Ablation – ABC CARDIOL

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Editorial

Atrial Fibrillation Ablation: Are We Still Looking for the Best Shot?

Lucas Simonetto Faganello et al. Mauricio Pimentel

Atrial fibrillation (AF) is independently associated with increased risks of mortality, stroke, heart failure, impaired quality of life, and cognitive decline. Rhythm control has proven superior to rate control in reducing cardiovascular outcomes, with catheter ablation demonstrating greater efficacy than antiarrhythmic drug therapy.^– Continuous advances in techniques and technologies have progressively established ablation as a cornerstone in the management of AF.

In recent years, 3D mapping and point-by-point ablation have evolved significantly with the introduction of contact force-sensing catheters and the development of lesion quality metrics, such as the Ablation Index and Lesion Size Index. These improvements have translated into better outcomes, reduced procedure times, and enhanced safety.^– Pulmonary vein isolation remains the cornerstone of invasive AF treatment, with radiofrequency (RF) point-by-point ablation still being the most widely used technique despite the emergence of alternative energy sources. Procedural success relies on delivering continuous, irreversible, and transmural lesions encircling the pulmonary veins while sparing adjacent structures, such as the esophagus and phrenic nerve.

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My Approach To

My Approach to Echocardiography in Radiofrequency Ablation of Hypertrophic Obstructive Cardiomyopathy

Antonio Tito Paladino et al. Andrea de Andrade Vilela Jorge Eduardo Assef Bruno Pereira Valdigem

Introduction

Hypertrophic cardiomyopathy (HCM), an autosomal dominant genetic disease that affects one in 500 people, is considered the most common isolated form of hereditary heart disease. HCM is characterized by varying degrees of ventricular hypertrophy, myocardial fiber disarray, interstitial fibrosis, and microvascular disease in the absence of cardiac or systemic conditions to justify these findings.

Echocardiography, an invaluable tool for the diagnosis and follow-up of patients with HCM, is used to assess morphology, hemodynamic disorders, left ventricular (LV) function, and patient prognosis. It also has a fundamental role in cases of hypertrophic obstructive cardiomyopathy (HOCM) in the indication of invasive treatments. Radiofrequency ablation (RFA) is a possible treatment under study.

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Editorial

Reconnection of Pulmonary Veins After Ablation. A Challenge to be Overcome

Silvia Helena Cardoso Boghossian et al. Ricardo Mourilhe-Rocha

Atrial fibrillation (AF) is the most common sustained arrhythmia in the population and its incidence significantly increases with age.As life expectancy rises, it is estimated that AF prevalence will suffer a significant increase, and its adequate control will continue to be a major challenge.

Until the end of the 90s, the therapeutic options available and most used in the reversion and prevention of AF recurrences were antiarrhythmic drugs (AA) and electrical cardioversion; however, clinical treatment with AA drugs has been shown ineffective in maintaining sinus rhythm, with a recurrence rate above 50%.

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Artigo Original

Contribution of the electrophysiological and anatomical analysis of the atypical atrioventricular nodal tachycardia circuit

Maila Seifert Macedo Silva et al. Roberto Luiz M. da Silva Sá Márcio Luiz A. Fagundes Fernando E. S. Cruz Filho … Leonardo B. Arantes Silvia Boghossian Adriana Monteiro C. David de Almeida Rafael Lopes Fagundes Luiz José Romeo Filho

OBJECTIVES: To analyze retrograde conduction during junctional ectopic tachycardia (JET) episodes and investigate the existence of a relationship between the presence of a retrograde block and the risk of atrioventricular block (AVB) development during radiofrequency ablation procedures in patients with nodal atrioventricular tachycardia (NAVT). METHODS: 145 male and female patients aged 16-84 years, with NAVT who had undergone radiofrequency catheter ablation in the posteroseptal region of the right atrium were studied. Evaluation criteria were anatomical location and electrophysiological behavior of retrograde conduction during NAVT, in order to understand the nodal reentrant circuit (classifying the tachycardia as typical or atypical), and monitoring of retrograde conduction during JET episodes for risk-predicting AVB events. RESULTS: Of the 145 patients studied, 132 (91%) met electrophysiological and anatomical criteria of the typical form of NAVT, and 13 (9%) of atypical form. During the ablation, 5.3% with the typical form and 30.8% of the atypical form presented risk events for AVB. After the ablation, complications were a total AVB episode in one patient and a first-degree AVB episode in another in the typical group, and one first-degree AVB in the atypical group. All three episodes were preceded by risk events and resulted in permanent nodal injury. CONCLUSION: Patients with atypical NAVT presented higher percentages of risk events for atrioventricular block than did patients with the typical form (p=0.021).A careful observation of retrograde conduction during JET episodes is vital in order to avoid permanent damage in AV nodal conduction, such as TAVB, after the ablation procedure.

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Original Article

Percutaneous transluminal septal alcoholization for the treatment of refractory hypertrophic obstructive cardiomyopathy: initial experience in the Federal District

Evandro César Vidal Osterne et al. Tamer Najar Seixas Walter Paulo Filho Ernesto Misael Cintra Osterne Otoni Moreira Gomes

OBJECTIVE: To analyze the efficacy of percutaneous transluminal septal alcoholization in the treatment of refractory obstructive hypertrophic cardiomyopathy (HOC). METHODS: The patients were referred for alcoholization after Doppler echocardiography. Before and after alcoholization, the intraventricular pressure gradient was recorded. Alcoholization was performed with a 3mL injection of absolute alcohol through a coronary angioplasty balloon catheter. The procedure was concluded after a significant reduction or abolition of the pressure gradient. RESULTS: Of 22 patients, 18 (81.8%) successfully concluded the procedure with a reduction in intraventricular pressure gradient at baseline (from 67.6±24.2 mmHg to 3.8± 1.9 mmHg, p<0.005) and after extrasystole (from 110.4± 24.2 mmHg to 9.6±2.6 mm Hg, p<0.005). A significant reduction in mean interventricular septal thickness (from 2± 0.3 mm to 1.7±0.2 mm, p<0.005) and in peak pressure gradient (from 90.7±23.5 mmHg to 6.1±1.4 mmHg, p<0.005) was observed on Doppler echocardiography after 6 months, when all patients were in functional class I. The most frequent acute complication, present in 11% of the patients, was the need for definitive pacing implantation. Relapse of the symptoms and reappearance of the pressure gradient occurred in 16.6% of the patients. One patient (5.5%) died probably due to a diffuse coronary spasm prior to the procedure, and another died suddenly on late follow-up. CONCLUSION: Percutaneous transluminal septal alcoholization is effective and safe in the treatment of HOC.

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Atrial Fibrillation Ablation: Are We Still Looking for the Best Shot?

My Approach to Echocardiography in Radiofrequency Ablation of Hypertrophic Obstructive Cardiomyopathy

Introduction

Reconnection of Pulmonary Veins After Ablation. A Challenge to be Overcome

Contribution of the electrophysiological and anatomical analysis of the atypical atrioventricular nodal tachycardia circuit

Percutaneous transluminal septal alcoholization for the treatment of refractory hypertrophic obstructive cardiomyopathy: initial experience in the Federal District

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