Reduced esophageal heating in high-power short-duration atrial fibrillation ablation in the contact force catheter era.

BACKGROUND:  Atrial fibrillation (AF) ablation is alternative treatment to medical therapy. Most feared complication is atrioesophageal fistula METHODS: Observational, retrospective analysis of consecutive 355 patients undergoing first AF ablation. Low-power long-duration (LPLD) group contained 158 patients, with 121 (76.58%) having paroxysmal AF who underwent ablation with power 20/30W (anterior and posterior left atrial wall), 17 mL/min flow, and a contact force of 10-30 g for 30 s. High-power short-duration group (HPSD) contained 197 patients, with 113 (57.36%) having paroxysmal AF who underwent ablation at 45/50W of power with a contact force of 8-15 g/10-20 g and a 35 mL/min flow rate for 6-8 s on the anterior and the posterior left atrial wall, respectively. Both groups had pulmonary veins isolated and atrial flutter was ablated when needed. For patients not in sinus rhythm, cardioversion was performed before ablation RESULTS: There were no complications. LPLD group: Left atrial time 118.74 min, total 145.32 min, radiofrequency time 4317.99s, X-ray 13.42 min, and elevation of luminal esophageal temperature (LET) in 132 (84.53%) patients. HPSD group: Left atrial time 72.16 min, total 93.76 min, radiofrequency time 1511.29s, X-ray 7.6 min, and LET elevation in only 75 (38.07%) patients. A markedly higher rate of first-pass isolation was observed in HPSD compared to LPLD, 77.16% versus 13.29%, respectively. Recurrence occurred in 64 (40.50%) and 32 (16.24%) in 28.45 and 22.35 months in LPLD and HPSD patients, respectively. In LPLD, 10 patients were submitted to endoscopy, and one (10%) had mild erythema and in HPSD, 13 performed the endoscopy, with two (15.38%) patients showing mild erythema CONCLUSION: HPSD technique compared to the LPLD technique showed significant reduced radiofrequency and fluoroscopy times, higher rate of first-pass isolation, lower recurrence rate, and esophageal temperature elevation and may also have a protective effect avoiding incidental esophageal injury due to these findings.

Changes and impacts in early recurrences after atrial fibrillation ablation in contact force era: comparison of high-power short-duration with conventional technique-FIRST experience data.

BACKGROUND OR PURPOSE: Different atrial tachyarrhythmias (AT) may be seen during follow-up after atrial fibrillation ablation. Evaluate and analyze characteristics and management of AT following first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) and its impact on late outcome. METHODS: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD with 71 and LPLD with 73 patients and no major clinical differences between the two groups. RESULTS: AT occurred in 60 patients (41.67%) in entire follow-up. HPSD 22 patients had AT: 13 during blanking period (BP) and 9 after that. LPLD: 38 patients with AT, 14 during BP and 24 after that. During BP, HPSD showed high rate of atrial flutter/tachycardia in 9 (69.23) of 13 and LPLD 4 (28.57%) of 14 patients. At 12 months' follow-up, 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD. CONCLUSIONS: HPSD ablation produced higher rates of early than late recurrence comparing to LPLD. Regular tachyarrhythmias were most common arrhythmia during BP with HPSD ablation and AF in LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months.

Alternativas de estimulação cardíaca definitiva em portadores de anomalia de Ebstein recém-operados pela cirurgia do cone / Alternatives for definitive cardiac pacing in patients with Ebstein's anomaly recently operated by cone surgery

A passagem do cabo-eletrodo ventricular pela valva tricúspide pode ser um problema em pacientes com anomalia de Ebstein recém-operados. Neste trabalho, em que analisamos os prontuários de 3 pacientes, entre 1998 e 2012, são apresentadas alternativas de implante de marcapasso definitivo nesses casos. A estimulação cardíaca artificial preservando a valva tricúspide na anomalia de Ebstein corrigida pode ser feita de maneira eficaz pelas técnicas apresentadas

Passing the ventricular lead through the tricuspid valve may be a problem in patients recently operated for Ebstein's anomaly. In this study, which evaluated hospital charts of 3 patients from 1998 to 2012 we report alternatives for definitive pacemaker implantation. Artificial cardiac pacing preserving the tricuspid valve in corrected Ebstein anomaly may be performed effectively using the described techniques