Justin Price

Efficacy of catheter ablation in nonparoxysmal atrial fibrillation patients with severe enlarged left atrium and its impact on left atrial structural remodeling

The effect of catheter ablation on severe left atrial enlargement especially in nonparoxysmal atrial fibrillation (NPAF) patients is not well understood. Whether reverse remodelling may occur after ablation has not been evaluated in this setting.

Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center

Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach.

Advances in Catheter Ablation: Atrial Fibrillation Ablation in Patients With Mitral Mechanical Prosthetic Valve

Atrial fibrillation (AF) is common in patients with mitral valve replacement (MVR). Treatment of AF in these subjects is challenging, as the arrhythmia is often refractory to antiarrhythmic drug therapy. Radiofrequency catheter ablation (RFCA) is usually avoided or delayed in patients with MVR due to the higher perceived risks and difficulty of left atrial catheter manipulation in the presence of a mechanical valve. Over the last few years, several investigators have reported the feasibility and safety of RFCA of AF in patients with MVR. Five case-control studies have evaluated the feasibility and safety of RFCA of AF or perimitral flutter (PMFL) in patients with MVR. Overall, a total of 178 patients with MVR have been included (21 undergoing ablation of only PMFL), and have been compared with a matched control group of 285 patients. Total procedural duration (weigthed mean difference [WMD] = +24.5 min, 95% confidence interval [CI] +10.2 min to +38.8 min, P = 0.001), and fluoroscopy time (WMD = +13.5 min, 95% CI +3.7 min to +23.4 min, P = 0.007) were longer in the MVR group. After a mean follow-up of 11.5 ± 8.6 months, 64 (36%) patients in the MVR group experienced recurrence of AF/PMFL, as compared to 73 (26%) patients in the control group, accounting for a trend toward an increased rate of recurrences in patients with MVR (odds ratio [OR] = 1.66, 95% CI 0.99 to 2.78, P = 0.053). Periprocedural complications occurred in 10 (5.6%) patients in the MVR group, and in 8 (2.8%) patients in the control group (OR = 2.01, 95% CI 0.56 to 7.15, P = 0.28). In conclusion, a quantitative analysis of the available evidence supports a trend toward a worse arrhythmia-free survival and a higher absolute rate of periprocedural complications in patients with MVR undergoing RFCA of AF or PMFL, as compared to a matched control group without mitral valve disease. These data would encourage the adoption of RFCA of AF in MVR patients mostly by more experienced Institutions.

IMPACT OF A NEW OPEN IRRIGATED CATHETER ON THE RISK OF FLUID OVERLOAD AFTER ABLATION OF LONG STANDING PERSISTENT ATRIAL FIBRILLATION: RESULTS FROM A PROSPECTIVE RANDOMIZED STUDY

Authors: Luigi Di Biase, Pasquale Santangeli, Rong Bai, Prasant Mohanty, Sanghamitra Mohanty, Chintan Trivedi, Justin Price, Rachel (Xue) Yan, Rodney Horton, Javier Sanchez, Joe Gallinghouse, Salwa Beheiry, Richard Hongo, Jason Zagrodzky, Robert Canby, Antonio Dello Russo, Michela Casella, Gaetano Fassini, Corrado Carbucicchio, Claudio Tondo, Andrea Natale, Texas Cardiac Arrhthmia Institute, Austin, TX, USA

WITHDRAWN: Hybrid Procedure (Endo/Epicardial) Versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center. ☆

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NEED OF EPICARDIAL INSTRUMENTATION TO OPTIMIZE THE ABLATION SITE FOR SINUS NODE MODIFICATION

Catheter ablation of inappropriate sinus tachycardia (IST) is a challenging procedure due to the proximity of the sinus node to the phrenic nerve, and the predominant epicardial location of the sinus node structure. We report a consecutive series of patients undergoing ablation of IST and

Use of ViperSlide Lubricant to Extract Entrapped Sheath after Severe Radial Artery Spasm during Coronary Angiography

Radial artery spasm is a known complication of transradial cardiac catheterization. However, severe spasm with sheath entrapment is rare. We describe such a case, and the conditions response to an alternative removal method after conventional efforts failed. A 68-year-old man presented for coronary angiography. We introduced a 5F sheath into the right radial artery, but, because of severe arterial spasm, we could not aspirate blood from the sheath or retract it. We sedated the patient and waited for the spasm to subside; however, the radial sheath remained entrapped. Nitroglycerin injection enabled blood aspiration and vasodilator injection, but not sheath removal. Finally, we injected ViperSlide lubricant into the sheath for its rapid, easy extraction. When sedation and vasodilator therapy fail, we recommend using ViperSlide for radial sheath removal before applying nerve block or general anesthesia.

ST SEGMENT ELEVATION MYOCARDIAL INFARCTION SECONDARY TO KOUNIS SYNDROME RESULTING FROM BEE STINGS

Kounis Syndrome is an acute coronary event resulting from an allergic trigger, ranging from vasospastic angina to acute myocardial infarction. Treatment strategies must target not only the acute coronary syndrome (ACS), but also the underlying allergic reaction. Due to the risk of coronary spasm,

DOES TERMINATION OF ATRIAL FIBRILLATION DURING ABLATION OF LONG STANDING PERSISTENT ATRIAL FIBRILLATION PREDICT THE OUTCOME AT FOLLOW-UP? RESULTS FROM A PROSPECTIVE RANDOMIZED STUDY

In patients with persistent and long standing persistent (LSP) atrial fibrillation (AF) in addition to pulmonary vein isolation (PVI), extensive substrate modification and Non PV triggers ablation is important to achieve long term success. Whether AF termination during ablation should be considered