Sokratis Pastromas

Flecainide: Current status and perspectives in arrhythmia management

Flecainide acetate is a class IC antiarrhythmic agent and its clinical efficacy has been confirmed by the results of several clinical trials. Nowadays, flecainide is recommended as one of the first line therapies for pharmacological conversion as well as maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is not recommended in patients with structural heart disease due to high proarrhythmic risk. Recent data support the role of flecainide in preventing ventricular tachyarrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia associated both with ryanodine receptor and calsequestrin mutations. We herein review the current clinical data related to flecainide use in clinical practice and some concerns about its role in the management of patients with coronary artery disease.

Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming.

Cardiac resynchronization therapy (CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class II, III and ambulatory IV, reduced left ventricular (LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes.

Ablation of Cavotricuspid Isthmus-Dependent Flutter Using a Mini-Electrode-Equipped 8-mm Ablation Catheter: Case Series

C atheter ablation is the treatment of choice for the prevention of recurrences and the long-term management of patients with cavotricuspid isthmus (CTI)-dependent atrial flutter. In current clinical practice, CTI ablation is performed with the use of large-tip or irrigated ablation catheters, since they have been shown to reduce the procedure duration and to increase the success rate as compared to the use of a standard 4-mm ablation catheter.1 A limitation of the large-tip ablation catheter is the impaired near-field electrogram resolution.2 A novel catheter technology designed to address this issue includes the embedment of mini-electrodes (ME) in close proximity to the edge of large-tip ablation catheters. Electrical activity recorded from the MEs, in contrast to the conventional bipolar recording, may provide improved spatial resolution, detailed and more accurate localization of the catheter tip, as well as reliable guidance for the titration of the radiofrequency energy delivered.3,4 Gupta et al have reported a case where this novel ablation catheter was used successfully for ablation of a gap in a previously deployed linear lesion across the CTI in a patient with recurrent atrial flutter.5 In the present study, we aimed to evaluate the efficacy and safety of this novel ablation catheter in a small series of consecutive patients with CTI-dependent atrial flutter.

The Role of Adiponectin and BNP in Predicting Cardiovascular Events

The present case report describes a patient who sustained an acute inferior wall myocardial infarction, but initially remained clinically stable, then he underwent a successful coronary angioplasty and stenting procedure of a totally occluded right coronary artery, subsequently developing a dramatic clinical course with cardiogenic shock and cardiac arrest due to acute stent thrombosis which was successfully managed with repeat coronary angioplasty. We attributed this discrepant clinical manifestation of acute coronary occlusion to coronary collaterals, initially being present and then disappearing following the recanalization procedure, as being responsible for the dramatic clinical picture following the stent thrombosis.Aim: The purpose of this investigation was to collect data on the appropriate nursing care to patients supported with an intra-aortic balloon pump (IABP).Patients: All 39 patients who were supported with an IABP during the year 2006 (23 men ??? 16 women) took part in this investigation. They received nursing and medical care in the Intensive Care Cardiovascular Unit (ICCU) of Evagelismos General Hospital of Athens.Πeριγράφeται η πeρίπτωση eνός ασθeνούς, 66 eτών, που παρουσιάσθηκe μe πολλαπλά eπeισόδια eμμένουσας μονόμορφης κοιλιακής ταχυκαρδίας 30 και 14 έτη μeτά δύο eμφράγματα του κατωτέρου και του προσθίου τοιχώματος του μυοκαρδίου. Αφού η ηλeκτρική θύeλλα κατeστάλη μe ένα μeικτό σχήμα τριπλής αντιαρρυθμικής αγωγής, ο ασθeνής υπeβλήθη σe eνδοκαρδιακή κατάλυση της αρρυθμιογόνου eστίας μe τη βοήθeια του ηλeκτροανατομικού συστήματος χαρτογράφησης στο ηλeκτροφυσιολογικό eργαστήριο. Ακολούθησe η eμφύτeυση eνός αντιταχυκαρδιακού βηματοδότου απινιδωτού που στους eπακόλουθους 30 μήνeς παρακολούθησης κινητοποιήθηκe αθόρυβα σe ένα μοναδικό στιγμιότυπο αντιταχυκαρδιακής βηματοδότησης.Ο όρος οξύ στeφανιαίο σύνδρομο ( ACS ) αναφέρeται σe ένα φάσμα τριών πιθανών κλινικών eκδηλώσeων της στeφανιαίας νόσου, την ασταθή στηθάγχη (UA), το έμφραγμα χωρίς ανάσπαση του ST (NSTEM) και το έμφραγμα μe ανάσπαση του ST (STEMI). Η διάκριση αυτή eίναι χρήσιμη στην ανάπτυξη θeραπeυτικών στρατηγικών. Το Αμeρικανικό κολλέγιο καρδιολογίας ( ACC ) και η Αμeρικανική καρδιολογική eταιρία ( AHA ), από κοινού δημοσιeύουν κατeυθυντήριeς οδηγίeς για την αντιμeτώπιση των οξέων στeφανιαίων συνδρόμων. Η τeλeυταία αναθeώρηση των προτeινόμeνων κατeυθυντήριων οδηγιών έγινe το 2007. Η ασταθής στηθάγχη ( UA ) και το NSTEMI έμφραγμα eίναι δύο δυσδιάκριτeς μeταξύ τους οντότητeς και η διαφορά τους έγκeιται στο γeγονός ότι το NSTEMI χαρακτηρίζeται από πeρισσότeρο eκτeταμένη μυοκαρδιακή βλάβη, μe απeλeυθέρωση στην κυκλοφορία τροπονίνης (TnT ή TnI ) ή CK-MB. Eίναι σημαντικό στην αντιμeτώπιση της ασταθούς στηθάγχης/NSTEMI να eπιλέξουμe πρώιμα ανάμeσα σe eπeμβατική ή συντηρητική θeραπeυτική στρατηγική. Η eπιλογή γίνeται μe βάση στοιχeία από το ιστορικό, την κλινική eικόνα και τα eργαστηριακά eυρήματα του ασθeνούς ... (excerpt)Despite primary and secondary methods for the prevention of acute coronary syndromes, there is still poor patient and physician understanding of the importance of smoking cessation. Cardiovascular risk decreases significantly after smoking cessation, however, there is a paucity of counseling programs regarding this issue after hospitalization. Such programs have proved to be cost effective and should be provided as standard care.

Cryoballoon dysfunction indicated by abrupt temperature drop during atrial fibrillation ablation

Pulmonary vein (PV) isolation remains the cornerstone of atrial fibrillation (AF) ablation. Cryoballoon ablation is shown to be non-inferior to radiofrequency ablation in terms of efficacy and safety among paroxysmal AF patients. In this case, we report an intraprocedural adverse event encountered during cryoballoon ablation. A 46-year-old male patient with symptomatic, paroxysmal AF underwent cryoballoon ablation. Following successful isolation of other PVs, a cryolesion was delivered at the right inferior PV. Initially, the recorded temperature fell at 42 C after 50 s. However, a second abrupt and rapid temperature decline was noted unexpectedly, reaching 72 C within the next 7 s (Figure 1). Ablation was terminated, but despite balloon deflation, retraction of the cryocatheter (Arctic Front Advance) within the sheath was not feasible. The dysfunction persisted despite subsequent cycles of inflation and deflation aiming to allow appropriate balloon unwrapping. Following deflation, the cryoballoon catheter and the sheath were carefully retracted en bloc to the right atrium, and the procedure was terminated. Visual inspection

Radiofrequency Ablation of a Nonsustained Ventricular Tachycardia Arising from the Left Coronary Cusp of a Bicuspid Aortic Valve: A Case Report.

Radiofrequency ablation is the therapy of choice for the suppression of medically intractable symptomatic ventricular arrhythmias. Here we present the case report of a 50-year-old woman with bicuspid aortic valve (BAV) and symptomatic nonsustained ventricular tachycardia arising from the left ventricular outflow tract (LVOT). The origin of the ventricular arrhythmia was confirmed in the left coronary cusp (LCC) of the BAV. The patient underwent a successful radiofrequency ablation. LCC of a tricuspid aortic valve is a common origin of idiopathic LVOT tachycardia; however, little is known for these types of arrhythmias when located in the cusps of a BAV.