Heart rhythm : the official journal of the Heart Rhythm Society
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Ebstein's anomaly is associated with a high incidence of atrial and ventricular arrhythmias. The Cone procedure has become an effective hemodynamic intervention for this malformation. In response to two late postoperative sudden deaths in our early institutional Cone experience, a standardized plan for aggressive rhythm evaluation was instituted, including preoperative electrophysiologic studies (EPS) and intraoperative implantable loop recorder (ILR) placement. ⋯ Preoperative EPS has a high diagnostic and therapeutic yield in patients with Ebstein's anomaly undergoing the Cone operation. It is reasonable to recommend EPS as a routine preoperative test for this population.
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Randomized Controlled Trial Comparative Study
Phased RF ablation in persistent atrial fibrillation.
Persistent and long-standing persistent atrial fibrillation (AF) often requires extensive and/or repeat radiofrequency (RF) ablation procedures. ⋯ Catheter ablation of persistent/long-standing persistent AF with the phased RF ablation system is effective with greater reduction of AF compared with MM. More intense anticoagulation strategies, careful attention to catheter placement relative to the pulmonary vein ostia, and elimination of electrode interaction are expected to reduce the risk of stroke, pulmonary vein stenosis, and asymptomatic cerebral emboli.
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Quantitative measures of the ventricular fibrillation waveform at the outset of resuscitation are associated with survival. However, little is known about the course of these measures during resuscitation and how this course is related to outcome. ⋯ Given their prognostic and dynamic qualities, quantitative waveform measures may provide an effective real-time strategy to guide individual treatment and improve survival.
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Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) of ventricular scar has been shown to be accurate for detection and characterization of arrhythmia substrates. However, the majority of patients referred for ventricular tachycardia (VT) ablation have an implantable cardioverter-defibrillator (ICD), which obscures image integrity and the clinical utility of MRI. ⋯ Wideband LGE MRI improves the ability to visualize myocardium for clinical interpretation, which correlated well with EAM findings during VT ablation.