RESUMO
O desenvolvimento anormal da válvula tricúspide na doença de Ebstein resulta em uma série de anormalidades na ativação, que inclui condução intra-atrial demorada, bloqueio de ramo direito(BRG) e pré-excitação ventricular. O objetivo desse tabalho era definir as características do ECG antes e depois da ablação de uma via anômala atrioventricular. De 226 pacientes consecutivos com anomalia de Ebstein, 64 apresentavam taquicardia documentada...
Assuntos
Humanos , Anomalia de Ebstein/complicações , Cardiopatias Congênitas/complicações , Eletrocardiografia/métodos , EletrocardiografiaRESUMO
UNLABELLED: The abnormal development of the tricuspid valve in patients with Ebstein's anomaly results in several activation abnormalities including delayed intraatrial conduction, right bundle branch block (RBBB), and ventricular preexcitation. The aim of the present study was to define the ECG characteristics before and after ablation of an accessory A-V pathway (AP) in patients with Ebstein's anomaly. METHODS: A series of 226 consecutive patients with Ebstein's anomaly was studied. Sixty-four patients (28%) had documented tachycardia. Thirty-three patients with recurrent tachycardia were found to have a single right-sided AP that was successfully ablated (study group). Thirty patients without tachycardia served as the control group. RESULTS: Only 21 of 33 patients (62%) had a typical ECG pattern of preexcitation. In addition, none of the patients had an ECG pattern of RBBB during sinus rhythm. In contrast, 28 of 30 (93%) patients in the control group had RBBB (P < 0.001). Radiofrequency catheter ablation resulted in appearance of RBBB in 31 of 33 (94%) patients. The absence of RBBB in patients with Ebstein's anomaly and recurrent tachycardia had a 98% sensitivity and 92% specificity for the diagnosis of an AP. The positive predictive value was 91% (0.77, 0.97 CI 95%) and the negative predictive value was 98% (0.85, 0.99 CI 95%). CONCLUSION: One-third of patients with Ebstein's anomaly and symptomatic tachyarrhythmias have minimal or absent ECG features of ventricular preexcitation. In these patients, the absence of RBBB pattern is a strong predictor of an AP.
Assuntos
Nó Atrioventricular/anormalidades , Nó Atrioventricular/cirurgia , Bloqueio de Ramo/diagnóstico , Ablação por Cateter , Anomalia de Ebstein/diagnóstico , Anomalia de Ebstein/cirurgia , Eletrocardiografia/métodos , Adulto , Bloqueio de Ramo/complicações , Feminino , Humanos , Masculino , Prognóstico , Resultado do Tratamento , Valva Tricúspide/anormalidades , Valva Tricúspide/cirurgiaRESUMO
Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia is based on the elimination of conduction of slow or fast intranodal pathway. To avoid potential atrioventricular (AV) block, a new technology has been developed, cryothermal ablation. We report a case of AV nodal reentrant tachycardia in whom direct cryoablation, without previous ice mapping, was successfully performed. Interestingly and as previously described, cryotherapy did not induce ectopic rhythms, the conventional surrogate during radiofrequency ablation.