Propofol has no effect on the electrophysiological properties of the AV node conduction system. It is thus a suitable anesthetic agent for use in patients undergoing ablative procedures.

BackgroundCatheter ablation provides curative treatment for tachyarrhythmias. Fluoroscopy, the method used for this, presents several risks. The electroanatomical mapping (MEA) presents a three-dimensional image without using X-rays, and may be adjunct to fluoroscopy.ObjectivesWe evaluated the possibility of performing catheter ablation with the exclusive use of electroanatomical mapping (MEA), dispensing with fluoroscopy. We compared the total time of procedure and success rates against the technique using fluoroscopy (RX) with emission of X-rays.MethodsRandomized, unicentric, uni-blind study of patients referred for tachyarrhythmia ablation.ResultsTwelve patients were randomized to the XR group and 11 to the EAM group. The mean age was 48.5 (±12.6) vs 46.3 (±16.6) (P = ns). Success occurred in 11 patients (91.7%) in the RX group and 9 (81.8%) in the MEA group (P = 0.46). The procedure time in minutes was higher in the MEA group than in the RX group (79-47-125min vs 49-30-100min; P = 0.006). The mean fluoroscopy time was 11 ± 9 min versus zero (RX vs MEA: P < 0.001). The mean radiofrequency applications were lower in the RX group against the MEA group (6 ± 3.5 × 13.2 ± 18.2 p < 0.019). There were no complications.ConclusionMEA opened new therapeutic possibilities for patients with arrhythmias, reducing the risk of radiation. In this study, it was possible to demonstrate that it is feasible to perform ablation only with the use of MEA, with similar success with fluoroscopy, at the expense of a longer procedure time.

In our population, CHA(2)DS(2)VASc score predicts major adverse cardiac outcomes, including stroke and death, in a cohort of patients without AF.

Arrhythmias during pregnancy pose a dilemma for the treating physician. Most antiarrhythmic drugs are classified as category C in the FDA labeling system during pregnancy. We describe the case of a pregnant woman who presented syncope due to drug-refractory supraventricular tachycardia who underwent catheter ablation without the use of fluoroscopy.Tratamento de taquicardia supraventricular sincopal durante a gestação sem uso de raios-X: relato de caso Resumo As arritmias na gestação geram um dilema para o médico que assiste o paciente. A maioria das drogas antiarrítmicas possuem indicação classe C durante a gestação. Aqui fazemos o relato de mulher na gestação que apresentou TSV, sincopal, refratária ao tratamento ao qual foi submetida a ablação por cateter sem o uso de fluoroscopia.ଝ Please cite this article as: Leiria TLL, Pires LM, Kruse ML, de Lima GG. Tratamento de taquicardia supraventricular sincopal durante a gestação sem uso de raios-X: relato de caso. Rev Port Cardiol. 2014;33:805.e1---805.e5.

IntroductionAtrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce.ObjectiveTo investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use.MethodsCross-sectional retrospective study, with data collection from medical records of every patient treated for atrial fibrillation and flutter in the emergency department of Instituto de Cardiologia do Rio Grande do Sul during the first trimester of 2012.ResultsWe included 407 patients (356 had atrial fibrillation and 51 had flutter). Patients with paroxysmal atrial fibrillation were in average 5 years younger than those with persistent atrial fibrillation. Compared to paroxysmal atrial fibrillation patients, those with persistent atrial fibrillation and flutter had larger atrial diameter (48.6 ± 7.2 vs. 47.2 ± 6.2 vs. 42.3 ± 6.4; p < 0.01) and lower left ventricular ejection fraction (66.8 ± 11 vs. 53.9 ± 17 vs. 57.4 ± 16; p < 0.01). The prevalence of stroke and heart failure was higher in persistent atrial fibrillation and flutter patients. Those with paroxysmal atrial fibrillation and flutter had higher prevalence of CHADS2 score of zero when compared to those with persistent atrial fibrillation (27.8% vs. 18% vs. 4.9%; p < 0.01). The prevalence of anticoagulation in patients with CHA2DS2-Vasc ≤ 2 was 40%.ConclusionsThe population in our registry was similar in its comorbidities and demographic profile to those of North American and European registries. Despite the high thromboembolic risk, the use of anticoagulants was low, revealing difficulties for incorporating guideline recommendations. Public health strategies should be adopted in order to improve these rates.