RESUMEN
A 31-year-old woman with a surgically corrected double outlet right ventricle and recurrent narrow QRS complex tachycardia was admitted to our hospital. The patient was scheduled for electrophysiology study. Coherent mapping identified the critical isthmus as a slow conduction area within posterolateral intercaval scar tissue. A continuous line of ablation was applied resulting in termination of the atrial tachycardia at the site of the critical isthmus from coherent mapping. Thus, coherent mapping facilitates complex ablation procedures and improves efficacy and efficiency.
Asunto(s)
Ablación por Catéter , Cardiopatías Congénitas , Taquicardia Supraventricular , Adulto , Femenino , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Frecuencia Cardíaca , Humanos , Taquicardia/cirugía , Taquicardia Supraventricular/cirugíaAsunto(s)
Angioplastia Coronaria con Balón , Bloqueo de Rama/terapia , Dispositivos de Terapia de Resincronización Cardíaca , Terapia de Resincronización Cardíaca , Estenosis Coronaria/terapia , Insuficiencia Cardíaca/terapia , Anciano , Bloqueo de Rama/complicaciones , Bloqueo de Rama/diagnóstico , Bloqueo de Rama/fisiopatología , Angiografía Coronaria , Estenosis Coronaria/complicaciones , Estenosis Coronaria/diagnóstico por imagen , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Resultado del TratamientoRESUMEN
Literature data on anatomic and electrophysiological properties of pulmonary veins (PVs) are very scarce. The study included an investigation of 20 human autopsy hearts with and without cardiovascular pathology. In addition, biopsy samples from the right superior PV were taken from 5 patients with atrial fibrillation (AF) for ultrastructural study. The investigation found myocardial sleeves (MS) in 86.3% of cases, an additional PV between right PVs--in 15%, a collector type of superior and inferior PV--in 25% of cases. MS were situated on the adventitial side of PVs; along the whole length of the PVs the MS myocyte fascicles ran in different directions. Local changes, such as productive myocarditis, fibrosis and fibro-lipomatosis, were observed in MS of PV of patients with AF. 106 patients (80 of whom were male; middle age 42.9 +/- 12.5 years) with symptomatic AF underwent clinical examination. Electrophysiological features of the PVs were evaluated in 30 patients. Effective and functional refractory periods of PVs were found to be shorter than those of the left atrium and non-arrhythmogenic PVs. Radiofrequency ablation (RA) with application of electrophysiological criteria proved to be effective in all patients with frequent ectopy from PVs. The use of electroanatomical mapping allowed successful RA in 82% of patients with persistent and chronic AF. The study demonstrates that the changes in MS of PV, discovered by means of light and electron microscopy, as well as their complex three-dimensional morphological structure may cause and maintain AF. Very distinct electrophysiological features, found in AF patients, probably play a major role in arrhythmogenicity.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter/métodos , Terapia por Estimulación Eléctrica/métodos , Contracción Miocárdica/fisiología , Venas Pulmonares/ultraestructura , Adolescente , Adulto , Anciano , Fibrilación Atrial/patología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/terapia , Niño , Femenino , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/ultraestructura , Humanos , Técnicas In Vitro , Masculino , Microscopía Electrónica , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
The paper provides the results of differential neogilurythmal therapy in 20 patients with high-grade atrial and ventricular premature contractions in the presence of coronary heart disease. The detection of cardiac arrhythmias and evaluation of the antiarrhythmic efficacy of neogilurythmal were performed by Holter monitoring and transesophageal electrophysiological study. After the baseline studies, the antiarrhythmic efficacy of the drug was evaluated during an acute drug test and then during a 8-day course of the therapy. In the acute drug test, the dose of neogilurythmal was 50% of the daily dosage. The studies indicated that neogilurythmal in a dose of 80 mg/day was beneficial in affecting both the atrial and ventricular extrasystolic arrhythmia. The agent failed to alter heart rate, sinus nodal function and atrioventricular conduction. Thus, neogilurythmal is low toxic and produces no adverse effects when given in the definite dosage range.