Hanney Gonna

P-Wave Abnormality Predicts Recurrence of Atrial Fibrillation after Electrical Cardioversion: A Prospective Study

Maintenance of atrial fibrillation (AF) is related to atrial electrical inhomogeneity and resultant chaotic reentry. Our aim was to test the hypothesis that abnormalities of P morphology on the surface electrocardiogram (ECG) predict recurrent AF following electrical cardioversion (ECV).

The ventricular ectopic QRS interval (VEQSI): Diagnosis of arrhythmogenic right ventricular cardiomyopathy in patients with incomplete disease expression

BACKGROUND The ventricular ectopic QRS interval (VEQSI) has been shown to identify structural heart disease and predict mortality. In arrhythmogenic right ventricular cardiomyopathy (ARVC), early diagnosis is difficult using current methods, and life-threatening arrhythmias are common and difficult to predict. OBJECTIVE The purpose of this study was to assess the utility of ventricular ectopic indices including VEQSI in ARVC diagnosis. METHODS We studied 70 patients with ARVC [30 with definite disease (age 47 ± 12 years; 60% male), 40 with incomplete disease expression (age 44 ± 18 years; 44% male)], 116 healthy controls (age 40 ± 15 years; 56% male), and 26 patients with normal heart right ventricular outflow tract (RVOT) ectopy (age 46 ± 17 years; 27% male). The duration of the broadest ventricular ectopic beat during 12-lead Holter monitoring was recorded as VEQSI max. RESULTS VEQSI max was associated with age and gender, but not with conducted QRS duration. Adjusted VEQSI max was greater in ARVC patients than in control groups. In healthy males (44.5 years), estimated VEQSI max was 163 ms (95% confidence interval [CI] 159-167 ms); in definite ARVC 212 ms (95% CI 206-217 ms); in incompletely expressed ARVC 204 ms (95% CI 199-210 ms); and in normal heart RVOT ectopy 171 ms (95% CI 165-178 ms). VEQSI max >180 ms had 98% sensitivity and specificity for diagnosis of ARVC (area under the curve 0.99, 95% CI 0.980-0.998). In our incompletely expressed ARVC patients, VEQSI max >180 ms identified 88% as affected. CONCLUSION VEQSI max distinguishes ARVC patients, including those with incomplete disease expression, from healthy controls and patients with normal heart RVOT ectopy.

Skin Burns Associated with Radiofrequency Catheter Ablation of Cardiac Arrhythmias

Skin burns are a rare complication associated with radiofrequency catheter ablation of cardiac arrhythmias. Burns related to the indifferent electrode patch may be severe and result in significant comorbidity. We describe our experience of skin burns and discuss potential predisposing and possible causative factors.

Feasibility and Efficacy of Simultaneous Pulmonary Vein Isolation and Cavotricuspid Isthmus Ablation Using Cryotherapy

Pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) ablation are often performed as part of the same procedure. In many cases, PVI is performed by cryotherapy and then CTI ablation by radiofrequency (RF) energy. We sought to determine whether it is more efficient to perform CTI ablation simultaneously with PVI using separate cryogenerators.

Initial clinical results with the ThermoCool® SmartTouch® Surround Flow catheter

Aim The Biosense Webster ThermoCool® SmartTouch® Surround Flow (STSF) catheter is a recently developed ablation catheter incorporating Surround Flow (SF) technology to ensure efficient cooling and force sensing to quantify tissue contact. In our unit, it superseded the ThermoCool® SF catheter from the time of its introduction in May 2015. Methods and results Procedure-related data were collected prospectively for the first 100 ablation procedures performed in our department using the STSF catheter. From a database of 654 procedures performed in our unit using the SF catheter, we selected one to match each STSF procedure, matching for procedure type, operator experience, patient age, and gender. The groups were well matched for patient age, gender, and procedure type. Procedure duration was similar in both groups (mean 225.5 vs. 221.4 min, IQR 106.5 vs. 91.5, P = 0.55), but fluoroscopy duration was shorter in the STSF group (mean 25.8 vs. 30.0, IQR 19.6 vs. 18.5, P = 0.03). No complication occurred in the STSF group. Complications occurred in two cases in the SF group (one pericardial effusion requiring drainage and one need for permanent pacing). Complete procedural success was achieved in 98 cases in the STSF group and 94 cases in the SF group (P = 0.15). The composite endpoint of procedure failure or acute complication was less common in the STSF group (2 vs. 8, P = 0.05). Conclusion The STSF catheter is safe and effective in treating a range of arrhythmias. Compared with the SF catheter, it shows a trend towards improved safety-efficacy balance.

Femoral implantation and pull through as an adjunct to traditional methods in cardiac resynchronization therapy

BACKGROUND We have described the use of femoral access followed by pull through of the lead to a pectoral position to circumvent difficulty in implanting a left ventricular (LV) lead by standard methods. OBJECTIVE The purpose of this study was to establish the effect of femoral implantation and pull through on the overall rate of success in percutaneous implantation of LV leads. METHODS We collected data prospectively in all attempts at LV lead implantation from the time that we envisioned the femoral pull-through approach. RESULTS In the 6 years to September 30, 2014, our group attempted to implant a new LV lead in 736 patients, including 16 who previously had failed attempts by other groups. A standard superior approach was successful in 726 of 731 patients (99.3%) in whom it was attempted. In 5 patients (0.7%), we failed to deliver a lead from a superior approach; in 5 of 16 patients, with previous failed attemtps (31%), we judged that those attempts had been exhaustive. In all 10 cases, LV lead placement was achieved from a femoral approach, with the procedure time being 186 ± 65 minutes. In the first case attempted, the pull through failed; the lead was tunneled to the pectoral generator. In 1 case, the coronary sinus was found to be occluded at the ostium: a transseptal approach was used with the subsequent pull through. No complication occurred. At 22.3 ± 18.5 months after the implantation, all systems implanted by a femoral approach continued to function. CONCLUSION Used as an adjunct to standard methods, the femoral access and pull through method allows percutaneous LV lead placement in virtually all cases.

Successful transvenous lead extraction after a failed open surgical attempt

An 81-year-old man was referred with an infected cardiac resynchronization therapy defibrillator (CRT-D) system, 8 years after initial implantation of a single-chamber implantable cardioverter-defibrillator and 2 years after upgrade of the system to CRT-D. After recurrent erosion, transvenous extraction was attempted with mechanical …

The Efficacy and Tolerability of Commonly Used Agents to Prevent Recurrence of Atrial Fibrillation After Successful Cardioversion

A number of therapeutic strategies exist for the restoration and maintenance of sinus rhythm in patients presenting with atrial fibrillation. The acute success rate with electrical cardioversion is high. However, many patients relapse into atrial fibrillation. A major challenge faced by those who care for patients with atrial fibrillation is the long-term maintenance of sinus rhythm whilst avoiding treatment-related adverse effects. This review examines the efficacy and tolerability of conventional anti-arrhythmic drugs for the secondary prevention of atrial fibrillation in the post-cardioversion period.

Intra‐isthmus Reentry Associated with Uncorrected Double Inlet Left Ventricle and Transposition of the Great Arteries

A 62-year-old man with uncorrected cyanotic congenital heart disease involving double inlet left ventricle with visceral and atrial situs solitus, L-looped ventricles, L-transposed great vessels, and pulmonary stenosis, presented with recurrent atrial tachycardia. Entrainment mapping revealed the arrhythmia mechanism to be an uncommon micro-reentrant cavotricuspid isthmus-dependent circuit (intra-isthmus reentry), which was amenable to radiofrequency ablation. This uncommon right atrial arrhythmia is yet to be reported in patients with complex congenital heart disease and was amenable to radiofrequency ablation.

A novel approach to mapping the atrial ganglionated plexus network by generating a distribution probability atlas: KIM et al.

The ganglionated plexuses (GPs) of the intrinsic cardiac autonomic system are implicated in arrhythmogenesis. GP localization by stimulation of the epicardial fat pads to produce atrioventricular dissociating (AVD) effects is well described. We determined the anatomical distribution of the left atrial GPs that influence atrioventricular (AV) dissociation.