Comparison of single and double vein approaches for His bundle ablation and pacemaker placement for symptomatic rapid atrial fibrillation.

Background: His Bundle ablation (HBA) with permanent pacemaker (PPM) implantation is an effective strategy for controlling heart rate in symptomatic patients with rapid atrial fibrillation (AF), resistant to pharmacologic therapy. The standard double vein (DV) approach involves mapping and HBA from a femoral approach to achieve complete heart block (CHB), while single chamber (SC), dual chamber (DC), or biventricular (BiV) PPM is then placed via a subclavian approach.

Methods: We compared 7 patients with drug-resistant rapid AF who underwent the standard DV approach to 8 patients who underwent a single vein (SV) approach, in which HBA and PPM implantation were performed through the subclavian vein.

Impact of magnesium sulfate on serum magnesium concentrations and intracellular electrolyte concentrations among patients undergoing radio frequency catheter ablation.

Background: We evaluated the impact of intravenous magnesium on intracellular magnesium (iMg) and serum magnesium (sMg) in patients undergoing radio frequency catheter ablation (RFCA) for atrial fibrillation (AF).

Method: Patients with AF received 4g intravenous magnesium sulfate or normal saline in a randomized, double-blinded fashion. Venous blood and buccal cells were collected for evaluation of sMg and iMg at baseline, postinfusion, at the end of ablation procedure and six-hours posttherapy.

The use of protamine after radiofrequency catheter ablation: a pilot study.

Objective: Evaluate the effect of administering intravenous protamine immediately post-radiofrequency catheter ablation (RFCA) on thrombotic and bleeding complications in heparinized patients.

Methods: Heparinized patients that had RFCA for atrial or ventricular arrhythmias at our institution between January 2001 and March 2006 and had a complete data set were included in this cohort evaluation. Patients receiving at least one dose of protamine within 15 min of RFCA were deemed the prophylactic group while those not receiving protamine within 15 min were the control group.

Implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava.

A persistent left superior vena cava was discovered in a 66-year-old man with heart failure undergoing implantation of a biventricular pacing and defibrillator device. An active fixation right ventricular defibrillator lead was placed through a curved guiding catheter. A sub-selection catheter and a guidewire allowed the engagement of a posterior-lateral branch of the coronary sinus, performance of an angiogram without an occlusive balloon, and optimal lead placement.