Ablación de fibrilación auricular: aplicación de la metodología enfermera / Atrial fibrillation ablation: application of nurse methodology

La ablación de las venas pulmonares como tratamiento de la fibrilación auricular consiste en la aplicación por medio de catéter de una onda de energía de radiofrecuencia que provoca una lesión circunferencial hasta conseguir el aislamiento eléctrico y la caída de voltaje en el interior. Se aplica fundamentalmente cuando hay resistencia al tratamiento y la recurrencia de los síntomas afecta a la calidad de vida del paciente. La enfermera es parte importante del equipo multidisciplinar que atiende a los pacientes que se someten a este procedimiento. La prestación de unos cuidados de enfermería integrales debe contemplar los cuidados previos, durante y después del tratamiento, utilizando el proceso enfermero como garantía del cuidado sistematizado y de calidad que requieren. Los objetivos de este artículo son: proporcionar conocimientos especializados sobre el procedimiento de ablación de la fibrilación auricular, describir la preparación del laboratorio o sala de electrofisiología, analizar los cuidados de enfermería durante el mismo y elaborar un plan de cuidados estandarizados para los pacientes a los que se le realiza este procedimiento utilizando la taxonomia North American Nursing Association (NANDA) y Nursing Intervention Classification (NIC) (AU)

Ablation of pulmonary veins for treatment of atrial fibrillation involves. The nurse is an important part of the multidisciplinary team who care for patients who undergo this procedure. The provision of comprehensive nursing care should include nursing procedures prior to, during, and after treatment to ensure the careful and systematic quality required. The aims of this article are: to provide specialised knowledge on the procedure of atrial fibrillation ablation, to describe the preparation of the electrophysiology laboratory, analyse nursing care and develop a standardized care plan for patients on whom this procedure is performed using the NANDA (North American Nursing Association) taxonomy and NIC (Nursing Intervention Classification). Applying radiofrequency energy wave by a catheter that causes a circumferential lesion to achieve electrical isolation and voltage drop in the interior. It is mainly applied when there is resistance to treatment and recurrence of symptoms affecting the quality of life of patients (AU)

[Atrial fibrillation ablation: application of nurse methodology]. / Ablación de fibrilación auricular: aplicación de la metodología enfermera.

Ablation of pulmonary veins for treatment of atrial fibrillation involves applying radiofrequency energy wave by a catheter that causes a circumferential lesion to achieve electrical isolation and voltage drop in the interior. It is mainly applied when there is resistance to treatment and recurrence of symptoms affecting the quality of life of patients. The nurse is an important part of the multidisciplinary team who care for patients who undergo this procedure. The provision of comprehensive nursing care should include nursing procedures prior to, during, and after treatment to ensure the careful and systematic quality required. The aims of this article are: to provide specialised knowledge on the procedure of atrial fibrillation ablation, to describe the preparation of the electrophysiology laboratory, analyse nursing care and develop a standardized care plan for patients on whom this procedure is performed using the NANDA (North American Nursing Association) taxonomy and NIC (Nursing Intervention Classification).

[Uncommon atrial flutter related to cicatrix from atriotomy surgery: radiofrequency catheter ablation]. / Aleteo auricular no común relacionado con cicatriz de atriotomía quirúrgica: ablación con catéter mediante radiofrecuencia.

A patient with a complex congenital abnormality required the implantation of an interatrial septum patch through a right lateral atriotomy. Nine years later he developed two different morphologies of an incessant uncommon atrial flutter refractory to antiarrhythmic drug treatment. The electrophysiological study localized a site on the right atrium lateral wall where local activation time was 75 ms earlier than the onset of the P wave, transient entrainment with concealed fusion was obtained, the first postpacing interval after transient entrainment was 5 ms longer than tachycardia cycle length and the stimulus to P wave interval was 50 ms. At this site, radiofrequency delivery terminated the atrial flutter in less than 1 second. No further induction or recurrences of any morphology of the atrial flutter were observed after a four month follow up. These findings suggest the existence of a narrow conduction isthmus amenable to interruption by focal delivery of radiofrequency. The isthmus was most probably located between the atriotomy and the crista terminalis, posterior to the former and anterior to the latter.

[Identification of the ischemic origin of dilated myocardiopathy using positron emission tomography]. / Identificación del origen isquémico de la miocardiopatía dilatada mediante tomografía por emisión de positrones.

INTRODUCTION AND OBJECTIVES: The aim of this study was to differentiate ischemic from nonischemic dilated cardiomyopathy with positron emission tomography. This differentiation is necessary to establish an adequate treatment, and it is often difficult with non-invasive diagnostic procedures. METHODS: Ten patients with an echocardiographic diagnosis of dilated cardiomyopathy who had undergone coronary angiography were selected. The presence or absence of angiographic coronary lesions was used to define the ischemic (n = 6) and the nonischemic group (n = 4). The ejection fraction was depressed in both groups, with no significant differences found. A perfusion study with 13N-ammonium and a metabolic imaging with 18F-florodeoxyglucose were performed on each patient. The images were quantitatively and qualitatively analysed, defining three criteria: accumulation defect (areas with activity under 50% of the maximal radioactivity), degree of heterogeneity, and match of images with both tracers. To determinate the degree of heterogeneity, nine segments on the three standard tomographic planes were studied. Based on the following heterogeneity features: irregular borders, coexisting different degrees of accumulation, and patched accumulation, a score ranging from 0 to 3 points was assigned to these segments. To analyse the radioactivity defects and the matching of studies with both tracers, the accumulation defects or the accumulating surface were outlined on a midventricular level coronal plane. RESULTS: The ischemic group has contrary to the nonischemic one, wider perfusion (0.26 +/- 0.21 vs 0.00) and metabolism defects (0.38 +/- 0.30 vs 0.06 +/- 0.09; p < 0.05). The degree of heterogeneity is significantly higher in the nonischemic group, either in perfusion (14.5 +/- 8.38 vs 2.5 +/- 1.04; p < 0.05) or in metabolism studies (15.5 +/- 3.31 vs 2.33 +/- 1.50; p < 0.005). Assigning wide defects and homogeneous accumulation to ischemic cardiomyopathy, and absence of defects and heterogeneous accumulation to nonischemic cardiomyopathy, the aetiology of the disease was identified in 9 of the 10 cases in the perfusion study and 100% of them with the metabolism imaging. CONCLUSIONS: Positron emission tomography allows to identify the aetiology of dilated cardiomyopathy, either with coronary perfusion or with myocardial glucose metabolism studies. Thus, only one of both PET studies could be used. Ischemic cardiomyopathy is characterised by wide defects and homogeneous radioactivity, and the nonischemic one by the absence of defects and heterogeneous accumulation of the tracer.