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Extrathoracic subclavian-axillary vein location and morphological features over the first rib for pacemaker and defibrillator lead implantation

We aimed to describe the variations of extrathoracic subclavian‐axillary vein location and its morphology over the first rib by venography in order to facilitate venous puncture using fluoroscopic landmarks without contrast venography, and evaluate the success rate of punctures, which is made with our method.

Percutaneous transapical approach and transcatheter closure for ventricular tachycardia ablation: VURGUN et al.

Yes, there is. The need for epicardial ablation has been reported in 10–15% of patients with ischemic cardiomyopathy,1 25–50% of patients with nonischemic cardiomyopathy (NICM),2 and 30–40% of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC).3 Epicardialmapping and ablation is nowcommonly performed in experienced centerswhen an epicardial ventricular tachycardia (VT) is suspected. In patients with NICM and ARVC, endoand epicardial mapping and ablation are frequently performed in combination since these patients have a higher likelihood of epicardial involvement.2 Epicardial ablation is more frequently required in patients referred after failed VT ablation.4 Our patient had hypertrophic cardiomyopathy, and we were aware of epicardial arrhythmic substrate. We consulted this case to the cardiovascular team to open pericardial window for epicardial VT ablation. But, due to supposed pericardial adhesions and high surgical risk, epicardial approachwasnot planned.Weperformed transapical access and an extensive ablation concept endocardially, including to ablate diastolic potentials and low-voltage areas and to create deeper lesions with long-time and high-voltage ablation for intramural and epicardial arrhythmic substrate.

Extrathoracic subclavian-axillary vein location over the first rib for pacemaker and defibrillator lead implantation: VURGUN et al.

We took these images to show that the position of the axillary vein over the first rib is not changed with the shoulder movement in our study.We recommend the “neutral” shoulder position when you puncture to the axillary vein. In some cases, the axillary vein puncture can be difficult when the clavicle is located caudally and completely covers the first rib. In this case, the puncture area on the first rib will come into view by moving the shoulder cranially, and the puncture can be performed over zone 2 (lateral), but this maneuver increases the risk

Percutaneous transapical approach and transcatheter closure for ventricular tachycardia ablation

In patients with mechanical aortic and mitral valve prosthesis, left ventricular endocardial ablation via retrograde transaortic or antegrade transmitral approach carry high risk of catheter entrapment and death. In such cases, ablation can be performed via ventricular transseptal or transapical approach. Transapical approach, with the ease of catheter maneuverability and better endocardial contact, may be performed surgically or percutaneously. In this case report, we describe a patient with both aortic and mitral mechanical prosthesis who underwent ventricular tachycardia ablation via percutaneous transapical endocardial approach with the use of closure device.

Serum neuron-specific enolase, a marker of neuronal injury, increases after catheter ablation of atrial fibrillation

Objective Catheter ablation of atrial fibrillation (AF) can lead to thromboembolic complications, especially stroke. We measured the periprocedural serum neuron-specific enolase (NSE) level, which is a biomarker of neuronal injury, after ablation of AF. Methods Forty-three patients with paroxysmal AF were prospectively enrolled before radiofrequency ablation. A neurological examination was performed before and after the procedure. The serum NSE level was determined before and at the end of the procedure and at 2, 24, and 48 h after the procedure. Results No patients developed new neurological deficits. However, the median (interquartile range) NSE level increased after ablation from 6.7 (3.87) ng/mL at baseline to 11.48 (5.3) ng/mL at 24 h postoperatively. The NSE level exceed the upper reference limit of normal (17 ng/mL) in 14 patients (33%), and these patients were found to have a larger left atrium. Conclusions Serum NSE increased in most of the patients undergoing ablation for AF, and it exceeded the normal limit in one-third of the patients. Although NSE is a biomarker of neuronal injury, the clinical importance of this increase after AF ablation and its relationship with the left atrial diameter should be evaluated in a longitudinal study.

Ablation of parahisian premature ventricular extrasystoles by subtricuspid retrograde approach using inverted catheter technique: back to the anatomy

This report illustrates a feasible and anatomical solution aiming to improve the success and decrease the possible hazards such as atrioventricular block during ablation of parahisian PVCs. We tried to illustrate the specific anatomy pertaining parahisian region and to explain a retrograde subvalvular catheter technique to overcome these procedural obstacles.

Transvenous extraction of a 26-year-old Accufix atrial lead using TightRail rotating dilator sheath

With the increasing number of implanted pacemakers and implantable cardioverter defibrillators, removal is required more frequently. Presently described is the transvenous extraction of a 26-year-old Accufix atrial lead using a mechanical dilator sheath. A 50-year-old male patient was admitted to the clinic with a pacemaker pocket infection. The atrial lead was an Accufix Bipolar J-Atrial active fixation lead, a model that was recalled in 1994, after reports of 2 deaths and 2 nonfatal injuries related to protrusion of the J retention wire. Both the atrial and ventricular leads were extracted using a mechanical dilator sheath. The Pacemaker Lead Extraction with the Excimer Sheath (PLEXES) Trial reported that of the 57 Accufix leads randomized to a non-laser approach, only 47% were removed successfully, compared with 96% of laser-randomized cases. Since laser sheaths are not available in Turkey, use of a mechanical dilator sheath was required. To our knowledge, this is the oldest Accufix lead extracted with a non-laser sheath. During the extraction of the ventricular lead, the tip of the lead broke off inside the right ventricle and the residual part was left inside the heart. During 3 months of follow-up, no signs of infection or any other undesirable events were encountered.

Implantation of a biventricular ICD in a patient with dextrocardia with situs inversus

In order to reduce sudden cardiac death and heart failure symptoms, biventricular implantable cardioverter defibrillator (ICD) implantation is a treatment method commonly used in selected patients with cardiomyopathy. The frequency of dextrocardia in congenital heart defects is approximately 0.4/10000. In this group, the frequency of cardiomyopathy development is rare. In this case report we present a patient with dextrocardia undergoing implantation of biventricular ICD.