 tamponades (Tx) that required pericardial drainage of which 28 (0.59%) could possibly be TP related and six could not. The total complication rate for all Tx was 0.72%. A higher rate of tamponades was observed in the AF (non-AP) group than in the AP group (0.88 vs. 0.17%, P < 0.02). The highest rate of tamponades was registered during the operators 51-100 cases, 1.3%, and decreased to 0.4% in cases 101-200, P = 0.04. CONCLUSION: TP can safely be done under fluoroscopy and pressure monitoring without routine use of additional techniques. With experience, operators should be able to further decrease complication rate.


Subject(s)
Atrial Fibrillation/surgery , Atrial Flutter/surgery , Catheter Ablation/methods , Heart Atria/surgery , Heart Septum/surgery , Radiography, Interventional , Tachycardia, Supraventricular/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Atrial Flutter/diagnostic imaging , Atrial Flutter/physiopathology , Atrial Function, Left , Cardiac Catheterization , Cardiac Tamponade/etiology , Cardiac Tamponade/therapy , Catheter Ablation/adverse effects , Child , Child, Preschool , Contrast Media/administration & dosage , Echocardiography, Transesophageal , Female , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Heart Septum/diagnostic imaging , Heart Septum/physiopathology , Humans , Male , Middle Aged , Patient Safety , Punctures , Radiography, Interventional/adverse effects , Retrospective Studies , Risk Assessment , Risk Factors , Tachycardia, Supraventricular/diagnostic imaging , Tachycardia, Supraventricular/physiopathology , Time Factors , Treatment Outcome , Young Adult
2.
Scand Cardiovasc J ; 51(2): 69-73, 2017 Apr.
Article in English | MEDLINE | ID: mdl-27826985

ABSTRACT

OBJECTIVES: Cryoablation (CRYO) is an alternative to radiofrequency (RF) for catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). We aimed to study whether different CTI morphologies had different impacts on procedural success for CRYO and RF. DESIGN: This study randomized 153 patients with CTI-dependent AFL (median age 65 years; range 34-82) to RF or CRYO (78 CRYO; 75 RF). Biplane angiography (RAO 30° and LAO 60°) was done before the ablation procedure and isthmuses were classified as straight (n = 81), concave (n = 43) or pouch-like (n = 29). RF was performed with a 3.5-mm open-irrigated tip catheter and CRYO was performed with a 9 F, 8-mm tip catheter. The ablation endpoint was bidirectional block of CTI. RESULTS: Acute procedural success was achieved in 70/75 patients in the RF group and in 72/78 patients in the CRYO group. With regard to CRYO or RF, acute procedural success rates were similar between the three isthmus types: straight: CRYO (92%) and RF (96%); concave: CRYO (92%) and RF (94%); and pouch-like: CRYO (94%) and RF (85%). There were no significant differences regarding success rate between the different morphologies in the CRYO or the RF group. The CTI was longer in patients with acute failure compared to the patients with acute success (38 ± 7 mm versus 33 ± 6 mm, p = 0.045). CONCLUSION: The CTI morphology did not influence the acute success rate for either the CRYO or the RF ablation of CTI-dependent AFL. A longer CTI was associated with a lower success rate regardless of energy source.


Subject(s)
Atrial Flutter/surgery , Catheter Ablation , Cryosurgery , Heart Conduction System/surgery , Tricuspid Valve/surgery , Venae Cavae/surgery , Adult , Aged , Aged, 80 and over , Atrial Flutter/diagnostic imaging , Atrial Flutter/physiopathology , Catheter Ablation/adverse effects , Coronary Angiography , Cryosurgery/adverse effects , Female , Heart Conduction System/diagnostic imaging , Heart Conduction System/physiopathology , Heart Rate , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Single-Blind Method , Sweden , Treatment Outcome , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/physiopathology , Venae Cavae/diagnostic imaging , Venae Cavae/physiopathology
5.
Pacing Clin Electrophysiol ; 29(5): 487-9, 2006 May.
Article in English | MEDLINE | ID: mdl-16689843

ABSTRACT

INTRODUCTION: Cryoablation is a new alternative to radiofrequency (RF) ablation for treatment of atrioventricular nodal reentry tachycardias (AVNRT). Mapping with reversible effect on the arrhythmia substrate or the AV node can be done before irreversible ablation is performed. This study evaluates an approach with systematic cryomapping, ablating only in areas with prompt effect on the arrhythmia substrate and evaluates whether the success rates and procedure times are similar to RF ablation. METHODS AND RESULTS: Seventy-five consecutive patients with typical slow-fast AVNRT were studied. Cryomapping at -30 degrees C was performed before ablation with a goal temperature of -70 degrees C for 240 seconds. The ablation procedure was successful in 74 of the 75 patients, giving an acute success rate of 99%. During a mean follow-up of 338 days, 70 of the 74 primarily successfully ablated patients were free from the treated arrhythmia, giving a recurrence rate of 5% and a total success rate of 93%. Total procedure time including a 30-minute test after successful ablation was 126+/-55 minutes. Fluoroscopy time was 18.5+/-14.9 minutes. CONCLUSION: Cryoablation of AVNRT appears to be as effective as RF ablation both acute and in long term with minimal risks for unwanted injuries on the conduction system. The procedure can be done with reasonable procedure and fluoroscopy times.


Subject(s)
Body Surface Potential Mapping/methods , Cryosurgery/methods , Tachycardia, Atrioventricular Nodal Reentry/diagnosis , Tachycardia, Atrioventricular Nodal Reentry/surgery , Female , Humans , Male , Middle Aged , Prognosis , Reproducibility of Results , Sensitivity and Specificity , Treatment Outcome
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