Lucas De Roy

Increased number of cerebral emboli during percutaneous endocardial pulmonary vein isolation versus a thoracoscopic epicardial approach

OBJECTIVE Pulmonary vein isolation (PVI) using ablation energy appears an effective treatment for atrial fibrillation (AF) with a success rate of approximately 80%. However, post-procedural neurological complications still occur in 0.5-10% of all patients undergoing PVI, presumably due to embolism. Therefore, we investigated the occurrence of cerebral micro-embolic signals (MES) as a surrogate marker for the risk of neurological impairment of two different PVI methods: (1) percutaneous endocardial radio-frequency (RF) ablation and (2) thoracoscopic epicardial ablation using RF energy. METHODS Ten patients (eight persistent AF and two paroxysmal AF) underwent a minimally invasive thoracoscopic epicardial (EPI) RF ablation and 10 patients (one persistent AF and nine paroxysmal AF) underwent a percutaneous endocardial (ENDO) isolation. Transcranial Doppler (TCD) was used to detect an MES in the middle cerebral arteries. RESULTS An average of 5 (+/-6) MES were detected during epicardial PVI procedure versus 3908 (+/-2816) MES during percutaneous endocardial PVI procedure. During the ablation application period, respectively, 1 (+/-1) and 2566 (+/-2296) cerebral MES were detected. CONCLUSIONS Cerebral micro-emboli during epicardial ablation are almost absent when compared to the thousands of emboli measured during percutaneous endocardial ablation.

Massive Air Embolism After Central Venous Catheter Removal

A 66-year-old patient had a left central venous catheter in place for 8 days. The catheter, which had to be removed, was withdrawn while the patient was in a 180° supine position during a Valsalva maneuver, with positive pressure during removal. A massage at the site of puncture was performed for 3 minutes, and a compressive plaster was applied. Several minutes after removal, the patient, still supine, needed to cough. He immediately became sweaty and breathless, with progressive improvement after 5 to 10 minutes. However, after ≈20 minutes, the patient was still coughing and became more breathless and somnolent, with an O2 saturation of 93% …

Variable morphologies of preexcitation due to a concomitant Brugada pattern

Since the first publication of the Brugada syndrome in 1992 several variants of this ECG pattern have been described. We report a very unusual case of preexcitation with changing electrocardiographic morphologies which appeared to be an association of a variable Brugada pattern with a persistent antegrade preexcitation.

Radiofrequency ablation of atrial flutter combined with closure of atrial septal defect.

Radiofrequency ablation of atrial flutter combined with patch closure of an atrial septal defect is described. Radiofrequency energy was delivered in the cavo-tricuspid isthmus and from the inferior margin of the atriotomy down to the septal defect using a temperature-controlled multipolar radiofrequency catheter. In addition, cryolesions were applied to the junction of the ablation scar with the tricuspid annulus and with the ostium of the inferior vena cava. Sinus rhythm was restored and an electrophysiologic study conducted 2 months later confirmed the bidirectional conduction block of the cavo-tricuspid isthmus.