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De Innocentiis C, Buonpane A, Totaro A, Restaino G, Astore P, Guarino M, Langella V, Gallina S, Santamaria M. It's a long way to the top! Congenital venous anomalies and left isomerism limiting atrial fibrillation transcatheter ablation. Curr Probl Cardiol 2024; 49:102467. [PMID: 38369208 DOI: 10.1016/j.cpcardiol.2024.102467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Catheter ablation is increasingly used to improve symptoms and prognosis in selected patients. Lower limb venous access with subsequent transseptal approach to the left atrium is the standard procedure for atrial fibrillation catheter ablation. CASE PRESENTATION We report an unusual case of complex venous anomaly with a left-sided inferior vena cava with hemiazygos continuation to a persistent left superior vena cava draining in an enlarged coronary sinus in a patient with persistent atrial fibrillation scheduled for transcatheter ablation. DISCUSSION Lower limb venous anomalies may limit a standard transseptal approach to the left atrium thus precluding an effective catheter ablation procedure for atrial fibrillation. Alternative interventions, such as unconventional percutaneous access, thoracoscopic approach and "ablate and pace" procedures, may be necessary in patients with symptomatic atrial fibrillation and complex venous anomalies.
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Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Responsible Research Hospital, Largo Agostino Gemelli, 1. 86100, Campobasso (CB), Campobasso, CB, Italy.
| | - Angela Buonpane
- Agostino Gemelli IRCCS University Hospital Foundation, Rome, Italy
| | - Antonio Totaro
- Interventional Cardiology Unit, Responsible Research Hospital, Campobasso, CB, Italy; Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, CB, Italy
| | - Gennaro Restaino
- Radiology Unit, Responsible Research Hospital, Campobasso, CB, Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Responsible Research Hospital, Largo Agostino Gemelli, 1. 86100, Campobasso (CB), Campobasso, CB, Italy
| | | | | | - Sabina Gallina
- Department of Neurosciences, Imaging and Clinical Sciences, Institute of Cardiology, Heart Department, "G. d'Annunzio" University Chieti-Pescara and University Cardiology Division, SS Annunziata University Hospital, Chieti, Italy
| | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Responsible Research Hospital, Largo Agostino Gemelli, 1. 86100, Campobasso (CB), Campobasso, CB, Italy
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De Innocentiis C, Astore P, Giannantonio M, Ienco V, Santamaria M. Multivessel coronary spasm triggered by ganglionated plexi stimulation during atrial fibrillation radiofrequency catheter ablation: a case report. Eur Heart J Case Rep 2023; 7:ytad007. [PMID: 36845832 PMCID: PMC9949709 DOI: 10.1093/ehjcr/ytad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
Background Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, and it is associated with a high burden of mortality and morbidity worldwide. AF can be managed with rate-control or rhythm-control strategies. The latter is increasingly used to improve symptoms and prognosis in selected patients, especially after the development of catheter ablation. Although this technique is generally considered safe, it is not free from rare but life-threatening procedure-related adverse events. Among these, coronary artery spasm (CAS) is an uncommon but potentially fatal complication that requires immediate diagnosis and treatment. Case summary We report a case of severe multivessel CAS triggered by ganglionated plexi stimulation during pulmonary vein isolation with radiofrequency catheter ablation in a patient with persistent AF, promptly resolved after intracoronary nitrate administration. Discussion Although rare, CAS is a serious complication of AF catheter ablation. Immediate invasive coronary angiography is key for both diagnosis confirmation and treatment of such dangerous condition. As the number of invasive procedures increases, it is important that both interventional and general cardiologists are aware of possible procedure-related adverse events.
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Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Maria Giannantonio
- Anesthesiology and Intensive Care Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Vincenzo Ienco
- Interventional Cardiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
| | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Largo Agostino Gemelli, 1, 86100 Campobasso (CB), Italy
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De Innocentiis C, Astore P, Buonpane A, Santamaria AP, Patragnoni F, Santamaria M. Case report: An unusual case of phrenic nerve stimulation in a patient with single chamber implantable cardioverter defibrillator. Front Cardiovasc Med 2023; 10:1088697. [PMID: 36910536 PMCID: PMC9995897 DOI: 10.3389/fcvm.2023.1088697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Background Phrenic nerve stimulation is a well-recognized complication related to cardiac implantable electronic devices, in particular with left ventricular coronary sinus pacing leads for cardiac resynchronization therapy. Case presentation We report an unusual case of symptomatic phrenic nerve stimulation due to inadvertent placement of a right ventricular defibrillation lead in coronary sinus posterior branch in a patient with heart failure with reduced ejection fraction with a recently implanted single-chamber cardioverter defibrillator. Discussion Phrenic nerve stimulation is a relatively common complication of left ventricular pacing. Inadvertent placement of a right ventricular lead in a coronary sinus branch is a rare but possible cause of phrenic nerve stimulation. Careful evaluation of intraprocedural fluoroscopic and electrocardiographic appearance of pacing and defibrillation leads during implantation may prevent inadvertent placement of a right ventricular lead in the coronary sinus.
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Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
| | - Angela Buonpane
- Agostino Gemelli IRCCS University Hospital Foundation, Rome, Italy
| | | | | | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Gemelli Molise Hospital, Campobasso, CB, Italy
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Innocentiis CD, Astore P, Buonpane A, Giannantonio M, Ienco V, Laborante R, Fumarulo I, Santamaria M. 1094 MULTIVESSEL CORONARY ARTERY SPASM TRIGGERED BY GANGLIONATED PLEXI STIMULATION DURING ATRIAL FIBRILLATION RADIOFREQUENCY CATHETER ABLATYION: A CASE REPORT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Atrial fibrillation could be managed with rate-control or rhythm-control strategies. The latter is increasingly used to improve symptoms and prognosis in selected patients, especially after the development of catheter ablation. Although this technique is generally considered safe, it is not free from rare but life-threatening procedure-related adverse events. Among these, coronary artery spasm is an uncommon but potentially fatal complication that requires immediate diagnosis and treatment.
Case summary
We report a case of severe multivessel coronary artery spasm triggered by ganglionated plexi stimulation during pulmonary vein isolation with radiofrequency catheter ablation in a patient with persistent atrial fibrillation, promptly resolved after intracoronary nitrate administration.
Discussion
Although rare, coronary artery spasm is a serious complication of atrial fibrillation catheter ablation. Immediate invasive coronary angiography is key for both diagnosis confirmation and treatment of such dangerous condition. As the number of invasive procedures increases, it is important that both interventional and general cardiologists are aware of possible procedure-related adverse events.
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De Innocentiis C, Astore P, Buonpane A, Santamaria AP, Patragnoni F, Santamaria M. 1101 AN UNUSUAL CASE OF PHRENIC NERVE STIMULATION IN A PATIENT WITH SINGLE CHAMBER IMPLANTABLE CARDIOVERTER DEFIBRILLATOR. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Phrenic nerve stimulation is a well-recognized complication related to cardiac implantable electronic devices, in particular with left ventricular coronary sinus pacing leads for cardiac resynchronization therapy.
Case presentation
We report an unusual case of symptomatic phrenic nerve stimulation due to inadvertent placement of a right ventricular defibrillation lead in coronary sinus posterior branch in a patient with heart failure with reduced ejection fraction with a recently implanted single-chamber cardioverter defibrillator.
Discussion
Phrenic nerve stimulation is a relatively common complication of left ventricular pacing. Inadvertent placement of a right ventricular lead in a coronary sinus branch is a rare but possible cause of phrenic nerve stimulation. Careful evaluation of intraprocedural fluoroscopic and electrocardiographic appearance of pacing and defibrillation leads during implantation may prevent inadvertent placement of a right ventricular lead in the coronary sinus.
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Modugno P, Picone V, Centritto EM, Calvo E, Canosa C, Piancone F, Testa N, Camposarcone N, Castellano G, Astore P, Di Martino L, Di Iusto F, De Filippo CM, Massetti M. Combined Treatment With Carotid Endoarterectomy and Coronary Artery Bypass Grafting: A Single-Institutional Experience in 222 Patients. Vasc Endovascular Surg 2022; 56:566-570. [PMID: 35499500 PMCID: PMC10233500 DOI: 10.1177/15385744221094148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Carotid atherosclerotic disease is a known independent risk factor of post operative stroke after coronary artery bypass grafting (CABG). The best management of concomitant coronary artery disease and carotid artery disease remains debated. Current strategies include simultaneous carotid endoarterectomy (CEA) and CABG, staged CEA followed by CABG, staged CABG followed by CEA, staged transfemoral carotid artery stenting (TF-CAS) followed by CABG, simultaneous TF-CAS and CABG and transcarotid artery stenting. METHODS We report our experience based on a cohort of 222 patients undergoing combined CEA and CABG surgery who come to our observation from 2004 to 2020. All patients with >70% carotid stenosis and severe multivessel or common truncal coronary artery disease underwent combined CEA and CABG surgery at our instituion. 30% of patients had previously remote neurological symptoms or a cerebral CT-scan with ischemic lesions. Patients with carotid stenosis >70%, either asymptomatic or symptomatic, underwent CT-scan without contrast media to assess ischemic brain injury, and in some cases, if necessary, CT-angiography of the neck and intracranial vessels. RESULTS The overall perioperative mortality rate was 4.1% (9/222 patients). Two patients (.9%) had periprocedural ipsilateral transient ischemic attack (TIA) which completely resolved by the second postoperative day. Two patients (.9%) had an ipsilateral stroke, while 7 patients (3.2%) had a stroke of the controlateral brain hemisphere. Two patients (.9%) patients were affected by periprocedural coma caused by cerebral hypoperfusion due to perioperative heart failure. There were no statistically significant differences between patients in Extracorporeal Circulation (ECC) and Off-pump patients in the onset of perioperative stroke. CONCLUSION Our experience reported that combined surgical treatment of CEA and CABG, possibly Off-Pump, is a feasible treatment procedure, able to minimize the risk of post-operative stroke and cognitive deficits.
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Affiliation(s)
- Pietro Modugno
- Vascular Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
- Intensive Care Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Veronica Picone
- Vascular Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Enrico Maria Centritto
- Vascular Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Eugenio Calvo
- Cardiac Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Carlo Canosa
- Cardiac Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Felice Piancone
- Cardiac Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Nicola Testa
- Cardiac Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Nicola Camposarcone
- Intensive Care Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Gaetano Castellano
- Intensive Care Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Pasquale Astore
- Intensive Care Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Luigi Di Martino
- Intensive Care Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Fabrizio Di Iusto
- Cardiac Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Carlo Maria De Filippo
- Cardiac Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
| | - Massimo Massetti
- Cardiac Surgery Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso,
Italy
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