András Temesvári

Preventing complicated transseptal puncture with intracardiac echocardiography: case report.

BackgroundRecently, intracardiac echocardiography emerged as a useful tool in the electrophysiology laboratories for guiding transseptal left heart catheterizations, for avoiding thromboembolic and mechanical complications and assessing the ablation lesions characteristics. Although the value of ICE is well known, it is not a universal tool for achieving uncomplicated access to the left atrium. We present a case in which ICE led to interruption of a transseptal procedure because several risk factors for mechanical complications were revealed.Case presentationA case of a patient with paroxysmal atrial fibrillation and atrial flutter, and distorted intracardiac anatomy is presented. Intracardiac echocardiography showed a small oval fossa abouting to an enlarged aorta anteriorly. A very small distance from the interatrial septum to the left atrial free wall was seen. The latter two conditions were predisposing to a complicated transseptal puncture. According to fluoroscopy the transseptal needle had a correct position, but the intracardiac echo image showed that it was actually pointing towards the aortic root and most importantly, that it was virtually impossible to stabilize it in the fossa itself. Based on intracardiac echo findings a decision was made to limit the procedure only to ablation of the cavotricuspid isthmus and not to proceed further so as to avoid complications.ConclusionThis case report illustrates the usefulness of the intracardiac echocardiography in preventing serious or even fatal complications in transseptal procedures when the cardiac anatomy is unusual or distorted. It also helps to understand the possible mechanisms of mechanical complications in cases where fluoroscopic images are apparently normal.

Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling

BackgroundRadiofrequency catheter ablation of atrial fibrillation (AF) has been proved to be effective and to prevent progressive left atrial (LA) remodeling. Cryoballoon catheter ablation (CCA), using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling.Methods36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV) and LA volume index (LAVI) were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aasept, Aalat), LA filling fraction (LAFF), LA emptying fraction (LAEF) and the systolic fraction of pulmonary venous flow (PVSF). Detailed left ventricular diastolic function assessment was also performed.ResultsExcluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%). In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p < 0.05), maximal LAV (73 ± 23 to 81 ± 24 ml; p < 0.05), LAVI (35 ± 10 to 39 ± 11 ml/m2; p = 0.01) and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p < 0.01) had all increased. PVSF (58 ± 9 to 50 ± 10%; p = 0.01) and LAFF (36 ± 7 to 33 ± 8%; p = 0.03) had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits.ConclusionsIn patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.

Left circumflex coronary artery occlusion due to a left atrial appendage closure device

Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease. With the presented case it could be concluded that coronary angiography is recommended before LAA closure.

Left atrial and left atrial appendage function in paroxysmal atrial fibrillation

PURPOSE In patients with paroxysmal atrial fibrillation (PAF) little information is available about left atrial (LA)function, and there is less information about LA appendage (LAA) function, and about their relations. METHODS AND RESULTS 46 patients were selected for catheter ablation (CA) because of nonvalvular PAF.Transthoracic, tissue Doppler and transoesophageal echocardiography was performed before CA. LA volumes and volume index (LAVI) were calculated. LA function was assessed by LA filling fraction (LAFF), LA emptying fraction (LAEF), systolic fraction of pulmonary venous flow (PVSF) and late diastolic velocities of mitral annulus(Aa,, A5at) LAA function was assessed by peak LAA emptying flow velocity (PLAAEFV). Diastolic dysfunction(DD) was also assessed. Dilated LAVI in 32, LA dysfunction in 20, DD with elevated LV filling pressure in 19 patients was found. Aa,at and Aa,p correlated with LAFF (r:0.53; p<0.001 and r:0.43; p<0.05), LAEF (r:0.51;p<0.001 and r:0.63; p<0.001), PVSF (r:0.49; p<0.001 and r:0.46; p<0.005) and PLAAEFV (r:0.58; p<0.001 and r:0.45; p<0.01). CONCLUSIONS In PAF patients Aa velocity is useful to assess LA function and correlates positively with other TTE derived LA functional parameters and LAA function by TEE derived PLAAEFV.

Treatment of arrhythmias associated with congenital heart disease using transcatheter ablation

disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progres sion of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappo inting.Aimandmethods: In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.Results: During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients re quired redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the interven tion. In four patients minor complications occured (small hematomas).Conclusions: Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly cu rative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.UNLABELLED Rhythm disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progression of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappointing. AIM AND METHODS In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease. RESULTS During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients required redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the intervention. In four patients minor complications occurred (small hematomas). CONCLUSIONS Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly curative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.

Veleszületett szívbetegséghez társuló ritmuszavarok katéterablatiós kezelése

disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progres sion of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappo inting.Aimandmethods: In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease.Results: During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients re quired redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the interven tion. In four patients minor complications occured (small hematomas).Conclusions: Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly cu rative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.UNLABELLED Rhythm disturbances are common long after surgical repair of congenital heart disease. These arrhythmias caused by the progression of the disease itself, however, a significant proportion is a result of the presence of surgical scar. Although interventional electrophysiology procedures are complex and encounter difficulties, pharmacological therapy is often very disappointing. AIM AND METHODS In the present study we aimed to describe our experience obtained between 2004 and 2006 in patients undergoing transcatheter ablation long after surgery for congenital heart disease. RESULTS During this period 26 patients underwent catheter ablation. The procedure was successful in 24 out of the 26 patients (92%). Three patients required redo ablations due to arrhythmia recurrences (11%). There were no major complications related to the intervention. In four patients minor complications occurred (small hematomas). CONCLUSIONS Our descriptive data indicate that transcatheter ablation for arrhythmias after surgery for congenital heart disease is a effective safe and more importantly curative procedure. It is associated with reasonable success rate, low complication rate, but slightly higher recurrence rate as compared to the classical electrophysiological interventions.

Detecting trabecules of the systemic right ventricle during quantification yields better correlation with flow measurement derived data

Background During the past few years commercial solutions became available to deal with ventricular trabecules. It has been already shown, that the new algorithms have a significant impact on all parameters measured during routine evaluation (EF: ejection fraction, ESVi: end systolic volume index, EDVi: end diastolic volume index, SVi: stroke volume index, Mi: mass index). The effect of trabecules become especially important in case of pressure overloaded right ventricle. It has been also published, that cardiac ultrasound (ECHO) tend to underestimate volumes and overestimate ejection fraction when compared to cardiac magnetic resonance (CMR) as a gold standard.

Percutaneous left atrial appendage closure in non-valvular atrial fibrillation – review of literature and own experiences

Nonvalvularis pitvarfi brillacioban szenvedő betegek eseten az oralis antikoagulans kezeles stroke-prevencios hatekonysaga egyertelműen bizonyitott. Ezen betegek nem elhanyagolhato hanyada szamara azonban a magas thromboembolias kockazat ellenere sem kivitelezhető a hosszu tavu antikoagulans kezeles. Elsősorban ennek koszonhető, hogy napjainkban egyre inkabb az alternativ kezelesi strategiak kerulnek az erdeklődes homlokterebe. Nonvalvularis pitvarfi brillacioban a thrombuskepződes leggyakoribb helye a bal pitvari fulcse. Az europai piacon jelenleg ket perkutan fulcsezaro eszkoz erhető el: Watchman LAA System (Atritech Inc.) es az Amplatzer Cardiac Plug (AGA Medical Corporation). Bar a kozelmultban zarult klinikai vizsgalatok (PLAATO, PROTECT AF) szerint a perkutan bal pitvari fulcsezaras elfogadhato biztonsagossagi profi l mellett csokkenti a hosszu tavu stroke-kockazatot, a rendelkezesunkre allo adatok meg korlatozottak. Jelenleg ezek a beavatkozasok a nonvalvularis pitvarfi brillacioban szenvedő magas stroke-kockazatu betegek azon csoportja szamara jelenthetnek elfogadhato megoldast, akiknel az oralis antikoagulans terapia nem alkalmazhato vagy az optimalis hatekonysag nem elerhető. A Gottsegen Gyorgy Orszagos Kardiologiai Intezetben 2010. januar 28-an, Magyarorszagon elsőkent, harom, nonvalvularis pitvarfi brillacioban szenvedő betegunknel vegeztunk sikeres perkutan bal pitvari fulcsezarast.In patients with non-valvular atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. Despite their high risk for thromboembolic events, there are substantial numbers of patients who are not candidates for long-term oral anticoagulant therapy, therefore the interest in alternative treatment strategies are in focus these days. The most common place within the heart for thrombus formation in patients with non-valvular atrial fibrillation is the left atrial appendage. Two devices specifically designed for percutaneous left atrial appendage closure are currently available in Europe: the WATCHMAN LAA system (Atritech, Inc) and the AMPLATZER Cardiac Plug (AGA Medical Corporation). Although present trial results (PLAATO, PROTECT AF) suggest that LAA closure may be performed at acceptable safety and it may reduce the long-term stroke risk, available data are still very limited. At present these procedures may be an acceptable alternative in selected high-risk patients with non-valvular atrial fibrillation who are not or suboptimal candidates for oral anticoagulant therapy. On 28. January, 2010 we performed the first three successful percutaneous left atrial appendage closure procedures in Gottsegen György Hungarian Institute of Cardiology in Hungary.Nonvalvularis pitvarfibrillacioban szenvedő betegek eseten az oralis antikoagulans kezeles stroke-prevencios hatekonysaga egyertelműen bizonyitott. Ezen betegek nem elhanyagolhato hanyada szamara azonban a magas thromboembolias kockazat ellenere sem kivitelezhető a hosszu tavu antikoagulans kezeles. Elsősorban ennek koszonhető, hogy napjainkban egyre inkabb az alternativ kezelesi strategiak kerulnek az erdeklődes homlokterebe. Nonvalvularis pitvarfibrillacioban a thrombuskepződes leggyakoribb helye a bal pitvari fulcse. Az europai piacon jelenleg ket perkutan fulcsezaro eszkoz erhető el: Watchman LAA System (Atritech Inc.) es az Amplatzer Cardiac Plug (AGA Medical Corporation). Bar a kozelmultban zarult klinikai vizsgalatok (PLAATO, PROTECT AF) szerint a perkutan bal pitvari fulcsezaras elfogadhato biztonsagossagi profil mellett csokkenti a hosszu tavu stroke-kockazatot, a rendelkezesunkre allo adatok meg korlatozottak. Jelenleg ezek a beavatkozasok a nonvalvularis pitvarfibrillacioban szenvedő magas stro...

[Percutaneous closure of left atrial appendage in non-valvular atrial fibrillation--international and Hungarian experiences].

Nonvalvularis pitvarfi brillacioban szenvedő betegek eseten az oralis antikoagulans kezeles stroke-prevencios hatekonysaga egyertelműen bizonyitott. Ezen betegek nem elhanyagolhato hanyada szamara azonban a magas thromboembolias kockazat ellenere sem kivitelezhető a hosszu tavu antikoagulans kezeles. Elsősorban ennek koszonhető, hogy napjainkban egyre inkabb az alternativ kezelesi strategiak kerulnek az erdeklődes homlokterebe. Nonvalvularis pitvarfi brillacioban a thrombuskepződes leggyakoribb helye a bal pitvari fulcse. Az europai piacon jelenleg ket perkutan fulcsezaro eszkoz erhető el: Watchman LAA System (Atritech Inc.) es az Amplatzer Cardiac Plug (AGA Medical Corporation). Bar a kozelmultban zarult klinikai vizsgalatok (PLAATO, PROTECT AF) szerint a perkutan bal pitvari fulcsezaras elfogadhato biztonsagossagi profi l mellett csokkenti a hosszu tavu stroke-kockazatot, a rendelkezesunkre allo adatok meg korlatozottak. Jelenleg ezek a beavatkozasok a nonvalvularis pitvarfi brillacioban szenvedő magas stroke-kockazatu betegek azon csoportja szamara jelenthetnek elfogadhato megoldast, akiknel az oralis antikoagulans terapia nem alkalmazhato vagy az optimalis hatekonysag nem elerhető. A Gottsegen Gyorgy Orszagos Kardiologiai Intezetben 2010. januar 28-an, Magyarorszagon elsőkent, harom, nonvalvularis pitvarfi brillacioban szenvedő betegunknel vegeztunk sikeres perkutan bal pitvari fulcsezarast.In patients with non-valvular atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. Despite their high risk for thromboembolic events, there are substantial numbers of patients who are not candidates for long-term oral anticoagulant therapy, therefore the interest in alternative treatment strategies are in focus these days. The most common place within the heart for thrombus formation in patients with non-valvular atrial fibrillation is the left atrial appendage. Two devices specifically designed for percutaneous left atrial appendage closure are currently available in Europe: the WATCHMAN LAA system (Atritech, Inc) and the AMPLATZER Cardiac Plug (AGA Medical Corporation). Although present trial results (PLAATO, PROTECT AF) suggest that LAA closure may be performed at acceptable safety and it may reduce the long-term stroke risk, available data are still very limited. At present these procedures may be an acceptable alternative in selected high-risk patients with non-valvular atrial fibrillation who are not or suboptimal candidates for oral anticoagulant therapy. On 28. January, 2010 we performed the first three successful percutaneous left atrial appendage closure procedures in Gottsegen György Hungarian Institute of Cardiology in Hungary.Nonvalvularis pitvarfibrillacioban szenvedő betegek eseten az oralis antikoagulans kezeles stroke-prevencios hatekonysaga egyertelműen bizonyitott. Ezen betegek nem elhanyagolhato hanyada szamara azonban a magas thromboembolias kockazat ellenere sem kivitelezhető a hosszu tavu antikoagulans kezeles. Elsősorban ennek koszonhető, hogy napjainkban egyre inkabb az alternativ kezelesi strategiak kerulnek az erdeklődes homlokterebe. Nonvalvularis pitvarfibrillacioban a thrombuskepződes leggyakoribb helye a bal pitvari fulcse. Az europai piacon jelenleg ket perkutan fulcsezaro eszkoz erhető el: Watchman LAA System (Atritech Inc.) es az Amplatzer Cardiac Plug (AGA Medical Corporation). Bar a kozelmultban zarult klinikai vizsgalatok (PLAATO, PROTECT AF) szerint a perkutan bal pitvari fulcsezaras elfogadhato biztonsagossagi profil mellett csokkenti a hosszu tavu stroke-kockazatot, a rendelkezesunkre allo adatok meg korlatozottak. Jelenleg ezek a beavatkozasok a nonvalvularis pitvarfibrillacioban szenvedő magas stro...

A bal pitvari fülcse perkután zárása nonvalvularis pitvarfibrillációban-nemzetközi és hazai tapasztalatok

Nonvalvularis pitvarfi brillacioban szenvedő betegek eseten az oralis antikoagulans kezeles stroke-prevencios hatekonysaga egyertelműen bizonyitott. Ezen betegek nem elhanyagolhato hanyada szamara azonban a magas thromboembolias kockazat ellenere sem kivitelezhető a hosszu tavu antikoagulans kezeles. Elsősorban ennek koszonhető, hogy napjainkban egyre inkabb az alternativ kezelesi strategiak kerulnek az erdeklődes homlokterebe. Nonvalvularis pitvarfi brillacioban a thrombuskepződes leggyakoribb helye a bal pitvari fulcse. Az europai piacon jelenleg ket perkutan fulcsezaro eszkoz erhető el: Watchman LAA System (Atritech Inc.) es az Amplatzer Cardiac Plug (AGA Medical Corporation). Bar a kozelmultban zarult klinikai vizsgalatok (PLAATO, PROTECT AF) szerint a perkutan bal pitvari fulcsezaras elfogadhato biztonsagossagi profi l mellett csokkenti a hosszu tavu stroke-kockazatot, a rendelkezesunkre allo adatok meg korlatozottak. Jelenleg ezek a beavatkozasok a nonvalvularis pitvarfi brillacioban szenvedő magas stroke-kockazatu betegek azon csoportja szamara jelenthetnek elfogadhato megoldast, akiknel az oralis antikoagulans terapia nem alkalmazhato vagy az optimalis hatekonysag nem elerhető. A Gottsegen Gyorgy Orszagos Kardiologiai Intezetben 2010. januar 28-an, Magyarorszagon elsőkent, harom, nonvalvularis pitvarfi brillacioban szenvedő betegunknel vegeztunk sikeres perkutan bal pitvari fulcsezarast.In patients with non-valvular atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. Despite their high risk for thromboembolic events, there are substantial numbers of patients who are not candidates for long-term oral anticoagulant therapy, therefore the interest in alternative treatment strategies are in focus these days. The most common place within the heart for thrombus formation in patients with non-valvular atrial fibrillation is the left atrial appendage. Two devices specifically designed for percutaneous left atrial appendage closure are currently available in Europe: the WATCHMAN LAA system (Atritech, Inc) and the AMPLATZER Cardiac Plug (AGA Medical Corporation). Although present trial results (PLAATO, PROTECT AF) suggest that LAA closure may be performed at acceptable safety and it may reduce the long-term stroke risk, available data are still very limited. At present these procedures may be an acceptable alternative in selected high-risk patients with non-valvular atrial fibrillation who are not or suboptimal candidates for oral anticoagulant therapy. On 28. January, 2010 we performed the first three successful percutaneous left atrial appendage closure procedures in Gottsegen György Hungarian Institute of Cardiology in Hungary.Nonvalvularis pitvarfibrillacioban szenvedő betegek eseten az oralis antikoagulans kezeles stroke-prevencios hatekonysaga egyertelműen bizonyitott. Ezen betegek nem elhanyagolhato hanyada szamara azonban a magas thromboembolias kockazat ellenere sem kivitelezhető a hosszu tavu antikoagulans kezeles. Elsősorban ennek koszonhető, hogy napjainkban egyre inkabb az alternativ kezelesi strategiak kerulnek az erdeklődes homlokterebe. Nonvalvularis pitvarfibrillacioban a thrombuskepződes leggyakoribb helye a bal pitvari fulcse. Az europai piacon jelenleg ket perkutan fulcsezaro eszkoz erhető el: Watchman LAA System (Atritech Inc.) es az Amplatzer Cardiac Plug (AGA Medical Corporation). Bar a kozelmultban zarult klinikai vizsgalatok (PLAATO, PROTECT AF) szerint a perkutan bal pitvari fulcsezaras elfogadhato biztonsagossagi profil mellett csokkenti a hosszu tavu stroke-kockazatot, a rendelkezesunkre allo adatok meg korlatozottak. Jelenleg ezek a beavatkozasok a nonvalvularis pitvarfibrillacioban szenvedő magas stro...