Circulation. Arrhythmia and electrophysiology
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Circ Arrhythm Electrophysiol · Oct 2013
Arrhythmia phenotype during fetal life suggests long-QT syndrome genotype: risk stratification of perinatal long-QT syndrome.
Fetal arrhythmias characteristic of long QT syndrome (LQTS) include torsades de pointes (TdP) and/or 2° atrioventricular block, but sinus bradycardia, defined as fetal heart rate<3% for gestational age, is most common. We hypothesized that prenatal rhythm phenotype might predict LQTS genotype and facilitate improved risk stratification and management. ⋯ Rhythm phenotypes of fetal LQTS have genotype-suggestive features that, along with heart rate-corrected QT interval duration, may risk stratify perinatal management.
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Circ Arrhythm Electrophysiol · Oct 2013
Renal dysfunction, stroke risk scores (CHADS2, CHA2DS2-VASc, and R2CHADS2), and the risk of thromboembolic events after catheter ablation of atrial fibrillation: the Leipzig Heart Center AF Ablation Registry.
There are limited data on the predictive value of stroke risk scores for thromboembolic events (TEs) after catheter ablation of atrial fibrillation (AF). Our objectives were to report the incidence of TEs after AF ablation in a large contemporary AF ablation cohort and to investigate the impact of renal dysfunction and the value of stroke risk stratification scores (CHADS2, CHA2DS2-VASc, and R2CHADS2) for predicting TE after AF ablation. ⋯ CHADS2, CHA2DS2-VASc, and R2CHADS2 scores were associated with TE risk. The CHA2DS2-VASc score differentiated TE risk in the low-risk strata based on CHADS2 and R2CHADS2 scores and may be superior in the subgroup with AF recurrences.
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Circ Arrhythm Electrophysiol · Aug 2013
The role of implantable cardioverter-defibrillators in patients with continuous flow left ventricular assist devices.
The prognosis for patients experiencing ventricular arrhythmias (VAs) while on continuous flow left ventricular assist device (LVAD) support has not been well elucidated. Accordingly, the role of implantable cardioverter-defibrillators (ICDs) in this patient population remains undefined. ⋯ VAs are common in patients with continuous flow LVADs. Although some episodes may be clinically significant, VAs are not associated with a worse prognosis, and concomitant ICDs in these patients may not reduce mortality.
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Circ Arrhythm Electrophysiol · Aug 2013
Left cardiac sympathetic denervation in long QT syndrome: analysis of therapeutic nonresponders.
Long QT syndrome (LQTS) is a potentially lethal but highly treatable cardiac channelopathy. Treatment options include pharmacotherapy, device therapy, and left cardiac sympathetic denervation (LCSD). Here, we sought to determine the characteristics of LQTS patients who have had ≥1 LQTS-related breakthrough cardiac event (BCE) after LCSD. ⋯ Although a marked reduction in number of cardiac events is usually seen after LCSD, ≈50% of high-risk LQTS patients have experienced ≥1 post-LCSD breakthrough. Therefore, LCSD must not be viewed as curative or as an alternative in implantable cardioverter defibrillator for high-risk patients. Prophylactic LCSD may provide another option to counter a suboptimal quality of life resulting from medication-related side effects.
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Circ Arrhythm Electrophysiol · Aug 2013
Case ReportsSuccessful nonsurgical treatment of esophagopericardial fistulas after atrial fibrillation catheter ablation: a case series.
Esophageal perforations are a rare but devastating complication of atrial fibrillation catheter ablation. Rapid treatment is crucial to avoid permanent disabilities and death. Surgical treatment is considered the treatment of choice. Alternatively, single case reports describe successful esophageal stenting, but others discourage this approach because of fatal consequences. ⋯ An early minimally invasive approach consisting of pericardial drainage and esophageal stenting proved effective in treating patients with esophagopericardial fistulas. However, constant interdisciplinary communication and attention is needed to recognize and manage potential evolving complications promptly.