Surgery for permanent atrial fibrillation: impact of patient factors and lesion set.

Background: Whether a complete Cox-maze procedure is needed to ablate permanent atrial fibrillation in patients undergoing concomitant cardiac surgery is unknown. Our objective was to assess the effectiveness of different lesion sets in such patients.

Methods: From November 1991 to January 2004, 575 patients underwent surgical treatment of permanent atrial fibrillation (duration > 6 months); mitral valve disease was the primary indication for surgery in 74%.

Circumferential ultrasound ablation for pulmonary vein isolation: analysis of acute and chronic failures.

Introduction: In patients undergoing circumferential isolation of the pulmonary veins with an ultrasound ablation system, we analyzed the temperatures achieved while delivering circumferential ostial lesions in the pulmonary veins. We also reviewed the angiograms obtained during the procedure and identified anatomic variants that could be responsible for ineffective lesion formation.

Methods And Results: During the early clinical use in 33 patients, a total of 85 veins were ablated.

Usefulness of midodrine in patients with severely symptomatic neurocardiogenic syncope: a randomized control study.

Introduction: The efficacy of midodrine for the management of patients with neurocardiogenic syncope was assessed prospectively in a randomized control study.

Methods And Results: Patients who had at least monthly occurrences of syncope and a positive tilt-table test were included in the study. A total of 61 patients were randomly allocated to treatment either with midodrine or with fluid, salt tablets, and counseling.

First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation.

Background: Standard mapping and ablation of focal sources of atrial fibrillation are associated with very long procedure times and low efficacy. An anatomic approach to complete pulmonary vein isolation could overcome these limitations.

Methods And Results: Fifteen patients with atrial fibrillation refractory to medication underwent circumferential isolation of the pulmonary veins by using a novel catheter, with an ultrasound transducer (8-MHz) mounted near the tip, in a saline-filled balloon.

Performance of implantable defibrillator pacing/sensing lead adapters.

The wide variety of implantable defibrillators (ICDs) available from different manufactures and the lack of universal industry standards has resulted in the frequent need for lead adapters at time of ICD implant or change. We analyzed the performance of 81 consecutive ICD sensing/pacing lead adapters used between 1988 and 1993. A total of 66 adapters was used for new epicardial systems, and 15 adapters served as lead connectors during ICD generator replacement.