Journal of cardiovascular electrophysiology
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J. Cardiovasc. Electrophysiol. · Dec 2009
Incidence and predictors of periprocedural cerebrovascular accident in patients undergoing catheter ablation of atrial fibrillation.
Cerebrovascular accident (CVA) is a serious complication of catheter ablation of atrial fibrillation (AF). The incidence and clinical predictors of periprocedural CVA in patients undergoing AF ablation are not fully understood. ⋯ Despite periprocedural anticoagulation and transesophageal echocardiography, we found a 1.4% incidence of periprocedural CVA in AF ablation patients. A CHADS(2) score > or = 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS(2) score of 0.
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J. Cardiovasc. Electrophysiol. · Dec 2009
Atrial fibrillatory wall motion and degree of atrial remodeling in patients with atrial fibrillation: a tissue velocity imaging study.
The atrial fibrillation cycle length (AFCL) and the intracardiac atrial electrogram morphology may be used to characterize atrial fibrillation (AF). However, assessment of these parameters requires an invasive electrophysiological study. We assessed clinical and electrophysiological correlates of noninvasive tissue velocity imaging (TVI) of the right and left atrial myocardial fibrillatory wall motion. ⋯ TVI of the atrial fibrillatory wall motion may enhance noninvasive characterization of atrial remodeling in patients with atrial fibrillation.
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J. Cardiovasc. Electrophysiol. · Oct 2009
Case ReportsTen-year follow-up of cardiac sympathectomy in a young woman with catecholaminergic polymorphic ventricular tachycardia and an implantable cardioverter defibrillator.
Current recommendations for therapy of catecholaminergic ventricular tachycardia (CPVT) include beta blockade and implantable cardioverter defibrillators (ICDs). Patients may experience recurrent arrhythmias, ICD shocks and, rarely, sudden death despite optimal medical therapy. We report a young woman with CPVT who received frequent ICD shocks despite beta blockade, who subsequently underwent cardiac sympathectomy with a dramatic reduction in shocks over 10 years of follow-up.
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J. Cardiovasc. Electrophysiol. · Sep 2009
Selecting the transthoracic defibrillation shock directional vector based on VF amplitude improves shock success.
Termination of ventricular fibrillation (VF) by a defibrillating shock is more likely to occur when the VF amplitude is larger. We hypothesized that a defibrillation shock would achieve higher success if the shock vector was oriented along the largest of the VF amplitudes measured simultaneously in 3 orthogonal ECG leads, and that this axis could be determined near-instantaneously in real time. ⋯ Choosing the defibrillation directional vector based on the largest VF amplitude improved shock success.
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J. Cardiovasc. Electrophysiol. · Sep 2009
Clinical TrialWarfarin is not needed in low-risk patients following atrial fibrillation ablation procedures.
The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low-risk patients. ⋯ Select low-risk patients with a low CHADS2 (0-1) score who undergo left atrial ablation with an aggressive anticoagulation strategy with heparin and use of an open irrigated tip catheter with low CHADS2 scores can safely be discharged following their procedure on aspirin alone.