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Chen CK, Huang HC, Ho LT, Liao MT, Liu YB, Tsai CT, Lin LY, Chen WJ, Yu CC. Minimal Fluoroscopic Catheter Ablation for Adult Patients with Paroxysmal Supraventricular Tachycardia without the Assistance of Intracardiac Echocardiography. Acta Cardiol Sin 2023; 39:546-560. [PMID: 37456947 PMCID: PMC10346061 DOI: 10.6515/acs.202307_39(4).20230111a] [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] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 01/11/2023] [Indexed: 07/18/2023]
Abstract
Background Radiation exposure during fluoroscopic procedures increases the risk of cancer for both patients and operators. Objectives The aim of this study was to investigate the safety and efficacy of adopting a three-dimensional electroanatomical mapping (3D EAM) system during ablation for paroxysmal supraventricular tachycardia (PSVT), without the assistance of intracardiac echocardiography (ICE), for both right- and left-chamber cardiac procedures. Methods We retrospectively enrolled all patients with PSVT from September 2018 to December 2020. The patients were grouped according to the use of the 3D EAM system (3D-guided group, n = 102 vs. conventional group, n = 226). Results The acute success rates were high in both groups (100% vs. 99.1%). The fluoroscopy time was significantly lower in the 3D-guided group than in the conventional group (2.4 ± 4.4 vs. 19.0 ± 10.8 min); the procedure time was significantly increased in the 3D-guided group (104.5 ± 29.9 vs. 94.0 ± 31.9 min), and this was associated with the post-electrophysiology test diagnosis after adjustment for multiple variables [standardized B coefficient (β) 0.188]. There was no learning curve for each electrophysiologist in terms of fluoroscopy and procedure times. Conclusions The 3D EAM system, without the assistance of ICE, was safe and effective in guiding PSVT ablation in both left- and right-chamber ablation.
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Affiliation(s)
- Chun-Kai Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Hui-Chun Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Yen-Bin Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Chieh Yu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Li D, Guo J, Li XH, Liao Y, Zhang MM, Shi L, Lin Y, Liu Y. A case report of an infant after episodes of paroxysmal supraventricular tachycardia with left ventricular thrombosis and cerebral infarction. Ann Palliat Med 2021; 10:8322-8327. [PMID: 33548988 DOI: 10.21037/apm-20-1797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/31/2020] [Indexed: 11/06/2022]
Abstract
Left ventricular thrombosis and cerebral infarction caused by recurrent episodes of paroxysmal supraventricular tachycardia (PSVT) are uncommon in infants. We present the case of a 23-month-old girl whose echocardiography revealed a left ventricular thrombus, which resolved after sinus rhythm was restored. The girl had experienced repeated systemic convulsions and high muscular tension of the left limb accompanied by movement disorder. Soon afterward, cranial magnetic resonance imaging (MRI) revealed scattered lacunar cerebral infarctions in the right lateral ventricle. The symptoms, signs, and laboratory examination satisfied the diagnosis of left ventricular thrombosis and cerebral infarction caused by recurrent episodes of PSVT. The girl was given antiarrhythmic drugs, including propranolol, esmolol, and amiodarone, intracranial pressure decreasing treatment (mannitol), heart and brain cell nutritional therapy, anticoagulant therapy, and her condition gradually improved. This case report highlights the importance of pediatric PSVT patients' clinical management and that more emphasis should be placed on early recognition and prevention of severe complications. Pediatricians should be trained early recognition of the nonspecific clinical manifestations of PSVT, make effectively and quickly diagnosis by electrocardiogram, evaluation of cardiac function and thrombosis by echocardiography, and termination PSVT as rapidly as possible. Thromboprophylaxis therapy might be considered for recurrent episodes of PSVT.
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Affiliation(s)
- Dan Li
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China; Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Graduate School of Peking Union Medical College, Beijing, China
| | - Jinghui Guo
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Xiao-Hui Li
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China; Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Graduate School of Peking Union Medical College, Beijing, China
| | - Yanmei Liao
- Department of Echocardiography, Hami Second People's Hospital, Hami, China
| | - Ming-Ming Zhang
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Lin Shi
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Yao Lin
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Yang Liu
- Department of Cardiology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
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