Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination of paroxysmal atrial fibrillation (AF) that occurs during radiofrequency ablation (RFA) of supraventricular tachycardias (SVT). Intravenous Ibutilide may be an alternative option in this setting. Thirty-four out of 386 patients who underwent SVT-RFA presented paroxysmal AF during the procedure and were randomized into receiving ibutilide or DC-ECV. Ibutilide infusion successfully cardioverted 16 out of 17 patients (94%) within 17.37 ± 7.87  min. DC-ECV was successful in all patients (100%) within 17.29 ± 3.04  min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94%) in the ibutilide arm and in all patients (100%) in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA

Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention

Percutaneous Extraction of Transvenous Permanent Pacemaker/Defibrillator Leads

Background. Widespread use of cardiovascular implantable electronic devices has inevitably increased the need for lead revision/replacement. We report our experience in percutaneous extraction of transvenous permanent pacemaker/defibrillator leads. Methods. Thirty-six patients admitted to our centre from September 2005 through October 2012 for percutaneous lead extraction were included. Lead removal was attempted using Spectranetics traction-type system (Spectranetics Corp., Colorado, CO, USA) and VascoExtor countertraction-type system (Vascomed GmbH, Weil am Rhein, Germany). Results. Lead extraction was attempted in 59 leads from 36 patients (27 men), mean ± SD age 61±5 years, with permanent pacemaker (n=25), defibrillator (n=8), or cardiac resynchronisation therapy (n=3) with a mean ± SD implant duration of 50±23 months. The indications for lead removal included pocket infection (n=23), endocarditis (n=2), and ventricular (n=10) and atrial lead dysfunction (n=1). Traction device was used for 33 leads and countertraction device for 26 leads. Mean ± SD fluoroscopy time was 4±2 minutes/lead for leads implanted <48 months (n=38) and 7±3 minutes/lead for leads implanted >48 months (n=21), P=0.03. Complete procedural success rate was 91.7% and clinical procedural success rate was 100%, while lead procedural success rate was 95%. Conclusions. In conclusion, percutaneous extraction of transvenous permanent pacemaker/defibrillator leads using dedicated removal tools is both feasible and safe

Grouped Beating in Eisenmenger: Successful Localization and Ablation of an Accelerated Idioventricular Rhythm from Within the Purkinje System

A 33-year old female with a background of Eisenmenger syndrome secondary to multiple congenital muscular ventricular septal defects (VSD) was admitted with a recent history of frequent intermittent palpitations. It was noted that she had an independent accelerated idioventricular rhythm (AIVR), with rates varying between 85-110 bpm, which exhibited a repetitive grouped beating pattern. Although generally perceived as benign, in this case this rhythm was drug refractory, was associated with significant compromise to cardiac filling and output and progressed to haemodynamically intolerable sustained ventricular tachyarrhythmia. Successful ablation was performed at the inferior aspect of the residual VSD, from within the Purkinje network

Successful Right Ventricular Tachycardia Ablation in a Patient with Left Ventricular Non-compaction Cardiomyopathy

We report a case of a 67-year old male with a recent diagnosis of left ventricular noncompaction (LVNC), initially presenting with symptomatic ventricular ectopy and runs of non-sustained ventricular tachycardia (VT). This ventricular arrhythmia originated in a structurally normal right ventricle (RV) and was successfully localized and ablated with the aid of the three-dimensional mapping and remote magnetic navigation

Atrial Fibrillation Ablation in Congenital Heart Disease: Therapeutic Challenges and Future Perspectives

The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique underlying anatomic and physiological background further adds to the difficulty in eliminating the AF burden in these patients. Herein, we provide an overview of the current knowledge on the pathophysiology and risk factors for AF in adult congenital heart disease, with a special focus on the existing challenges in AF ablation. Emerging imaging modalities and ablation techniques might have a role to play. Evidence regarding the safety and efficacy of AF ablation in adult congenital heart disease is summarized, especially for patients with an atrial septal defect, Ebstein anomaly of the tricuspid valve, tetralogy of Fallot, and Fontan circulation. Finally, any remaining gaps in knowledge and potential areas of future research are highlighted