Sukriye Ebru Golcuk

Gastroparesis as a Complication of Atrial Fibrillation Ablation

Percutaneous catheter ablation is a safe and effective treatment for symptomatic drug-resistant atrial fibrillation (AF). Gastroparesis is a little known complication of AF ablation. We aimed to evaluate the frequency of gastroparesis in the patients who underwent catheter ablation for AF by cryoballoon (CB) or radiofrequency (RF) and to define risk factors for gastroparesis. In all, 104 patients were treated with pulmonary vein (PV) isolation with 2 different technologies: CB in 58 patients (group 1) and open-irrigated tip RF catheter in 46 patients (group 2). Gastroparesis was seen in 7 cases (6 cases in group 1 and 1 case in group 2, respectively). The complaints related with gastroparesis began during the procedure in 4 of 6 patients of group 1. The other 3 patients admitted to our outpatient clinic with similar complaints within 72 to 96 hours after the procedure. For gastroparesis cases of group 1, mean minimal CB temperature on inferior PVs was lower and left atrium diameter was smaller. Management was conservative, and the patients have no residual symptoms at 6-month follow-up. The only patient still demonstrating residual symptoms during follow-up was in group 2. Although, clinically manifest gastroparesis is quite common with CB ablation, the process is generally reversible. However, damage may not be as reversible with RF ablation. In conclusion, during cryoablation, lower temperatures on inferior PVs and small left atrium size may be associated with increased risk of gastroparesis, and fluoroscopic guidance may be useful to avoid this complication.

Predictors of atrial fibrillation recurrence after cryoballoon ablation.

Objective Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein isolation in the treatment of paroxysmal atrial fibrillation (AF). There are conflicting results about the predictors of AF recurrence. The aim of this study is to evaluate the role of hematological indices to predict AF recurrence after CA. Methods A total of 49 patients (mean age 58.3±12.2 years, 51.02% female) with symptomatic paroxysmal AF underwent CA procedure. One hundred and sixty-eight pulmonary veins were used for pulmonary vein isolation with the second-generation cryoballoon. The hematological samples were obtained before and 24 hours after ablation. Results At a mean follow-up of 10.2±2.4 months, the probability of being arrhythmia-free after a single procedure was 86%. Patients with AF recurrence had higher red cell distribution width levels (16.10%±1.44% vs 14.87%±0.48%, P=0.035). The neutrophil/lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein levels were detected in the patients with or without recurrence. Left atrial diameter (46.28±4.30 mm vs 41.02±4.10 mm, P=0.002), duration of AF (6.71±4.57 years vs 3.59±1.72 years, P=0.003), and age (65.01±15.39 years vs 54.29±11.32 years, P=0.033) were the other independent predictors of clinical recurrence after CA. Multiple regression analysis revealed that left atrial diameter was the only independent predictor for AF recurrence (P=0.012). Conclusion In this study of patients with paroxysmal AF undergoing cryoablation, increased preablation red cell distribution width levels, and not C-reactive protein or erythrocyte sedimentation rate, was associated with a higher rate of AF recurrence. Our results support the role of a preablation, proinflammatory, and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important.

Functional permanent 2:1 atrioventricular block treated with cardioneuroablation: Case report

A 54-year-old woman had undergone slow pathway ablation for AV nodal reentrant tachycardia 3 years ago. Before admission she had started to present with recurrent dizziness and syncope due to 2:1 AV block and was referred for pacemaker implantation. She was asymptomatic and had no signs of AV conduction abnormalities until 2 weeks ago. AV conduction abnormality resolved with atropine infusion until stage 2 of a treadmill exercise test. Electrophysiologic study showed suprahisian 2:1 AV block. After cardioneuroablation, the parameters of AV conduction normalized. Holter recordings were normal, and the patient was asymptomatic at the end of 12-month follow-up. Several clinical conditions comprise autonomic dysfunction by enhanced parasympathetic tone together with decreased sympathetic tone. Enhanced parasympathetic tone may cause sinus bradycardia or pauses, transient or permanent atrioventricular (AV) block, carotid sinus syndrome, or neurally mediated reflex syncope. Although the conduction system is not involved in these patients, they may present with serious symptoms. The parasympathetic postganglionic neuron body cell is located at the cardiac wall in the paracardiac ganglia. Cardioneuroablation is a little known technique for management of patients with excessive vagal activation. The technique is based on radiofrequency (RF) catheter ablation of autonomic connections in the 3 main ganglia around the heart.

Haemoptysis and pulmonary haemorrhage associated with cryoballoon ablation

A 55-year-old male patient was referred to our hospital for pulmonary vein isolation (PVI) by cryoballoon of drug-resistant paroxysmal atrial fibrillation. Pulmonary vein isolation was performed with a 28 mm cryoballoon. The patient was anti-coagulated with iv heparin and the activated clotting time was …

Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: Transcoronary and Endocardial Approach

ABSTRACT Septal reduction therapy is the gold standard treatment method for symptomatic, hypertrophic obstructive cardiomyopathy. Although surgical myectomy is a well‐established and effective technique with decades of experience in its application, use of transcoronary alcohol septal ablation has increased precipitously owing to the less‐invasive nature of the procedure. Moreover, endocardial septal ablation therapy is a relatively newly defined modality, and outcomes of the procedure are not clearly elucidated yet. In this review, we aimed to present nonsurgical septal reduction approaches in patients with hypertrophic obstructive cardiomyopathy.

Radiofrequency Ablation of Typical Atrial Flutter via Right Jugular Vein due to Bilateral Obstructed Iliac Veins in a Patient with Dilated Cardiomyopathy.

Ablation of cavotricuspid isthmus (CTI) is the gold standard method in the treatment of isthmus dependent atrial flutter (AFl). Venous access was obtained usually via right or left femoral veins. In rare cases of obstruction of iliofemoral veins, ablation of CTI can be performed only through the superior approach. We present a 74-year-old woman of typical AFl and dilated cardiomyopathy that was ablated through the right jugular vein because of obstruction of the left and the right iliac veins. This is the first report of successful ablation of CTI in a patient with dilated cardiomyopathy via superior approach.