Ismail Erden

Gastroparesis as a Complication of Atrial Fibrillation Ablation

Percutaneous catheter ablation is a safe and effective treatment for symptomatic drug-resistant atrial fibrillation (AF). Gastroparesis is a little known complication of AF ablation. We aimed to evaluate the frequency of gastroparesis in the patients who underwent catheter ablation for AF by cryoballoon (CB) or radiofrequency (RF) and to define risk factors for gastroparesis. In all, 104 patients were treated with pulmonary vein (PV) isolation with 2 different technologies: CB in 58 patients (group 1) and open-irrigated tip RF catheter in 46 patients (group 2). Gastroparesis was seen in 7 cases (6 cases in group 1 and 1 case in group 2, respectively). The complaints related with gastroparesis began during the procedure in 4 of 6 patients of group 1. The other 3 patients admitted to our outpatient clinic with similar complaints within 72 to 96 hours after the procedure. For gastroparesis cases of group 1, mean minimal CB temperature on inferior PVs was lower and left atrium diameter was smaller. Management was conservative, and the patients have no residual symptoms at 6-month follow-up. The only patient still demonstrating residual symptoms during follow-up was in group 2. Although, clinically manifest gastroparesis is quite common with CB ablation, the process is generally reversible. However, damage may not be as reversible with RF ablation. In conclusion, during cryoablation, lower temperatures on inferior PVs and small left atrium size may be associated with increased risk of gastroparesis, and fluoroscopic guidance may be useful to avoid this complication.

successful focal ablation in a patient with electrical storm in the early postinfarction period: case report

Electrical storm (ES) is associated with a poor prognosis if it occurs in the early postinfarction period (within 4 weeks). There are limited data on the efficacy and safety of catheter ablation in the early period. In the patients with postinfarction cardiomyopathy, ventricular tachycardia (VT) is usually caused by re-entry through slowly conducting tissue within areas of a myocardial scar, whereas for the early postinfarction period, the underlying mechanism of ES is not fully understood. We report a case of ES for which macroreentry was excluded as a mechanism of VT because of the clinical and electrophysiological properties of the tachycardia. The tachycardia was terminated by focal radiofrequency catheter ablation of the earliest site. The total procedure time was only 35 minutes. During a 12-month follow-up period, the patient has remained free of monomorphic VT episodes. On the basis of this case, we aimed to discuss the underlying mechanism of ES in the early postinfarction period and to evaluate the role of radiofrequency catheter ablation as a primary approach for treating ES.

Functional permanent 2:1 atrioventricular block treated with cardioneuroablation: Case report

A 54-year-old woman had undergone slow pathway ablation for AV nodal reentrant tachycardia 3 years ago. Before admission she had started to present with recurrent dizziness and syncope due to 2:1 AV block and was referred for pacemaker implantation. She was asymptomatic and had no signs of AV conduction abnormalities until 2 weeks ago. AV conduction abnormality resolved with atropine infusion until stage 2 of a treadmill exercise test. Electrophysiologic study showed suprahisian 2:1 AV block. After cardioneuroablation, the parameters of AV conduction normalized. Holter recordings were normal, and the patient was asymptomatic at the end of 12-month follow-up. Several clinical conditions comprise autonomic dysfunction by enhanced parasympathetic tone together with decreased sympathetic tone. Enhanced parasympathetic tone may cause sinus bradycardia or pauses, transient or permanent atrioventricular (AV) block, carotid sinus syndrome, or neurally mediated reflex syncope. Although the conduction system is not involved in these patients, they may present with serious symptoms. The parasympathetic postganglionic neuron body cell is located at the cardiac wall in the paracardiac ganglia. Cardioneuroablation is a little known technique for management of patients with excessive vagal activation. The technique is based on radiofrequency (RF) catheter ablation of autonomic connections in the 3 main ganglia around the heart.

Prediction of mid-term outcome after cryo-balloon ablation of atrial fibrillation using post-procedure high-sensitivity troponin level : cardiovascular topics

Objective High-sensitivity troponin I (hsTnI) assays lead to, among other things, improvement in the detection of myocardial injury and improved risk stratification of patients with atrial fibrillation (AF). The aim of this study was to investigate the association between post-procedure cardiac biomarkers and clinical outcome in patients undergoing cryo-balloon ablation (CA) for AF. Methods A total of 57 patients (mean age 55.1 ± 12.2 years, 50.9% female) with symptomatic paroxysmal AF underwent the CA procedure. Two hundred and twenty-eight pulmonary veins (PVs) were attempted for pulmonary vein isolation (PVI) with a second-generation cryo-balloon. hsTnI, CK-MB mass and myoglobin samples were prospectively obtained before and 24 hours after ablation. Result At a mean follow up of 214.6 ± 24.3 days, the probability of being arrhythmia free after a single procedure was 86%. Post-ablation hsTnI (p = 0.001), left atrial (LA) diameter (p = 0.002), duration of AF (p = 0.002), mean minimal temperature of the left superior pulmonary vein (p = 0.005), and age (p = 0.021) were associated with increased AF recurrence rate. On multivariate analysis, lower hsTnI level was the only independent predictor for AF recurrence (p = 0.012). Post-ablation hsTnI levels lower than 4.40 ng/ml predicted AF recurrence during follow up, with a sensitivity of 86% and a specificity of 96%. Conclusion It is well recognised that the PV antrum contributes to initiation and/or perpetuation of AF. A lower postablation hsTnI level may predict an increased AF recurrence rate, suggesting inadequate ablation of the PV antrum. This may be used as a non-invasive marker to predict the outcome of AF.

An Underestimated Complication of Atrial Fibrillation Ablation: Gastroparesis

-OP-001 R A C An Under-estimated Complication ff Atrial Fibrillation Ablation: Gastroparesis. Tolga Aksu, Tumer Erdem Guler, Sukriye Ebru Golcuk, Kazim Serhan Ozcan, Ismail Erden. Department of Cardiology, Kocaeli Derince Education and Research Hospital. T S Objectives: Percutaneous catheter ablation is a safe and effective treatment for symptomatic drug-resistant atrial fibrillation (AF). Gastroparesis is a little known complication of AF ablation. We aimed to evaluate the frequency of gastroparesis in the patients who underwent catheter ablation for AF by cryoballoon or radiofrequency (RF) and to define risk factors for gastroparesis. Methods-Results: Seventy-four patients (mean age 56.2þ12.1 years, 51% male) with symptomatic paroxysmal AF underwent pulmonary vein isolation with two different ablation techniques: Cryoballoon in 58 patients (Group 1), open-irrigated tip RF catheter in 16 patients (Group 2). The baseline characteristics of the patients did not differ among groups. The incidence of gastroparesis was 9.4% (7/74). Gastroparesis was seen in 6 patients in group 1 and 1 patient in group 2. Four of 7 patients complained of epigastric discomfort, abdominal pain, and heartburn during the procedure. The other 3 patients admitted to our outpatient clinic with similar complaints within 72-96 hours after the procedure. Mean minimal cryoballoon temperature in inferior pulmonary veins (IPVs) was lower (in the left IPV -55.3 4.8 C vs -47.2 2.7 C, p<0.0001, in the right IPV -50.3 1.5 C vs -44.8 3.3 C, p<0.0001) and left atrium (LA) diameter was smaller

Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report

Radiofrequency catheter ablation of the slow pathway is considered to be the treatment of choice for patients with atrioventricular nodal reentrant tachycardia. We report a 34-year-old female with mirror image dextrocardia due to unilateral pulmonary agenesis who underwent successful slow pathway ablation for typical atrioventricular nodal reentrant tachycardia. Using contrast injection, cardiac anatomy was identified in a short time and successfully ablated.

ablation of idiopathic ventricular tachycardia originating from posterior mitral annulus by using electroanatomical mapping

Idiopathic ventricular tachycardia (IVT) is an important type of arrhythmia, which has distinct electrocardiographic features and treatment options. Most of the cases originate from right ventricular outflow tract and less frequently from the left ventricular outflow tract. IVTs originating from mitral annulus are rare, and little is known about the efficacy of radiofrequency catheter ablation in this form. We hereby present a rare case of IVT arising from posterior mitral annulus. The electrocardiographic, electrophysiological, and electroanatomical characteristics of this tachycardia are discussed.

Radiofrequency Ablation of Typical Atrial Flutter via Right Jugular Vein due to Bilateral Obstructed Iliac Veins in a Patient with Dilated Cardiomyopathy.

Ablation of cavotricuspid isthmus (CTI) is the gold standard method in the treatment of isthmus dependent atrial flutter (AFl). Venous access was obtained usually via right or left femoral veins. In rare cases of obstruction of iliofemoral veins, ablation of CTI can be performed only through the superior approach. We present a 74-year-old woman of typical AFl and dilated cardiomyopathy that was ablated through the right jugular vein because of obstruction of the left and the right iliac veins. This is the first report of successful ablation of CTI in a patient with dilated cardiomyopathy via superior approach.