Steven Mickelsen

Atrial fibrillation ablation leads to long-term improvement of quality of life and reduced utilization of healthcare resources.

In some patients, rapid activation from one or several foci can lead to atrial fibrillation. This study evaluated long-term changes in quality of life and healthcare resource utilization in patients with atrial fibrillation treated by ablation of focal triggers. Thirty-three patients underwent ablation for paroxysmal atrial fibrillation. Health surveys (SF-36) were obtained at baseline, and after 1 year and 3 years of follow-up. Health care costs were measured for the 3 years before and after ablation. Ablation was successful in 82%, partially successful in 12% (no sustained episodes but on antiarrhythmic drug therapy), and unsuccessful in 6% of patients. The average number of ablation procedures was 1.6 ± 0.6 per patient. After ablation, patients reported significantly improved quality of life in all SF-36 categories except bodily pain. Healthcare resource utilization was significantly reduced after ablation (Clinic visits: 7.4 ± 2.5 per year vs. 1.1 ± 0.6 per year, p < 0.05; Emergency room visits: 1.7 ± 0.90 per year vs. 0.03 ± 0.17 per year, p < 0.05; Hospitalization: 1.6 ± 0.81 vs. 0, p < 0.05). Cost of healthcare (not including procedural costs) was significantly reduced after ablation (Pre-ablation:

Long-term outcomes on quality-of-life and health care costs in patients with supraventricular tachycardia (radiofrequency catheter ablation versus medical therapy)

1,920 ± 889/year vs. post-ablation:

A Left Free‐Wall, Decrementally Conducting, Atrioventricular (Mahaim) Fiber: Diagnosis at Electrophysiological Study and Radiofrequency Catheter Ablation Guided by Direct Recording of a Mahaim Potential

87 ± 68/year; p < 0.01). Procedural cost of ablation was

Transvenous access to the pericardial space : An approach to epicardial lead implantation for cardiac resynchronization therapy

17,173 ± 2,466/patient. Ablation of focal triggers of atrial fibrillation is associated with a sustained improvement in quality of life. Although the initial cost of ablation is high, after ablation, utilization of healthcare resources is significantly reduced.

Doppler evaluation of the descending aorta in Patients with hypertrophic cardiomyopathy: Potential for assessing the functional significance of outflow tract gradients and for optimizing pacemaker function

A lthough several studies have examined the costeffectiveness of radiofrequency catheter ablation and its effect on health-related quality of life, these studies examined only highly selected patients with severe drug refractory symptoms or were limited to 1-year follow-up. This study prospectively compares the long-term effects on health care outcome of radiofrequency catheter ablation versus medical therapy as an initial treatment strategy for patients with paroxysmal supraventricular tachycardia. • • • The potential patient population included all patients with newly documented paroxysmal supraventricular tachycardia referred to Lovelace hospitals or the University of New Mexico hospitals from June 1995 to June 1996. Patients with drug refractory symptoms referred specifically for ablation, and patients with atrial fibrillation or atrial flutter were excluded. Ninety-five consecutive patients with newly diagnosed paroxysmal supraventricular tachycardia were enrolled in the study. All patients had follow-up at 1 year, but 12 patients were lost to follow-up after 5 years (1 death was due to unrelated causes, and 11 could not be contacted). The remaining 83 patients form the basis of the study. Of these, 39 chose initial therapy with radiofrequency catheter ablation and 44 chose medical therapy. In the medical therapy group, 22 patients underwent radiofrequency catheter ablation between the first and fifth years. The Medical Outcomes Study Short-Form Health Survey (SF-36) and additional disease-specific questions were administered at 1and 5-year follow-up and were used to measure perceived health and quality of life. Medical costs due to treatment of supraventricular tachycardia during the 5-year follow-up period were obtained and adjusted to 2001 dollars. The details of our protocol have been previously published. For the 2 treatment groups, the baseline characteristics and quality-of-life scores were compared with the follow-up quality of life scores using multivariate analysis of variance to evaluate for age and sex effects. A chi-square test was used to analyze categorical variables at baseline and at 5-year follow-up. Repeated-measures analysis of variance was used to compare the baseline and follow-up quality-of-life scores within each treatment group. Unless otherwise specified, results are expressed as mean 1 SD. Age (medical therapy, 51 14 years; ablation, 50 18 years, p NS), sex ratio (medical therapy, 13 men and 31 women; ablation, 12 men and 27 women, p NS), and duration of symptoms before enrollment (medical therapy, 39 30 months; ablation, 37 30 months, p NS) were similar for the 2 groups. At baseline, symptom frequency did not vary significantly between the 2 groups, and there were no significant differences in any of the SF-36 subsets (Table 1 and Figure 1). Fifteen of 44 patients (34%) in the medical therapy group were treated with 1 drug. The average number of medications used was 1.49 0.59 drugs per patient. Beta blockers were the most effective drug class. Twenty-two of the 44 patients who initially chose drug therapy ultimately underwent radiofrequency catheter ablation because of continued symptoms or adverse effects from the medications. Documented arrhythmias in the patients treated with radiofrequency catheter ablation (including crossovers) were atrioventricular node reentrant tachycardia in 41 patients (67%), accessory pathwaymediated tachycardia in 17 patients (28%), and atrial tachycardia in 3 patients (5%). The primary success rate was 100% in the initial ablation treatment group and 100% in the crossover group. One patient in the initial ablation treatment group had recurrent arrhythmia and required a second ablative attempt, which proved successful. The 1 significant complication was a patient in the ablation group who developed pericardial effusion and tamponade, necessitating emergency pericardiocentesis. After 4 days of hospitalization, the patient was discharged without any permanent sequelae. Hospitalization for the ablation procedure averaged 0.5 0.6 days, and 28 patients (46%) were discharged on the same day as their ablation. Table 1 summarizes the SF-36 scores at baseline, at 1 year, and at 5 years for medical therapy and the ablation groups. At 1 year follow-up, both medical therapy and ablation were associated with improvement in SF-36 scores. Medical therapy resulted in a significant improvement from baseline in physical function, physical role, and social function subsets at From the Electrophysiology and Pacing Service, Department of Cardiology, Lovelace Medical Center, Albuquerque; and Division of Cardiology, Department of Medicine, University of New Mexico, Albuquerque, New Mexico. Dr. Kusumoto’s address is: Electrophysiology and Pacing Service, Cardiology Division, Lovelace Medical Center, 5400 Gibson Boulevard SE, Albuquerque, New Mexico 87108. E-mail: fred.kusumoto@lovelace.com. Manuscript received November 26, 2001; revised manuscript received and accepted January 16, 2002.

Balancing Quality and Thoroughness with Efficiency in Invasive Cardiac Electrophysiology

A 64‐year‐old female with Wolff‐Parkinson‐White syndrome and an ECG demonstrating a rigbt posterolateral accessory pathway was referred for electrophysiological study. During electrophysiological testing two AV pathways were identified: a right posterolateral pathway that displayed conventional electrophysiological properties: and a left free‐wall pathway tbat conducted only anterogradely and demonstrated decremental properties. Two separate wide complex tachycardias were induced that utilized the left free‐wall pathway anterogradely and either the AV node or the right posterolateral accessory pathway retrogradely. A discrete electrical potential on the free wall of the mitral an‐nulus was identified during tachycardia and was utilized to facilitate mapping and ablation.

Electromechanical analysis of infarct border zone in chronic myocardial infarction

Background: Percutaneous access to the pericardial space (PS) may be useful for a number of therapeutic modalities including implantation of epicardial pacing leads. We have developed a catheter‐based transvenous method to access the PS for implanting chronic medical devices.

Trends and patterns in electrophysiologic and ablation catheter reuse in the united states

AbstractWe evaluated whether analysis of aortic flow could be useful for determining the functional significance of left ventricular outflow gradients and for optimizing pacing therapy in patients with hypertrophic cardiomyopathy (HOCM). Methods: Doppler echocardiography was performed in 32 patients with HOCM. Eleven patients with pacemakers (PPM) also underwent treadmill and quality-of-life (QOL) testing in a randomized crossover trial (1 month of backup pacing (AAI at 30 beats per minute), 1 month with an atrioventricular interval (AVI) of 30 ms (DDD30), and 1 month with an “optimized” AVI (DDDop) that maximized the descending aortic Doppler velocity time integral. Results: Patients with HOCM displayed a notch in the aortic Doppler flow profile. The location of the notch in systole corresponded with the development of the peak left ventricular outflow gradient. Aortic flow after the notch was variable ranging from 6–48% of the total flow. In patients with pacemakers, improved response to pacing was noted in those patients that developed the notch early in systole and had subsequent attenuation of aortic flow. Optimizing the AVI was associated with improved exercise tolerance (AAI: 4.6 ± 2.3 min., DDD30: 5.5 ± 2.2 min., and DDDop: 7.7 ± 2.5 min.; p < 0.05) and improved QOL. Conclusions: Patients with HOCM have a notch in their aortic Doppler flow profile. The location of the notch correlates with the development of the peak left ventricular outflow gradient and flow after the notch is variable. Patients with an early notch and attenuated flow after the notch appear to have the greatest response to pacing therapy.

electrophysiology catheters Safety and efficacy of hydrogen peroxide plasma sterilization for repeated use of

Over the last twenty years invasive cardiac electrophysiology has evolved from a research technique performed in a handful of centers to an ubiquitous and indispensible clinical procedure performed in over 500 hospitals in the United States [1]. Although the technique has become more widespread, reimbursement for invasive cardiac electrophysiologic testing procedures has been significantly reduced, which has placed a greater premium on performing an efficient but complete study [2]. The necessary components of a thorough but efficient invasive electrophysiologic study will vary depending on the clinical situation and will be the subject of this review (Table 1).