Cardiac Catheters – ABC CARDIOL

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Editorial

The Cold Season Begins in the Tropics. Cryoablation for Atrial Fibrillation in Brazil

Pulmonary vein isolation is the cornerstone for atrial fibrillation ablation. The onset of fibrillation episodes by rapid firing of atrial tachycardias originating from these structures is well documented. The elimination of these triggers by electrical isolation of the pulmonary vein antrum is associated with better arrhythmia control and fewer adverse events, in both the paroxysmal and persistent forms of atrial fibrillation. However, this is not the only mechanism involved, especially in more advanced forms of this arrhythmia. An enormous amount of different ablation techniques has been described to address these other mechanisms. Despite the initial promising results, no other approach has shown effectiveness in large multicenter randomized trials until now.

Obtaining durable pulmonary vein isolation is not a simple task. The standard ablation catheters were designed to ablate a small circumscribed area of cardiac tissue, which is desirable for arrhythmia circuits like Wolff-Parkinson White, but it is a challenge when it is necessary to ablate large areas of complex tridimensional structures, such as the pulmonary vein antrum. The development of non-fluoroscopic navigation, irrigated tips and contact force real-time measurement, among other catheter remarkable improvements, were crucial for the adoption of atrial fibrillation ablation as a routine procedure in clinical electrophysiology. However, ablation with these catheters are still performed by point-by-point lesion deployment.

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ABC

Editorial

One Catheter, Two Coronaries. Haven’t We Seen This Before?

Cesar Rocha Medeiros

Radial access is the default for diagnostic coronariography in many centers and, according to the latest consensus, should be in all.

Over these more than 60 years, coronariography has been performed by several techniques. One of them, ironically the very first one, using just one catheter to canulate both coronaries and enter the left ventricle.

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Image

Crescent Moon Image as a Peculiar Complication During Percutaneous Coronary Intervention of an In-Stent Chronic Total Occlusion

Mohsen Mohandes et al. Jordi Guarinos Cristina Moreno Sergio Rojas Alfredo Bardají

Case

55-year-old male with history of ischemic cardiomyopathy with previous percutaneous coronary intervention (PCI) in the anterior descending coronary artery (LAD) middle segment was admitted to our hospital for chest pains. A new coronary angiogram showed in-stent chronic total occlusion (ISCTO) of LAD receiving collaterals from right coronary artery (RCA). Left circumflex (LCX) was totally occluded and RCA presented a significant mid-segment lesion. Complete percutaneous revascularization was planned. First attempt to recanalize the LAD failed because the lesion obstructed the passage of the balloon, so a second dedicated attempt was planned. Bilateral injection using radial and femoral arteries was used, and a Confianza Pro 9 (Asahi Intecc, Japan) guidewire was progressively advanced through the ISCTO () and the wire’s position in true lumen was verified by contralateral injection. Considering the lesion, which impeded the balloon’s passage, a microcatheter Tornus (Asahi Intecc, Japan) was utilized to penetrate and advance through and past the occlusion (). After balloon predilatation, intravascular ultrasound sonography (IVUS) verified the position of the wire in a very short segment into true lumen, but outside the previously implanted stent (). Several drug eluting stents (DES) were implanted and the artery was successfully recanalized, although a very distal embolization was detected (). A new IVUS examination showed partial crush of the previous stent in the shape of a crescent moon ().

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The Cold Season Begins in the Tropics. Cryoablation for Atrial Fibrillation in Brazil

One Catheter, Two Coronaries. Haven’t We Seen This Before?

Crescent Moon Image as a Peculiar Complication During Percutaneous Coronary Intervention of an In-Stent Chronic Total Occlusion

Case

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)