Publications by authors named "Andres Enriquez"
Background: Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation.
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- * Mapping procedures, especially in regions like the left ventricular ostium and interventricular septum, are essential for pinpointing intramural arrhythmias and planning appropriate ablation strategies.
- * Advanced techniques, such as bipolar ablation or transvenous ethanol injection, may be necessary during ablation, highlighting the importance of comprehensive mapping that includes the coronary venous system.
Article Synopsis
- Advanced bipolar radiofrequency catheter ablation (Bi-RFA) is being studied as a new treatment for patients with ventricular tachycardia (VT) and premature ventricular contractions (PVC) that do not respond to standard unipolar radiofrequency ablation (Uni-RFA).
- A multicenter registry conducted in Europe showed that out of 91 patients treated with Bi-RFA, 74% achieved elimination of clinical VT/PVC, and 78% experienced a significant reduction in PVC burden during follow-up.
- The procedure was found to be generally safe and feasible, though there were some major complications reported, indicating that Bi-RFA could be a valid option for managing refractory VT/PVC
Background: The importance of nonpulmonary vein (PV) triggers for the initiation/recurrence of atrial fibrillation (AF) is well established.
Objectives: This study sought to assess the incremental benefit of provocative maneuvers for identifying non-PV triggers.
Methods: We included consecutive patients undergoing first-time AF ablation between 2020 and 2022.
Article Synopsis
- A study was conducted to evaluate the success and outcomes of electroanatomical-guided cardioneuroablation (EACNA) in treating patients with vagally induced atrioventricular blocks (VAVBs).
- The results showed a high acute procedural success rate of 96.2%, but 14% of patients experienced recurrence of AVB or new syncopal episodes during a follow-up period of approximately 300 days.
- The findings suggest that EACNA is a promising option for patients with VAVB, but further research is needed to explore its effects on daytime symptom burden.
Article Synopsis
- Epicardial access is important during ventricular tachycardia ablation, and the study compares two methods: traditional ConvEpi access and a newer method called EpiCO, which involves puncturing coronary venous branches.
- The study included 153 patients and found that both methods had similar success rates, but ConvEpi was quicker and associated with more complications, especially significant bleeding.
- Overall, EpiCO access showed a decrease in major complications and bleeding compared to ConvEpi, suggesting it might be a safer option for patients.
Background: Catheter ablation of ventricular tachycardia (VT) typically requires radiation exposure with its potential adverse health effects. A completely fluoroless ablation approach is achievable using a combination of electroanatomical mapping and intracardiac echocardiography. Nonetheless, data in patients undergoing VT ablation are limited.
View Article and Find Full Text PDFComparison of anterior mitral line and mitral isthmus line for ablation of mitral annular flutter.
J Cardiovasc Electrophysiol
July 2024
Article Synopsis
- * A study comparing two ablation techniques (anterior mitral line and mitral isthmus line) found that both methods had similar short-term success rates, but the mitral isthmus line resulted in significantly fewer long-term recurrences of atrial flutter.
- * Overall, using a mitral isthmus line for ablation led to better long-term outcomes for patients with MAF, with no serious complications reported in either treatment group.
Establishing the precise mechanism of cardiac arrhythmias in the electrophysiology laboratory is one of the main requisites for a successful and safe ablation. This article provides an organized approach to the differential diagnosis of narrow and wide complex tachycardias based on the analysis of electrical activation patterns, followed by specific pacing maneuvers in each case.
View Article and Find Full Text PDFMapping and Ablation of Premature Ventricular Complexes: State of the Art.
JACC Clin Electrophysiol
June 2024
Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice. Although benign and asymptomatic in most cases, PVCs may result in disabling symptoms, left ventricular systolic dysfunction, or PVC-induced ventricular fibrillation. Catheter ablation has emerged as a first-line therapy in such cases, with high rates of efficacy and low risk of complications.
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- * It focuses on the CNA-FWRD Registry, a multicenter prospective study that compares outcomes between patients receiving standard therapy and those undergoing cardioneuroablation over a follow-up period of three years.
- * The findings aim to provide valuable data on long-term effects, recurrence of symptoms, and overall safety of cardioneuroablation, addressing a gap in existing research which is largely based on retrospective studies.
Background: Catheter ablation of premature ventricular complexes (PVCs) and ventricular tachycardia (VT) from the left ventricular summit (LVS) may require advanced ablation techniques. Bipolar ablation from the coronary veins and adjacent endocardial structures can be effective for refractory LVS arrhythmias.
Objective: The aim of this study was to investigate the outcomes of bipolar ablation performed between the coronary venous system and adjacent endocardial left ventricular outflow tract (LVOT) or right ventricular outflow tract (RVOT).
Background: Cavotricuspid isthmus (CTI) ablation requires permanent bidirectional block to prevent recurrence of typical atrial flutter (AFL). Catheter irrigation with half-normal saline (HNS) produces larger and deeper lesions in experimental models compared with normal saline (NS). This study was performed to compare the clinical efficacy and safety of HNS vs NS irrigation for typical AFL ablation.
View Article and Find Full Text PDFBipolar ablation of ventricular arrhythmias: Step-by-step.
J Cardiovasc Electrophysiol
December 2023
Radiofrequency (RF) ablation of intramural ventricular arrhythmias (VAs) may require advanced ablation techniques to achieve effective energy transfer to the targeted tissue. As an alternative to standard RF ablation, catheter ablation can also be conducted in bipolar configuration when two ablation catheters participate in the RF circuit. This strategy has proved to result in deeper lesion formation and may be effective for eliminating arrhythmias that have been refractory to standard ablation.
View Article and Find Full Text PDFRight atrial collision time (RACT): A novel marker of propensity for typical atrial flutter.
J Cardiovasc Electrophysiol
June 2023
Introduction: The risk of typical atrial flutter (AFL) is increased proportionately to right atrial (RA) size or right atrial scarring that results in reduced conduction velocity. These characteristics result in propagation of a flutter wave by ensuring the macro re-entrant wave front does not meet its refractory tail. The time taken to traverse the circuit would take account of both of these characteristics and may provide a novel marker of propensity to develop AFL.
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- This study looked at how effectively doctors can treat ventricular arrhythmias located deep in the heart's tissue using a procedure called ablation.
- Out of 92 patients with intramural outflow tract PVCs, 75% achieved immediate suppression of the arrhythmias, and the overall burden of PVCs significantly decreased after the procedure.
- The research shows that while it’s challenging to ablate these arrhythmias, many patients benefit from specialized techniques, and about a third may need repeat procedures within the following months.
Swallowing is an uncommon trigger of reflex situational syncope. We discuss the case of a 61-year-old woman who presented without a prior cardiac history complaining of 15 years of dizzy spells and hot facial flushing provoked by the swallowing of solid foods.
View Article and Find Full Text PDFDeductive Electrocardiographic Analysis of Left Ventricular Summit Arrhythmias.
Card Electrophysiol Clin
March 2023
The left ventricular summit is a source of idiopathic ventricular arrhythmias and presents distinct challenges for mapping and ablation. These arrhythmias are typically targeted from the distal coronary venous system or most often from endocardial vantage points such as the left coronary cusp, basal left ventricle or septal right ventricular outflow tract. In this article, we review the electrocardiographic patterns that suggest a possible origin from the left ventricular summit and the features that may help to predict the most likely site of successful ablation.
View Article and Find Full Text PDFFluoroless catheter ablation of atrial fibrillation: a step-by-step workflow.
J Interv Card Electrophysiol
August 2023
Catheter ablation is an important therapeutic strategy for patients with atrial fibrillation (AF). While some critical steps of the procedure have traditionally relied on fluoroscopy, advances in electroanatomic mapping and the growing use of intracardiac echocardiography have made non-fluoroscopic AF ablation a reality. This hands-on review provides an overview on how to perform radiofrequency ablation of AF without the use of fluoroscopy, focusing on technical aspects, new technologies, and troubleshooting.
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