Background-Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation. Methods and Results-Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation Ͼ2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5Ϯ1.5°C. No patients had esophageal thermal injury on follow-up endoscopy. Conclusions-A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures. (Circ Arrhythm Electrophysiol. 2011;4:149-156.)
Catecholaminergic polymorphic ventricular tachycardia occurs in healthy children and young adults causing syncope and sudden cardiac death. This is a familial disease, which affect de novo mutation in 50% of the cases. At least two causative genes have been described to be localized in the chromosome 1; mutation of the ryanodine receptor gene and calsequestrin gene. The classical clinical presentation is syncope triggered by exercise and emotion in children and adolescents with no structural heart disease. Polymorphic ventricular tachycardia during treadmill testing, or after isoproterenol infusion, is the most common feature. Therapeutic options include, beta-blockers, calcium-channel blockers and, an implantable cardioverter defibrillator is indicated in high-risk patients. Risk stratification of this disease is very challenging, since some risk factors proved to be useful in some series but not in others. However, family history of sudden cardiac death and symptoms initiated in very young children are important predictors.
Our report is illustrative as it emphasizes that a thorough diagnostic investigation should be done in cases of sudden cardiac arrest during the perioperative period, even in patients that appear to be healthy.
Objective. Although oral anticoagulation (OAC) has proved beneficial for patients with atrial fibrillation (AF) and embolic risk factors, it is still underused. The objective of this study was to evaluate the adequacy of anticoagulation therapy in patients with AF followed up in a private clinic specialized in cardiology, in accordance with the American and European societies of cardiology guidelines/2006 and with the Sociedade Brasileira de Cardiologia (Brazilian Society of Cardiology -SBC) guidelines/2003. MethOds. Between November 2005 and August 2006, 7,486 electrocardiograms were evaluated and 53 patients with AF diagnosis and complete detailed information in medical records on embolic risk factors and oral anticoagulation treatment were selected. Results. Among the 53 patients included (68±16 years; 29 men -55%), 25 (48%) had hypertension, 20 (38%) heart failure and 3 (6%) diabetes mellitus. Among the 15 patients with high embolic risk, 13 (86%) were using OAC. In accordance with the American and European guidelines: 32 (60%) patients were Class I, 17 (32%) Class IIa, 1 (2%) Class IIb and 3 (6%) Class III. Treatment was adequate in 21 (66%) Class I patients and 13 (76%) Class IIa. In this subgroup, anticoagulation therapy was being used in 7/19 (37%) patients ≥ 75 years compared to 22/30 (73%) younger (p=0.016). Among the 3 patients within Class III, 1 was incorrectly on OAC. According to Brazilian guidelines, 33 (62%) were on correctly indicated antithrombotic therapy. There was no difference in the appropriate prescription of oral anticoagulants, comparing Brazilian and American/European guidelines (55% vs. 55%). cOnclusiOn. Anticoagulant therapy is being adequately prescribed for the majority of AF patients, although this index is still far from ideal, especially in a cardiology clinic. This is even more critical in the group of elder patients.
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