Complex electrophysiology intervention in a patient with an inferior vena cava filter

Catheter ablation is currently a routine clinical method for the treatment of heart rhythm disorders. The presence of a filter in the lumen of the inferior vena cava represents a mechanical obstruction that may complicate or contraindicate the procedure. Still, there is not enough information available on this topic and there is no research data on the catheter ablation of complex left atrial arrhythmias with a transseptal puncture in the presence of an inferior vena cava filter. Our case report represents a successful complex electrophysiology intervention in both the left and right atria with femoral venous access in a patient with an inferior vena cava filter.     

Persistence of left superior vena cava and focal right atrial tachycardia: Challenges and interventional treatment

We describe the case of a patient with persistence of left superior vena cava and right atrial tachycardia originating between right superior vena cava and crista terminalis. We present the initial suspect of anatomical anomaly, the diagnosis and the interventional treatment of the arrhythmia. Potential challenges and the role of anomalous thoracic veins in promoting rhythm disturbances are also discussed.     

Intrathecal catheterisation after observed accidental dural puncture in labouring women: update of a meta-analysis and a trial-sequential analysis

BackgroundOur meta-analysis from 2013 showed that inserting a catheter intrathecally after an observed accidental dural puncture can reduce the need for epidural blood patch in labouring women requesting epidural analgesia. We updated our conventional meta-analysis and added a trial-sequential analysis (TSA).MethodsA systematic literature search was conducted to identify studies that compared inserting the catheter intrathecally with an epidural catheter re-site or with no intervention. The extracted data were pooled and the risk ratio (RR) and 95% confidence interval (95%CI) for the incidence of post-dural puncture headache (PDPH) was calculated, using the random effects model. A contour-enhanced funnel plot was constructed. A TSA was performed and the cumulative Z score, monitoring and futility boundaries were constructed.ResultsOur search identified 13 studies, reporting on 1653 patients, with a low risk of bias. The RR for the incidence of PDPH was 0.82 (95%CI 0.71 to 0.95) and the RR for the need for epidural blood patch was 0.62 (95%CI 0.49 to 0.79); heterogeneity of both analyses was high. The TSA showed that the monitoring or futility boundaries were not crossed, indicating insufficient data to exclude a type I error of statistical analysis. Contour-enhanced funnel plots were symmetric, suggesting no publication bias.ConclusionsConventional meta-analyses showed for the first time that intrathecal catheterisation can reduce the incidence of PDPH. However, TSA did not corroborate this finding. Despite increasing use in clinical practice there is no firm evidence on which to base a definite conclusion.