Background Many studies have reported the predictors of atrial fibrillation (AF) recurrence after persistent AF (peAF) ablation. However, the correlation between the atrial defibrillation threshold (DFT) for internal cardioversion (IC) and AF recurrence rate is unknown. Here we investigated the relationship between the DFT prior to catheter ablation for peAF and AF recurrence. Hypothesis DFT prior to ablation was the predictive factor for AF recurrence after peAF ablation. Methods From June 2016 to May 2019, we enrolled 82 consecutive patients (mean age, 65.0 ± 12.4 years), including 45 with peAF and 37 with long‐standing peAF, at Hamamatsu Medical Center. To assess the DFT, we performed IC with gradually increasing energy prior to radiofrequency application. Results Forty‐nine and 33 patients showed DFT values less than or equal to 10 J (group A) and greater than 10 J or unsuccessful defibrillation (group B). During the mean follow‐up duration of 20.5 ± 13.1 months, patients in group B showed significantly higher AF recurrence rates than those in group A after the ablation procedure (p = .017). Multivariate analysis revealed that DFT was the only predictive factor for AF recurrence (odds ratio, 1.07; 95% CI, 1.00–1.13, p = .047). Conclusions The DFT for IC was among the strongest prognostic factors in the peAF ablation procedure.
Case series Patients: Male, 15-year-old • Female, 19-year-old Final Diagnosis: Wolff-Parkinson-White (WPW) syndrome Symptoms: Palpitation Medication: — Clinical Procedure: — Specialty: Anatomy • Cardiology Objective: Unknown etiology Background: Radiofrequency ablation in cases of Wolff-Parkinson-White (WPW) syndrome is a relatively safe procedure that yields good results. However, the electrical characteristics of WPW syndrome have not yet been fully elucidated. Herein, we report 2 cases of WPW syndrome, wherein antegrade conduction was abolished first, followed by retrograde conduction. Case Reports: Case 1: A 15-year-old boy who recently reported experiencing frequent palpitations was diagnosed with type A WPW syndrome by electrocardiography (ECG). Radiofrequency energy was delivered to the earliest activation site using an ablation catheter. This procedure abolished antegrade accessory pathway conduction in 6 seconds, and then the ablation was continued for 60 seconds; however, retrograde accessory pathway conduction remained intact. Hence, radiofrequency ablation was performed to further deliver radiofrequency energy to abolish the retrograde accessory pathway conduction. Case 2: A 19-year-old woman with palpitations since elementary school was diagnosed with type A WPW syndrome by ECG. Radiofrequency energy was delivered to the earliest activation site through an ablation catheter to abolish antegrade accessory pathway conduction in approximately 1 second, and then the ablation was continued for 60 seconds. Retrograde accessory pathway conduction was preserved, and further radiofrequency ablation performed multiple times in the same vicinity abolished retrograde accessory pathway conduction. Conclusions: We managed 2 cases of WPW syndrome wherein antegrade and retrograde accessory pathway conduction were individually abolished. This phenomenon may have been caused by an incomplete lesion that resulted in a functional block.
IntroductionSurgical procedures for pacemaker implantation vary among facilities. The extrathoracic venous puncture method has been utilized for lead insertion, although patients' body movements can displace the targeted vein from the area into which a contrast agent has been injected for imaging. Failed punctures cause edema around the puncture site, spasm, or venous collapse due to bleeding, which may render another puncture impractical. To overcome these problems, we report a new technique for the extrathoracic puncture method.Methods and resultsFrom April 2007 through March 2011, we performed 35 new dual chamber pacemaker implantation procedures. This study compared a conventional puncture group (from April 2007 through March 2009; Group A) with a catheter‐guided puncture group (from April 2009 through March 2011; Group B). We analyzed procedure time and procedure‐related complications in each group. The procedure time was 138.6±41.8 min in the conventional puncture group (Group A) and 109.8±23.2 in the catheter‐guided puncture group (Group B). There was a significant reduction in the procedure time in the catheter‐guided puncture group (Group B) compared with the conventional puncture group (Group A; p=0.016). No patients in either group had pneumothorax, hematoma, or any other complications.ConclusionOur puncture method involving catheter insertion appears to be safe and effective.
A 43-year-old woman was found to have premature ventricular contractions (PVCs) during a health check conducted 6 months ago. She was admitted to our hospital 1 month ago because of heart failure. Frequent PVCs occurring in a bigeminal or trigeminal rhythm originated from the right ventricular outflow tract (RVOT), and the total heart rate was 62,830 pulses (48%). The patient was diagnosed with heart failure caused by frequent PVCs. We performed a catheter ablation under the guidance of an electroanatomic mapping system. PVCs of 2 types were detected, and PVC1 with a notch in the inferior axis was frequently observed. Activation mapping revealed that the free wall of the RVOT was the site of earliest activation. After ablation, PVC1 and PVC2 disappeared but PVC3 and later PVC4 appeared. The notch shape of the PVCs changed. Repeat activation mapping of PVC4 showed that the earliest excited site was now the posterior wall of the right ventricle (the initial deflection preceded the QRS complex during the PVCs by 40 ms). Ablation of the posterior wall completely inhibited the PVCs. On day 3 after the ablation, the brain natriuretic peptide levels decreased from 1,294 to 86 pg/dL, indicating significant improvement in heart failure. An echocardiogram taken 3 months after discharge revealed that the ejection fraction had improved by 50-71%. (J Arrhythmia 2010; 26: 204-208)
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