José Castro-Rodriguez

Is There a Potential Benefit to Increased Irrigation Channels During Radiofrequency Ablation? Results From a Two-Center Prospective Randomized Study

Potential Benefit to Increased Irrigation Channels During Radiofrequency Ablation. Introduction: Open irrigation during radiofrequency (RF) application allows a higher power delivery in the setting of temperature‐controlled ablation, without causing blood clots. This study sought to evaluate the clinical value of the additional 6 supplementary channels at the proximal catheter tip compared to a standard irrigated RF catheter with 6 conventional channels present at the distal tip only.

Percutaneous transhepatic access for ablation of atypical atrial flutter in complex congenital heart disease.

A 12-year-old boy with complex congenital heart disease presented with symptomatic incessant atrial flutter resistant to antiarrhythmic medication. He had 5 previous surgical interventions for (1) a single left ventricle, (2) D-transposition of the great vessels, and (3) interruption of the aortic arch type C. As a result, he had a complete aorto-bifemoral reconstruction, an atrioseptectomy, and a complete cavopulmonary derivation with fenestration to the right atrium, which was subsequently closed by an Amplatz umbrella device for poor oxygen saturation (with a residual cavo-atrial communication). Due to previous surgical interventions and a thrombosis of the right internal jugular vein, he had no transcutaneous venous access except the left internal jugular vein and the hepatic vein. Percutaneous transhepatic access was obtained using a needle positioned below the right costal margin and guided with ultrasound and contrast visualization of the hepatic vein (Figure 1A and B). A single 3.5 mm externally irrigated-tip ablation catheter (Navistar, Biosense Webster, Diamond Bar,

The left atrial septal pouch as a risk factor for stroke: A systematic review

The left atrial septal pouch (LASP) is formed by incomplete fusion of the septum primum and septum secundum, leaving a cavity open towards the left atrium, but without interatrial shunting. There is no recommendation concerning strategy in the presence of a LASP, especially in the setting of stroke. The aim of this review was to determine whether the LASP could be incriminated as the aetiology of a stroke. We included all pertinent publications on the subject, and calculated hazard ratios for ischaemic stroke and cryptogenic stroke. There were only five case-control studies concerning the LASP, involving 516 stroke patients and 779 controls. Overall LASP prevalence was 21%, with a slightly higher prevalence in the cryptogenic stroke group (26%), but this difference was not statistically significant (P=0.27). In a random-effects meta-analysis, there was no difference between controls and patients with ischaemic stroke (hazard ratio 1.20, 95% confidence interval 0.96-1.53; P=0.14). Cryptogenic stroke appeared more frequently in patients with LASP (hazard ratio 1.53, 95% confidence interval 1.07-2.24; P=0.02), but this was driven by only one severely underpowered study. The published case reports demonstrated that thrombus formation inside the pouch can occur in the presence of major predisposing factors. The LASP can be a site for thrombus formation, leading to embolic events, but its presence does not correlate with an increased incidence of stroke. Associated factors should be taken into consideration in the setting of stroke. Further studies are necessary to validate a possible relationship with cryptogenic stroke.

Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.

Does diffuse irrigation result in improved radiofrequency catheter ablation? A prospective randomized study of right atrial typical flutter ablation.

AIMS Recent developments of open irrigated catheters have sought to create uniform cooling of the entire ablating electrode. The aim of this randomized study was to assess whether the diffuse irrigation of the Coolflex(®) (CF) catheter results in improved short-term procedural benefits in patients undergoing ablation of right atrial typical flutter. METHODS AND RESULTS Sixty consecutive patients (age 62 ± 13) with typical atrial flutter were prospectively randomized to ablation of the cavotricuspid isthmus (CTI) using either a standard 3.5 mm tip ablation catheter with six distal irrigation channels (6C) (30 patients) or a 4 mm tip fully irrigated ablation catheter (CF) (30 patients). There were no significant differences seen between procedures performed with the diffusely irrigated CF catheter and the standard six-channel irrigated-tip catheter. This concerned the total procedural duration RF duration, fluoroscopic duration, the total amount of irrigation fluid, and the occurrence of steam pop. CONCLUSIONS The use of a diffuse irrigation at the ablation catheter tip does neither facilitate lesion formation nor reduce the amount of irrigation during RF ablation for typical right atrial flutter using recommended flow and power settings.

Pre-excited or Not Pre-excited?

Figure 1. Twelve-lead ECG before ablation. Case Report An 18-year-old man was referred with a history of paroxysmal palpitations for more than 10 years. The 12-lead electrocardiogram (ECG) recorded during an episode showed a narrow QRS tachycardia. Prior to the electrophysiological study (EPS), two distinct and alternating P-wave morphologies were observed on the ECG monitoring during a sinus rhythm (Fig. 1). One of the