RESUMEN
BACKGROUND: More patients with cardiac implantable electrical devices (CIEDs) are presenting to spine and pain practices for radiofrequency ablation (RFA) procedures for chronic pain. Although the potential for electromagnetic interference (EMI) affecting CIED function is known with RFA procedures, available guidelines do not specifically address CIED management for percutaneous RFA for zygapophyseal (z-joint) joint pain, and thus physician practice may vary. OBJECTIVES: To better understand current practices of physicians who perform RFA for chronic z-joint pain with respect to management of CIEDs. Perioperative CIED management guidelines are also reviewed to specifically address risk mitigation strategies for potential EMI created by ambulatory percutaneous spine RFA procedures. STUDY DESIGN: Web-based provider survey and narrative review. SETTING: Multispecialty pain clinic, academic medical center. METHODS: A web-based survey was created using Research Electronic Data Capture (REDCap). A survey link was provided via e-mail to active members of the Spine Intervention Society (SIS), American Society of Regional Anesthesia and Pain Medicine, as well as distributed freely to community Pain Physicians and any receptive academic departments of PM&R or Anesthesiology. The narrative review summarizes pertinent case series, review articles, a SIS recommendation statement, and multi-specialty peri-operative guidelines as they relate specifically to spine RFA procedures. RESULTS: A total of 197 clinicians participated in the survey from diverse clinical backgrounds, including anesthesiology, physical medicine and rehabilitation, radiology, neurosurgery, and neurology, with 81% reporting fellowship training. Survey responses indicate wide variability in provider management of CIEDs before, during, and after RFA for z-joint pain. Respondents indicated they would like more specific guidelines to aid in management and decision-making around CIEDs and spine RFA procedures. Literature review yielded several practice guidelines related to perioperative management of CIEDs, but no specific guideline for percutaneous spine RFA procedures. However, combining the risk mitigation strategies provided in these guidelines, with interventional pain physician clinical experience allows for reasonable management recommendations to aid in decision-making. LIMITATIONS: Although this manuscript can serve as a review of CIEDs and aid in management decisions in patients with CIEDs, it is not a clinical practice guideline. CONCLUSIONS: Practice patterns vary regarding CIED management in ambulatory spine RFA procedures. CIED presence is not a contraindication for spine RFA but does increase the complexity of a spine RFA procedure and necessitates some added precautions. KEY WORDS: Radiofrequency ablation, neurotomy, cardiac implantable electrical device, zygapophyseal joint, spondylosis, neck pain, low back pain, chronic pain.
Asunto(s)
Dolor de Espalda/cirugía , Ablación por Catéter/normas , Desfibriladores Implantables/normas , Médicos/normas , Guías de Práctica Clínica como Asunto/normas , Encuestas y Cuestionarios , Anestesia de Conducción/métodos , Anestesia de Conducción/normas , Anestesiología/métodos , Anestesiología/normas , Ablación por Catéter/métodos , Dolor Crónico/cirugía , Humanos , Articulación Cigapofisaria/cirugíaRESUMEN
COVID-19 is a rapidly evolving public health emergency that has largely impacted the provision of healthcare services around the world. The challenge for electrophysiology teams is double; on one side preventing disease spread by limiting all nonessential face-to-face interactions, but at the same time ensuring continued care for patients who need it. These guidelines contain recommendations regarding triaging in order to define what procedures, device checks and clinic visits can be postponed during the pandemic. We also discuss best practices to protect patients and healthcare workers and provide guidance for the management of COVID-19 patients with arrhythmic conditions.
Asunto(s)
Arritmias Cardíacas/cirugía , Ablación por Catéter/estadística & datos numéricos , Infecciones por Coronavirus/prevención & control , Atención a la Salud , Técnicas Electrofisiológicas Cardíacas/normas , Pandemias/prevención & control , Neumonía Viral/prevención & control , Guías de Práctica Clínica como Asunto , Argentina , Arritmias Cardíacas/diagnóstico , Brasil , COVID-19 , Electrofisiología Cardíaca/organización & administración , Ablación por Catéter/normas , Colombia , Infecciones por Coronavirus/epidemiología , Procedimientos Quirúrgicos Electivos/normas , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Técnicas Electrofisiológicas Cardíacas/estadística & datos numéricos , Femenino , Humanos , Control de Infecciones/organización & administración , América Latina , Masculino , México , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Administración de la Seguridad/normas , Sociedades MédicasRESUMEN
ABSTRACT Surgical ablation, concomitant with other operations, is an option for treatment in patients with chronic atrial fibrillation. The aim of this study is to present a literature review on surgical ablation of atrial fibrillation in patients undergoing cardiac surgery, considering energy sources and return to sinus rhythm. A comprehensive survey was performed in the literature on surgical ablation of atrial fibrillation considering energy sources, sample size, study type, outcome (early and late), and return to sinus rhythm. Analyzing studies with immediate results (n=5), the percentage of return to sinus rhythm ranged from 73% to 96%, while those with long-term results (n=20) (from 12 months on) ranged from 62% to 97.7%. In both of them, there was subsequent clinical improvement of patients who underwent ablation, regardless of the energy source used. Surgical ablation of atrial fibrillation is essential for the treatment of this arrhythmia. With current technology, it may be minimally invasive, making it mandatory to perform a procedure in an attempt to revert to sinus rhythm in patients requiring heart surgery.
Asunto(s)
Humanos , Técnicas de Ablación/normas , Fibrilación Atrial/cirugía , Fuentes de Energía Bioeléctrica/normas , Ablación por Catéter/normas , Arritmia Sinusal/cirugía , Arritmias Cardíacas/cirugía , Resultado del TratamientoRESUMEN
Surgical ablation, concomitant with other operations, is an option for treatment in patients with chronic atrial fibrillation. The aim of this study is to present a literature review on surgical ablation of atrial fibrillation in patients undergoing cardiac surgery, considering energy sources and return to sinus rhythm. A comprehensive survey was performed in the literature on surgical ablation of atrial fibrillation considering energy sources, sample size, study type, outcome (early and late), and return to sinus rhythm. Analyzing studies with immediate results (n=5), the percentage of return to sinus rhythm ranged from 73% to 96%, while those with long-term results (n=20) (from 12 months on) ranged from 62% to 97.7%. In both of them, there was subsequent clinical improvement of patients who underwent ablation, regardless of the energy source used. Surgical ablation of atrial fibrillation is essential for the treatment of this arrhythmia. With current technology, it may be minimally invasive, making it mandatory to perform a procedure in an attempt to revert to sinus rhythm in patients requiring heart surgery.
Asunto(s)
Técnicas de Ablación/normas , Fibrilación Atrial/cirugía , Fuentes de Energía Bioeléctrica/normas , Ablación por Catéter/normas , Arritmia Sinusal/cirugía , Arritmias Cardíacas/cirugía , Humanos , Resultado del TratamientoRESUMEN
Bronchial thermoplasty is a new bronchoscopic procedure that delivers radiofrequency energy to the airway and potentially reduces the smooth muscle-mediated bronchoconstriction. We report the case of a 48-year-old man with persistent moderate asthma submitted to bronchial thermoplasty. The treatment increased the forced expiratory volume in one second, increased the number of symptom-free days, reduced the use of relief medications, and improved the Juniper Asthma Quality of Life Scale score. In this patient, bronchial thermoplasty was well tolerated and safe. This was the first bronchial thermoplasty performed in Latin America. At 12 months after the procedure, the results were encouraging in terms of its potential benefits in patients with difficult-to-control asthma.
Asunto(s)
Asma/cirugía , Bronquios/cirugía , Broncoscopía/métodos , Ablación por Catéter/métodos , Asma/fisiopatología , Ablación por Catéter/normas , Humanos , América Latina , Masculino , Persona de Mediana EdadRESUMEN
A termoplastia brônquica é um novo procedimento broncoscópico que libera energia por radiofreqüência nas vias aéreas, com potencial redução da broncoconstrição causada pela contratura da musculatura lisa. Relatamos o caso de um homem de 48 anos, portador de asma persistente moderada, submetido à termoplastia brônquica. O tratamento aumentou o volume expiratório forçado no primeiro segundo, aumentou o número de dias livres de sintomas, reduziu o uso da medicação de resgate e melhorou o escore no questionário de Juniper Asthma Quality of Life Scale. A termoplastia brônquica foi bem tolerada e segura. Esta foi a primeira termoplastia brônquica na América Latina, com resultados estimulantes após 12 meses quanto ao seu potencial benefício em asmáticos pouco controlados.
Bronchial thermoplasty is a new bronchoscopic procedure that delivers radiofrequency energy to the airway and potentially reduces the smooth muscle-mediated bronchoconstriction. We report the case of a 48-year-old man with persistent moderate asthma submitted to bronchial thermoplasty. The treatment increased the forced expiratory volume in one second, increased the number of symptom-free days, reduced the use of relief medications, and improved the Juniper Asthma Quality of Life Scale score. In this patient, bronchial thermoplasty was well tolerated and safe. This was the first bronchial thermoplasty performed in Latin America. At 12 months after the procedure, the results were encouraging in terms of its potential benefits in patients with difficult-to-control asthma.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Asma/cirugía , Bronquios/cirugía , Broncoscopía/métodos , Ablación por Catéter/métodos , Asma/fisiopatología , Ablación por Catéter/normas , América LatinaRESUMEN
BACKGROUND: Two types of myocardia can be observed through the endocardial spectral mapping (SM) in sinus rhythm: the compact type with a smooth spectrum and the fibrillar type with a segmented spectrum (atrial fibrillation nests). During the atrial fibrillation (AF), the compact type has an organized activation and low frequency (passive), whereas the fibrillar type has a rather disorganized activation and high frequency (active/resonant), with both being activated by high-frequency sustained tachycardia--the background tachycardia (BT). OBJECTIVE: To describe the treatment of AF by the ablation of the AF nests and BT. METHODS: 1) Catheter ablation of the AF nests with RF [4/8 mm-60 masculine/30-40 J/30s] guided by SM in sinus rhythm, outside the pulmonary vein; 2) atrial stimulation -300 ppm; 3) Additional ablation of the AF nests if AF is induced; 4) Focal ablation if BT and/or Flutter is induced; 5) Clinical follow-up+ ECG+ Holter. RESULTS: A total of 50+/-18 AF nests/patient were treated. After 11.3+/-8 m, 81 patients (88%) did not present AF (28.3% with antiarrhythmic drugs). After the ablation of the AF nests, AF was not reinduced in 61 patients (71%) and BT was induced and treated in 24 patients (26%). There were two episodes of pericardial bleeding (1 treated clinically and 1 surgically), caused by sheaths that are no longer used CONCLUSION: The SM in sinus rhythm can be used in the ablation of AF nests. During the AF, the AF nests present a reactive-resonant pattern and the compact myocardium is passive, stimulated by the high frequency of the BT. After the ablation of the AF nests and the BT, it was not possible to reinduce the sustained AF. The Ablation of AF nests outside the pulmonary veins showed to be safe and highly effective in the cure and/or clinical control of the AF.
Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Taquicardia/cirugía , Fibrilación Atrial/fisiopatología , Ablación por Catéter/efectos adversos , Ablación por Catéter/normas , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Venas Pulmonares/cirugía , Taquicardia/fisiopatologíaRESUMEN
FUNDAMENTO: Através de mapeamento espectral-(ME) endocárdico em ritmo sinusal, observam-se dois tipos de miocárdio atrial: o compacto de espectro liso e o fibrilar de espectro segmentado ("Ninho de FA" [NFA]). Durante a FA o compacto tem ativação organizada e baixa freqüência (passivo) enquanto o fibrilar apresenta ativação bastante desorganizada e alta freqüência (ativo/ressonante) sendo ambos ativados por uma taquicardia protegida de alta freqüência, taquicardia de background (TB). OBJETIVO: Descrever o tratamento da FA pela ablação dos NFA e da TB. MÉTODOS: 1) Ablação por cateter-RF [4/8mm-60°/30-40J/30s] dos NFA guiada por ME em ritmo sinusal, fora das veias pulmonares; 2) Estimulação atrial-300ppm; 3) Ablação adicional de NFA se induzida FA; 4) Ablação focal se induzida TB e/ou Flutter; 5) Seguimento clínico+ECG+Holter. RESULTADOS: Foram tratados 50±18 NFA/paciente. Após 11,3±8m 81p (88 por cento) estavam sem FA (28,3 por cento com antiarrítmico). Após a ablação dos NFA: a FA não foi reinduzida em 61p(71 por cento); TB foi induzida e tratada em 24p(26 por cento). Ocorreram 2 sangramentos pericárdicos (1 tratado clinicamente e 1 cirurgicamente) ocasionados por bainhas não mais utilizadas. CONCLUSÃO: O ME em ritmo sinusal ablaciona os NFA. Durante a FA os NFA apresentam um padrão reativo-ressonante e o miocárdio compacto apresenta-se passivo, estimulados pela alta freqüência da TB. Após a ablação dos NFA e da TB não foi possível reinduzir FA sustentada. A ablação dos NFA fora das VP se mostrou segura e altamente eficiente para a cura e/ou o controle clínico da FA.
BACKGROUND: Two types of myocardia can be observed through the endocardial spectral mapping (SM) in sinus rhythm: the compact type with a smooth spectrum and the fibrillar type with a segmented spectrum (atrial fibrillation nests). During the atrial fibrillation (AF), the compact type has an organized activation and low frequency (passive), whereas the fibrillar type has a rather disorganized activation and high frequency (active/resonant), with both being activated by high-frequency sustained tachycardia - the background tachycardia (BT). OBJECTIVE: To describe the treatment of AF by the ablation of the AF nests and BT. METHODS: 1) Catheter ablation of the AF nests with RF [4/8mm-60°/30-40J/30s] guided by SM in sinus rhythm, outside the pulmonary vein; 2) atrial stimulation -300ppm; 3) Additional ablation of the AF nests if AF is induced; 4) Focal ablation if BT and/or Flutter is induced; 5)Clinical follow-up+ ECG+ Holter. RESULTS: A total of 50±18 AF nests/patient were treated. After 11.3±8m, 81 patients (88 percent) did not present AF (28.3 percent with antiarrhythmic drugs). After the ablation of the AF nests, AF was not reinduced in 61 patients (71 percent) and BT was induced and treated in 24 patients (26 percent). There were two episodes of pericardial bleeding (1 treated clinically and 1 surgically), caused by sheaths that are no longer used CONCLUSION: The SM in sinus rhythm can be used in the ablation of AF nests. During the AF, the AF nests present a reactive-resonant pattern and the compact myocardium is passive, stimulated by the high frequency of the BT. After the ablation of the AF nests and the BT, it was not possible to reinduce the sustained AF. The Ablation of AF nests outside the pulmonary veins showed to be safe and highly effective in the cure and/or clinical control of the AF.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Taquicardia/cirugía , Fibrilación Atrial/fisiopatología , Ablación por Catéter/efectos adversos , Ablación por Catéter/normas , Electrocardiografía , Técnicas Electrofisiológicas Cardíacas , Estudios de Seguimiento , Venas Pulmonares/cirugía , Taquicardia/fisiopatologíaRESUMEN
OBJECTIVES: To evaluate if radiofrequency catheter ablation is an effective procedure for the treatment of right ventricular outflow tract premature ventricular contractions (RVOT-PVC) and ascertain if it results in an improvement of symptoms. METHODS: A prospective study with 30 consecutive patients (mean age 40 +/- 13 years, 25 females), with no apparent structural cardiopathy, with very frequent (mean density of 1,263 +/- 593/h) RVOT-PVC, symptomatic for more than one year (mean = 74 months) and resistant to antiarrhythmic drugs (3 +/- 1.7, including beta-blockers), who underwent radiofrequency catheter ablation. RESULTS: After the first procedure, there were 23 initial successful cases (76.6%) and 7 initial failures (23.4%). Four patients experienced relapses, two of whom did not undergo the second procedure. The second procedure was carried out in 9 patients (7 initial failures and 2 relapses), and there was success in 5 additional patients, one of them by epicardial access. The final success rate was 80% (24/30), and there were no major complications. After a mean follow-up of 14 +/- 6 months, in the successful group there was a reduction greater than 90% in density of premature ventricular contractions (PVC) (24/24; p<0.0001) and a resulting absence of symptoms in the majority of patients (23/24; p<0.001). CONCLUSION: Radiofrequency catheter ablation is a safe and effective treatment for patients with persistent and symptomatic PVC with RVOT morphology.
Asunto(s)
Ablación por Catéter/normas , Obstrucción del Flujo Ventricular Externo/cirugía , Complejos Prematuros Ventriculares/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Recurrencia , Reoperación , Resultado del Tratamiento , Obstrucción del Flujo Ventricular Externo/complicaciones , Complejos Prematuros Ventriculares/complicacionesRESUMEN
OBJECTIVES: Both ablation catheters with closed irrigated system and 8mm tip-catheters have been shown to be more effective for typical atrial flutter radiofrequency (RF) ablation when compared to conventional 4 mm tip catheter. Considering the differences in complexity and costs of both systems, a prospective study was designed to compare the efficacy and safety of cooled-tip and 8mm-tip catheters for atrial flutter ablation. METHODS: Fifty-two consecutive patients underwent RF ablation of cavotricupsid isthmus (CTI) for the treatment of typical atrial flutter, using catheter with closed irrigation system (n=26) or 8 mm-tip catheter (n=26). The RF pulses were applied point-by-point for 60 seconds, with power limited at 50 w for the irrigated catheter and by temperature control (60 degrees/70 w) for the 8 mm catheter. RESULTS: The CTI block was successfully performed in 98.1%. Four patients in the irrigated group needed to switch to the other group. There was no significant difference with regard to ablation parameters, such as total time of RF ablation (591.1+/-309.0 s vs 486.2+/-250.8 s), total procedure duration (86.4+/-23.6 vs 78.1+/-22.5 min) and time of fluoroscopy (17.0+/-6.7 vs 15.4+/-4.6 min). During follow-up of 10.6 months in average, one patient in the irrigated group had recurrence of typical atrial flutter. CONCLUSION: Efficacy and safety of CTI ablation was comparable between both techniques (irrigated catheter and 8 mm-tip catheter). The complexity of irrigated catheter makes it less competitive.
Asunto(s)
Aleteo Atrial/cirugía , Ablación por Catéter/normas , Ablación por Catéter/instrumentación , Cateterismo/instrumentación , Cateterismo/normas , Frío , Técnicas Electrofisiológicas Cardíacas , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Irrigación Terapéutica , Resultado del Tratamiento , Válvula Tricúspide/cirugíaRESUMEN
OBJETIVOS: Avaliar se a ablação com radiofreqüência é um procedimento eficiente para o tratamento das extra-sístoles da via de saída do ventrículo direito (EVSVD), e se resulta em melhora dos sintomas. MÉTODOS: Estudo prospectivo, com 30 pacientes consecutivos (idade média de 40±13 anos, 25 do sexo feminino), sem cardiopatia estrutural aparente, com EVSVD, muito freqüentes (densidade média de 1.263±593/h), sintomáticos por mais de 1 ano (média =74 meses) e refratários aos fármacos antiarrítmicos (3±1,7, incluindo os beta-bloqueadores), que foram submetidos à ablação com radiofreqüência. RESULTADOS: Após o primeiro procedimento, houve 23 sucessos iniciais (76,6 por cento) e 7 iniciais insucessos (23,4 por cento). Quatro pacientes tiveram recorrências, sendo que dois desses não se submeteram ao segundo procedimento. O segundo procedimento foi realizado em 9 pacientes (7 insucessos iniciais e 2 recorrências), e o sucesso ocorreu em 5 pacientes adicionais, sendo 1 caso por acesso epicárdico. A taxa de sucesso final foi de 80 por cento (24/30), e nenhuma complicação maior ocorreu. Após um seguimento médio de 14±6 meses, no grupo de sucesso final houve uma redução de mais de 90 por cento na densidade das extra-sístoles(24/24; p<0,0001) e resultante ausência de sintomas na maioria dos pacientes (23/24; p<0,001). CONCLUSÃO: A ablação com radiofreqüência é um tratamento seguro e eficaz para os pacientes com extra-sístoles persistentes e sintomáticas com morfologia do trato de saída do ventrículo direito.
OBJECTIVES: To evaluate if radiofrequency catheter ablation is an effective procedure for the treatment of right ventricular outflow tract premature ventricular contractions (RVOT-PVC) and ascertain if it results in an improvement of symptoms. METHODS: A prospective study with 30 consecutive patients (mean age 40 ± 13 years, 25 females), with no apparent structural cardiopathy, with very frequent (mean density of 1,263 ± 593/h) RVOT-PVC, symptomatic for more than one year (mean = 74 months) and resistant to antiarrhythmic drugs (3 ± 1.7, including beta-blockers), who underwent radiofrequency catheter ablation. RESULTS: After the first procedure, there were 23 initial successful cases (76.6 percent) and 7 initial failures (23.4 percent). Four patients experienced relapses, two of whom did not undergo the second procedure. The second procedure was carried out in 9 patients (7 initial failures and 2 relapses), and there was success in 5 additional patients, one of them by epicardial access. The final success rate was 80 percent (24/30), and there were no major complications. After a mean follow-up of 14 ± 6 months, in the successful group there was a reduction greater than 90 percent in density of premature ventricular contractions (PVC) (24/24; p<0.0001) and a resulting absence of symptoms in the majority of patients (23/24; p<0.001). CONCLUSION: Radiofrequency catheter ablation is a safe and effective treatment for patients with persistent and symptomatic PVC with RVOT morphology.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Ablación por Catéter/normas , Obstrucción del Flujo Ventricular Externo/cirugía , Complejos Prematuros Ventriculares/cirugía , Estudios de Seguimiento , Estudios Prospectivos , Recurrencia , Reoperación , Resultado del Tratamiento , Obstrucción del Flujo Ventricular Externo/complicaciones , Complejos Prematuros Ventriculares/complicacionesRESUMEN
OBJETIVOS: Trabalho prospectivo, randomizado para comparar a eficácia e a segurança do cateter irrigado em relação ao cateter com eletrodo distal de 8 mm para ablação com radiofreqüência (RF) do flutter atrial. MÉTODOS: Em 52 pacientes consecutivos referidos para tratamento do flutter atrial típico, a ablação do istmo cavotricuspídeo (Ist-CT) foi realizada com cateter de irrigação fechada (n=26) ou com cateter de eletrodo distal de 8 mm (n=26). Os pulsos de RF foram aplicados ponto a ponto por 60 segundos com potência limitada a 50 w com o cateter irrigado e por controle de temperatura (60°C, 70 w) com cateter de 8 mm. O critério de fim do procedimento foi a obtenção de bloqueio bidirecional do Ist-CT. RESULTADOS: O bloqueio Ist-CT foi obtido em 98,1 por cento dos pacientes. O "crossover" ocorreu em quatro pacientes do grupo com cateter irrigado. Não se encontrou diferença estatística significante em relação aos parâmetros da ablação, tais como tempo total de aplicação de RF (591,1±309,0s vs 486,2±250,8s), duração do procedimento (86,4 ± 23,6 vs 78,1±22,5min) e tempo de fluoroscopia (17,0±6,7 vs 15,4±4,6min) entre os dois grupos. Durante seguimento médio de 10,6 meses, um paciente do grupo irrigado apresentou recorrência do flutter atrial típico. CONCLUSÃO: A ablação do Ist-CT resultou ser efetiva e segura para o controle do flutter atrial com ambas as técnicas empregadas (cateter com eletrodo distal de 8 mm e cateter irrigado). A complexidade técnica do cateter irrigado proporciona menor competitividade.
OBJECTIVES: Both ablation catheters with closed irrigated system and 8mm tip-catheters have been shown to be more effective for typical atrial flutter radiofrequency (RF) ablation when compared to conventional 4 mm tip catheter. Considering the differences in complexity and costs of both systems, a prospective study was designed to compare the efficacy and safety of cooled-tip and 8mm-tip catheters for atrial flutter ablation. METHODS: Fifty-two consecutive patients underwent RF ablation of cavotricupsid isthmus (CTI) for the treatment of typical atrial flutter, using catheter with closed irrigation system (n=26) or 8 mm-tip catheter (n=26). The RF pulses were applied point-by-point for 60 seconds, with power limited at 50 w for the irrigated catheter and by temperature control (60°C / 70 w) for the 8mm catheter. RESULTS: The CTI block was successfully performed in 98.1 percent. Four patients in the irrigated group needed to switch to the other group. There was no significant difference with regard to ablation parameters, such as total time of RF ablation (591.1±309.0s vs 486.2±250.8s), total procedure duration (86.4±23.6 vs 78.1±22.5min) and time of fluoroscopy (17.0±6.7 vs 15.4±4.6min). During follow-up of 10.6 months in average, one patient in the irrigated group had recurrence of typical atrial flutter. CONCLUSION: Efficacy and safety of CTI ablation was comparable between both techniques (irrigated catheter and 8mm-tip catheter). The complexity of irrigated catheter makes it less competitive.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Aleteo Atrial/cirugía , Ablación por Catéter/normas , Frío , Ablación por Catéter/instrumentación , Cateterismo/instrumentación , Cateterismo/normas , Técnicas Electrofisiológicas Cardíacas , Estudios de Seguimiento , Estudios Prospectivos , Recurrencia , Irrigación Terapéutica , Resultado del Tratamiento , Válvula Tricúspide/cirugíaAsunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/normas , Venas Pulmonares/cirugía , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Ablación por Catéter/instrumentación , Ablación por Catéter/métodos , Humanos , Recurrencia , Reproducibilidad de los Resultados , Resultado del TratamientoAsunto(s)
Humanos , Fibrilación Atrial/cirugía , Ablación por Catéter/normas , Venas Pulmonares/cirugía , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Ablación por Catéter/instrumentación , Ablación por Catéter/métodos , Recurrencia , Reproducibilidad de los Resultados , Resultado del TratamientoRESUMEN
La ablación percutánea mediante radiofrecuencia (APRF) es una alternativa mínimamente invasiva al tratamiento habitual de resección en block de los osteomas osteoides. La APRF es una alternativa particularmente útil en lugar de la cirugía para el típico osteoma osteoide cuando este se encuentra en localizaciones estratégicas, donde puede existir un aumento del riesgo de injuria a importantes estructuras suprayecentes. En el presente artículo presentamos el tratamiento de dos clásicos osteomas osteoides mediante APRF (90º C durante 5-6 minutos), ubicados en el fémur proximal, inmediatamente distales al trocánter menor. En dichos casos empleamos una vía de abordaje alternativa a través de la cortical opuesta para evitar al nervio ciático así como la musculatura asociada y
Asunto(s)
Humanos , Femenino , Adolescente , Osteoma Osteoide/cirugía , Ablación por Catéter/métodos , Fémur/cirugía , Fémur/diagnóstico por imagen , Ablación por Catéter/normas , Tomografía Computarizada por Rayos X/métodos , Osteosarcoma/diagnóstico , Osteosarcoma/diagnóstico por imagen , Espectroscopía de Resonancia Magnética/diagnóstico , Osteoma Osteoide/diagnóstico por imagen , Diagnóstico DiferencialRESUMEN
La ablación percutánea mediante radiofrecuencia (APRF) es una alternativa mínimamente invasiva al tratamiento habitual de resección en block de los osteomas osteoides. La APRF es una alternativa particularmente útil en lugar de la cirugía para el típico osteoma osteoide cuando este se encuentra en localizaciones estratégicas, donde puede existir un aumento del riesgo de injuria a importantes estructuras suprayecentes. En el presente artículo presentamos el tratamiento de dos clásicos osteomas osteoides mediante APRF (90º C durante 5-6 minutos), ubicados en el fémur proximal, inmediatamente distales al trocánter menor. En dichos casos empleamos una vía de abordaje alternativa a través de la cortical opuesta para evitar al nervio ciático así como la musculatura asociada y la vasculatura del comportamiento posterior del muslo. Se observó remisión sintomática completa en el lapso de 24 hs. posteriores al procedimiento, no observándose recidiva clínica en un período de seguimiento de 12 a 18 meses subsiguientes
Asunto(s)
Humanos , Femenino , Adolescente , Ablación por Catéter/métodos , Osteoma Osteoide/cirugía , Ablación por Catéter/normas , Diagnóstico Diferencial , Fémur , Fémur/cirugía , Osteoma Osteoide , Osteosarcoma , Osteosarcoma/diagnóstico , Espectroscopía de Resonancia Magnética , Tomografía Computarizada por Rayos X/métodosRESUMEN
Los mejores métodos de diagnóstico por imágenes, la introducción de técnicas denominadas intervencionistas y la incorporación de nuevos materiales han condicionado que muchos procedimientos percutáneos se hayan convertido en una alternativa terapéutica para algunas afecciones quirúrgicas. Desde el año 1991 funciona una sección de Cirugía Percutánea. Desde el comienzo de la misma se han realizado 561 procedimientos. Su número, fue aumentado desde el inicio de esta sección, así como la complejidad de los mismos. En cuanto a la elección del procedimiento, es trascendente la evaluación integral de la enfermedad a tratar. La implementación de esta técnica por parte de un cirujano contará con las ventajas de poder solucionar eventuales complicaciones agudas o de aplicar el tratamiento quirúrgico en caso de fracaso del procedimiento empleado. De cualquier manera el cirujano moderno no puede desconocer sus alcances, sepa o no instrumentarlos. Este concepto trasciende al mero hecho de quién debe hacer el procedimiento, porque lo más importante será cuál es el mejor procedimiento que deba realizarse y que los resultados sean comparables a los niveles existentes para cada uno de ellos (AU)