Initial experience and treatment of atrial fibrillation using a novel irrigated multielectrode catheter: Results from a prospective two-center study.

BACKGROUND: PV electrical isolation has become the cornerstone of catheter ablation for the treatment of atrial fibrillation (AF). Several strategies have been proposed to achieve this goal. The aim of this study was to assess the efficacy and safety of AF ablation using a new circular irrigated multielectrode ablation catheter designed to achieve single-delivery pulmonary vein (PV) isolation. METHODS: Thirty-five patients with drug refractory paroxysmal AF and normal ejection fraction from two centers were prospectively enrolled in this study. All patients underwent PV isolation with an nMARQ circular irrigated multielectrode ablation catheter guided by an electroanatomic mapping system. Magnetic resonance imaging was performed to exclude PV stenosis. RESULTS: PV isolation was achieved in 138 of 140 (98.57%) targeted veins. The mean procedure time was 79.5 min (SD 39.3 min). During a mean follow up of 16.8±2.8 months, 27 of 35 (77.2%) patients were free of AF. No PV narrowing was observed. One case of pericardial effusion due to perforation of the left atrial free wall during catheter manipulation did occur. CONCLUSIONS: PV isolation with a circular irrigated multielectrode ablation catheter is a feasible technique with a high acute success rate. The majority of patients remained asymptomatic during the midterm follow-up period. PV stenosis was not detected. While only a single serious adverse event occurred, this technique׳s safety profile should be tested in larger studies.

Tratamiento farmacológico de la fibrilación auricular. Antiarrítmicos y anticoagulantes orales / Pharmacological treatment of atrial fibrillation. Antiarrhythmics and oral anticoagulants

El tratamiento farmacológico de la fibrilación auricular recae en dos aspectos fundamentales, la prevención del ictus mediante la anticoagulación oral y el control de la arritmia en sí, fundamentalmente control de la frecuencia cardiaca o del ritmo. En la presente revisión se repasan los principales anticoagulantes, desde los clásicos antagonistas de la vitamina K hasta los más recientes anticoagulantes directos, y se revisan las principales características de cada uno de ellos. También se revisan los distintos tratamientos para controlar la frecuencia cardiaca, así como los fármacos antiarrítmicos utilizados tanto para lograr la reversión a ritmo sinusal como para mantenerlo una vez conseguido (AU)

The pharmacological treatment of atrial fibrillation is based on two fundamental approaches: stroke prevention using oral anticoagulants and control of the arrhythmia itself, primarily by heart rate or rhythm control. This review provides an overview of the main characteristics of each of the principal anticoagulants, from classical vitamin-K antagonists to the most recent direct anticoagulants. In addition, the different treatments used to control the heart rate are discussed, as are the various antiarrhythmic drugs used both to induce reversion to normal sinus rhythm and to maintain a normal rhythm once it has been achieved (AU)

Successful retrieval of an irretrievable jugular tesio catheter using a fogarty arterial embolectomy catheter.

Long life expectancy and wide development of therapies have increased the number of patients under artificial treatment for lost kidney function or dialysis. Different options for vascular access are suitable for receiving this therapy. The use of tunneled catheters has consequently increased complications related to its use. A difficult retrieval of catheters caused by a hard fibrin sheath along its trajectory is a common drawback. Herein, we report a woman with suspicion of hemodialysis catheter infection and an irretrievable Tesio catheter. A novel technique using a Fogarty arterial catheter allowed a successful retrieval and avoided an aggressive management.

Dronedarone for recurrent ventricular tachycardia: a real alternative?

Sustained ventricular tachycardia (VT) is an important cause of morbidity and sudden death in patients with dilated cardiomyopathy. Although ICD effectively terminate VT episodes and improve survival, shocks reduce quality of life, and episodes of VT predict increased risk of heart failure and death despite effective therapy. Patients suffering recurrent VT episodes remain a challenge. Antiarrhytmic therapy reduces VT episodes, but it is associated with serious adverse events, and disappointing efficacy. Catheter ablation has emerged as an important option to control recurrent VT, but major procedure-related complications, and even death, are still issues to concern. And even with these armamentaria, some patients still have recurrent VT episodes and ICD shocks. We report on a patient with non-ischemic dilated cardiomyopathy and recurrent ventricular tachycardia resistant to multiple antiarrhytmic agents, in whom dronedarone was effective in completely suppressing ventricular tachycardia episodes.

Uncommon etiology of syncope in a patient with isolated ventricular noncompaction.

Isolated noncompaction of left ventricular myocardium (IVNC) is categorized as an unclassified cardiomyopathy by the World Health Organization. We describe the case of a 29-year-old woman who was diagnosed with IVNC after suffering two syncopes caused by an atrioventricular nodal reentrant tachycardia (AVNRT) that was successfully ablated. We report successful radiofrequency ablation in an adult with this cardiomyopathy. Although the presence of syncope in these patients obliged us to rule out a ventricular tachycardia as the most probable etiology, our case shows how an exhaustive study is needed to look for other possible and curable causes.

Guías de práctica clínica de la Sociedad Española de Cardiología sobre requerimientos y equipamiento en electrofisiología / Guidelines of the Spanish Society of Cardiology on Requirements and Equipment in Electrophysiology

La evolución, tanto cualitativa como cuantitativa, experimentada por la electrofisiología en los últimos años ha llevado a la necesidad de crear unidades específicas dedicadas al manejo de los pacientes con arritmias cardíacas. En estas guías se consideran las necesidades materiales y humanas mínimas con las que debe contar una unidad de arritmias (AU)