Peri-procedural anesthesia and patient pain experience in pulmonary vein isolation by means of very high-power short-duration radiofrequency ablation.

BACKGROUND: Very high-power short-duration (vHPSD) temperature-controlled radiofrequency ablation (vHPSD) may reduce ablation times and improve patient tolerability, permitting pulmonary vein (PV) isolation under mild conscious sedation. We evaluated of the anesthetic drugs use and patients' pain experience during vHPSD PV isolation. METHODS: Fifty-eight patients, with paroxysmal and persistent atrial fibrillation (AF), treated with QDot Micro catheter and vHPSD (90 w for 4 s) (vHPSD group), were compared with the last 33 patients treated with a surround flow contact force-sensing catheter guided by the ablation index (450 anteriorly at 50 W, 330 posteriorly at 40 W) (AI group). Anesthetic drugs use was compared as well as pain experience, measured using a 0-10 scale. RESULTS: All PVs were acutely isolated. Procedural time (78 ± 10 min vs 84 ± 12 min, p = 0.012), fluoroscopy time (369 ± 139 s vs 441 ± 172 s, p = 0.03), and RF time in the vHPSD group (8.3 ± 2.1 min) were shorter than in the AI group (25 ± 11 min, p < 0.001). Only 4 patients experienced an access site-related vascular complication (groin hematoma). Midazolam was required in 36 (62%) vHPSD group patients vs 31 (94%) AI group patients (p < 0.001). Fentanyl was required in 4 (7%) vHPSD group patients vs 25 (76%) AI group patients (p < 0.001). No patients required general anesthesia. Twenty-two (38%) vHPSD group patients underwent PV isolation without any anesthetic drug. Pain experience was significantly lower in vHPSD group (4.9 ± 2 vs 6.6 ± 1.8, p < 0.001). CONCLUSIONS: vHPSD radiofrequency ablation for PVI can be performed under conscious sedation using only benzodiazepine in most of patients without compromising patient pain experience.

Utility of a new imaging system for displaying complex anatomy during AF ablation with cryoenergy

Background@#A new catheter-based 3D dielectric imaging modality to guide electrophysiology ablation procedures that does not require contact or X-ray to image and offers new benefits for cryoablation procedures.Case presentation A 51-year-old male with paroxysmal atrial fibrillation was admitted to our hospital for atrial fibrillation ablation that was performed using cryoballoon fourth generation combined with a novel wide-band dielectric imaging system [KODEX-EPD (EPD Solutions, a Philips company)]. @*Conclusions@#This system allowed to visualize left common pulmonary vein before balloon positioning and then confirmed by pulmonary vein angiography.

ALERT-HF: adherence to guidelines in the treatment of patients with chronic heart failure.

BACKGROUND: The prognosis of chronic heart failure (CHF) may be substantially improved by strict adherence to current therapeutic guidelines. AIM AND METHODS: To assess the adherence to current guidelines, 660 CHF patients consecutively referred to the ARCA (Associazioni Regionali Cardiologi Ambulatoriali Campania) cardiologists were evaluated. As indicators of adherence to the guidelines, we considered use of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers, beta-blockers, loop diuretics, aldosterone antagonists, digoxin, anticoagulant therapy, and implantation of cardiac devices. RESULTS: The adherence to guidelines has been characterized in patients with reduced ejection fraction, who represent the majority in the ALERT-HF (Adherence to Guidelines in the Treatment of patients with Chronic Heart Failure) trial and in whom the current guidelines are well defined and shared. Among 528 patients affected by CHF with ejection fraction 45% or less, 399 (75.6%) were treated with a beta-blocker, 282 (53.4%) received an angiotensin-converting enzyme inhibitor and 199 (37.7%) an angiotensin receptor blocker. Four hundred and sixty-nine patients (88.9%) used loop diuretics, but only 163 patients (30.9%) an aldosterone antagonist. Among 148 patients with atrial fibrillation, 95 (64.2%) were treated with anticoagulants. As few as 31 patients received cardiac electrical stimulation devices: 10 patients were implanted with a cardioverter-defibrillator and 21 received a device for cardiac resynchronization therapy. CONCLUSION: The study reveals poor adherence to current therapeutic guidelines for CHF, particularly with regard to aldosterone antagonists and anticoagulant therapy in the presence of atrial fibrillation. Even poorer is the adherence to guidelines as regards the use of implantable cardiac devices. The underlying reasons are discussed in relation to the data of other registries.