Implementation of a strict "No-X-Ray, simplified 2-catheter" CA approach is safe and effective in majority of the patients with SVT. This modified approach for SVTs should be prospectively validated in a multicenter study.
Current recommendations avoid the use of antiarrhythmic drugs in pregnancy and support catheter ablation (CA) due to symptomatic arrhythmias prior to pregnancy. Zero-fluoroscopy (ZF) mapping and navigation with three-dimensional electroanatomical mapping systems (3D-EAMS) allowed routine and safe non-fluoroscopic guidance of the procedure without X-ray exposure. We present the first case of a pregnant patient who underwent successful ZF CA of symptomatic pre-excitation from non-coronary cusp (NCC). A 24-year-old Caucasian pregnant without structural heart disease at the 24 th week of pregnancy was referred for CA due to three recurrences of syncope and drug-refractory palpitations associated with Wolf-Parkinson-White (WPW) syndrome. Twelve months prior to pregnancy the woman had failed radiofrequency (RF) ablation procedure in another centre for para-Hisian right-sided pathway. A 12-lead electrocardiogram (ECG) showed pre-excitation with a positive delta wave in leads I, II, aVF, V4, and V5 and a negative delta wave in lead V1, suggesting a para-Hisian accessory pathway ( Fig. 1). She was referred to our hospital for rescue CA with ZF. Our centre had at least five years of experience with the minimally invasive non-fluoroscopic imaging and navigation approach using the Ensite NavX system (St. Jude Medical, St. Paul, MN) for CA of regular supraventricular arrhythmias and idiopathic ventricular arrhythmias. A multidisciplinary consultation reached the consensus that only pre-excitation is a substrate for syncope recurrences and poses a potential risk to the foetus and mother. The right femoral vein was cannulated with a 7 F or 8 F sheath and one ablation 4 mm Gold tip catheter and one diagnostic decapolar catheter (Biotronik, Berlin, Germany) were introduced. Atrial pacing protocols demonstrated a septal accessory pathway, but no isoproterenol was given to induce tachycardia. The refractory period of the accessory pathway was 300 ms. After six failed right-sided applications right sided mapping was stopped due to frequent junctional beats and proximity of His potential recordings. Then, the right femoral artery was cannulated with an 8 F introducer, and the ablation catheter was removed using a right to left retrograde approach (Fig. 2). Finally, six RF applications (240 s) were delivered approximately in the NCC and the accessory pathway was successfully ablated (Fig. 1). The procedure time was 71 min and no fluoroscopy was used. Several ECGs and Holter monitoring confirmed no pre-excitation and arrhythmias within 14 months. The patient delivered a healthy male child at 35 weeks of gestation by Caesarean section. Both mother and child had an uneventful postoperative course. The case documents that routinely using ZF for CA may support this approach even for unfavourable locations (e.g. NCC) and not only as the last resort for several arrhythmias including WPW-syndrome in pregnant patients.
INTRODUCTION Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long-term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported. OBJECTIVES This aim of the study was to determine the short-and long-term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening. PATIENTS AND METHODS This was a prospective multicenter registry (AVATAR, Aortic Cusp Ventricular Arrhythmias: Long Term Safety and Outcome from a Multicenter Prospective Ablation Registry) study. A total of 103 patients at a mean age of 56 years (34-64) from the "Electra" Registry (2005-2017) undergoing RFA of aortic cusps VA were enrolled. The following 3 ablation techniques were used: zero-fluoroscopy (ZF; electroanatomical mapping [EAM] without fluoroscopy), EAM with fluoroscopy, and conventional fluoroscopy-based RFA. Data on clinical history, complications after RFA, echocardiography, and 24-hour Holter monitoring were collected. The follow-up was 12 months or longer. RESULTS There were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median (interquartile range [IQR]) procedure time was 75 minutes (IQR, 58-95), median follow-up, 32 months (IQR, 12-70). Acute and long-term procedural success rates were 93% and 86%, respectively. The long-term RFA outcomes were observed in ZF technique (88%), EAM with fluoroscopy (86%), and conventional RFA (82%), without differences. During long-term follow-up, no abnormalities were found within the aortic root. CONCLUSIONS Ablation of VA within the aortic cusps is safe and effective in long-term follow-up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities.
Typical atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common forms of paroxysmal supraventricular tachycardia (SVT) referred for radiofrequency catheter ablation (RFCA). Dual atrioventricular nodal pathways, which are the substrate for AVNRT, are rarely occurring congenital abnormalities. We report a three-generation family from the southeastern region of Poland (Podkarpackie voivodship) with 6 women having normal hearts and presenting with a history of paroxysmal tachycardia with onset of symptoms in adulthood (Fig. 1). Recordings of clinical SVT, dual AVN electrophysiology, induction of typical AVNRT (Fig. 2), and results of RFCA are available for 5 of the affected women: the proband (57 years old), her 2 sisters (aged 51 and 47 years), proband's daughter (21 years old) and her cousin (26 years old). They underwent RFCA with modification of a slow pathway. The proband's mother (aged 80 years) reported a 30-year history of paroxysmal, regular, and rapid palpitations, usually lasting for several minutes and terminated by vagal manoeuvres. At the time of the evaluation she suffered from advanced lung cancer, and refused regular check-ups and electrophysiological study, so an electrocardiography with documented paroxysmal tachyarrhythmia was not available. Two asymptomatic young women from this family (the second proband's daughter (30 years old) and niece (26 years old) refused an evaluation of dual AVN electrophysiology and inducibility of AVNRT. Interestingly, having never been trained by the doctor, the proband's mother herself found a way to terminate the palpitations and explained to all of her daughters how to perform the Valsalva manoeuvre, so the youngest women in this family were taught by their mothers how to do it, long before the first episode of palpitations occurred. Of note, the symptoms of paroxysmal arrhythmia were not present in males. During 8-year follow-up a second RFCA procedure was required in the proband. The other members of this family have not reported palpitations or arrhythmias requiring invasive evaluation and treatment. There are only limited reports on the familial form of AVNRT (FAVNRT) with up to 4 first-degree relatives within two generations, with no genetic substrate identified so far. To our knowledge, this is the largest family with FAVNRT reported until now, and the first in which inheritance through the maternal line is reported, due to probable autosomal dominant, X-linked dominant, or mitochondrial mode of transmission. Up to now we have observed more than 20 new families with FAVNRT, and further studies are planned to confirm the presumed higher incidence of familial AVNRT in Podkarpackie voivodeship and to evaluate its genetic background. Finally, the history of this family shows the significance of a careful and detailed collection of medical history, and points towards the importance of family screening in AVNRT patients.
The PR/RR ratio is a simple tool for slow pathway substrate and AVNRT evaluation. Eliminating PR/RR ratios ≥1 may serve as a surrogate endpoint for slow pathway ablation in children and adults with AVNRT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.