RESUMO
Persistent left superior vena cava is the most common thoracic venous anomaly. It is usually asymptomatic, but it can make implanting intracardiac devices difficult.We present a novel technique to facilitate desfibrillator lead implantation in patients with persistent left superior vena cava and the absence of the right superior vena cava. We used a fixed-curve Selectra 3D 65-42 cm sheath (Biotronik), orienting it toward the tricuspid valve (TV) by rotating it counter-clockwise. During follow-up, the electrodes remained stable.Our technique was safe, simple, and feasible for patients with this complex venous anatomy.
Assuntos
Marca-Passo Artificial , Veia Cava Superior Esquerda Persistente , Humanos , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgia , CoraçãoAssuntos
Potenciais de Ação , Fibrilação Atrial/cirurgia , Flutter Atrial/cirurgia , Nó Atrioventricular/fisiopatologia , Ablação por Cateter , Frequência Cardíaca , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: Ablation of atrioventricular (AV) conduction and pacemaker implantation is the therapy of last resort for symptomatic atrial tachyarrythmias when rhythm and rate control fail, but is far from ideal. To evaluate whether interatrial electrical disconnection as a result of catheter ablation is feasible and of potential clinical utility as a means of non-pharmacological heart rate control. METHODS: Eleven patients with medically refractory atrial fibrillation or left atrial flutter and symptomatic rapid ventricular response were included. The ablation strategy consisted primarily of right atrial ablation of the interatrial electrical connections, which were located by electroanatomical activation maps performed during coronary sinus stimulation. Successive activation maps were performed as each connection was blocked. If the procedure was considered unsuccessful AV nodal ablation was performed. RESULTS: The coronary sinus ostium was earliest in 10/11 and could be ablated in 5/10 patients. Interatrial conduction block was only achieved in one patient (9.1%). An unexpected AV nodal modulation with an increase in the Wenckebach cycle length (> 50 ms) occurred in 8/11 patients. These patients remained without pacemaker implantation and only 1/8 required AV nodal ablation during the 1-year follow-up. Quality of life questionnaires indicated significant improvement in patients with AV nodal modulation. CONCLUSION: Interatrial electrical disconnection by right atrial catheter ablation is a not feasible with present day technology. The extensive right atrial septal ablation performed resulted in significant AV nodal modulation in most patients, which persisted and resulted in improvement in quality of life.
Assuntos
Fibrilação Atrial/cirurgia , Flutter Atrial/cirurgia , Ablação por Cateter/métodos , Frequência Cardíaca , Idoso , Ecocardiografia , Eletrocardiografia Ambulatorial , Mapeamento Epicárdico , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de VidaRESUMO
Variant (Prinzmetal's) angina pectoris is a clinical syndrome characterized by the presence of angina at rest, coinciding with a transient ST-segment elevation. This syndrome is often caused by vasospasm, either on a normal coronary artery or at the site of a coronary atherosclerotic stenosis. We describe a classic case of variant angina associated with an angiosarcoma of the right heart chambers.
Assuntos
Angina Pectoris Variante/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Angina Pectoris Variante/diagnóstico , Angina Pectoris Variante/patologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/patologia , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
Coronary artery spasm is usually defined as a focal constriction of a coronary artery segment, reversible, and causing myocardial ischaemia by coronary blood flow restriction. Sometimes this condition is not focal and can compromise all the coronary tree. This is a very rarely described event. Generally, coronary vasospasm may occur spontaneously or induced, either physically by catheter, physiological manoeuvres (hyperventilation), or by pharmacological agents. It may also occur with or without underlying atheromatous coronary disease. The mechanism of coronary spasm remains unclear but endothelial dysfunction seems to be the main triggering factor in all causes.