Nonfluoroscopic catheter ablation of cardiac arrhythmias in adults: feasibility, safety, and efficacy.

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.

Correlation of noninvasive markers of cardiac allograft rejection with endomyocardial biopsy: a case report.

Although endomyocardial biopsy remains the gold standard to diagnose cardiac allograft rejection, the search continues for clinical parameters that may aid in the early diagnosis of rejection. We report the case of a 29-year-old man who underwent orthotopic heart transplantation and subsequently had multifocal moderate allograft rejection. During the patient's hospital course, he exhibited a number of clinical parameters that served as important clues for the worsening rejection. After aggressive immunosuppression, the improvement of these markers hinted toward his eventual recovery.

Transient peaked T waves during exercise stress testing: an unusual manifestation of reversible cardiac ischemia.

A 57-year-old man presented with atypical upper body pain, initially attributed to musculoskeletal etiology. After analgesic failure, an exercise myocardial perfusion imaging was performed. During stress testing, patient's pain was reproduced, accompanied by prominent T-wave peaking with minor J-point elevation. T-wave amplitude decreased at the end of the recovery phase when his chest pain completely resolved. The myocardial perfusion imaging revealed extensive reversible ischemia of the septum and apical walls. Subsequent coronary arteriography demonstrated a 99% stenosis of the left anterior descending artery that was stented. Patient has remained asymptomatic since. We conclude that transient peaked T waves with minor J-point elevation during exercise may be an unusual electrocardiographic manifestation of reversible cardiac ischemia.

Women with atrial fibrillation: Greater risk, less attention.

BACKGROUND: In 1995, atrial fibrillation (AF) was estimated to affect 2.2 million people in the United States. After the age of 75 years (the median age for onset of AF), approximately 60% of people with AF are women. Women have a significantly higher risk of AF-related stroke than do men and are more likely to live with stroke-related disability and a significantly lower quality of life. OBJECTIVE: This article provides an overview of the contributing factors and clinical presentation of AF in women and offers a rational, safe, effective, and gender-specific approach to therapy for women with AF. METHODS: Search engines, including PubMed and Google Scholar, were used to review the English-language literature addressing AF gender differences for the years 1989-2009. The search term atrial fibrillation was combined with multiple other terms, as well as with female, gender, sex, or women. Full-length manuscripts were reviewed. Original studies obtained were searched for additional relevant manuscripts using the cited references. RESULTS: Studies have shown that women are more likely than men to experience symptomatic attacks, a higher frequency of recurrences, and significantly higher heart rates during AF. Hormonal fluctuations during the menstrual cycle that affect QT intervals are an important consideration when selecting antiarrhythmic drugs for premenopausal women. Women are treated with statins less frequently than are men, possibly contributing to an increased incidence of AF in women. Women may have a higher incidence of AF because of the association with obesity. Some evidence suggests that women have a significantly higher risk of bleeding from anticoagulation. Reluctance among physicians and patients to use warfarin may be especially problematic in elderly women, who benefit most from it. Outcomes after catheter ablation for AF are similar between the sexes, yet women are referred later and less frequently. CONCLUSIONS: We favor emphasizing therapies to prevent AF and ensure safe arrhythmia management (ie, rate control and appropriate anticoagulation) once AF has been diagnosed. Gender differences should be kept in mind for women with AF to reduce risks and improve quality of life.