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Cardiac dysrhythmia management in the radiology department
Published in William H. Bush, Karl N. Krecke, Bernard F. King, Michael A. Bettmann, Radiology Life Support (Rad-LS), 2017
With 3:1 or 4:1 conduction, ventricular rates may be slow enough for treatment to be unnecessary. For fast ventricular rates with hemodynamic compromise, synchronized cardioversion at low energy (25–50 joules) is the therapy of choice.10,18 For rapid rates without hemodynamic compromise, calcium-channel blockers and beta-blockers can be used.
Cryoballoon ablation beyond pulmonary vein isolation in the setting of persistent atrial fibrillation
Published in Expert Review of Medical Devices, 2022
Vincenzo Miraglia, Antonio Bisignani, Luigi Pannone, Saverio Iacopino, Gian-Battista Chierchia, Carlo de Asmundis
Non-PV triggers initiating AF have been described in up to 10–15% of unselected patients referred for AF ablation, regardless of the AF type [22]. However, their prevalence increased (up to 80%) when extrapulmonary ectopic beats initiating non-sustained runs of atrial tachyarrhythmias are considered [15]. The definition of non-PV triggers has been initially restricted only to those causing AF. However, other investigators have broadened the definition including premature atrial contractions with a requirement for a specific frequency (typically>10/min), that can be a target for ablation. Thus, it is controversial whether premature atrial contractions that do not directly trigger AF need to be ablated to improve outcomes and prevent recurrences [23]. A standard protocol to elicit non-PV triggers has been defined. Specifically, if the patients presents in AF, cardioversion is performed; isoproterenol infusion (starting at 3 μg and incrementing every 3–5 minutes to 6, 12, and 20–30 μg on the basis of the heart rate response) is started; AF is induced with rapid atrial burst and post-cardioversion ectopic atrial beat eliciting AF is targeted [24].
Prolonged care delivery time and reduced rate of electrophysiological procedures during the lockdown period due to Covid-19 outbreak
Published in Expert Review of Medical Devices, 2021
Francesca Menichetti, Martina Nesti, Pasquale Notarstefano, Antonio Fazi, Attilio Del Rosso, Gianluca Solarino, Federica La Pira, Davide Giorgi, Giuseppe Arena, Andrea Rossi, Luca Segreti, Marcello Piacenti, Tiziana Giovannini, Amato Santoro, Ernesto Casorelli, Maria Grazia Bongiorni, Marzia Giaccardi
Number of procedures: a significant decrease in all kinds of procedures for arrhythmias was observed; in particular, external cardioversion (ECV) was reduced from 100 to 21 (−79%), electrophysiological studies (EPS) from 59 to 22 (−63%) and arrhythmia ablations from 234 to 19 (−92%).
Interatrial shunts: technical approaches to percutaneous closure
Published in Expert Review of Medical Devices, 2018
Gianluca Rigatelli, Marco Zuin, Nguyen Tuong Nghia
Despite the fact that transcatheter device closure is a safe and efficient treatment, even in the long term, some procedural complications may occur. Firstly, the use of general anesthesia, which is generally performed in children, is related to the well-known intra-procedural risks. Conversely, adult patients are generally premedicated with conscious sedation or in some cases with deep sedation. However, the diffusion of ICE has drastically limited the use of general anesthesia in these patients, since TEE is not required for the procedure. Moreover, as any other interventional cardiac procedure, vessel or cardiac perforation, pericardial effusion or cardiac tamponade and endocarditis have been rarely reported [54]. The risk of contrast reactions, which could be prevented in most of cases with an adequate prophylactic administration (either oral or intravenous) of an H-1 receptor antagonist or corticosteroids, is generally low. However, the procedure is generally performed electively, so a careful anamnestic evaluation is mandatory to assess potential risk factors for either anaphylactoid or non-anaphylactoidreactions, especially in patients with atopic tendencies. Moreover, patients with a previous history of sickle cell disease, polycythemia, paraproteinemias, diabetes mellitus, chronic kidney disease or in treatment with b-blockers, interleukin-2 or nephrotoxic agents as nonsteroidal anti-inflammatories, methotrexate, aminoglycosides, biguanides and hydralazine, should be adequately prepared before the procedure and administration of contrast medium. Complications related to the vascular access, which are unusual as the vein is a low-pressure district, are still possible. Haematomas are generally self-imitating and rarely require blood transfusions. Similarly, retroperitoneal hematomas have been rarely described for inadvertent arterial puncture. Device embolization or malposition depend on anatomical properties, careful evaluation of the device’s size and expertise of the operator. These adverse events could be managed by surgical retrieval or using an endovascular technique. Arrhythmias are another possible common complication. The most frequently observed is AF which could require pharmacological or electrical cardioversion, followed by atrio-ventricular blocks and paroxysmal supraventricular tachycardia. Ventricular arrhythmias are rare but should promptly managed in the cath-lab.