Different faces of Brugada syndrome

Zaprezentowano przypadek kliniczny 57-letniego pacjenta z zespołem Brugadów (BS), u którego elektrokardiograficzne cechy BS typu 2 ujawniły się pod wpływem gorączki w przebiegu infekcji dróg oddechowych. Pod wpływem flekainidu indukowano charakterystyczne dla BS zmiany odcinka ST typu 1. Ze względu na brak objawów klinicznych i brak spontanicznych zmian odcinka ST typu 1 pacjentowi nie implantowano kardiowertera-defibrylatora.We present a clinical case of a 57-year-old patient with Brugada syndrome (BS), who presented with electrocardiographical features of BS type 2 in course of fever due to respiratory tract infection. Upon administration of flecainide ST segment elevation of type 1 was induced. As the patient had no clinical symptoms and no spontaneous abnormalities of ST segment, he did not receive an implantable cardioverter-defibrillator

Safety and efficacy of cryoablation without the use of fluoroscopy

Background: Development of electroanatomical systems make it possible to perform ablations without the use of fluoroscopy. The aim of this study was to evaluate the efficacy and safety of cryoablation pro­cedures without the use of fluoroscopy. Methods: The study group consisted of 45 patients (14 female; age 36 ± 15 years) treated with cry­oablation using the EnSite electroanatomical system: 10 with ventricular extrasystoly from the right ventricle, 6 with the arrhythmogenic site near the left coronary artery, 17 patients with Wolff-Parkinson- -White syndrome (WPW), 2 patients with atrioventricular nodal reentrant tachycardia (AVNRT) type 2, 7 patients with AVNRT type 1, 3 patients with atrial tachycardia. Results: In 38 of the 45 patients (84%) cryoablation procedure was performed without the use of fluoroscopy. Cryoablation efficacy was 78.9%. In 5 patients unsuccessful cryoablation was fallowed by radiofrequency applications. Finally, efficacy reached 92.1%. There were no deaths. In 1 patient a small adverse event — right bundle branch block was observed after ablation of para-Hisian accessory path­way. No other adverse events were observed. In the long term follow-up efficacy was 89.5%. Conclusions: Cryoablation using electroanatomical system without the use of fluoroscopy is a safe and efficient procedure and it is a possible alternative in most patients qualified for cryoablation

Kardioneuroablacja w omdleniach odruchowych — nowa nadzieja dla trudnych pacjentów

We are presenting a new method of treatment of vasovagal syncope, which is the ablation of parasympathetic ganglia in the atria. This method, shifting the balance of the autonomic nervous system in the sympathetic direction, is directed to the immediate cause of syncope which is excessive activation of the vagus nerve. Its effectiveness in the annual observation is within 80-100%. This method offers a great chance to improve the quality of life in patients with reflex syncope what have not been prevented by conventional treatment.Autorzy niniejszej pracy przybliżają nową metodę leczenia omdleń wazowagalnych, jakąjest ablacja zwojów przywspółczulnych w przedsionkach. Metoda ta, przesuwając równowagęautonomicznego układu nerwowego w kierunku współczulnym, jest ukierunkowanana bezpośrednią pr zyczynę omdlenia, czyli nadmierne pobudzenie ner wu błędnego. Jejskuteczność w obserwacji rocznej mieści się w granicach 80–100%. Metoda ta daje dużeszanse poprawy jakości życia u pacjentów z omdleniami odruchowy mi, które nie uległywyciszeniu pod wpływem typowego leczenia

Periprocedural decrease in tumor necrosis factor alpha is a risk factor for atrial fibrillation recurrence after ablation

Background: Concentration of tumor necrosis factor alpha (TNF-alpha) might be useful in selecting patients with paroxysmal atrial fibrillation (PAF) who will benefit the most from pulmonary vein isolation. Material and methods: This is a prospective cohort study among patients with PAF who had sinus rhythm prior to undergoing either radiofrequency ablation or cryoablation procedure. Blood samples were collected at the start of the procedure and 16-24 h after. TNF-alpha concentrations were measured. Follow-up data was obtained during a structured telephone interview and 24-hour ECG Holter monitoring 12 months after the ablation procedure. Results: Thirty seven patients were enrolled. After 12-month follow-up 27 patients maintained sinus rhythm, 8 had recurrence of AF and 2 were lost to follow-up. There was no significant correlation between TNF-alpha concentrations in any of the samples and the recurrence of arrhythmia (for pre-procedural samples: 1.75 pg/ ml vs. 1.74 pg/ml; p = 0.72; for post-procedural samples: 1.49 pg/ml vs. 1.79 pg/ml; p = 0.16). In patients who had a recurrence of AF, we observed a decrease in the periprocedural TNF-alpha concentration (-0.12 pg/ml vs 0.05 pg/ml; p = 0.05). Conclusions: Neither pre- nor post-procedural TNF-alpha concentrations are predictive of ablation outcome in patients with PAF. We observed a decrease in the periprocedural TNF-alpha concentration in patients who had AF recurrence

Efficacy of multi-electrode duty-cycled radiofrequency ablation in patients with paroxysmal and persistent atrial fibrillation

Background: Radiofrequency (RF) catheter ablation is a first-line therapy for patients with drug-refractory atrial fibrillation (AF). Complete isolation of electrical potentials at the ostium of pulmonary vein (PV) is a challenging procedure. There are different techniques and devicesused for PV isolation (PVI). The objective of this study was to evaluate the efficacy and safety of PV ablation catheter (PVAC).Methods: A total of 67 consecutive patients with paroxysmal and persistent AF were treated with the PVAC. The patients’ information were obtained from clinical charts. Follow-up was obtained by one day Holter monitoring at 2, 4, 6, 8, 10 and 12 months after ablation and ECG registration if any symptoms or arrhythmia occurred.Results: The median follow-up duration was 16 months (IQR: 12–20 months). In the population which was available at follow-up (n = 60), 22 (36.7%) patients were in sustained sinus rhythm (SR) without anti-arrhythmic drugs (AAD). Overall 26 (43.3%) patients were in sustained SR with and without AAD. In the paroxysmal AF group, after a single PVAC ablation procedure (n = 39), 19 (48.7%) patients had sustained SR without AAD. In the persistent AF group (n = 15), after the single PVAC ablation, 2 (13.3%) patients had sustained SR without AAD.Conclusions: PVI with PVAC is a safe procedure with 48.7% efficacy in patients with paroxysmal AF. The efficacy of PVAC in patients with persistent or long-standing persistent AF is not acceptable

High-power and short-duration ablation with the Qdot+ algorithm for pulmonary vein isolation and the right superior ganglion plexus ablation without fluoroscopy

In this report we present pulmonary vein and posterior box isolation together with the right superior ganglion plexus ablation using the Qdot Micro catheter without fluoroscopy. We describe different possibilities of this new technology for catheter ablation. The main advantages of this catheter to potentially increase ablation safety and effectiveness are discussed. Specifically, the possibility to perform high-density mapping with the lowest available distance between points. Furthermore, the possibility to decrease the risk of collateral tissue damage and to improve atrial linear lesions contiguity, transmurality and durability due to the dominance of resistive heating supported by the feedback temperature control. Finally, the possibility to shorten the procedure and fluoroscopy duration due to the high shortening of application duration to 4 seconds only

Trzepotanie przedsionków — ewolucja choroby jako efekt proarytmii leczenia kardiologicznego

Autorzy niniejszej pracy przedstawiają zagadnienie kolejnej niejednorodnej grupy arytmii, która kryje się pod nazwą: trzepotanie przedsionków. Wymieniają metody różnicowania trzepotania przedsionków od ich migotania i częstoskurczu przedsionkowego, zwracając uwagę na częste współwystępowanie tych arytmii, co legło u podstaw zmiany klasyfikacji miarowych arytmii przedsionkowych. Wobec rosnącej liczby pacjentów po operacjach serca, rozległych ablacjach w przedsionkach (głównie w leczeniu migotania przedsionków), po leczeniu zawału serca i z niewydolnością serca zmienia się proporcja pacjentów z trzepotaniem przedsionków zależnym od cieśni trójdzielno-żylnej i częstoskurczów przedsionkowych o typie makroreentry niezależnych od tej cieśni (rosnący odsetek tych drugich). W ujęciu historycznym zaprezentowano drogę zrozumienia mechanizmów tych arytmii i wynikających z nich metod leczenia (przerywania i profilaktyki nawrotów). Wobec niskiej skuteczności farmakoterapii (w warunkach polskich w zasadzie ma ona zastosowanie do zwalniania rytmu komór i poprawy tolerancji arytmii) autorzy opierają się one głównie na elektroterapii. Do przerywania służy albo kardiowersja elektryczna o niskiej energii (≤ 100 J) lub różne techniki stymulacji (z elektrody przedsionkowej urządzenia wszczepionego — stymulator/defibrylator, stymulacja przezprzełykowa, stymulacja endokawitarna). W profilaktyce nawrotów najlepiej sprawdza się przeznaczyniowa ablacja (w przypadku trzepotanie przedsionków i częstoskurczu przedsionkowego o typie makroreentry niezależnych od cieśni trójdzielno-żylnej powinna być wykonywana w doświadczonym ośrodku). Zagadnienie zilustrowano opisem przypadku pacjentki poddanej ablacji lewoprzedsionkowego częstoskurczu przedsionkowego o typie makroreentry będącego konsekwencją wcześniejszych zabiegów ablacji triggera i substratu migotania przedsionków. W podsumowaniu zaprezentowano schemat postępowania u pacjenta z napadem trzepotania przedsionków zmodyfikowany do warunków polskich.

Ablacja w leczeniu migotania przedsionków. Jak prowadzić pacjenta w praktyce lekarza rodzinnego ręka w rękę z elektrofizjologiem?

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Irrigated DiamondTemp catheter and return to ablation under temperature control. First Polish experience with DiamondTemp catheter in pulmonary vein isolation

We present the first Polish experience with ablation performed using DiamondTemp catheter. The study was conducted with 3 male patients diagnosed with atrial fibrillation (AF). In the first 2 patients typical transseptal punctures were performed, followed by mapping with the Advisor catheter and EnSite-Precision system. One patient had a residual atrial septal leak, therefore ablation without fluoroscopy was attempted. High-power, short-duration ablation under temperature control was performed around pulmonary vein (PV) ostia. The power was 49-53 W, the temperature was 45-48 ͦC. Duration of procedures/fluoroscopy were: 146/8.9, 177/5.9, 132/0.0 min. In the reference group, 10 recent AF identical ablation procedures performed with traditional equipment resulted in 143.0±27.0/6.0±4.4 min. Duration of DiamondTemp applications were 14.7, 32.7, 30.8 min (reference group 37.3 ± 11.4 min). Procedural endpoints were achieved in all but one patient with incomplete isolation of the low segment of the right inferior PV. There were no procedural complications noted. In conclusion, the DiamondTemp saline-irrigated catheter is safe and effective for high-power short-duration ablation in patients with AF. Furthermore, this technology makes it possible to complete the procedure without fluoroscopy. However these findings must be confirmed in larger group of patients