New Results in Catheter Ablation for Atrial Fibrillation

Pulmonary vein isolation (PVI) is the cornerstone of rhythm-control therapy for atrial fibrillation (AF). A few years ago, contact force-sensing ablation catheters (CFSAC) were introduced. Nowadays the use of CFSAC became a part of the everyday practice. The durability of PVI depends much on the accurate lesion creation. The recently developed techniques (ablation index, CLOSE protocol) may facilitate the procedure in terms of achieving durable PVI which has already been confirmed by randomized trials. In this chapter, we would like to introduce the theoretical background of PVI and compare different techniques (radiofrequency point-by-point, cryoballoon, additional ablation lines for persistent AF) with special highlight on the importance of durable PVI

High-Power, Short-Duration Ablation in the Treatment of Atrial Fibrillation Patients

Catheter ablation is the cornerstone of the rhythm control treatment of atrial fibrillation (AF). During this procedure, creating a contiguous and durable lesion set is essential to achieve good long-term results. Radiofrequency lesions are created in two phases: resistive and conductive heating. The ablation catheters and the generators have undergone impressive technical developments to enable homogenous and good-quality lesion creation. Despite recent years’ achievements, the durable isolation of the pulmonary veins remains a challenge. These days, intensive research aims to evaluate the role of high-power radiofrequency applications in the treatment of patients with cardiac arrhythmias. The use of high-power, short-duration applications might result in a uniform, transmural lesion set. It is associated with shorter procedure time, shorter left atrial, and fluoroscopy time than low-power ablation. This technique was also associated with a better clinical outcome, possibly due to the better durability of lesions. Multiple clinical studies have proven the safety and efficacy of high-power, short-duration PVI

Successful ablation of atrioventricular nodal re-entrant tachycardia in a patient with interruption of inferior vena cava and azygos continuation

Congenital anomalies of the venous system are a challenge for cardiac catheterization and radiofrequency ablation. This article describes ablation of atrioventricular nodal re-entrant tachycardia performed solely through the azygos continuation in a patient with inferior vena cava interruption

Krónikus Lyme-infekcióban észlelt akut atrioventricularis blokk = Acute atrioventricular block in chronic Lyme disease

A Lyme-kór az egyik leggyakoribb antropozoonosis, a Borrelia kórokozója kullancs csípésével kerül az emberi szervezetbe, Magyarországon évente 10000 friss fertőzést okozva. A Lyme-kór tünetei és lefolyása változatosak, késői formában nemritkán carditist okoz. Esetünkben szerológiailag igazolt borreliosis okozott teljes atrioventricularis blokkot fiatal férfinél, aki praesyncope miatt került intézetünkbe. A blokk hátterében, a közeli kullancscsípésre való tekintettel, Lyme-carditist gyanítottunk, antibiotikum adását és monitoros obszervációt kezdtünk. A betegségre jellemző bőrtünetek nem jelentkeztek, a laborvizsgálat kórosat nem igazolt. Elektrofiziológiai vizsgálattal domináló supra-His atrioventricularis blokkot regisztráltunk. Az obszerváció másnapjától a blokk regressziót mutatott, később teljesen megjavult. Szerológiai vizsgálat egy évnél régebbi borreliosist igazolt. Terápiás ajánlás a potenciálisan reverzíbilis Lyme-carditisben egyelőre nincs. Fiataloknál rizikófaktor nélkül jelentkező ingerületvezetési zavar esetén is célszerű Lyme-carditisre gondolni, segítséget a pontos anamnézis felvétele és megfelelő labordiagnosztika jelenthet, amellyel elkerülhető a pacemakerbeültetés. Orv. Hetil., 2010, 39, 1585–1590. | The tick bite transmitted Lyme disease is one of the most common antropozoonosis, about 10 000 new infections are reported in Hungary each year. The progress and clinical presentation can vary, and carditis can occur in later stages. A serologically verified Lyme disease caused third degree atrioventricular block in young male presenting with presyncope. Based on the tick-bites mentioned a few weeks prior to hospital admission, Lyme carditis was considered with the administration of antibiotics and monitor observation. Typical skin lesions were not recognized and laboratory findings showed no pathology. An electrophysiological study recorded a predominant supra-His atrioventricular block. Total regression of conduction could be detected later and the serological tests established an underlying Lyme disease. Currently no definite treatment recommendation is available for the potentially reversible Lyme carditis. The tick bite seemed to be the key on our way to diagnosis; however, serological tests proved the disease to be older than one year. A detailed medical history and serological tests are essential in identifying the cause and pacemaker implantation can be avoided. Orv. Hetil., 2010, 39, 1585–1590