Mauricio Abello

Cardioverter Defibrillator Implantation in a Pregnant Woman Guided with Transesophageal Echocardiography

This report describes a 28‐year‐old pregnant woman with mitral valve prolapse and sudden cardiac death due to a ventricular fibrillation who underwent an ICD implantation guided by tranesophageal echocardiography. (PACE 2003; 26:1913–1914)

Superior Vena Cava Flutter: Electrophysiology and Ablation

Introduction: Reentry within a major thoracic vein has been suggested as a cause of atrial arrhythmias. However, little is known about these potential reentrant circuits.

Ablación de taquicardias ventriculares guiada mediante sistema LocaLisa en pacientes con cardiopatía estructural

Introduccion La ablacion de taquicardias ventriculares (TV) en pacientes con cardiopatia estructural presenta diversas limitaciones que condicionan una menor eficacia que en otros sustratos arritmicos. En los ultimos anos, se han desarrollado diversas tecnicas de navegacion no fluoroscopica que facilitan la cartografia de sustratos arritmogenicos complejos; una de ellas es el sistema LocaLisa. Sin embargo, aun no se ha descrito su utilizacion en la ablacion de TV. Pacientes y metodo Se incluyo a 32 pacientes con cardiopatia estructural que fueron sometidos a ablacion de TV sostenidas en nuestro centro. En 10 se utilizo el sistema LocaLisa como medio de visualizacion de los cateteres durante el procedimiento. Se compararon los resultados del procedimiento del grupo LocaLisa con los de un grupo control de 22 pacientes en quienes se empleo solo fluoroscopia durante la ablacion. Resultados Se consiguio una ablacion eficaz en 9 (75%) de 12 y 17 (68%) de 25 procedimientos, en el grupo LocaLisa y en el control, respectivamente (p = NS). En el grupo LocaLisa, la duracion media total del procedimiento, de la ablacion y de la radioscopia fue de 243 ± 84, 86 ± 56 y 46 ± 19 min, respectivamente; los tiempos medios en el grupo control fueron de 244 ± 72, 79 ± 58 y 43 ± 27 min, y no se alcanzo la significacion estadistica. En el grupo LocaLisa se observo una tendencia a una mayor intolerancia hemodinamica de las TV (grupo LocaLisa: 42%, grupo control 24%; p = 0,05), asi como un mayor numero de procedimientos de mapeo en ritmo sinusal (grupo LocaLisa: 33%, grupo control 4%; p = 0,03). El sistema LocaLisa permitio localizar y volver precisamente a los puntos endocardicos de interes, comprobado por el registro de los mismos electrogramas y una similar posicion fluoroscopica. Conclusiones El sistema LocaLisa ayuda a delinear el circuito de reentrada y la reubicacion precisa del cateter de ablacion en puntos de interes.

Taquicardia ventricular postinfarto de QRS inferior a 140 ms: caracterización y ablación con catéter

Las taquicardias ventriculares monomorficas sostenidas (TVMS) en pacientes con infarto de miocardio (IM) previo presentan, habitualmente, un complejo QRS ancho. Sin embargo, en ocasiones se han descrito TVMS de complejos QRS «estrechos» (TVMS-E). Se analizo retrospectivamente la incidencia de TVMS-E (QRS

Post-Infarction Ventricular Tachycardia With a QRS Complex Narrower Than 140 ms: Characterization and Catheter Ablation

Typically, sustained monomorphic ventricular tachycardia (SMVT) in patients with a previous myocardial infarction (MI) is characterized by a wide QRS complex. However, occasionally patients present with SMVT and a narrow QRS complex (N-SMVT). We studied retrospectively the incidence of N-SMVT (i.e., QRS interval <140 ms) in patients with a previous MI and inducible SMVT who underwent electrophysiological evaluation. Of the 135 consecutive patients with inducible SMVT, 8 (5.9%) presented with inducible N-SMVT. The mean QRS complex duration in patients with N-SMVT was 126 (8) ms. Radiofrequency ablation was successful in 5 out of 6 patients (83%). One of the remaining two received an implantable defibrillator, while the other was given amiodarone. Findings during radiofrequency ablation showed that the reentry circuit was located in the left septum in 4 out of the 5 patients (80%). N-SMVT is relatively uncommon, but the success rate of radiofrequency ablation is high. The reentry circuit is most often located in the septum.

Ventricular Tachycardia Ablation Guided by LocaLisa System in Patients With Structural Heart Disease

INTRODUCTION The ablation of ventricular tachycardia is limited by a number of factors that reduce the effectiveness of this intervention in patients with structural heart disease compared to other types of arrhythmia. Recent years have seen the development of several nonfluoroscopic navigation techniques that facilitate the mapping of complex arrhythmogenic substrates. One such technique, the LocaLisa system, has not previously been tested for the ablation of ventricular tachycardia. PATIENTS AND METHOD A total of 32 patients with structural heart disease were treated at our center with ablation for sustained ventricular tachycardia. In 10 patients the LocaLisa system was used to visualize the catheters during the procedure. We compared the results in the LocaLisa group with those in a control group of 22 patients treated with conventional fluoroscopy-guided ablation. RESULTS The success rate of ablation was 75% (9/12 procedures) in the LocaLisa group and 68% (17/25 procedures) in the control group (P=NS). In the LocaLisa group, mean total duration of the procedure (243 +/- 84), duration of ablation (86 +/- 56) and fluoroscopy time (46 +/- 19) did not differ significantly from those in the control group (244 +/- 72 min, 79 +/- 58 min, and 43 +/- 27 min, respectively). In the LocaLisa group the trend toward greater hemodynamic intolerance in ventricular tachycardia approached significance (42% in the LocaLisa group vs 24% in the control group, P=.05) and the number of mapping procedures performed during sinus rhythm was significantly higher in the former (33% in the LocaLisa group vs 4% in the control group, P=.03). With the LocaLisa system it was possible to locate and reposition the ablation catheter accurately at the target endocardial sites, as confirmed by electrographic recordings and fluoroscopic verification. CONCLUSIONS The LocaLisa system helps to delineate the reentry circuit and facilitates accurate catheter repositioning in patients with structural heart disease and ventricular tachycardia.

The Inferior Radiolucent Area Within the Cardiac Silhouette: Validation as a Landmark for Coronary Sinus Catheterization

Background: Catheterization of the coronary sinus (CS) plays a preponderant role in device implantation and electrophysiology. Nevertheless, catheterization of this structure can be time‐consuming and is related to operator experience. An inferior radiolucent area of the cardiac right anterior oblique (RAO) view has been suggested as a landmark to guide CS catheterization. However, the true relationship of this area with the CS ostium (CSO) has not been studied.