radiofrequency catheter ablation

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Research Letter

Treating Brugada Syndrome: A Case of Successful Radiofrequency Catheter Ablation

Mirella Esmanhotto Facin et al. Cristiano Faria Pisani Luciana Sacilotto Francisco Carlos da Costa Darrieux … Nelson Samesima Maurício Ibrahim Scanavacca

Introduction

Brugada syndrome (BrS) is a severe health condition characterized by a distinctive electrocardiographic pattern and an increased risk of life-threatening cardiac arrhythmias. Traditional therapy has been limited to implantable cardioverter defibrillators (ICD). In the past two decades, however, radiofrequency catheter ablation (RFCA) has emerged as a valuable treatment option, especially for those ineligible for ICD implantation or who have already undergone appropriate device therapy.^, Nevertheless, reports on medium to long-term success of this procedure are still scarce. We reported herein the case of a symptomatic patient with BrS who underwent RFCA after experiencing an appropriate ICD shock.

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Original Article

Treatment of atrial fibrillation with radiofrequency ablation and simultaneous multipolar mapping of the pulmonary veins

Almino C. Rocha Neto et al. Roberto Lima Farias Angelo A. V. de Paola

OBJECTIVE: To demonstrate the feasibility and safety of simultaneous catheterization and mapping of the 4 pulmonary veins for ablation of atrial fibrillation. METHODS: Ten patients, 8 with paroxysmal atrial fibrillation and 2 with persistent atrial fibrillation, refractory to at least 2 antiarrhythmic drugs and without structural cardiopathy, were consecutively studied. Through the transseptal insertion of 2 long sheaths, 4 pulmonary veins were simultaneously catheterized with octapolar microcatheters. After identification of arrhythmogenic foci radiofrequency was applied under angiographic or ultrasonographic control. RESULTS: During 17 procedures, 40 pulmonary veins were mapped, 16 of which had local ectopic activity, related or not with the triggering of atrial fibrillation paroxysms. At the end of each procedure, suppression of arrhythmias was obtained in 8 patients, and elimination of pulmonary vein potentials was accomplished in 4. During the clinical follow-up of 9.6±3 months, 7 patients remained in sinus rhythm, 5 of whom were using antiarrhythmic drugs that had previously been ineffective. None of the patients had pulmonary hypertension or evidence of stenosis in the pulmonary veins. CONCLUSION: Selective and simultaneous catheterization of the 4 pulmonary veins with microcatheters for simultaneous recording of their electrical activity is a feasible and safe procedure that may help ablation of atrial fibrillation.

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Artigo Original

Type I atrial flutter radiofrequency ablation. Importance of bidirectional line of block in the inferior vena cava tricuspide annulus isthmus

Mauricio Scanavacca et al. Eduardo Sosa José Luis Velarde André D'Ávila … Denise Hachul Basileu Reolão Osvaldo Sanches Márcio Silva Francisco Darrieux

PURPOSE: To determine the clinical importance of a bi-directional line of block demonstration in the inferior vena cava-tricuspid annulus isthmus as an end-point for radiofrequency (RF) atrial flutter (FL) ablation. METHODS: Forty consecutive patients (51±11 years) with type I FL were divided in 2 groups: GI (30 patients) anatomic, non-electrophysiologic isthmus ablation technique (interruption and non-induction FL criteria); and GII (10 patients) anatomic with electrophysiologic evaluation of bi-directional isthmus conduction. The isthmus activation was analyzed before and after anatomic RF ablation with a cateter exploring each side of the line of block, depending on the conduction evaluation (anterograde or retrograde). RESULTS: FL was interrupted and not reinduced in 26/30 (86.6%) GI patients and in 10 (100%) GII patients (p= 0.5558). During follow-up FL recurred in 30% of the patients in both groups. In GII, 6 patients with bi-directional block remained assymptomatic, whereas 3 patients with unidirectional block presented recurrence (p= 0.012). CONCLUSION: Electrophysiologic demonstration of bi-directional line of block in the isthmus is related to long-term success and should be the criterion for interruption of type I atrial FL RF ablation.

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Artigo Original

Pulmonary veins isolation to treat patients with refractory paroxysmal atrial fibrillation: clinical results after a single procedure

Mauricio Scanavacca et al. Raul Sartini Fernando Tondato André d'Ávila … Denise Hachul Francisco Darrieux Sissy Lara Eduardo Sosa

OBJECTIVE: The purpose of this study was to access the clinical outcome of patients submitted to a single procedure of radiofrequency pulmonary veins (PV) isolation to treat refractory paroxysmal atrial fibrillation (AF). METHODS: This study included 49 consecutive patients (36 male; mean age 54±10 years old) who had frequent symptomatic paroxysmal AF refractory to at least three antiarrhythmic drugs. We used a circular decapolar catheter for mapping PVs – left atrial connections and a 4-mm distal tip catheter for ablation (30 W and 50 C), aiming to achieve electrical isolation of 3 -4 PVs. RESULTS: Twenty-five patients (51%) did not present any AF recurrence in a mean follow-up of 12±5 months. Twenty-four (49%) had at least one recurrence during outcome; twenty (83%) of them within the first month after the procedure and four after two to nine months. After introducing antiarrhythmic drugs 15 (63%) patients were under control, 10 were asymptomatic and five complained of sporadic short duration AF episodes. Nine (37%) patients remained very symptomatic despite the use of antiarrhythmic drugs and were referred to a new procedure of PV isolation. No patient presented major complications. At the end of the follow-up, 35 (71%) patients remained in stable sinus rhythm with no AF recurrences after a single procedure, 50% of them without antiarrhythmic drugs. CONCLUSION: Most patients who present symptomatic paroxysmal AF refractory to antiarrhythmic drugs obtain a good clinical control after a single PV isolation procedure.

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Original Article

Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

Niraj Mehta et al. Maria Zildany Pinheiro Távora Noriaki Takeschita Edilberto Figueiredo … Ricardo M. Lourenço Hélio Germiniani Dalton Précoma

OBJECTIVE: To identify useful clinical characteristics for selecting patients eligible for mapping and ablation of atrial fibrillation. METHODS: We studied 9 patients with atrial fibrillation, without structural heart disease, associated with: 1) antiarrhythmic drugs, 2) symptoms of low cardiac output, and 3) intention to treat. Seven patients had paroxysmal atrial fibrillation and 2 had recurrent atrial fibrillation. RESULTS: In the 6 patients who underwent mapping (all had paroxysmal atrial fibrillation), catheter ablation was successfully carried out in superior pulmonary veins in 5 patients (the first 3 in the left superior pulmonary vein and the last 2 in the right superior pulmonary vein). One patient experienced a recurrence of atrial fibrillation after 10 days. We observed that patients who had short episodes of atrial fibrillation on 24-hour Holter monitoring before the procedure were those in whom mapping the focus of tachycardia was possible. Tachycardia was successfully suppressed in 4 of 6 patients. The cause of failure was due to the impossibility of maintaining sinus rhythm long enough for efficient mapping. CONCLUSION: Patients experiencing short episodes of atrial fibrillation during 24-hour Holter monitoring were the most eligible for mapping and ablation, with a final success rate of 66%, versus the global success rate of 44%. Patients with persistent atrial fibrillation were not good candidates for focal ablation.

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Treating Brugada Syndrome: A Case of Successful Radiofrequency Catheter Ablation

Introduction

Treatment of atrial fibrillation with radiofrequency ablation and simultaneous multipolar mapping of the pulmonary veins

Type I atrial flutter radiofrequency ablation. Importance of bidirectional line of block in the inferior vena cava tricuspide annulus isthmus

Pulmonary veins isolation to treat patients with refractory paroxysmal atrial fibrillation: clinical results after a single procedure

Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

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