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Minimally Invasive Atrial Ablation Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
The advances in technology since the original maze procedure have facilitated the expansion of a minimally invasive surgical option to many patients with non-paroxysmal AF. Yet despite these advances, none approach the low level of invasiveness of catheter ablation. To evaluate the differences in catheter and surgical ablation for AF, Boersma et al. compared the efficacy and safety of catheter ablation and minimally invasive surgical ablation in 124 patients with drug-refractory AF, left atrial dilatation (>4 cm) and hypertension [22]. AF was paroxysmal (67%), persistent (33%) or long-standing persistent (8%). The surgical ablation consisted of the Dallas lesion set as described by Edgerton. Catheter ablation consisted of wide-area linear antrum ablation with PV isolation guided by circular mapping catheter. Additional lines were made at the discretion of the operator. Patients were followed with ECG and 7-day Holter monitoring at 6 and 12 months. The median length of stay was 5.5 days vs 2 days for surgical or catheter ablation, respectively.
Supraventricular rhythms
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Focal atrial tachycardia should be treated with urgent electrical cardioversion if the patient is haemodynamically unstable. Stable patients may cardiovert with adenosine (in adenosine-sensitive cases), or with beta blockers or non-dihydropyridine calcium channel blockers (verapamil or diltiazem). If digoxin toxicity is the cause of the atrial tachycardia, the digoxin should of course be stopped. Rate control and/or prophylaxis against recurrent paroxysms of atrial tachycardia can be attained using beta blockers or non-dihydropyridine calcium channel blockers. Catheter ablation is also a treatment option in such cases.
Catheter ablation therapy
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Catheter ablation therapy is a growing field within the physician’s armament for treating cardiac arrhythmias. From humble and narrowly prescribed beginnings, this therapy has grown and rapidly expanded to include treatment for a variety of cardiac arrhythmias, with a wide range of varying techniques and equipment. The safety and efficacy of this therapy can only improve as technology continues to expand and develop.
Mexiletine for ventricular arrhythmias in patients with chronic coronary syndrome: a cohort study
Published in Acta Cardiologica, 2022
Giacomo Mugnai, Carla Paolini, Stefano Cavedon, Alessandro Mecenero, Cosimo Perrone, Claudio Bilato
Previous studies have already proven that catheter ablation is able to reduce the rate of ventricular arrhythmias, especially in patients with coronary artery disease. Sapp et al. [8] conducted a multicenter, randomised, controlled trial (VANISH) involving 259 ICD patients with ischaemic cardiomyopathy and refractory ventricular arrhythmias unresponsive to antiarrhythmic drugs. Patients were randomly assigned to receive either catheter ablation or escalated antiarrhythmic drug therapy. During a mean follow-up time of 27.9 ± 17.1 months, the composite primary outcome of death, ventricular tachycardia storm or appropriate ICD shock occurred in 59.1% of patients in the ablation group and 68.5% in the medical treatment group (p = 0.04). Our study investigates patients with a very compromised ischaemic heart disease: most of them (64.7%) showed a severe LVEF reduction, an extensive coronary artery disease (55.9% of the patients had three-vessel coronary disease) and were old (half of the subjects were >75 years old). A part of the subjects in whom catheter ablation was ineffective (n = 8, 23.5%), in the remaining ones (n = 26, 76.5%) catheter ablation was not feasible because of the evidence of polymorphic VT or VF, advanced heart failure and high operative risk.
The challenges of an aging tetralogy of Fallot population
Published in Expert Review of Cardiovascular Therapy, 2021
Jennifer P. Woo, Doff B. McElhinney, George K. Lui
Catheter ablation is well established as an important adjunct therapy for arrhythmias associated with CHD, especially for atrial tachyarrhythmias and refractory ventricular tachycardia. Catheter ablation for focal atrial arrythmias and intra-atrial reentrant tachycardia are extremely effective [74,78]. There are, unfortunately, much less data on the efficacy of atrial fibrillation ablation in CHD. Data on ventricular tachycardia ablation are mixed and limited to small case series. Intracardiac ventricular tachycardia mapping demonstrated macroreentry and slow conducting isthmuses related to tissue in the RVOT around surgical scars, patches and valves, which are sometimes amenable to catheter ablation [74,84]. When Sandhu et al. prospectively performed cryoablation on adults with TOF and inducible ventricular tachycardia during PVR surgery, 45% still had inducible ventricular tachycardia after ablation [87]. Another more promising small case series demonstrated no recurrent arrhythmia an average of 5 years after catheter ablation combined with antiarrhythmic therapy [88].
Etripamil nasal spray: an investigational agent for the rapid termination of paroxysmal supraventricular tachycardia (SVT)
Published in Expert Opinion on Investigational Drugs, 2020
Anthony H. Kashou, Peter A. Noseworthy
Management algorithms and guidelines exist for paroxysmal SVT [3]. Vagal maneuvers (e.g. Valsalva and carotid sinus massage) and/or intravenous adenosine are often first-line interventions to terminate the SVT by blocking or slowing AV nodal conduction. If these are ineffective or not feasible, immediate synchronized cardioversion should be performed in hemodynamically unstable patients – however, this uncommonly needed. In hemodynamically stable patients, intravenous medications (beta blockers or calcium-channel blockers) can be administered. If intravenous drug therapy is ineffective, not tolerated, or not feasible, synchronized cardioversion may be performed. When patients are unable to tolerate or are refractory to drug therapy, catheter ablation remains the mainstay of treatment. However, we do stress that a single episode of SVT is not considered an indication for ablation since recurrence rates vary considerably and some patients may become asymptomatic over time [4].