No abstract

Catheter ablations were efficiently and effectively performed in adults with a variety of arrhythmias using only IE, EAM, and ICE for catheter guidance. This nonfluoroscopic technique was feasible, posed no additional safety concerns, and should be readily implementable in most electrophysiology laboratories.

A 59-year-old male with an secundum atrial septal defect status post repair with an Amplatzer occluder in 2001 was admitted with sepsis and MRSA bacteremia. Transesophageal Echocardiography (TEE) showed presence of an overlying mobile echogenic structure on the left atrial surface of the device suggestive of a vegetation/infected thrombus. This is only the 3rd case description of late endocarditis involving the Amplatzer ASD closure device in an adult.

PurposeCryothermal ablation (CTA) for atrioventricular nodal reentrant tachycardia (AVNRT) is considered safer than radiofrequency ablation (RFA) since it eliminates the risk of inadvertent AV block. However, it has not been widely adopted due to high late recurrence rate (LRR). In an effort to improve LRR, we evaluated a new approach to cryothermal mapping (CTM): “time to tachycardia termination” (TTT).MethodsThis single-center study had 88 consecutive patients who underwent CTA using TTT for AVNRT. The CTA catheter was positioned in sinus rhythm at the posteroseptal tricuspid annulus, and then AVNRT was induced. The CTA target site was identified by prompt tachycardia termination in ≤20 s during CTM. Procedural success was defined as no inducible AVNRT and ≤1 single AV nodal echoes.ResultsAcute procedural success was achieved in 87 of 88 patients (98.9 %) and was similar to prior studies for both CTA and RFA. No permanent AV block was observed. LRR was 3.7 % at a mean follow-up of 19.7 months. LRR was equivalent to that commonly reported for RFA and improved when compared to conventional CTA.ConclusionTTT for CTA of AVNRT provides enhanced safety and similar long-term efficacy when compared to RFA. Based upon this experience, TTT provides an enhancement to conventional CTA that appears to result in improved long-term outcomes. In light of these findings, it seems reasonable to undertake additional randomized trials to determine whether RFA or CTA using TTT is the optimal approach for the catheter ablation of AVNRT.

A 65-year-old gentleman presented with epigastric discomfort and dyspnea on exertion for 2 weeks. Electrocardiogram was consistent with atrial flutter with 2:1 conduction and persistent ST-segment elevation in the lateral leads. Echocardiography (A and B) showed akinesis, thinning, and bulging of the inferoposterior wall, suggestive of an aneurysm, with left ventricular (LV) ejection fraction of 35%. Coronary angiography showed severe 2-vessel disease involving proximal right and left circumflex arteries, large posterior aneurysm (C, Online Videos 1 and 2) and overall LV ejection fraction of 25%. Viability was negative, and he was prescribed medical management, including anticoagulation. In 6 weeks, he returned with progressive dyspnea, palpitations, and atypical chest pains. Repeat echocardiography demonstrated LV spontaneous contrast (D) and unexpected obvious enlargement of the previous aneurysm (E and F). Cardiac computed tomography (G and H, Online Video 3) confirmed the suspected pseudoaneurysm (PSA), measuring 10.5 ϫ 7.8 ϫ 8.8 cm, with an unusually large neck measuring 5.4 cm. He underwent successful surgical repair. LA ϭ left atrium; LVOT ϭ left ventricular outflow tract; PSA ϭ pseudoaneurysm; PT ϭ pulmonary trunk; RA ϭ right atrium; RV ϭ right ventricle.