Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
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Coronary artery spasm has been known to induce ischaemia and ventricular arrhythmias. We present a case of recurrent ventricular fibrillation caused by spasm-associated transmural myocardial ischaemia. During an intra-coronary acetylcholine provocation test, severe coronary spasm could be induced. The patient was treated with a hybrid approach of medication and an implantable defibrillator.
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Catheter-based radiofrequency ablation with pulmonary vein (PV) isolation has emerged as an effective therapy for patients with symptomatic atrial fibrillation. Real-time intracardiac echocardiography with two-dimensional and Doppler colour flow imaging can facilitate left heart ablation procedures. ⋯ It has a critical role for guiding transseptal catheterization, assisting placement of mapping and ablation catheters, and allows for titration of energy delivery. More importantly, it allows identification and potential reduction of procedural complications including damage to intracardiac structures, left atrial thrombus formation, PV stenosis, and pericardial effusion during left heart ablation.
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Clinical Trial
Electrogram-guided substrate ablation with or without pulmonary vein isolation in patients with persistent atrial fibrillation.
Ablation of complex fractionated atrial electrograms (CFAEs) is a new approach for the treatment of atrial fibrillation (AF). The purpose of the study was to assess the efficacy of CFAE ablation as a stand-alone strategy in patients with persistent AF and to compare it with a combined approach of CFAE ablation and pulmonary vein isolation (PVI). ⋯ Ablation of CFAE as a stand-alone ablation strategy seems insufficient for the treatment of patients with persistent AF. Pulmonary vein isolation plus CFAE ablation significantly increases the mid-term success rate.