RESUMEN
Aims: Oesophagogastroduodenoscopy (OGD) after catheter ablation (CA) of atrial fibrillation (AF) revealed a high rate of procedure related oesophageal lesions. We hypothesized that magnetically guided CA with careful radiofrequency energy titration at the posterior left atrial (LA) wall limits the incidence of oesophageal tissue damage. Methods and results: As a part of the prospective "Remote MAGNetic catheter Ablation for Atrial Fibrillation" (MAGNA-AF) registry, 251 out of 266 consecutive patients underwent OGD after magnetically guided single-CA for AF. All detected pathologies were analysed. Simultaneous pacing and ablation from the tip of the magnetically guided catheter was found to be a safe and feasible method for energy titration. Post-interventional OGD documented midoesophageal tissue damage in four (1.6%) patients. Although a thermal origin of these injuries must be discussed, none of them was located at the anterior oesophageal wall. Risk factors for midoesophageal lesions were female gender and concomitant acetylsalicylic acid (ASA) treatment. Mechanical lesions in 16 patients were attributed to periprocedural transoesophageal echocardiography (TOE). There was no atrio-oesophageal fistula (AOF). Five hundred and one incidental pathologies were found endoscopically, most frequent axial oesophageal herniation (71%), oesophagitis (22%), and gastritis (57%). Conclusion: Magnetically guided CA for AF with careful energy titration at the posterior LA wall and no oesophageal temperature monitoring is not associated with an increased incidence of oesophageal thermal injury. The routine use of periprocedural TOE may cause a low rate of mechanical oesophageal lesions but reliably prevents major complications like transient ischaemic attack, stroke, or cardiac tamponade. An observed high prevalence of upper digestive system inflammation (63%) may further support the recommendation for a routine post-interventional treatment with a proton-pump-inhibitor.
Asunto(s)
Fibrilación Atrial/cirugía , Cateterismo Cardíaco/efectos adversos , Ablación por Catéter/efectos adversos , Esófago/lesiones , Magnetismo , Tecnología de Sensores Remotos/efectos adversos , Cirugía Asistida por Computador/efectos adversos , Heridas y Lesiones/epidemiología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/fisiopatología , Cateterismo Cardíaco/métodos , Ablación por Catéter/métodos , Técnicas Electrofisiológicas Cardíacas , Endoscopía Gastrointestinal , Femenino , Alemania/epidemiología , Humanos , Incidencia , Magnetismo/métodos , Masculino , Prevalencia , Recurrencia , Sistema de Registros , Tecnología de Sensores Remotos/métodos , Factores de Riesgo , Cirugía Asistida por Computador/métodos , Resultado del Tratamiento , Heridas y Lesiones/diagnósticoRESUMEN
We present a case of successful interventional laser-assisted extraction of an endovascularly trapped long-term implanted ventriculoatrial shunt in a patient with shunt-associated septicemia. This approach is based on modified techniques for explantation of pacemaker leads and might be considered an additional option for extraction of otherwise nonremovable trapped endovascular catheters in experienced centers.
Asunto(s)
Infecciones Relacionadas con Catéteres/cirugía , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Remoción de Dispositivos/métodos , Terapia por Láser/métodos , Adulto , Antibacterianos/uso terapéutico , Femenino , Atrios Cardíacos/cirugía , Humanos , Venas Yugulares/cirugía , Marcapaso Artificial , Sepsis/etiología , Resultado del Tratamiento , Vena Cava Superior/cirugíaRESUMEN
AIM: The need for implantable cardioverter-defibrillator (ICD) defibrillation testing (DT) and subsequent intraoperative system modifications is discussed controversially. The study's goal was to prove that consequent abdication of intraoperative DT does not impair defibrillation efficacy and does not increase the rate of postoperative system revisions. METHODS: In a prospective single-center observational study, 609 out of 648 consecutive patients underwent transvenous ICD implantation (left-sided, active can, dual coil lead, and biphasic shock waveform) waiving intraoperative DT. Defibrillation efficacy was validated prior to hospital discharge (PHD) by applying two 10 J safety margin (SM) shocks. RESULTS: Following "schockless" implantation 580 out of 609 patients (95.2 %) met a 10 J SM with default programming. Shock path reversal provided 10 J SM in 13 out of 29 cases with initially failed DT. In four patients (0.7 %) maximum energy shocks were ineffective. There was no morbidity or mortality related to DT. The total rate of surgical ICD revisions was 1.8 %. CONCLUSION: Routine ICD implantation without intraoperative DT does not lead to an increased rate of postoperative system modifications and does not decrease defibrillation efficacy as tested PHD.
Asunto(s)
Desfibriladores Implantables/estadística & datos numéricos , Cardioversión Eléctrica/mortalidad , Traumatismos por Electricidad/mortalidad , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/prevención & control , Monitoreo Intraoperatorio/mortalidad , Anciano , Comorbilidad , Cardioversión Eléctrica/estadística & datos numéricos , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Medición de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
A 9-year-old girl presented with systemic infection related to a Port-a-Cath system (PAC); therefore, the urgent removal of the PAC was indicated. However, the catheter was trapped and not extractable by conventional means. Using existing comprehensive experience in the removal of pacemaker and implantable cardioverter defibrillator leads, the entrapped PAC was successfully extracted by laser technique, thus avoiding open heart surgery.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia/efectos adversos , Remoción de Dispositivos/métodos , Terapia por Láser , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/cirugía , Niño , Desfibriladores Implantables , Electrodos Implantados , Femenino , Humanos , Marcapaso Artificial , Resultado del TratamientoRESUMEN
We present the case of a 45-year-old female with a normal heart, who exhibited an episode of a broad QRS tachycardia that was initially suggested to be sustained ventricular tachycardia. Coronary angiography showed the left main stem originating from the right aortic sinus with an interarterial course between aorta and right ventricular outflow tract. Electrophysiological study revealed the presence of a right atriofascicular accessory pathway with decremental antegrade conduction (Mahaim bundle), which was successfully ablated.