A significant age dependence of the risk of complete heart block complicating radiofrequency ablation of the AV nodal slow pathway was noticed, with no patients <45 years of age experiencing this ...complication.
Background
Ablation of outflow flow ventricular arrhythmia (VA) originating from aortic cusps can be challenging. The aim of this study was to describe our approach for this ablation.
Methods
All ...patients with outflow VA suspected to originate from aortic cusps according to ECG or after failed ablation from right ventricular outflow tract (RVOT) underwent cardiac CT and radiofrequency ablation. CT image of aortic cusps and coronary arteries was integrated into electroanatomic mapping system by point (left main ostium)-based registration. Ablation was performed at the earliest activation site.
Results
Ten patients were included in this case cohort. The ablation catheter was easily maneuvered above and below the aortic valve after registration. Two patients who had previous failed ablation of RVOT focus had successful ablation at right coronary cusp (RCC) and at left coronary cusp (LCC). A patient who had previous failed ablations of RVOT and LCC focuses had successful ablation at RCC-LCC junction. A patient who had previous failed ablation at LCC had successful ablation at RCC-LCC junction. Three patients had successful ablation at RCC-LCC junction, and one patient at LCC. One patient had successful ablation at anterior interventricular vein–great cardiac vein junction. One patient had successful ablation at non-coronary cusp. During follow-up (12–30 months), one patient had recurrence of VA controlled by flecainide. The remaining patients were free of VA without medications.
Conclusions
Catheter ablation of VA originating from aortic cusps is safe and effective. CT image integration into electroanatomic mapping system can be helpful in this challenging ablation.
Differentiation between the different right ventricular rhythm disorders and specifically between arrhythmogenic right ventricular dysplasia (ARVD) and right ventricular outflow tract (RVOT) ...tachycardias has important clinical implications but remains a clinical challenge. We tested the hypothesis that the spatial association of local electrographic parameters may be used to discriminate between these 2 entities. Electroanatomic mapping of the right ventricle was performed in 3 groups: patients who had typical RVOT tachycardia, a control group of patients who had no ventricular arrhythmias, and patients who had a diagnosis of ARVD based on clinical, electrocardiographic, and structural findings. Electroanatomic mapping in the RVOT tachycardia group showed normal electrographic parameters throughout the right ventricle (unipolar electrographic amplitude 9.9 ± 0.9 mV, duration 55 ± 1 ms, amplitude/duration 0.193 ± 0.022) that were no different from those in the control group. In contrast, dysplastic regions in the ARVD group were characterized by significantly lower amplitude (unipolar 3.6 ± 0.4 mV), prolonged electrographic duration (unipolar 73 ± 4 ms), and a decreased amplitude/duration ratio (unipolar 0.054 ± 0.008) compared with the unaffected zones in the same hearts and with all regions in the RVOT and control groups. Thus, endocardial electrographic parameters do not differ between patients who have RVOT and control patients. RVOT tachycardia can be differentiated from ARVD by the absence of abnormal right ventricular electrographic findings. This ability may have important clinical implications and supports the concept of different underlying mechanisms for these 2 entities.
Diabetes mellitus is associated with increased risk after acute coronary syndromes. Primary percutaneous coronary intervention is the most effective method of reperfusion for acute ST-elevation ...myocardial infarction and can limit the ischaemic damage to the left ventricle. However, there are few data on the impact of diabetes mellitus on the risk of heart failure following primary percutaneous coronary intervention.
We studied 958 ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention, of whom 263 (27.5%) had diabetes mellitus, with 67 (7.0%) treated with insulin. The primary end points of the study were re-admission for heart failure. Secondary end points were all-cause mortality and recurrent infarctions. The follow-up period was 5 years after hospital discharge.
The cumulative incidence of re-admission for heart failure was 8.4%, 15.2% and 26.7% in patients without diabetes mellitus, non-insulin-treated and insulin-treated diabetes mellitus, respectively. Compared with patients without diabetes mellitus, the adjusted hazard ratio for heart failure was 1.95 (95% confidence intervals 1.30-2.93) and 3.09 (95% confidence intervals 1.71-5.60) in non-insulin-treated and insulin-treated diabetes mellitus, respectively. The corresponding hazard ratios for mortality were 1.03 (95% confidence intervals 0.68-1.55) and 2.04 (95% confidence intervals 1.22-3.42), respectively. There was a J-shaped association between fasting glucose levels in the acute phase and risk of mortality (P=0.0001) and a direct association with heart failure (P=0.03).
Despite modern treatment of ST-elevation myocardial infarction and high levels of guideline-based medical care, diabetes mellitus had an independent adverse effect on the risk of re-admissions for heart failure, which was particularly high among insulin-treated patients.
Abstract Background Transient hyperglycemia is common during acute myocardial infarction in non-diabetic patients and is associated with a worse outcome. There is limited data on the outcome of ...patients who undergo primary percutaneous coronary intervention and have transient hyperglycemia. Methods Fasting plasma glucose was measured in 431 consecutive acute myocardial infarction patients who underwent primary percutaneous coronary interventions. Patients were classified into three groups: non-diabetics/non-hyperglycemic (NDNH, glucose < 126 mg/dL; n = 224); non-diabetics/hyperglycemic (NDH, glucose ≥ 126 mg/dL; n = 119); and diabetics ( n = 88). Data were analyzed according to the different groups and according to exact glucose levels. Results In-hospital mortality was significantly lower in NDNH (1%) compared to NDH (8%) and diabetic (5%) patients ( p = 0.01). One-year cumulative mortality was highest (10%) in patients with NDH ( p < 0.001). One year target lesion revascularization rates were identical in NDNH and NDH patients (6% vs. 8%) and higher in diabetic patients (19%, p = 0.001). In a multivariate model, a striking increase in the risk of death (0.6%, p = 0.05) and target lesion revascularization (2%, p < 0.0001) was found for every increment of 1 mg/dL in glucose level. Conclusions Transient hyperglycemia in non-diabetic acute myocardial infarction patients who undergo primary percutaneous coronary interventions is associated with high one-year mortality. One year target lesion revascularization rates were significantly higher in diabetics compared to non-diabetics with normoglycemia or transient hyperglycemia.
PDF
