Long-standing Persistent Atrial Fibrillation Ablation in a Patient With High Risk of Bleeding

A 57 year-old patient with dilated cardiomyopathy, long-standing persistent atrial fibrillation, heart failure and episodes of gastrointestinal bleeding underwent AF ablation with pulmonary vein isolation, homogeneization of septal scar, posterior wall isolation and also left atrial appendage isolation. Additionally, because of the high risk of embolism, underwent left atrial appendage occlusion.

Long-standing Persistent Atrial Fibrillation Ablation in a Patient With High Risk of Bleeding

A 57 year-old patient with dilated cardiomyopathy, long-standing persistent atrial fibrillation, heart failure and episodes of gastrointestinal bleeding underwent AF ablation with pulmonary vein isolation, homogeneization of septal scar, posterior wall isolation and also left atrial appendage isolation. Additionally, because of the high risk of embolism, underwent left atrial appendage occlusion.

Displasia arritmogênica do ventrículo direito: relato de caso e revisao dos critérios diagnósticos e atuais das indicaçoes de cardiodesfibrilador implantável (CDI)

A displasia arritmogênica do ventrículo direito é uma forma de cardiomiopatia geneticamente determinada, que afeta primariamente o ventrículo direito. Caracteriza-se pela substituiçao dos miócitos por tecido fibrogorduroso. É considerada uma doença cardíaca potencialmente letal e tem sido associada a arritmias, insuficiência cardíaca e morte súbita. Relata-se o caso clínico de um paciente jovem, em que a síncope foi a primeira manifestaçao da doença

Successful Improvement of Frequency and Symptoms of Premature Complexes after Oral Magnesium Administration

Background: Premature ventricular and supraventricular complexes (PVC and PsVC) are frequent and often symptomatic. The magnesium (Mg) ion plays a role in the physiology of cell membranes and cardiac rhythm. Objective: We evaluated whether the administration of Mg Pidolate (MgP) in patients with PVC and PsVC is superior to placebo (P) in improving symptoms and arrhythmia frequency. Methods: Randomized double-blind study with 60 consecutive symptomatic patients with more than 240 PVC or PsVC/h on 24-hour Holter monitoring who were selected to receive placebo or MgP. To evaluate symptom improvement, a categorical and a specific questionnaire for symptoms related to PVC and PsVC was made. Improvement in premature complex density (PCD) per hour was considered significant if percentage reduction was >= 70% after treatment. The dose of MgP was 3.0 g/day for 30 days, equivalent to 260mg of Mg element. None of the patients had structural heart disease or renal failure. Results: Of the 60 patients, 33 were female (55%). Ages ranged from 16 to 70 years old. In the MgP group, 76.6% of patients had a PCD reduction >70%, 10% of them >50% and only 13.4% <50%. In the P group, 40% showed slight improvement, <30%, in the premature complexes frequency (p < 0.001). Symptom improvement was achieved in 93.3% of patients in the MgP group, compared with only 16.7% in the P group (p < 0.001). Conclusion: Oral Mg supplementation decreases PCD, resulting in symptom improvement. (Arq Bras Cardiol 2012;98(6):480-487

Cavotricuspid isthmus ablation for the treatment of atrial flutter: prospective randomized study comparing efficacy and safety of cooled-tip versus 8-mm-tip catheters.

O cateter irrigado foi comparado com o de 8 mm para ablação com radiofrequência do istmo cavo-tricuspídeo(Ist-CT). Foram randomizados 52 pacientes portadores de flutter atrial típico para ablação com cateter irrigado(grupoI) ou com cateter de 8 mm(grupo II). O bloqueio do Ist-CT foi obtido em 51 pacientes. Não houve diferença estatística em relação aos parâmetros de aplicação de RF entre os dois grupos. A ablação do Ist-CT com cateter irrigado versus cateter de 8mm foi igualmente eficaz e segura no controle do flutter atrial típico.A 4-mm cooled tip catheter was compared to an 8-mm tip catheter to cavotricuspid isthmus(CTI) ablation. This prospective study enrolled 52 patients with typical atrial flutter to ablation with a closed cooled-tip catheter(group1) or an 8-mm tip catheter. Radiofrequency(RF) applications were performed to achieve complete CTI block wich was achieved in 51 patients. No significant differences were found in the procedure parameters. CTI ablation with an irrigated tip catheter versus an 8-mm tip catheter was equally effective and satisfactorily safe for ablation of typical atrial flutter

Factores predictores de fibrilación atrial tras ablación del flutter atrial típico

FUNDAMENTO: A ocorrência de fibrilação atrial (FA) após a ablação com sucesso do flutter atrial istmo cavo-tricuspídeo (FLA-ICT) dependente consiste em um evento de importância clínica. Os fatores preditores dessa ocorrência ainda são controversos. OBJETIVO: Determinar a incidência de FA e os fatores preditores para a sua ocorrência nos pacientes submetidos a ablação do flutter atrial istmo cavo-tricuspídeo (FLA-ICT) dependente. MÉTODOS: Cinquenta e dois pacientes portadores de FLA-ICT foram submetidos à ablação no período de janeiro de 2003 a março de 2004, no InCor do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTADOS: Durante o seguimento médio de 26,2 (± 9,2) meses, 16 (30,8%) pacientes apresentaram FA. A análise univariada revelou duas variáveis clínicas como preditoras de ocorrência de FA após a ablação do FLA-ICT maior ou igual a três anos (RR: 3,00; P = 0,020). Na análise multivariada, esses fatores foram variáveis independentes associadas à ocorrência de FA após ablação do FLA-ICT. CONCLUSÃO: A FA é frequentemente observada durante o seguimento dos pacientes após ablação de FLA-ICT dependente. O FLA-ICT persistente e a história de arritmia maior que três anos são fatores preditores para a ocorrência de FA durante o seguimento clínico.BACKGROUND: The occurrence of atrial fibrillation (AF) after successful ablation of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) is an important medical event, but predictors of this event are still controversial. OBJECTIVE: To determine the incidence of AF and its predictors in patients undergoing ablation of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL). METHODS: Fifty two patients with CTI-AFL underwent ablation from January 2003 to March 2004, in Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTS: During the mean follow-up period of 26.2 ± 9.2 months, 16 (30.8%) patients presented AF. The univariate analysis revealed two clinical variables as predictive of the occurrence of AF after ablation of CTI-AFL for three years or longer (RR: 3.00; p = 0.020). In the multivariate analysis, these factors were independent variables associated with the occurrence of AF after ablation of CTI-AFL. CONCLUSION: AF is frequently observed during the follow-up of patients undergoing ablation of CTI-AFL. Persistent CTI-AFL and history of arrhythmia for more than three years are predictors of the occurrence of AF during the clinical follow-up.FUNDAMENTO: La ocurrencia de fibrilación atrial (FA) tras la ablación con éxito del flutter atrial istmo cavotricuspídeo (FLA-ICT) dependiente consiste en un evento de importancia clínica. Los factores predictores de esta ocurrencia todavía son controvertidos. OBJETIVO: Determinar la incidencia de FA y los factores predictores para su ocurrencia en los pacientes sometidos a la ablación del flutter atrial istmo cavotricuspídeo (FLA-ICT) dependiente. MÉTODOS: Cincuenta y dos pacientes portadores de FLA-ICT se sometieron a la ablación en el período de enero de 2003 a marzo de 2004, en el InCor del Hospital de Clínicas de la Facultad de Medicina de la Universidad de São Paulo. RESULTADOS: Durante el seguimiento promedio de 26,2 (± 9,2) meses, 16 (30,8%) pacientes presentaron FA. El análisis univariado reveló dos variables clínicos como predictoras de ocurrencia de FA después de la ablación del FLA-ICT mayor o igual a tres años (RR: 3,00; P = 0,020). En el análisis multivariado, estos factores fueron variables independientes asociadas a la ocurrencia de FA tras ablación del FLA-ICT. CONCLUSIÓN: La FA se observa frecuentemente durante el seguimiento de los pacientes tras la ablación de FLA-ICT dependiente. El FLA-ICT persistente y la historia de arritmia mayor que tres años son factores predictores para la ocurrencia de FA durante el seguimiento clínico.CAP