1
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Palmieri V, Yijin X, Fischbach P, Whitehill R. Safety of same-day discharge without anticoagulation for left-sided radiofrequency catheter ablations in pediatrics. Heart Rhythm 2024; 21:592-599. [PMID: 38215810 DOI: 10.1016/j.hrthm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND For left-sided radiofrequency catheter ablation (LCA) in pediatrics, significant practice variability exists regarding anticoagulation and discharge practices. Given the lack of data in pediatric patients, the risks and benefits of these practices are not well defined. OBJECTIVE The purpose of this study was to evaluate the safety of same-day discharge and use of aspirin (ASA) in pediatric patients following LCA. METHODS We performed a retrospective cohort study of pediatric patients who underwent LCA from 2010 to 2020 at our institution. Discharge timing and ASA usage were based on operator preference. The primary outcome was incidence of postablation anticoagulation complications reported within 1 month of the procedure. RESULTS Three hundred seventy-six patients underwent LCA and met inclusion criteria. Median [25th, 75th percentiles] age was 13.9 [10.5, 16.2] years; 18 (4.7%) had a history of structural heart disease. The most common substrates for ablation were Wolff-Parkinson-White syndrome (183 patients [48.7%]), concealed accessory pathway (159 patients [42.3%]), and ectopic atrial tachycardia (10 patients [2.7%]). Three hundred thirty-eight patients (89.9%) were discharged on the day of LCA. Seventy-six patients (20.2%) were prescribed ASA at discharge. Of those who underwent follow-up (273 patients [72.6%]), 7 (2.7%) reported an anticoagulation complication (5 with hematoma, 2 with headache). One of these patients was prescribed ASA; none required readmission. There was no correlation between anticoagulation complications and same-day discharge or with ASA usage. CONCLUSION Given the rare incidence of anticoagulation complications in pediatric patients undergoing LCAs, same-day discharge from the electrophysiology laboratory without anticoagulation should be considered.
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Affiliation(s)
- Vincent Palmieri
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - Xiang Yijin
- Emory University School of Medicine, Atlanta, Georgia
| | - Peter Fischbach
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - Robert Whitehill
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
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2
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Kamali H, Kafali HC, Caran B, Sulu A, Ergul Y. Coronary sinus ablations in pediatric patients with supraventricular arrhythmias. J Interv Card Electrophysiol 2023; 66:2153-2164. [PMID: 37864653 DOI: 10.1007/s10840-023-01675-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Intracoronary sinus ablations have been performed for various arrhythmical substrates. The aim of this study is to report our experience on pediatric patients of the safety and efficacy of ablations in the coronary sinus. METHODS This is a retrospective study of all patients who underwent ablations in the coronary sinus from October 2013 to October 2021 at a single center. Clinical presentation, type of arrhythmia causing tachycardia, ablation procedure, and outcome were recorded. RESULTS A total of 27 patients were included in the study. Nineteen (69%) of those followed up received a diagnosis of Wolff-Parkinson-White syndrome (WPW), 4 (15%) were cases of supraventricular tachycardia with concealed accessory pathway (AP), 2 (8%) were cases of focal atrial tachycardia, and 2 (8%) were cases of permanent junctional reciprocating tachycardia. Negative delta wave was noteworthy especially in lead II in 11/19 (58%) cases and coronary sinus diverticulum was detected in the WPW cases. Of those with manifest AP (19 cases), 15 (79%) had a high-risk AP and the AP in all WPW cases was adenosine unresponsive. Radiofrequency (RF) catheter ablation was performed in 25/27 (93%) cases during the procedure, and 16/25 (64%) of these were irrigated RF catheters. No complications were observed in the follow-up, including coronary artery injury. CONCLUSIONS Catheter ablation of supraventricular tachyarrhythmias can be accomplished effectively and potentially safely within the coronary sinus. Coronary sinus diverticula should be suspected in patients with manifest posteroseptal APs who have a previous failed ablation and typical electrocardiographic signs.
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Affiliation(s)
- Hacer Kamali
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey.
| | - H Candas Kafali
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
| | - Bahar Caran
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
| | - Ayşe Sulu
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Bezirganbahce Street, Halkali, Istanbul, 34303, Turkey
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3
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Nesti M, Lucà F, Duncker D, De Sensi F, Malaczynska-Rajpold K, Behar JM, Waldmann V, Ammar A, Mirizzi G, Garcia R, Arnold A, Mikhaylov EN, Kosiuk J, Sciarra L. Antiplatelet and Anti-Coagulation Therapy for Left-Sided Catheter Ablations: What Is beyond Atrial Fibrillation? J Clin Med 2023; 12:6183. [PMID: 37834826 PMCID: PMC10573733 DOI: 10.3390/jcm12196183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 09/07/2023] [Indexed: 10/15/2023] Open
Abstract
Aim: International guidelines on the use of anti-thrombotic therapies in left-sided ablations other than atrial fibrillation (AF) are lacking. The data regarding antiplatelet or anticoagulation strategies after catheter ablation (CA) procedures mainly derive from AF, whereas for the other arrhythmic substrates, the anti-thrombotic approach remains unclear. This survey aims to explore the current practices regarding antithrombotic management before, during, and after left-sided endocardial ablation, not including atrial fibrillation (AF), in patients without other indications for anti-thrombotic therapy. Material and Methods: Electrophysiologists were asked to answer a questionnaire containing questions on antiplatelet (APT) and anticoagulation therapy for the following left-sided procedures: accessory pathway (AP), atrial (AT), and ventricular tachycardia (VT) with and without structural heart disease (SHD). Results: We obtained 41 answers from 41 centers in 15 countries. For AP, before ablation, only four respondents (9.7%) used antiplatelets and two (4.9%) used anticoagulants. At discharge, APT therapy was prescribed by 22 respondents (53.7%), and oral anticoagulant therapy (OAC) only by one (2.4%). In patients with atrial tachycardia (AT), before ablation, APT prophylaxis was prescribed by only four respondents (9.7%) and OAC by eleven (26.8%). At discharge, APT was recommended by 12 respondents (29.3%) and OAC by 24 (58.5%). For VT without SHD, before CA, only six respondents (14.6%) suggested APT and three (7.3%) suggested OAC prophylaxis. At discharge, APT was recommended by fifteen respondents (36.6%) and OAC by five (12.2%). Regarding VT in SHD, before the procedure, eight respondents (19.5%) prescribed APT and five (12.2%) prescribed OAC prophylaxis. At discharge, the administration of anti-thrombotic therapy depended on the LV ejection fraction for eleven respondents (26.8%), on the procedure time for ten (24.4%), and on the radiofrequency time for four (9.8%), with a cut-off value from 1 to 30 min. Conclusions: Our survey indicates that the management of anti-thrombotic therapy surrounding left-sided endocardial ablation of patients without other indications for anti-thrombotic therapy is highly variable. Further studies are necessary to evaluate the safest approach to these procedures.
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Affiliation(s)
- Martina Nesti
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy; (M.N.)
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, 89129 Reggio Calabria, Italy
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | | | | | | | | | - Ahmed Ammar
- Barts NHS Trust, London E13 8SL, UK
- Department of Cardiology, Ain Shams University, Cairo 11517, Egypt
| | | | - Rodrigue Garcia
- CHU de Poitiers, 2 Rue de la Milétrie, 86021 Poitiers, France;
- Department of Cardiology, University of Poitiers, 15 Rue de l’Hotel Dieu, 86000 Poitiers, France
| | - Ahran Arnold
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | | | - Jedrzej Kosiuk
- Rhythmology Department, Helios Clinic Köthen, 06366 Köthen, Germany
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environment Sciences, L’Aquila University, 67100 L’Aquila, Italy
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4
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Phillips V, Schauvliege S, Decloedt A, Van Steenkiste G, van Loon G. Anaesthetic management for cardiac 3D electro‐anatomical mapping and radiofrequency catheter ablation in a horse with sustained atrial tachycardia. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Victoria Phillips
- Willows Veterinary Centre and Referral Service Highlands Road Shirley UK
- Department of Surgery and Anaesthesia of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Annelies Decloedt
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Glenn Van Steenkiste
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
| | - Gunther van Loon
- Equine Cardioteam Department of Large Animal Internal Medicine Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
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5
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Zhang X, Ni T, Zhang W. Ultrasonography-Guided Thermal Ablation for Cervical Lymph Node Metastasis of Recurrent Papillary Thyroid Carcinoma: Is it Superior to Surgical Resection? Front Endocrinol (Lausanne) 2022; 13:907195. [PMID: 35832431 PMCID: PMC9272822 DOI: 10.3389/fendo.2022.907195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
AIM The study aimed to systematically evaluate the safety and efficacy of ultrasonography-guided percutaneous thermal ablation in the treatment of cervical lymph node metastasis (LNM) of recurrent papillary thyroid carcinoma (PTC). METHODS PubMed, PubMed Central (PMC), Embase, and Cochrane were examined. The inclusion and exclusion criteria were determined and the relevant data were extracted from the library and other databases for LNM thermal ablation of recurrent PTC. The data were analyzed using Stata15.1, Revman5.3 software, and the standard errors of 95% confidence intervals were estimated using fixed or random effects models. Volume reduction rate (VRR), Serum thyroglobulin (Tg) level before and after thermal ablation, the total complications and major complications incidence were analyzed. RESULTS A total of 18 literature articles were included, namely, 10 radiofrequency ablation (RFA), 4 laser ablation (LA), and 4 microwave ablation (MWA). A total of 321 patients had 498 LNM. LNM volume changes before and at the last follow-up of thermal ablation (SMD = 1.04, I2 = 8%, 95% CI 0.86-1.21, P <0.0001). The postoperative lymph node VRR was 88.4% (95% CI 77.8-97.3%, I2 = 34%, P = 0.14). Tg measurements before and after thermal ablation (SMD = 1.15, 95% CI 0.69-1.60, I2 = 84%, P <0.0001). The incidence of total complications was 5.0% (95% CI 3.0-7.0%, I2 = 0.0%, P = 0.915), and the incidence of major complications was 4.0% (95% CI 2.0-6.0%, I2 = 0.0%, P = 0.888). A total of 131 LNM were located in the central region, and the major complication rate was 12.0% (95% CI 6.0-18.0%, I2 = 0.0%, P = 0.653). CONCLUSION Ultrasonography-guided thermal ablation is safe and effective in the treatment of LNM of recurrent PTC. The ablation strategy of central LNM needs to be further explored and improved. It can be used as an alternative to surgery for patients with high surgical risk or who refuse resurgery. SYSTEMATIC REVIEW REGISTRATION 10.37766/inplasy2022.6.0004, identifier INPLASY202260004.
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6
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Buja LM, Schoen FJ. The pathology of cardiovascular interventions and devices for coronary artery disease, vascular disease, heart failure, and arrhythmias. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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7
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Mullen MT, Messé SR. Stroke Related to Surgery and Other Procedures. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Yaşar S, Gökoğlan Y, Görmel S, Asil S, Kabul HK. Left atrial ıntramural hematoma after radiofrequency catheter ablation of left lateral accessory pathway. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractWe report a case of left atrial hematoma after ablation of left lateral concealed accessory pathway. A 46-year-old male patient experienced chest pain after radiofrequency ablation. Transthoracic echocardiography and computed tomography revealed the intramural mass consistent with hematoma in the left atrium. He was hemodynamically stable, and conservative approach was decided. Atrioventricular groove is a vulnerable part of left atrium, and ablation of left free wall accessory pathway may require targeting both atrial and ventricular surfaces of the mitral annulus. Avoidance of forceful catheter manipulation during the electrophysiological procedure is important for prevention of this complication. Optimal periprocedural anticoagulation might reduce the risk of procedure-related thromboembolic complications, but electrophysiologists should always pay attention to an intramural hematoma that may occur after radiofrequency catheter ablation.
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9
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Nguyen HL, Do D, Han JK, Boyle N, Lewis M, Feliciano Z. Incessant Atrial Tachycardia as First Presentation of Cardiac Angiosarcoma. JACC Case Rep 2021; 3:619-624. [PMID: 34317589 PMCID: PMC8302794 DOI: 10.1016/j.jaccas.2021.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Abstract
Primary cardiac angiosarcomas are rare malignant tumors with a very poor prognosis. We present a case of a 48-year-old man with no previous cardiac history who developed an incessant focal atrial tachycardia complicated by tachycardia-mediated cardiomyopathy as a consequence of cardiac angiosarcoma. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Heajung L Nguyen
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Duc Do
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Janet K Han
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.,Cardiac Electrophysiology Section, Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Noel Boyle
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Michael Lewis
- Department of Pathology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Zenaida Feliciano
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.,Cardiac Electrophysiology Section, Division of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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10
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Grinstein J, Garan AR, Oesterle A, Fried J, Imamura T, Mai X, Kalantari S, Sayer G, Kim GH, Sarswat N, Raikhelkar J, Adatya S, Jeevanandam V, Flatley E, Moss J, Uriel N. Increased Rate of Pump Thrombosis and Cardioembolic Events Following Ventricular Tachycardia Ablation in Patients Supported With Left Ventricular Assist Devices. ASAIO J 2021; 66:1127-1136. [PMID: 33136600 PMCID: PMC10024475 DOI: 10.1097/mat.0000000000001155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Ventricular arrhythmias are common following left ventricular assist device implantation (LVAD), and the effects of ventricular tachycardia (VT) ablation on thrombosis and embolic events are unknown. We aimed to assess LVAD thrombosis, stroke, and embolic event rates after VT ablation. Left ventricular assist device implantation patients from two academic centers who underwent endocardial VT ablation between 2009 and 2016 were compared to a control group with VT who were not ablated and followed for one year. The primary composite outcome was confirmed or suspected LVAD thrombosis, stroke, or other embolic event. Survival analysis was conducted with Kaplan-Meier curves, log-rank tests, and Cox regression. Forty-three LVAD patients underwent VT ablation, and 73 LVAD patients had VT but were not ablated. Patients who were ablated were more likely have VT prior to LVAD (p = 0.04), monomorphic VT (p < 0.01), and to be on antiarrhythmics (p < 0.01). Fifty-eight percent of the patients in the ablation group experienced the primary composite outcome (11% had confirmed device thrombosis [DT], 41% suspected DT, 39% had a stroke or embolic event) compared to 30% in the control group (12% with confirmed DT, 11% with suspected DT, 14% with stroke or embolic event) (p = 0.002). In multivariable regression, ablation was an independent predictor of the primary composite outcome (hazard ratios, 2.24; 95% confidence interval, 1.09-4.61; p = 0.03). Patients with LVADs referred for endocardial VT ablation had elevated rates of DT and embolic events.
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Affiliation(s)
| | | | | | - Justin Fried
- Division of Cardiology, Columbia University, New York, NY
| | | | - Xingchen Mai
- Division of Cardiology, Columbia University, New York, NY
| | - Sara Kalantari
- Department of Medicine, University of Chicago, Chicago, IL
| | - Gabriel Sayer
- Division of Cardiology, Columbia University, New York, NY
| | - Gene H. Kim
- Department of Medicine, University of Chicago, Chicago, IL
| | | | | | - Sirtaz Adatya
- Kaiser Permanente Advanced Heart Failure, Santa Clara, CA
| | - Valluvan Jeevanandam
- Department of Surgery, University of Chicago Medical Center, University of Chicago, Chicago, IL
| | - Erin Flatley
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Joshua Moss
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - Nir Uriel
- Division of Cardiology, Columbia University, New York, NY
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11
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Kim YG, Shim J, Boo KY, Kim DY, Lee KN, Choi JI, Kim YH. Slit-based irrigation catheters can reduce procedure-related ischemic stroke in atrial fibrillation patients undergoing radiofrequency catheter ablation. PLoS One 2020; 15:e0239339. [PMID: 33002011 PMCID: PMC7529237 DOI: 10.1371/journal.pone.0239339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022] Open
Abstract
Open irrigation ablation catheters are now the standard in radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Among various irrigation catheters, laser-cut slit-based irrigation system (Cool Flex and FlexAbility) has a unique design to cool the catheter tip more efficiently. We aimed to assess the safety of slit-based irrigation catheters regarding prevention of procedure-related ischemic complication in AF patients undergoing RFCA. The analysis was performed with Korea University Medicine Anam Hospital RFCA registry. Procedure-related ischemic complication was defined as ischemic stroke or transient ischemic attack (TIA) occurring within 30 days after RFCA. Patients were divided into 3 groups: non-irrigation, hole-based irrigation, and slit-based irrigation catheter groups. A total of 3,120 AF patients underwent first RFCA. Non-irrigation, non-slit-based irrigation, and slit-based irrigation catheters were used in 290, 1,539, and 1,291 patients, respectively. As compared with non-irrigation and non-slit-based irrigation catheter groups, slit-based irrigation catheter group had significantly older age, higher prevalence of non-paroxysmal AF, large left atrial size, and decreased left atrial appendage flow velocity. The CHA2DS2-VASc score was not different among the 3 groups. Procedure-related ischemic complication occurred in 17 patients (0.54%) with 16 ischemic strokes and 1 TIA event: 5/290 (1.72%), 11/1,539 (0.71%), and 1/1,291 (0.08%) events in non-irrigation, non-slit-based irrigation, and slit-based irrigation catheter groups, respectively (p = 0.001). Slit-based irrigation catheter was superior in direct comparison with non-slit-based irrigation catheter (0.71% vs. 0.08%; p = 0.009). Slit-based irrigation catheters were highly effective in preventing procedure-related ischemic complications.
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Affiliation(s)
- Yun Gi Kim
- Arrhythmia Center, Korea University Medicine, Seoul, Republic of Korea
| | - Jaemin Shim
- Arrhythmia Center, Korea University Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Ki Yung Boo
- Arrhythmia Center, Korea University Medicine, Seoul, Republic of Korea
| | - Do Young Kim
- Arrhythmia Center, Korea University Medicine, Seoul, Republic of Korea
| | - Kwang-No Lee
- Arrhythmia Center, Korea University Medicine, Seoul, Republic of Korea
| | - Jong-Il Choi
- Arrhythmia Center, Korea University Medicine, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Arrhythmia Center, Korea University Medicine, Seoul, Republic of Korea
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12
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Houck CA, Chandler SF, Bogers AJJC, Triedman JK, Walsh EP, de Groot NMS, Abrams DJ. Arrhythmia Mechanisms and Outcomes of Ablation in Pediatric Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2019; 12:e007663. [PMID: 31722541 DOI: 10.1161/circep.119.007663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In contrast to the adult population with congenital heart disease (CHD), arrhythmia mechanisms and outcomes of ablation in pediatric patients with CHD in recent era have not been studied in detail. Aims of this study were to determine arrhythmia mechanisms and to evaluate procedural and long-term outcomes in pediatric patients with CHD undergoing catheter ablation. METHODS Consecutive patients <18 years of age with CHD undergoing catheter ablation over an 11-year period (2007-2018) were included. Procedural outcome included complete or partial success, failure or empirical ablation. Long-term outcome included arrhythmia recurrence and burden according to a 12-point clinical arrhythmia severity score. RESULTS The study population consisted of 232 patients (11.7 years [0.01-17.8], 33.5 kg [2.2-130.1]). The most common diagnoses were Ebstein's anomaly (n=44), septal defects (n=39), and single ventricle (n=36). Arrhythmia mechanisms included atrioventricular reentry tachycardia (n=104, 90 patients), atrioventricular nodal reentry tachycardia (n=33, 29 patients), twin atrioventricular nodal tachycardia (n=3, 2 patients), macroreentrant atrial tachycardia (n=59, 56 patients), focal atrial tachycardia (n=33, 25 patients), ventricular ectopy (n=10, 8 patients), and ventricular tachycardia (n=15, 13 patients). Fifty-six arrhythmias (39 patients) were undefined. Outcomes included complete success (n=189, 81%), partial success (n=7, 3%), failure (n=16, 7%), or empirical ablation (n=20, 9%). Over 3.6 years (0.3-10.7) arrhythmia recurred in 49%. Independent of arrhythmia recurrence, arrhythmia scores decreased from 4 (0-10) at baseline to 0.5 (0-8) at 4 years follow-up (P<0.001). In 23/51 repeat procedures (45%), a different arrhythmia substrate was found. Overall adverse event rate was 9.4%, although only 1.6% (n=4) were of major severity and 0.8% (n=2) of moderate severity. CONCLUSIONS Pediatric patients with CHD demonstrate a broad spectrum of arrhythmia mechanisms. Despite recurrence and emergence of novel mechanisms after a successful procedure, ablation can be performed safely and successfully resulting in decreased arrhythmia burden.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stephanie F Chandler
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Natasja M S de Groot
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
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13
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Aksoy F. Radiofrequency catheter ablation increases mean platelet volume. ACTA ACUST UNITED AC 2019; 65:1080-1085. [PMID: 31531605 DOI: 10.1590/1806-9282.65.8.1080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Radiofrequency ablation (RFA) may increase the risk of thromboembolic events. The objective of this study was to evaluate the effect of RFA on mean platelet volume (MPV), an indicator of platelet activity. METHODS A total of 95 patients undergoing RFA were included in the study. MPV was measured before and one month after the procedure. The control group was formed by 83 individuals of the same sex and age as those in the study group. RESULTS Beta-blockers, non-dihydropyridine calcium channel blockers, and acetylsalicylic acid use was higher in the ablation group compared with the control group. Other baseline clinical characteristics and baseline hemoglobin, white blood cell count, platelet count, and MPV values were similar between the ablation and control groups. In the ablation group, baseline and post-procedural hemoglobin, white blood cell counts were similar. However, postprocedural MPV values were higher, and platelet counts were lower compared with the preprocedural values. CONCLUSION Our results indicate that MPV values are higher after RFA compared with baseline values.
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Affiliation(s)
- Fatih Aksoy
- . Department of Cardiology, Suleyman Demirel University, Isparta, Turkey
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Głowniak A, Janczarek M, Tarkowski A, Wysocka A, Szczerbo-Trojanowska M, Wysokiński A. Silent Cerebral Infarcts Following Left-Sided Accessory Pathway Ablation in Wolff-Parkinson-White (WPW) Syndrome: A Preliminary Report. Med Sci Monit 2019; 25:1336-1341. [PMID: 30778023 PMCID: PMC6391861 DOI: 10.12659/msm.914652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Catheter ablation is a routine procedure in patients with WPW syndrome. Silent cerebral infarcts (SCI) detected in magnetic resonance imaging may be a complication of the ablation procedure, but it is well documented only in atrial fibrillation ablation. Ablation of left-sided accessory pathways (L-AP) has a similar target area, but WPW patients differ from those with atrial fibrillation, due to lower initial risk of cerebral embolic events. The aim of this study was to determine whether the ablation of left-sided accessory pathways carries the risk of SCI. Material/Methods Twenty consecutive patients with overt L-AP referred for RF ablation in our center were included in the study. An irrigated ablation catheter was used in 8 patients, and a non-irrigated ablation catheter was used in 12 patients. Diffusion-weighted magnetic resonance imaging was performed pre-procedurally and on the next day after the ablation in all patients. Results Ablation procedures were completed without complications and there were no neurological symptoms following the procedure, although in 2 patients (10%), post-procedural diffusion-weighted magnetic resonance revealed new acute silent cerebral infarcts. Both patients with new cerebral lesions were female, and a non-irrigated catheter was used in both cases. Conclusions This is the first study documenting the presence of silent cerebral infarcts after WPW ablation. Further investigations are needed to evaluate the risk of silent cerebral infarcts associated with L-AP ablation.
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Affiliation(s)
- Andrzej Głowniak
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Marzena Janczarek
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
| | - Adam Tarkowski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Anna Wysocka
- Department of Cardiology, Medical University of Lublin, Lublin, Poland.,Department of Internal Medicine in Nursing, Medical University of Lublin, Lublin, Poland
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15
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Berrueco R, Sarquella-Brugada G. Worldwide Variability of Antithrombotic Therapy During Cardiac Catheter Ablation in Children: A Survey from 50 Centers Around the World. Pediatr Cardiol 2019; 40:456-458. [PMID: 30673800 DOI: 10.1007/s00246-019-02053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- R Berrueco
- Pediatric Hematology Department, Hospital Sant Joan de Déu de Barcelona, Universitat de Barcelona, Servicio de Hematología Pediátrica, Edificio consultas externas, planta 2, puerta 222, Passeig Sant Joan de Déu, nº 2., CP 08950, Esplugues de Llobregat, Barcelona, Spain. .,Institut de Recerca Pediàtrica Hospital Sant Joan de Déu de Barcelona (IRP-HSJD), Barcelona, Spain. .,Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBER ER), Instituto de Salud Carlos III, Madrid, Spain.
| | - G Sarquella-Brugada
- Arrhythmia Unit, Cardiology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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16
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Percutaneous Laser Ablation of Unifocal Papillary Thyroid Microcarcinoma: Utility of Conventional Ultrasound and Contrast-Enhanced Ultrasound in Assessing Local Therapeutic Response. World J Surg 2018; 42:2476-2484. [PMID: 29488064 DOI: 10.1007/s00268-018-4500-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To investigate the use of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in assessing local therapeutic response of percutaneous laser ablation (PLA) for papillary thyroid microcarcinoma (PTMC). METHODS Sixty-four patients with 64 PTMCs who were referred to our hospital from November 2013 to July 2016 were treated with PLA. The extent of ablation was assessed by CEUS at 10-20 min and 7 days after PLA. The size and volume of the ablation zone were evaluated on conventional ultrasound at 1 h, 1, 3, 6 and 12 months, and every half-year thereafter, and recurrences were also recorded. Ultrasound-guided fine needle aspiration biopsy (FNAB) of the ablated area was performed at 1, 6 and 12 months after PLA. RESULTS Two incomplete ablations were detected by CEUS, and a second ablation was performed. The mean largest diameter and volume of the ablated area on CEUS at 10-20 min and 7 days after PLA were significantly larger than those of pre-treatment on conventional ultrasound (p < 0.05, for both). At the last follow-up, the mean largest diameter was reduced from 4.6 ± 1.5 to 0.6 ± 1.3 mm (p < 0.0.5), and the average volume was 41.0 ± 40.4 mm3, which decreased to 1.8 ± 6.7 mm3 (p < 0.0.5). A cervical metastatic lymph node was detected on ultrasound and confirmed by ultrasound-guided FNAB at 30 months after PLA. CONCLUSIONS CEUS could play a crucial role in assessing the completeness of PLA for treating PTMC, and conventional ultrasound can not only guide the FNAB process but also is important in the follow-up of PTMC after PLA.
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Igel DA, Urban JF, Kent JP, Lim B, Venkatachalam KL, Asirvatham SJ, Sigg DC. Effect of Charge Delivery on Thromboembolism During Radiofrequency Ablation in Canines. JACC Clin Electrophysiol 2018; 4:958-966. [PMID: 30025698 DOI: 10.1016/j.jacep.2018.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study investigated whether delivering negative charge to catheter tips reduces thromboembolism during catheter ablation. BACKGROUND Radiofrequency (RF) ablation prevents atrial fibrillation that can cause stroke or death. However, ablation itself can cause stroke (2%) or silent ischemia (2% to 41%), possibly via particulate debris that embolizes after coagulum adherence to catheter surfaces. Coagulum formation on RF catheters can be prevented by applying negative charge, but it is unknown if charge reduces peripheral thromboembolism. METHODS Paired (Charge ON vs. OFF) endocardial RF ablations were performed in 9 canines using nonirrigated RF catheters. Continuous negative charge was delivered via -100 μA of DC current applied to ablation catheter electrodes. Intracardiac echocardiography was used to navigate the catheter and to monitor coagulum formation. In a subset of 5 canines, microemboli flowing through polyester tubing between the femoral artery and vein (extracorporeal loop) were monitored with bubble counters and inline filter fabric. After each ablation, catheter-tip coagulum and blood particles deposited on the filters were quantified using photography and imaging software (ImageJ, U.S. National Institutes of Health, Bethesda, Maryland). RESULTS Negative charge significantly decreased the extracorporeal loop median filter area covered by particles (n = 19 pairs) by 10.2 mm2 (p = 0.03), and decreased median filter particles by 349 (p = 0.03). Negative charge also decreased the percentage of the catheter tip surface area covered by coagulum (n = 39 pairs) by 7.2% (p = 0.03). CONCLUSIONS Negative charge delivery to ablation catheter tips during RF ablation can reduce particulate embolization material in an extracorporeal loop, and potentially reduce thromboembolic risk associated with RF ablation.
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Affiliation(s)
| | | | | | - Bernard Lim
- Heart and Vascular Program, Baystate Medical Center, Springfield, Massachusetts
| | - K L Venkatachalam
- Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida
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18
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Zhang L, Zhou W, Zhan W. Role of ultrasound in the assessment of percutaneous laser ablation of cervical metastatic lymph nodes from thyroid carcinoma. Acta Radiol 2018; 59:434-440. [PMID: 28786300 DOI: 10.1177/0284185117721261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Few studies have examined the feasibility and efficiency of performing ultrasound and contrast-enhanced ultrasound (CEUS) after percutaneous laser ablation (PLA) of cervical metastatic lymph nodes from thyroid cancer. Purpose To investigate and describe the use of conventional ultrasound and CEUS in evaluating PLA of metastatic lymph nodes. Material and Methods PLA was performed in a small, prospective, observational study of 21 metastatic lymph nodes in 17 thyroid cancer patients who underwent radical thyroid resection. CEUS was conducted prior to PLA and 1 h and seven days after ablation. Conventional ultrasound examination of all nodes was performed during follow-up after ablation. We observed contrast agent perfusion in the lymph nodes, calculated perfusion defect volumes using CEUS and determined the rates of reduction for metastatic lymph nodes for a mean duration of 17.86 ± 4.704 months (range = 12-27 months). Results CEUS demonstrated that the perfusion defect volume was larger on day 7 than on day 1 post-ablation in 47% of the ablated nodes. Compared to the largest diameters and volumes pre-PLA, the corresponding post-PLA values significantly decreased ( P < 0.05 versus baseline). No statistically significant change in thyroglobulin (Tg) levels before and after PLA was observed in this study ( P > 0.05 versus baseline). Conclusion CEUS can be effectively used to distinguish the margins of ablated regions, assess the accuracy of PLA, and monitor short-term changes in necrotic areas. However, long-term follow-up assessments of the curative effect of PLA will predominantly rely on conventional ultrasonography.
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Affiliation(s)
- Lu Zhang
- Ruijin Hospital Affiliated to Shanghai JiaoTong University of Medicine School, Shanghai, PR China
| | - Wei Zhou
- Ruijin Hospital Affiliated to Shanghai JiaoTong University of Medicine School, Shanghai, PR China
| | - WeiWei Zhan
- Ruijin Hospital Affiliated to Shanghai JiaoTong University of Medicine School, Shanghai, PR China
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Arakawa M, Shimoyama T, Matsumoto N, Suda S, Kurita J, Kimura K. A case of cerebral embolism with a large thrombus in the left atrium, and a recurrence of thrombus in the left atrium after the maze procedure. Rinsho Shinkeigaku 2017; 57:584-590. [PMID: 28954974 DOI: 10.5692/clinicalneurol.cn-001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 67-year-old woman developed weakness of the entire left side of the body and disturbance of consciousness, and was admitted to our hospital. She had atrial fibrillation (AF) on arrival at the hospital. Diffusion weighted magnetic resonance imaging showed high intensity area in the right basal ganglia, and magnetic resonance angiography showed occlusion of the right internal carotid artery (ICA). Thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) was administered 225 minutes after onset, and endovascular procedure also performed. After endovascular therapy, the patient had successful recanalization of the right ICA. Transesophageal echocardiography (TEE) showed a mass in the left atrium. Cardiac surgery for the excision of a left atrial mass and the maze procedure for atrial fibrillation were performed on the 29th hospital day. The mass was pathologically confirmed as thrombus. Follow up TEE after cardiac surgery revealed recurrence of thrombus at the both origin of pulmonary vein in the left atrium. Finally, the thrombus was disappeared at 6-month after onset with taking warfarin. She had no stroke events during the clinical course.
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Affiliation(s)
- Masafumi Arakawa
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School
| | - Takashi Shimoyama
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School
| | - Noriko Matsumoto
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School
| | - Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School
| | - Jiro Kurita
- Department of Cardiovascular surgery, Graduate School of Medicine, Nippon Medical School
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School
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20
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Outcomes after repeat ablation of ventricular tachycardia in structural heart disease: An analysis from the International VT Ablation Center Collaborative Group. Heart Rhythm 2017; 14:991-997. [DOI: 10.1016/j.hrthm.2017.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Indexed: 11/17/2022]
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21
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Aagaard P, Briceno D, Csanadi Z, Mohanty S, Gianni C, Trivedi C, Nagy-Baló E, Danik S, Barrett C, Santoro F, Burkhardt JD, Sanchez J, Natale A, Di Biase L. Atrial Fibrillation Ablation and Stroke. Cardiol Clin 2017; 34:307-16. [PMID: 27150179 DOI: 10.1016/j.ccl.2015.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Catheter ablation has become a widely available and accepted treatment to restore sinus rhythm in atrial fibrillation patients who fail antiarrhythmic drug therapy. Although generally safe, the procedure carries a non-negligible risk of complications, including periprocedural cerebral insults. Uninterrupted anticoagulation, maintenance of an adequate ACT during the procedure, and measures to avoid and detect thrombus build-up on sheaths and atheters during the procedure, appears useful to reduce the risk of embolic events. This is a review of the incidence, mechanisms, impact, and methods to reduce catheter ablation related cerebral insults.
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Affiliation(s)
- Philip Aagaard
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA
| | - David Briceno
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA
| | - Zoltan Csanadi
- Department of Cardiology, University of Debrecen, 22 Móricz Zs, Debrecen H4032, Hungary
| | - Sanghamitra Mohanty
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Carola Gianni
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Edina Nagy-Baló
- Department of Cardiology, University of Debrecen, 22 Móricz Zs, Debrecen H4032, Hungary
| | - Stephan Danik
- The Al-Sabah Arrhythmia Institute at Mount Sinai St. Luke, New York, NY, USA
| | - Conor Barrett
- The Al-Sabah Arrhythmia Institute at Mount Sinai St. Luke, New York, NY, USA
| | | | - J David Burkhardt
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Javier Sanchez
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA
| | - Andrea Natale
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; CaseWestern Reserve University, Cleveland, OH, USA; EP Services, California Pacific Medical Center, San Francisco, CA, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Dell Medical School, University of Texas, Austin, TX, USA.
| | - Luigi Di Biase
- Department of Cardiology, Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy; Department of Biomedical Engineering, University of Texas, Austin, TX, USA.
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Prevention and Treatment of Lower Limb Deep Vein Thrombosis after Radiofrequency Catheter Ablation: Results of a Prospective active controlled Study. Sci Rep 2016; 6:28439. [PMID: 27329582 PMCID: PMC4916462 DOI: 10.1038/srep28439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/06/2016] [Indexed: 01/07/2023] Open
Abstract
We conducted a prospective, single-center, active controlled study from July 2013 to January 2015, in Chinese patients with rapid ventricular arrhythmia who had received radiofrequency catheter ablation (RFCA) treatment to determine formation of lower extremity deep vein thrombosis (LDVT) post RFCA procedure, and evaluated the effect of rivaroxaban on LDVT. Patients with asymptomatic pulmonary thromboembolism who had not received any other anticoagulant and had received no more than 36 hours of treatment with unfractionated heparin were included. Post RFCA procedure, patients received either rivaroxaban (10 mg/d for 14 days beginning 2–3 hours post-operation; n = 86) or aspirin (100 mg/d for 3 months beginning 2–3 hours post-operation; n = 90). The primary outcome was a composite of LDVT occurrence, change in diameter of femoral veins, and safety outcomes that were analyzed based on major or minor bleeding events. In addition, blood flow velocity was determined. No complete occlusive thrombus or bleeding events were reported with either of the group. The lower incidence rate of non-occluded thrombus in rivaroxaban (5.8%) compared to the aspirin group (16.7%) indicates rivaroxaban may be administered post-RFCA to prevent and treat femoral venous thrombosis in a secure and effective way with a faster inset of action than standard aspirin therapy.
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23
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Lim B, Venkatachalam KL, Henz BD, Johnson SB, Jahangir A, Asirvatham SJ. Prevention of Coagulum Formation With Simultaneous Charge Delivery in Radiofrequency Ablation: A Canine Model. JACC Clin Electrophysiol 2016; 2:233-241. [PMID: 29766876 DOI: 10.1016/j.jacep.2015.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/23/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study reports on a novel method to prevent coagulum formation by continuously delivering a negative charge to the catheter tip to repel negatively charged fibrinogen molecules during RF ablation. BACKGROUND Radiofrequency (RF) ablation for cardiac arrhythmias is associated with a 70% incidence of coagulum formation on the catheter tip during ablation and a 10% incidence of thromboembolic events. Catheter tip thrombus can impede RF energy to the tissue, reducing efficacy and increasing procedure times. METHODS A novel circuit was built to deliver a negative, fixed-offset, direct current-based charge using a 9-V battery, placed in parallel with an RF delivery unit during RF ablation. In in vivo canine experiments, standard ablation catheters were advanced into atria and ventricles under fluoroscopic guidance. The presence of thrombus with and without RF delivery was identified with intracardiac echocardiography. RESULTS Scanning electron microscopy of the catheter tips showed clot coverage of the catheter tip to be 90% for noncharged catheters compared to 0% (p < 0.01) in negatively charged catheters. Volume of clot formed on the catheter tip decreased with increased amount of charge (140 ± 5.3 arbitrary units with no charge vs. 0 arbitrary units with a 100-μA current delivering negative charge, p < 0.01). Application of a negative charge did not affect the quality of the intracardiac electrogram or induce malignant ventricular arrhythmias. CONCLUSIONS Negative-charge delivery to ablation catheter tips and tissue during RF ablation is feasible and safe and can eliminate coagulum formation, potentially reducing thromboembolic complications.
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Affiliation(s)
- Bernard Lim
- Prairie Cardiovascular Consultants, Springfield, Illinois, USA.
| | - K L Venkatachalam
- Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Susan B Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Arshad Jahangir
- Aurora Health Care, Center for Integrative Research on Cardiovascular Aging (CIRCA), Milwaukee, Wisconsin, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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24
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Stroke Related to Surgery and Other Procedures. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Buja L, Schoen F. The Pathology of Cardiovascular Interventions and Devices for Coronary Artery Disease, Vascular Disease, Heart Failure, and Arrhythmias. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00032-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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26
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Gonzalez J, Levinstein M, Brugada P. [Cryoablation: Clinical applications in cardiac electrophysiology from their biophysical bases]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 86:41-50. [PMID: 26556222 DOI: 10.1016/j.acmx.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/14/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022] Open
Abstract
Cryoablation is an energy alternative to radiofrequency for ablation of various arrhythmias, where its unique biophysical properties offer a greater safety profile. Since its first use for the surgical treatment of different arrhythmias until its conceptualization in the current technical transcatheter, cryoablation has proven not to be only a safe source of energy, but also an effective source in the long-term. While the radiofrequency has been the energy most used for isolation of pulmonary veins in atrial fibrillation ablation, technological advances in cryoballon have managed to simplify the procedure without sacrificing its effectiveness. Cryoablation has been widely used for arrhythmias located in high-risk locations, such as the ablation of the atrioventricular nodal reentrant tachycardia and septal accessory pathways, due to its theoretical null risk of complete AV block. This review intends to give the clinical applications of the cryothermy through a thorough understanding of their biophysical basis.
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Affiliation(s)
- Jorge Gonzalez
- Centro Especializado en Terapia Endovascular, Jardines Hospital de Especialidad, Guadalajara, Jalisco, México.
| | | | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Bruselas, Bélgica
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Abo-Salem E, Lockwood D, Boersma L, Deneke T, Pison L, Paone RF, Nugent KM. Surgical Treatment of Atrial Fibrillation. J Cardiovasc Electrophysiol 2015; 26:1027-1037. [PMID: 26075595 DOI: 10.1111/jce.12731] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common chronic arrhythmia in the adult population. Ablation lines have largely replaced the historical and challenging cut and sew techniques. Surgical ablation of AF is commonly performed in cases with other indications for cardiac surgery and less commonly as a stand-alone therapy. Pulmonary vein isolation is the cornerstone of this procedure. Extended left atrial ablation lines may increase efficacy in cases with longstanding persistent or permanent AF. Additional efficacy by adding right atrial ablation is controversial but is often performed in cases undergoing right atrial or atrial septal surgery. Left atrial volume reduction is recommended in cases with large left atria and AF undergoing another cardiac surgery. Arrhythmia recurrence is not uncommon after surgical ablation of AF and varies among studies due to heterogeneity in patient population, lesion set and endpoints. Freedom from AF recurrence was 65-87% at 12 months and 58-70% at 2 years follow-up. Long-term monitoring is recommended due to an increased prevalence of asymptomatic recurrences. The strongest predictors of AF recurrence are longstanding or persistent AF and a large left atrium. The most common mechanisms of recurrence are pulmonary vein reconnection, nonpulmonary vein triggers, and gaps in the ablation lines. About 20% of atrial tachyarrhythmia recurrences are atrial flutter or atrial tachycardia. There are not enough data in the surgical literature to support withdrawal of anticoagulation after surgical AF ablation. Patients selected for stand-alone surgical ablation usually have low risk profiles and low postoperative mortality rates (0.2%).
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Affiliation(s)
- Elsayed Abo-Salem
- Division of Cardiovascular Health and Diseases, University of Cincinnati, Cincinnati, Ohio
| | - Deborah Lockwood
- Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Thomas Deneke
- Department of Cardiology, BG-Kliniken Bergmannsheil, University of Bochum, Bochum, Germany
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ralph F Paone
- Department of Surgery, Texas Tech University HSC, Lubbock, Texas, USA
| | - Kenneth M Nugent
- Division of Pulmonary and Critical Care Medicine, Texas Tech University HSC, Lubbock, Texas, USA
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Abstract
Atrial fibrillation is a very common clinical problem with a high prevalence that is expected to rise over time because of increasing risk factors (eg, age, obesity, hypertension). This high prevalence is also associated with high cost, because atrial fibrillation represents about 1% of overall health care spending. The management of atrial fibrillation involves multiple facets: (1) management of underlying disease if present and the management of atrial fibrillation risk factors, (2) prevention of thromboembolism, (3) control of the ventricular rate during atrial fibrillation, and (4) restoration and maintenance of normal sinus rhythm.
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Affiliation(s)
- Talal Moukabary
- Clinical Electrophysiology, Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Penn State University, 500 University Drive, Hershey, PA 17033, USA
| | - Mario D Gonzalez
- Clinical Electrophysiology, Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Penn State University, 500 University Drive, Hershey, PA 17033, USA.
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29
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Chen YH, Lin H, Xie CL, Zhang XT, Li YG. Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis. Sci Rep 2015; 5:10910. [PMID: 26039980 PMCID: PMC4454189 DOI: 10.1038/srep10910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/06/2015] [Indexed: 11/09/2022] Open
Abstract
We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time.
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Affiliation(s)
- Yi-He Chen
- Department of Cardiology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Hui Lin
- Department of Respiratory, the second affiliated hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Cheng-Long Xie
- Department of Neurology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xiao-Ting Zhang
- Department of Dermatology, the second affiliated hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
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Bhatty S, Saliaris AP. Atrial fibrillation ablation in the era of cryoballoon and force-sensing catheters: freeze or burn? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:374. [PMID: 25791081 DOI: 10.1007/s11936-015-0374-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT Atrial fibrillation can adversely affect the quality of life for many patients. Though antiarrhythmic drug therapy remains an option for the treatment of atrial fibrillation, the drugs are associated with numerous side effects. Atrial fibrillation ablation has been shown to be as efficacious as antiarrhythmic drug therapy. The field of atrial fibrillation ablations has evolved over time from utilizing radiofrequency energy to using cryoenergy. Newer technologies are being developed with efforts to improve outcomes in patients undergoing atrial fibrillation ablations. This article will highlight two such technologies: cryoballoon ablation catheters and contact force-sensing catheters. These novel catheters appear to be further revolutionizing this young field in electrophysiology.
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Affiliation(s)
- Shaun Bhatty
- University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA,
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Hasebe Y, Yamamoto H, Fukuda K, Nishimiya K, Hanawa K, Shindo T, Kondo M, Nakano M, Wakayama Y, Takayama K, Shimokawa H. Development of a novel shock wave catheter ablation system--the first feasibility study in pigs. PLoS One 2015; 10:e0116017. [PMID: 25633373 PMCID: PMC4310588 DOI: 10.1371/journal.pone.0116017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/29/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Radio-frequency catheter ablation (RFCA) using Joule heat has two fundamental weaknesses: the limited depth of treatment and the risk of thrombus formation. In contrast, focused shock wave (SW) therapy could damage tissues at arbitrary depths without heat generation. Thus, we aimed to develop a SW catheter ablation (SWCA) system that could compensate for the weaknesses of RFCA therapy. Methods and Results We developed a SWCA system where the SW generated by a Q-switched Holmium: yttrium aluminum garnet (YAG) laser beam was reflected by a reflector attached to 14-Fr catheter tip and then was converged onto the focus. We examined the feasibility of our system on pigs in vivo. When applied using the epicardial approach, the SWCA caused persistent spheroidal lesions with mild superficial injury than the RFCA. The lesions were created to a depth based on the focal length (2.0 mm) [2.36 ± 0.45 (SD) mm immediately after procedure, n = 16]. When applied to the atrioventricular (AV) node using the endocardial approach, the SWCA caused junctional escape rhythms in 2 pigs and AV block in 12 pigs (complete AV block in 9) in acute phase (n = 14). Nine of the 14 pigs survived with pacemakers for the long-term study, and the AV block persisted for 12.6 ± 3.9 (SD) days in all surviving pigs. Histological examination showed AV nodal cell body atrophy in the acute phase and fibrotic lesions in the chronic phase. Importantly, no acute or chronic fatal complications were noted. Conclusions Our novel SWCA system could be a promising modality as a non-thermal ablation method to compensate for the weaknesses of RFCA therapy. However, further research and development will be necessary as the current prototype still exhibited the presence of micro-thrombus formation in the animal studies.
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Affiliation(s)
- Yuhi Hasebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Yamamoto
- Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Fukuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kensuke Nishimiya
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichiro Hanawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masateru Kondo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuji Wakayama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuyoshi Takayama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Simão MF, Rios MN, Leiria TLL, Kruse ML, Pires LM, SantAnna RT, Lima GGD. Electrophysiological studies and radiofrequency ablations in children and adolescents with arrhythmia. Arq Bras Cardiol 2014; 104:53-7. [PMID: 25372472 PMCID: PMC4387611 DOI: 10.5935/abc.20140163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/18/2014] [Indexed: 11/20/2022] Open
Abstract
Background Radiofrequency ablation is the standard non-pharmacological treatment for
arrhythmias in pediatric patients. However, arrhythmias and their associated
causes have particular features in this population. Objective To analyze the epidemiological characteristics and findings of
electrophysiological diagnostic studies and radiofrequency ablations in pediatric
patients referred to the Electrophysiology Unit at Instituto de Cardiologia do Rio
Grande do Sul, in order to characterize the particularities of this
population. Methods Cross-sectional study with 330 electrophysiological procedures performed in
patients aged less than 20 years between June 1997 and August 2013. Results In total, 330 procedures (9.6% of the overall procedures) were performed in
patients aged less than 20 years (14.33 ± 3.25 years, age range 3 months to 19
years), 201 of which were males (60.9%). A total of 108 (32.7%)
electrophysiological diagnostic studies were performed and of these, 48.1% showed
abnormal findings. Overall, 219 radiofrequency ablations were performed (66.3%)
with a success rate of 84.8%. The presence of an accessory pathway was the most
prevalent finding, occurring in 158 cases (72.1%), followed by atrioventricular
nodal reentrant tachycardia (16.8%), typical atrial flutter (3.1%) and
extrasystoles originating from the right ventricular outflow tract (2.7%). Three
patients developed complications during ablation (1.4%). Among congenital heart
diseases, which occurred in 51 (15.4%) patients, atrial sept defect was the most
frequent (27.4%), followed by ventricular sept defect (25.4%) and Ebstein's
anomaly (17.6%). Conclusion Electrophysiological study and radiofrequency ablation are effective tools for
diagnosis and treatment of arrhythmias in the pediatric population.
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Affiliation(s)
- Mariana Fernandez Simão
- Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Matheus Nardi Rios
- Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Tiago Luiz Luz Leiria
- Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Marcelo Lapa Kruse
- Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Leonardo Martins Pires
- Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Roberto Tofani SantAnna
- Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Gustavo Glotz de Lima
- Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
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Conte G, de Asmundis C, Baltogiannis G, Di Giovanni G, Ciconte G, Sieira J, Saitoh Y, Wauters K, Mugnai G, Julià J, Irfan G, Levinstein M, Cotino-Moreno HE, Chierchia GB, Brugada P. Periprocedural outcomes of prophylactic protamine administration for reversal of heparin after cryoballoon ablation of atrial fibrillation. J Interv Card Electrophysiol 2014; 41:129-34. [DOI: 10.1007/s10840-014-9922-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/13/2014] [Indexed: 11/24/2022]
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Csanadi Z, Nagy-Baló E, Danik S, Barrett C, Burkhardt JD, Sanchez J, Santangeli P, Santoro F, Di Biase L, Natale A. Cerebrovascular Complications Related to Atrial Fibrillation Ablation and Strategies for Periprocedural Stroke Prevention. Card Electrophysiol Clin 2014; 6:111-123. [PMID: 27063826 DOI: 10.1016/j.ccep.2013.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Transcatheter treatment of atrial fibrillation (AF) is a complex intervention performed in patients who are at inherently increased risk of a thromboembolic complication, including stroke. It is therefore not surprising that cerebrovascular accidents have been among the most feared complications since the inception of AF ablation. While improvements have been made to limit the incidence of thromboembolic events during catheter ablation of AF, the optimal strategy to minimize such complications has yet to be determined. It is hoped that larger trials using periprocedural anticoagulation strategies can be undertaken to definitively address these important concerns.
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Affiliation(s)
- Zoltan Csanadi
- Department of Cardiology, University of Debrecen, 22 Móricz Zs, Debrecen H4032, Hungary.
| | - Edina Nagy-Baló
- Department of Cardiology, University of Debrecen, 22 Móricz Zs, Debrecen H4032, Hungary
| | - Stephan Danik
- Al-Sabah Arrhythmia Institute (AI), St. Luke's Hospital, NY, USA
| | - Conor Barrett
- Al-Sabah Arrhythmia Institute (AI), St. Luke's Hospital, NY, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Javier Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Pasquale Santangeli
- Clinical Cardiac Electrophysiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Cardiology, University of Foggia, Foggia, Italy
| | | | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy; Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA
| | - Andrea Natale
- Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA
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Katsouras G, Dubuc M, Khairy P. Transcatheter mapping and ablation of arrhythmias in the coronary sinus. Expert Rev Cardiovasc Ther 2014; 4:711-20. [PMID: 17081093 DOI: 10.1586/14779072.4.5.711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The coronary sinus (CS) is a complex structure of particular interest to cardiac electrophysiologists. It is exploited as an anatomical reference, a site to record left-sided atrial and ventricular signals and for cardiac resynchronization therapy. Perhaps less appreciated, it may itself serve as a substrate for arrhythmias. It is now increasingly recognized that arrhythmias may be targeted by transcatheter ablation within the CS. This review summarizes pertinent anatomic considerations, explores the relationship between the CS and various arrhythmia substrates, elaborates on current indications for intra CS ablation and addresses efficacy and safety concerns associated with transcatheter ablation.
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Affiliation(s)
- Grigorios Katsouras
- Montreal Heart Institute, Electrophysiology and Adult Congenital Heart Disease, 5000 Belanger St E., Montreal, QC H1T 1C8, Canada
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Montenero AS, Andrew P. Current treatment options for atrial flutter and results with cryocatheter ablation. Expert Rev Cardiovasc Ther 2014; 4:191-202. [PMID: 16509815 DOI: 10.1586/14779072.4.2.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Rhythm disturbances arising in the upper chambers of the heart are not uncommon. They are associated with a heavy burden of illness for the affected individual, as well as society in general. Atrial flutter, a re-entrant atrial tachycardia, is one such rhythm disturbance. The objective of this review article is twofold: first, to provide a brief insight into atrial flutter and the typical treatments for this arrhythmia in clinical practice; and second, to give an in-depth account of cryocatheter ablation as a relatively new treatment option for this potentially debilitating condition. The many recent clinical studies documenting the use of cryocatheter ablation for treatment of atrial flutter are presented, and their results briefly discussed. Overall, as cryocatheter ablation embeds itself among the arsenal of treatments for atrial flutter, the promising results from clinical studies appear destined to elevate cryocatheter ablation to a premier position among the treatment options for atrial flutter.
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Affiliation(s)
- Annibale S Montenero
- MultiMedica General Hospital, Via Milanese 300, 20099, Sesto S. Giovanni, Milan, Italy.
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Effect of Remote Ischemic Preconditioning on Platelet Activation and Reactivity Induced by Ablation for Atrial Fibrillation. Circulation 2014; 129:11-7. [DOI: 10.1161/circulationaha.113.005336] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Radiofrequency ablation of atrial fibrillation has been associated with some risk of thromboembolic events. Previous studies showed that preventive short episodes of forearm ischemia (remote ischemic preconditioning [IPC]) reduce exercise-induced platelet reactivity. In this study, we assessed whether remote IPC has any effect on platelet activation induced by radiofrequency ablation of atrial fibrillation.
Methods and Results—
We randomized 19 patients (age, 54.7±11 years; 17 male) undergoing radiofrequency catheter ablation of paroxysmal atrial fibrillation to receive remote IPC or sham intermittent forearm ischemia (control subjects) before the procedure. Blood venous samples were collected before and after remote IPC/sham ischemia, at the end of the ablation procedure, and 24 hours later. Platelet activation and reactivity were assessed by flow cytometry by measuring monocyte-platelet aggregate formation, platelet CD41 in the monocyte-platelet aggregate gate, and platelet CD41 and CD62 in the platelet gate in the absence and presence of ADP stimulation. At baseline, there were no differences between groups in platelet variables. Radiofrequency ablation induced platelet activation in both groups, which persisted after 24 hours. However, compared with control subjects, remote IPC patients showed a lower increase in all platelet variables, including monocyte-platelet aggregate formation (
P
<0.0001), CD41 in the monocyte-platelet aggregate gate (
P
=0.002), and CD41 (
P
<0.0001) and CD62 (
P
=0.002) in the platelet gate. Compared with control subjects, remote IPC was also associated with a significantly lower ADP-induced increase in all platelet markers.
Conclusions—
Our data show that remote IPC before radiofrequency catheter ablation for paroxysmal atrial fibrillation significantly reduces the increased platelet activation and reactivity associated with the procedure.
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Neurologic complications of catheter ablation/defibrillators/pacemakers. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 24365294 DOI: 10.1016/b978-0-7020-4086-3.00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Approaches to the management of patients with cardiac arrhythmias have significantly evolved over the last decade, with advancement in catheter ablation and device implantation techniques. As the techniques and tools evolve, so does our understanding of the possible complications from these procedures. The focus of this chapter is discussion of the neurologic complications involved with catheter ablation, pacemaker and defibrillation implantation, with the focus on timely diagnosis, and management strategies.
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40
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Giglia TM, Massicotte MP, Tweddell JS, Barst RJ, Bauman M, Erickson CC, Feltes TF, Foster E, Hinoki K, Ichord RN, Kreutzer J, McCrindle BW, Newburger JW, Tabbutt S, Todd JL, Webb CL. Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease. Circulation 2013; 128:2622-703. [DOI: 10.1161/01.cir.0000436140.77832.7a] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kimura T, Takatsuki S, Miyoshi S, Fukumoto K, Takahashi M, Ogawa E, Ito A, Arai T, Ogawa S, Fukuda K. Nonthermal cardiac catheter ablation using photodynamic therapy. Circ Arrhythm Electrophysiol 2013; 6:1025-31. [PMID: 23995252 DOI: 10.1161/circep.113.000810] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency ablation has limitations, largely related to creation of lesions by heating. Here, we report the first nonthermal ablation by applying photodynamic therapy (PDT) to cardiac tissues using a custom-made deflectable laser catheter. The present study investigated the feasibility of PDT for cavotricuspid isthmus ablation in a canine model. METHODS AND RESULTS We evaluated the pharmacokinetic profiles of 17 canines after administration of a photosensitizer (talaporfin sodium) by various protocols. We succeeded in maintaining the photosensitizer concentration at a level in excess of the clinically effective dose for humans. Using a 4-polar 7-French deflectable laser catheter, we performed PDT-mediated cavotricuspid isthmus ablation in 8 canines. PDT caused oxidative injury only to the irradiated area and successfully produced a persistent electric conduction block. No acute, gross changes such as edematous degeneration, thrombus formation, steam pops, or traumatic injury were observed after irradiation. Hematoxylin and eosin staining of tissues samples also showed well-preserved endothelial layers. Testing of the blood samples taken before and after the procedure revealed no remarkable changes. Lesion size at 2 weeks after the procedure and the temperature data collected during irradiation were compared between the PDT and irrigated radiofrequency ablation procedures. A ventricular cross-section revealed a solid PDT lesion, which was as deep as a radiofrequency lesion. In addition, endocardial, surficial, and intramural temperature monitoring during the PDT irradiation clearly demonstrated the nonthermal nature of the ablation technique. CONCLUSIONS Nonthermal PDT-mediated catheter ablation is a potentially novel treatment for cardiac arrhythmias.
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Affiliation(s)
- Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Abstract
The management of ventricular tachycardia and ventricular fibrillation in the cardiac intensive care unit can be complex. These arrhythmias have many triggers, including ischemia, sympathetic stimulation, and medication toxicities, as well as many different substrates, ranging from ischemic and nonischemic cardiomyopathies to rare genetic conditions such as Brugada syndrome and long QT syndrome. Different settings, such as congenital heart disease, postoperative ventricular arrhythmias, and ventricular assist devices, increase the complexity of management. This article reviews the variety of situations and cardiac conditions that give rise to ventricular arrhythmias, focusing on inpatient management strategies.
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Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. ACTA ACUST UNITED AC 2013; 15:1337-82. [DOI: 10.1093/europace/eut082] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Providência R, Barra S, Pinto C, Paiva L, Nascimento J. Surgery for Atrial Fibrillation: Selecting the Procedure for the Patient. J Atr Fibrillation 2013; 6:743. [PMID: 28496848 DOI: 10.4022/jafib.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/13/2013] [Accepted: 03/26/2013] [Indexed: 11/10/2022]
Abstract
This manuscript aims to review the current knowledge in the field of surgical ablation of atrial fibrillation (AF), including a brief discussion regarding the standard Maze procedure, its variants, minimally invasive thoracoscopic procedures and hybrid treatments, which briefly summarizes the advantages and differences between each technique. The rationale for the surgical approach of the left atrial appendage, its different techniques and complications will also be briefly covered. To conclude, the current Expert Consensus recommendations will be reviewed and an algorithm for the surgical management of the patient with AF, suggesting which technique applies better to which patient, under specific settings, will also be proposed.
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Affiliation(s)
- Rui Providência
- Cardiology Department, Coimbra's Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sérgio Barra
- Cardiology Department, Coimbra's Hospital and University Centre, Coimbra, Portugal
| | - Carlos Pinto
- Cardiothoracic Surgery Department, Coimbra's Hospital and University Centre, Coimbra, Portugal
| | - Luís Paiva
- Cardiology Department, Coimbra's Hospital and University Centre, Coimbra, Portugal
| | - José Nascimento
- Cardiology Department, Coimbra's Hospital and University Centre, Coimbra, Portugal
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Tao W, Jian-ping G, Xu H, Wen-sheng L, Liang C, Guo-ping C, Hao-bo S, Jin-hua S. The effects of endovenous radiofrequency ablation on coagulation and the vein wall in an experimental canine model. Vascular 2013; 21:215-9. [PMID: 23518853 DOI: 10.1177/1708538113478762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endovenous radiofrequency ablation (RFA) has been introduced as a less invasive alternative to traditional surgery for varicose veins, but vein thrombosis after RFA remains a concern. This study investigated the influence of endovenous RFA on coagulable states of canine blood, and changes in the vein wall and lumen. Eight canines underwent RFA of the iliac-femoral vein. Levels of plasma granule membrane protein-140, tissue plasminogen activator and plasminogen activator inhibitor-1 increased at different time points after RFA, which were monitored by enzyme-linked immunosorbent assay. Venography after ablation showed that there was left iliac-femoral vein occlusion in three canines and vein stenosis in the remaining five. Histological examination revealed intimal injury and inflammatory cell infiltration of the vessel wall. Our findings suggest that RFA is an effective microinvasive technique, which can result in a hypercoagulable state, with venous thrombosis and stenosis.
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Affiliation(s)
- Wang Tao
- Department of Interventional Radiology, Nanjing First Hospital affiliated to Nanjing Medical University, Nanjing, Jiangsu 210006, China
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Haines DE, Stewart MT, Ahlberg S, Barka ND, Condie C, Fiedler GR, Kirchhof NA, Halimi F, Deneke T. Microembolism and Catheter Ablation I. Circ Arrhythm Electrophysiol 2013; 6:16-22. [PMID: 23392585 DOI: 10.1161/circep.111.973453] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David E. Haines
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Mark T. Stewart
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Sarah Ahlberg
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Noah D. Barka
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Cathy Condie
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Gary R. Fiedler
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Nicole A. Kirchhof
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Franck Halimi
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
| | - Thomas Deneke
- From the Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI (D.E.H.); Medtronic, Inc, Minneapolis, MN (M.T.S., S.A., N.D.B., C.C., G.R.F., N.A.K.); Centre Médico-Chirurgical Parly II, Le Chesnay, France (F.H.); and Heart Center Bad Neustadt, Bad Neustadt, Germany (T.D.)
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Nishida K, Chiba K, Iwasaki YK, Katsouras G, Shi YF, Blostein MD, Khairy P, Guerra PG, Dubuc M, Tardif JC, Tanguay JF, Nattel S. Atrial fibrillation-associated remodeling does not promote atrial thrombus formation in canine models. Circ Arrhythm Electrophysiol 2012; 5:1168-75. [PMID: 23095228 DOI: 10.1161/circep.112.974410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The most important complication of atrial fibrillation (AF) is thromboembolic stroke. Although AF-related remodeling is considered important in atrial thrombogenesis, its role never has been directly tested. This study assessed effects of AF-related remodeling on the atrial thrombogenic milieu by using radiofrequency ablation (RFA) to create a quantifiable prothrombotic nidus. METHODS AND RESULTS We studied normal control dogs (control, n=16) and 3 canine AF-models: (1) atrial tachycardia remodeling (ATR; n=16) induced by atrial tachypacing (400 bpm for 1 week, with atrioventricular block and ventricular pacing at 80 bpm); (2) congestive heart failure (CHF; n=14) attributable to ventricular tachypacing (240 bpm for 2 weeks); and (3) chronic AF (CAF; n=8) induced by atrial tachypacing (35±3 days) without atrioventricular block. CAF dogs had AF for 13±1 days until euthanization. After remodeling was established, RFA lesions were created in both atria. Half the ATR and CHF dogs were subjected to atrial tachypacing during 7-day post-RFA follow-up. Electrophysiological and echocardiographic studies were performed before RFA and 7 days after RFA, and then hearts were removed and atrial thrombi were quantified by histomorphometry. Burst-pacing-induced AF duration was significantly greater in ATR, CHF, and CAF groups versus control group. The atrial effective refractory period shortened in ATR and CAF groups. Left atrial diameter was significantly larger with CHF, but not with ATR. Neither total thrombus volume nor thrombus volume per lesion differed significantly among groups. Table.Properties of Ablation Lesions and Atrial Thrombi Experimental GroupControl (n=16)ATR (n=16)CHF (n=14)CAF (n=8)N of ablation lesions per dog6.9±0.36.6±0.27.2±0.26.9±0.4Ablation lesion area, mm(2)53.1±3.558.3±4.857.7±4.944.3±3.7Ablation lesion depth, mm5.2±0.25.1±0.35.3±0.25.2±0.2Ablation lesion volume, mm(3)205.2±17.8211.6±17.6231.5±29.0176.8±22.2N of thrombi per dog5.4±0.44.7±0.35.6±0.46.5±0.4Presence of thrombus, %80±572±577±695±3Mean thrombus volume in both atria, mm(3)20.8±3.414.9±2.212.2±2.622.5±5.6Mean thrombus volume in left atria, mm(3)8.2±1.54.0±0.95.5±1.68.1±3.3Mean thrombus volume in right atria, mm(3)30.1±5.422.7±4.317.9±4.132.8±8.3Total thrombus volume in both atria, mm(3)140.5±21.399.7±16.886.1±17.5131.1±22.7Total thrombus volume in left atria, mm(3)22.8±5.311.8±3.317.0±3.723.3±6.4Total thrombus volume in right atria, mm(3)117.7±21.587.8±17.269.1±16.1107.8±23.3Thrombus volume normalized to ablation lesion area in both atria, mm(3)/mm(2)0.5±0.10.4±0.11.5±1.10.8±0.3Thrombus volume normalized to ablation lesion volume in both atria0.2±0.10.1±0.00.5±0.40.3±0.1 ATR indicates atrial tachycardia remodeling; CAF, chronic atrial fibrillation; and CHF, congestive heart failure. There were no statistically significant differences for any groups vs control group for any of these variables studied. CONCLUSIONS None of the AF substrates tested, including sustained atrial tachycardia/AF itself, enhanced post-RFA atrial thrombus formation. Indices of electrical and structural remodeling did not predict post-RFA thrombogenic potential. Contrary to widely held but previously untested notions, we were unable to demonstrate prothrombotic effects of AF-related remodeling.
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Affiliation(s)
- Kunihiro Nishida
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Quebec, Canada
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Houmsse M, Daoud EG. Biophysics and clinical utility of irrigated-tip radiofrequency catheter ablation. Expert Rev Med Devices 2012; 9:59-70. [PMID: 22145841 DOI: 10.1586/erd.11.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Catheter ablation by radiofrequency (RF) energy has successfully eliminated cardiac tachyarrhythmias. RF ablation lesions are created by thermal energy. Electrode catheters with 4-mm-tips have been adequate to ablate arrhythmias located near the endocardium; however, the 4-mm-tip electrode does not readily ablate deeper tachyarrhythmia substrate. With 8- and 10-mm-tip RF electrodes, ablation lesions were larger; yet, these catheters are associated with increased risk for coagulum, char and thrombus formation, as well as myocardial steam rupture. Cooled-tip catheter technology was designed to cool the electrode tip, prevent excessive temperatures at the electrode tip-tissue interface, and thus allow continued delivery of RF current into the surrounding tissue. This ablation system creates larger and deeper ablation lesions and minimizes steam pops and thrombus formation. The purpose of this article is to review cooled-tip RF ablation biophysics and outcomes of clinical studies as well as to discuss future technological improvements.
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Affiliation(s)
- Mahmoud Houmsse
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University, Columbus, USA.
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Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ, Paul T, Perry JC, Sanatani S, Tanel RE. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 2012; 9:1006-24. [PMID: 22579340 DOI: 10.1016/j.hrthm.2012.03.050] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Indexed: 10/28/2022]
Affiliation(s)
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- Arizona Pediatric Cardiology Consultants & Phoenix Children's Hospital, Phoenix, AZ, USA
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BUDDHE SUJATHA, SINGH HARINDER, DU WEI, KARPAWICH PETERP. Radiofrequency and Cryoablation Therapies for Supraventricular Arrhythmias in the Young: Five-Year Review of Efficacies. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:711-7. [DOI: 10.1111/j.1540-8159.2012.03372.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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