D.A.M.J. Theuns

Transseptal left heart catheterisation guided by intracardiac echocardiography

OBJECTIVE To develop a novel approach of transseptal puncture guided by intracardiac echocardiography and to assess its efficacy. METHODS Transcatheter intracardiac echocardiography with a 9 MHz rotating transducer was performed to guide transseptal puncture in 12 patients (mean age 43.1 years, range 31–68) who underwent radiofrequency catheter ablation of left sided accessory pathways. Initially, the echocardiography and transseptal catheters were placed adjacent to each other in the superior vena cava and were withdrawn to the level of the fossa ovalis. RESULTS The successful puncture site was associated with visualisation of the fossa ovalis (12 patients, 100%) and the aorta (12 patients, 100%), tenting of the fossa (six patients, 50%), penetration of the needle visualised by the ultrasound catheter (12 patients, 100 %), and echocardiographic contrast material applied in the left atrium (12 patients, 100%). The characteristic jump of the needle onto the fossa ovalis was observed simultaneously with fluoroscopy and intracardiac ultrasound (12 patients, 100%). All procedures were successful. There were no complications associated with the transseptal procedure. CONCLUSIONS Intracardiac echocardiography is feasible to guide transseptal puncture. The optimal puncture site can be assessed by simultaneous detection of the characteristic downward jump of the transseptal needle onto the fossa ovalis by intracardiac ultrasound and fluoroscopy.

The role of remote monitoring in the reduction of inappropriate implantable cardioverter defibrillator therapies.

SummaryImplantable cardioverter defibrillators (ICDs) with the integrated Home Monitoring feature use dedicated mobile phone and internet links to provide the physicians and technicians in the ICD clinic with the essential device- and arrhythmia-related data stored in the ICD diagnostic memory. Various counters, graphs and intracardiac electrograms are automatically transmitted via Home Monitoring each day to allow prompt, remote presentation of arrhythmias or detection of technical problems. One of the most inconvenient side-effects of the ICD therapy is inappropriate intervention of the device. Home Monitoring data can help the physician to identify and subsequently reduce the incidence of inappropriate ICD therapy.

Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands: An expert consensus report of the netherlands society of cardiology

Remote monitoring of cardiac implanted electronic devices (CIED: pacemaker, cardiac resynchronisation therapy device and implantable cardioverter defibrillator) has been developed for technical control and follow-up using transtelephonic data transmission. In addition, automatic or patient-triggered alerts are sent to the cardiologist or allied professional who can respond if necessary with various interventions. The advantage of remote monitoring appears obvious in impending CIED failures and suspected symptoms but is less likely in routine follow-up of CIED. For this follow-up the indications, quality of care, cost-effectiveneness and patient satisfaction have to be determined before remote CIED monitoring can be applied in daily practice. Nevertheless remote CIED monitoring is expanding rapidly in the Netherlands without professional agreements about methodology, responsibilities of all the parties involved and that of the device patient, and reimbursement. The purpose of this consensus document on remote CIED monitoring and follow-up is to lay the base for a nationwide, uniform implementation in the Netherlands. This report describes the technical communication, current indications, benefits and limitations of remote CIED monitoring and follow-up, the role of the patient and device manufacturer, and costs and reimbursement. The view of cardiology experts and of other disciplines in conjunction with literature was incorporated in a preliminary series of recommendations. In addition, an overview of the questions related to remote CIED monitoring that need to be answered is given. This consensus document can be used for future guidelines for the Dutch profession.

Comparison of radiofrequency versus cryothermy catheter ablation of septal accessory pathways

Approximately 30% of all accessory pathways are located in the “septal” area. As these pathways are close to the atrioventricular node, there is an increased risk of right bundle branch block or inadvertent complete atrioventricular block during catheter ablation.1 Lesions created by radiofrequency (RF) energy inevitably involve some degree of tissue disruption and are irreversible. As cryothermy energy has the ability to reversibly show loss of function of tissue with cooling (“ice mapping”) at less negative temperatures, and progressive ice formation at the catheter tip causes adherence to the adjacent tissue, this ablation method potentially has advantages over RF for safe ablation of septal accessory pathways.2–4 In this retrospective study we compare transvenous RF with cryoablation in patients with septal accessory pathways. Between January 2000 and October 2001, 15 patients were treated with RF and the next consecutive nine patients with cryoablation for septally located accessory pathways. The final classification of the accessory pathways was made according to the successful ablation site on fluoroscopy. A standard electrophysiological study was performed and, after confirmation of the presence of an accessory pathway, transvenous RF or cryoablation was carried out. Mapping was performed beginning at the anteroseptal region at the His deflection down to the coronary os and further to the right posterior region. For both energy forms standard techniques were used to identify prospective ablation sites. For cryoenergy procedures, initially ice mapping was done by cooling to −30°C for a maximum of 80 seconds with the use of a 7 French cryocatheter (Freezor, curve 3, CryoCath Technologies Inc, Montreal, Quebec, Canada). …

Ten Year Follow‐Up After Radiofrequency Catheter Ablation for Atrioventricular Nodal Reentrant Tachycardia in the Early Days Forever Cured, or a Source for New Arrhythmias?

Background: Radiofrequency (RF) catheter ablation is highly effective with a low complication rate. However, lesions created by RF energy are irreversible, inhomogeneous, and therefore potentially proarrhythmic.

Use of remote monitoring in the management of system-related complications in implantable defibrillator patients

Remote monitoring of implantable defibrillators (ICDs) is designed to minimise regular follow-up visits and to facilitate early detection of adverse events. With the increased rate of ICD implantations in today’s clinical setting and multiple device advisories, which pose management challenges, this approach becomes very attractive. The aim of this article is to present the role of remote monitoring in the detection of system-related complications, its potential benefits and its barriers in the outpatient management of ICD patients.