Evaluation of electronic screening in the preoperative process.

Study Objective: Rising patient numbers, with increasing complexity, challenge the sustainability of the current preoperative process. We evaluated whether an electronic screening application can distinguish patients that need a preoperative consultation from low-risk patients that can be first seen on the day of surgery.

Design: Prospective cohort study.

Usefulness of remote magnetic navigation for ablation of ventricular arrhythmias originating from outflow regions.

Monomorphic ventricular tachycardia (VT) and symptomatic monomorphic PVCs originating from the region of the right and left outflow tracts are increasingly treated by radiofrequency (RF) catheter ablation. Technical difficulties in catheter manipulation to access these outflow tract areas, very accurate mapping and reliable catheter stability are key issues for a successful treatment in this vulnerable region. VT ablation from the aortic sinus cusp (ASC) in particular carries a significant risk of perforation, of creating left coronary artery injury and of damage to the aorta and the aortic valve.

Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins.

Introduction: The 28 mm cryoballoon catheter is a device used for pulmonary vein isolation (PVI). The aim of this study was to evaluate the extent of the ablation in the antral regions of the left atrium.

Methods And Results: Eighteen patients with drug refractory, symptomatic, paroxysmal AF were enrolled.

Single-catheter approach for ablation of the slow pathway in a patient with type IV Ehlers-Danlos syndrome and AV nodal reentrant tachycardia using a magnetic navigation system.

Patients with Ehlers-Danlos syndrome type IV have thin-walled, friable arteries and veins. Invasive procedures carry a significantly increased risk for perforation of blood vessels. The aim of this case report is to demonstrate the feasibility and potential benefits of using a stereotactic magnetic navigation system (MNS) for mapping and ablation under these very special circumstances.

Baffle puncture guided by transoesophageal echocardiography in a patient with dextrocardia and Mustard correction.

A baffle puncture is a challenging procedure but can be safely done using direct visualization of the region of interest. To our knowledge, however, it has never been performed in a patient with dextrocardia. We present a 62-year-old male with dextrocardia, right isomerism, congenitally corrected transposition of the great arteries, persistent left-sided superior and inferior caval veins, atrial septum defect, and pulmonary valve stenosis.

Magnetically guided left ventricular lead implantation based on a virtual three-dimensional reconstructed image of the coronary sinus.

Aims: Left ventricular (LV) lead implantation is feasible using remote magnetic navigation of a guidewire (Stereotaxis, St Louis, MO, USA). A novel software that performs a three-dimensional (3D) reconstruction of vessels based on two or more angiographic views has been developed recently (CardiOp-B system, Paeion Inc., Haifa, Israel).

Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters.

Objectives: To compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and cryocatheters.

Methods: Sixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was performed to assess the isthmus.

Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome.

Aims: To assess safety, feasibility and short term outcome of pulmonary vein (PV) isolation in paroxysmal atrial fibrillation (AF) with a cryoballoon.

Methods: We consecutively treated 57 patients with a double lumen 23 or 28 mm cryoballoon. The acute results, complications and follow-up over the first three months were analysed, using a comprehensive and intensive follow-up period.

Effects of stimulation site on diastolic function in cardiac resynchronization therapy.

Background: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) systolic function and clinical status, and prolongs survival of patients suffering from heart failure. An optimal LV site selection is key with respect to improvements in systolic function, though whether a site-specific effect on diastolic function exists is unclear. This study compared the effects of CRT on changes in systolic and diastolic function from 2 LV stimulation sites.

Ten year follow-up after radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia in the early days forever cured, or a source for new arrhythmias?

Background: Radiofrequency (RF) catheter ablation is highly effective with a low complication rate. However, lesions created by RF energy are irreversible, inhomogeneous, and therefore potentially proarrhythmic.

Objectives: The aim of this study was to examine the magnitude and importance of long-term proarrhythmic effects of RF energy.

Sarcoidosis mimicking ischaemic ventricular arrhythmia and pulmonary embolism.

Sarcoidosis is a multisystem granulomatous disorder characterised pathologically by the presence of noncaseating granulomas in the organs involved. Cardiac involvement, although well known, is rare. We describe a 72-year-old patient who was admitted to the intensive care unit after coronary artery bypass grafting.

Long-term follow-up of patients with refractory heart failure and myocardial ischemia treated with cardiac resynchronization therapy.

Studies in patients without coronary artery disease have shown the restoration of glucose metabolism by cardiac resynchronization therapy (CRT) without changes in myocardial perfusion. We report on the long-term outcome of CRT in 24 patients with severe heart failure (HF) and advanced coronary artery disease not amenable for revascularization. All patients had documented myocardial ischemia on stress (99)Tc-sestamibi single-photon emission computed tomography, and all underwent successful implantations of CRT systems.

Repetitive intraoperative dislocation during transvenous left ventricular lead implantation: usefulness of the retained guidewire technique.

Dislocation of the transvenous left ventricular lead has been reported in a substantial number of patients selected for cardiac resynchronization therapy. We describe a novel technique using a retained guidewire in patients with repetitive intraoperative dislocation to stabilize the lead in its final position. Pacing and sensing parameters between patients in whom the retained guidewire technique was used (n = 6) were not significantly different as compared to the group of patients (n = 67) without this technique during a 6-month follow-up.

A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery.

Aim: Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining the Maze III procedure with mitral valve surgery.

The effect of maze operations on atrial volume.

Background: Unmodified maze III operations show long-term eradication of atrial fibrillation (AF) in more than 85% of patients with or without structural heart disease. The effect of this procedure on atrial volumes is not known.

Methods: Two patient populations were studied: (1) patients undergoing unmodified maze III operations combined with surgical structural heart disease, mostly mitral valve operations (group A; n = 32); and (2) patients with only AF selected for unmodified maze III operations (group B; n = 32).

Right atrial modification of maze surgery does not affect refractoriness and conduction patterns of human lone atrial fibrillation.

Background: Tissue mass and structure are relevant for initiation and persistence of fibrillation. Modification of the right atrium during maze surgery may change the arrhythmogenic substrate of atrial fibrillation (AF).

Methods And Results: Epicardial mapping was performed in 9 patients undergoing unmodified maze III surgery for lone paroxysmal AF.

Fast and slow narrow complex tachycardia in one patient: two of a kind?

A 35-year-old female was referred to our hospital. For more than ten years, she had had complaints of two types of paroxysmal palpitations, both with a sudden onset. The first type was rapid and often accompanied by light-headedness; the second she described as much less rapid, better tolerated, and often terminated by the Valsalva manoeuvre.

Relation between body surface mapping and endocardial spread of ventricular activation in postinfarction heart.

Introduction: Body surface mapping (BSM) can be used to identify the site of earliest endocardial activation of ventricular tachycardias (VTs). The multielectrode QRS morphology during VT is determined by both the site of earliest activation and the subsequent spread of electrical activation through the ventricles. This study investigated the relationship between the site of earliest endocardial activation, endocardial spread of activation, and the morphology of the multielectrode surface map in patients with remote myocardial infarction.

Successful surgical ablation of sustained ventricular tachycardia associated with mitral valve prolapse guided by a multielectrode basket catheter.

Ventricular tachycardia occurs frequently in patients with mitral valve prolapse. If antiarrhythmic drug therapy fails or mitral valve surgery is indicated, concomitant arrhythmia surgery may be considered. This report describes the first clinical use of an atrial transseptally inserted multielectrode basket catheter, placed across the mitral valve, to guide intraoperative mapping and ablation of monomorphic sustained ventricular tachycardia in association with mitral valve prolapse.

Pace mapping of postinfarction scar to detect ventricular tachycardia exit sites and zones of slow conduction.

Introduction: The exit site and central common pathway of slow conduction are preferred sites to guide radiofrequency ablation of postinfarction ventricular tachycardia (VT). Both require inducibility of VT. In addition, their low amplitude hampers direct recording of potentials generated by activation in pathways of slow conduction.

Brugada syndrome: a case report of monomorphic ventricular tachycardia.

A 56-year-old woman without structural heart disease had an ECG typical of Brugada syndrome. Syncope occurred due to monomorphic VT with left bundle branch block (LBBB) morphology. At electrophysiological study, VT with the same morphology was inducible.

Temporary pacing after His bundle ablation for drug-refractory atrial fibrillation: a risky enterprise?

Aim: In patients with and without a permanent pacemaker His bundle ablation was performed for symptomatic drug-refractory atrial fibrillation. This study was performed to examine the complications of temporary pacing in patients without an already implanted pacemaker.

Methods And Results: Between January 1996 and December 1998, 152 consecutive patients, both referred and our own (non-referred), underwent His bundle ablation for drug-refractory atrial fibrillation.