Accelerated idioventricular rhythm during ajmaline test: a case report.

Contains fulltext : 87846.pdf (publisher's version ) (Open Access)We present an unusual transient pro-arrhythmic effect of ajmaline in a patient with resuscitated cardiac arrest and a left ventricular apical aneurysm. We discuss the clinical presentation and the possible physio-pathological explanation for this new pro-arrhythmic effect linked to administration of intravenous ajmaline

Carotid sinus hypersensitivity following radiotherapy delivery in a patient with bilateral glomus jugular tumour

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Ajmaline challenge in young individuals with suspected Brugada syndrome

Item does not contain fulltextBACKGROUND: The clinical characteristics and the results of ajmaline challenge in young individuals with suspected Brugada syndrome (BS) have not been systematically investigated. METHODS: Among a larger series of patients included in the BS database of our Department, 179 patients undergoing ajmaline challenge were included in the study and categorized in two groups according to age: group 1 (/=18 years old). Clinical features and results of the ajmaline challenge of each group were compared. RESULTS: Young individuals were more often asymptomatic compared to adult patients (P = 0.002). They showed a higher number of normal ECGs (P = 0.023), a lower percentage of Brugada type II electrocardiographic pattern compared to the adult population (P = 0.011), and a comparable amount of spontaneous Brugada type III electrocardiographic pattern (P = 0.695). Ajmaline provoked a higher degree of intraventricular conduction delay (P = 0.002) and higher degree of prolongation of the ventricular repolarization phase (P = 0.013) in young individuals but its pro-arrhythmic risk was comparable in the two groups (P = 0.684). Furthermore, inducibility of ventricular arrhythmias in young patients with a positive ajmaline test was comparable to that of the adults with a positive ajmaline test (P = 0.694). CONCLUSIONS: The present study demonstrates the low-risk profile of the ajmaline test in young patients when performed by experienced physicians and nurses in an appropriate environment

Dissociation between Anterograde and Retrograde Conduction during Transvenous Cryoablation of Parahissian Accessory Pathways

Item does not contain fulltextAblation of parahissian accessory pathways (APs) is a challenging procedure because of the high risk to provoke "iatrogenic" atrioventricular (AV) nodal block. The feasibility and safety of cryoablation (CA) have been already demonstrated both in patients with AV nodal reentry tachycardia and in those with anteroseptal APs. However, dissociation between anterograde and retrograde conduction after CA has not yet been described. We report two cases of CA of parahissian AP associated with transient dissociation between anterograde and retrograde conduction. (PACE 2011; 34:e98-e101)

The importance of class-I antiarrhythmic drug test in the evaluation of patients with syncope: unmasking Brugada syndrome

Item does not contain fulltextINTRODUCTION: The Brugada syndrome (BrS) can first present with syncope. Class-I antiarrhythmic drug (AAD) test is used to unmask the diagnostic coved-type ECG pattern in case it is not spontaneously present. The aim of the study was to analyze patients with BrS presenting with syncope as first manifestation and compare patients with syncope and a spontaneous coved-type ECG to patients with syncope in whom a class-I AAD test unmasked the disease. METHODS AND RESULTS: Fifty-eight of 157 probands (36.9%) had syncope as first manifestation of the disease. Twenty-six patients (44.8%, group A) showed a spontaneous coved-type ECG diagnostic for BrS at first presentation. In 32 patients (55.2%, group B) without spontaneous coved-type ECG pattern at first presentation (36% normal ECGs and 19% type-II ECG pattern), a class-I AAD test unmasked the disease. Twenty-one patients of group A and 29 patients of group B underwent implantable cardioverter defibrillator (ICD) implantation. The mean follow up as 9.7 +/- 55.7 month. Four patients in group A (15.4%) and 3 patients (9.3%) in group B had appropriate ICD shock delivery due to ventricular fibrillation or ventricular tachycardia (P = NS). CONCLUSION: One of 3 patients with BrS presents first with syncope. More than one-third of these patients have a normal ECG at investigation for syncope and the correct diagnosis would have been missed without a class-I AAD test. Patients presenting with syncope are at similar risk irrespective of the presence of a spontaneous coved-type ECG.1 maart 201

Anatomical extent of pulmonary vein isolation after cryoballoon ablation for atrial fibrillation: comparison between the 23 and 28 mm balloons

Item does not contain fulltextBACKGROUND: Pulmonary vein isolation seems to occur in the distal part of the ostium leaving the atrium largely unablated when using the 23 mm cryoballoon catheter ablation for atrial fibrillation. We hypothesize that ablating with the larger 28 mm cryoballoon would target a wider portion of the left atrial cavity. AIM: To compare the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing atrial fibrillation ablation with a 23 mm or a 28 mm cryoballoon. METHODS: Eight consecutive patients selected for circumferential pulmonary vein cryoballoon isolation for highly symptomatic paroxysmal atrial fibrillation were randomly assigned to ablation with the 23 or 28 mm balloon. After ablation, electroanatomical mapping was performed to compare the anatomical extent of pulmonary vein isolation between the two balloon dimensions. RESULTS: Extent of pulmonary vein isolation significantly differed when the lesions with either balloon dimensions were compared. Pulmonary vein isolation only occurred in the tubular part of the ostium when performed with the 23 mm balloon. Conversely, the lesion created with the 28 mm balloon included a larger portion of the left atrium. In fact, when using the smaller balloon (23 mm) the mean documented extent of electrical isolation was 20.7 +/- 2.8% of the maps' surface, whereas it was 40.2 +/- 3.9% when performing ablation with the bigger balloon (28 mm). The difference in calculated area of electrical isolation between group A and B was statistically significant (P < 0.05). CONCLUSION: Pulmonary vein isolation occurs significantly more proximally in the atrium when performing atrial fibrillation ablation with a 28 mm cryoballoon when compared with a 23 mm balloon

Ivabradine to treat inappropriate sinus tachycardia after the fast pathway ablation in a patient with severe pectus excavatum.

Item does not contain fulltextWe present the case of a 49-year-old woman with atrioventricular nodal re-entrant tachycardia and a severe pectus excavatum. The patient underwent an electrophysiological study and fast pathway ablation. Fast pathway ablation was not done on purpose but accidentally, likely due to the abnormal position of the heart in the chest cavity in this patient suffering from severe pectus excavatum. Some hours after the ablation, the patient developed inappropriate sinus tachycardia (IST), complaining of dyspnea and fatigue. IST has been described as a complication of fast pathway ablation in 10% of the cases. In our case it was not possible to treat IST with beta-blockers due to an important lowering of the blood pressure. Digitalis, given as second choice, was not successful. Ivabradine-the specific sinus node If current inhibitors-was used to successfully lower the heart rate with immediate relief of symptoms. A 24-hour Holter, 10 days later, showed a complete control of the heart rate without any episode of IST. The patient was completely symptom free and able to undertake her normal daily activities without any discomfort. Our case confirms the potential use of ivabradine for indications other than coronary artery disease.1 maart 201

Cryoballoon ablation for paroxysmal atrial fibrillation in septuagenarians: a prospective study

Aims: To evaluate the effects of pulmonary vein isolation (PVI) in terms of feasibility, safety and success rate on a midterm follow-up period in septuagenarians undergoing ablation with the Arctic Front Cryoballoon for atrial fibrillation (AF). Methods and Results: We prospectively enrolled 21 patients aged 70 years or older (14 male; age 73 \ub1 2.5 years) elected to circumferential PVI with the 28mm cryoballoon for symptomatic drug resistant paroxysmal AF. A total number of 82 pulmonary veins (PV) were evidenced. Successful isolation could be obtained in all 82 (100%) PV ostia at the end of procedure. No major complication occurred during procedure. At a mean follow-up of 11.5 \ub1 4.7 months following ablation, 62% of patients did not present recurrence of atrial arrhythmias. Conclusion: Cryoballoon ablation may be feasible and safe in older patients. Moreover a large proportion of the latter did not present AF recurrence during follow-up

Verification of pulmonary vein isolation during single transseptal cryoballoon ablation: a comparison between the classical circular mapping catheter and the inner lumen mapping catheter

Item does not contain fulltextAIMS: Cryoballoon ablation has proven very effective in achieving pulmonary vein isolation (PVI). The novel Achieve inner lumen mapping catheter designed to be used in conjunction with the cryoballoon, serves as both a guidewire and a mapping catheter. To our knowledge, this is the first study comparing the latter to verification of electrical isolation with the 'traditional' circular mapping catheter. METHODS AND RESULTS: We assigned 40 consecutive patients matched for age and left atrial diameter suffering of paroxysmal atrial fibrillation to cryoballoon PVI using either the circular mapping catheter or the Achieve as a mapping catheter. Duration of procedure as well as fluoroscopy times were significantly lower in the Achieve group than in the circular mapping catheter group (111 +/- 14 min vs. 126 +/- 13 min, P < 0.005 and 22 +/- 5 min vs. 29 +/- 4 min, P < 0.0001, respectively). There were no significant differences between both groups in terms of mean degree of occlusion, mean minimal temperatures, and PVI. Pulmonary vein isolation could be documented by real-time recordings in 55% of veins in the Achieve group with mean time to isolation of 65 +/- 23 s. CONCLUSION: Cryoballoon ablation in conjunction with the novel Achieve is feasible, safe, and affords PVI in nearly all veins in similar proportions to the approach with the traditional guidewire. Furthermore, if compared to the procedure with the circular mapping catheter, cryoballoon ablation with the Achieve is significantly faster and associated to shorter fluoroscopy times