Mapping and ablation: A worldwide perspective

Currently, many ablative techniques have reported excellent long-term results in restoring and maintaining sinus rhythm among patients with paroxysmal and persistent AF. Catheter ablation of AF should not be performed too late over time when recurrent paroxysmal AF progresses to the persistent or to the permanent form. Among patients with permanent AF, the stepwise approach requires very extensive lesions in both the left and right atrium to obtain the same success rate as reported by CPVA as performed in Milan many years ago. Long-term prospective multicenter randomized studies comparing the impact of medical therapy with catheter ablation strategy on “hard” outcomes such as morbidity and mortality are required to better define the patient population that may mostly benefit from ablation at the lowest risk and acceptable cost.     

A new guidewire for coronary rotational ablation

We report three cases using a new guidewire designed for coronary rotational ablation. The tips are.014 in diameter and available in different degrees of flexibility. The improved torquability of these guidewires may improve the success rate of coronary rotablation in select cases. © 1995 Wiley-Liss, Inc.     

轴支撑消融导管在猪右上肺静脉标测和消融的操控性研究

目的在左房内精准有效操控消融导管是保证心房颤动(简称房颤)消融高效成功的技术关键。我们根据圆规画圆原理设计了新型轴支撑消融导管,本实验拟验证其是否具有精准有效的操控性。方法将同一实验动物先后随机分入实验组和对照组,分别采用轴支撑冷盐水灌注消融导管(轴支撑组)和非轴支撑冷盐水灌注消融导管(非轴支撑组)进行右上肺静脉标测/消融操作。将轴支撑导管的轴支撑钢丝撤回钢丝腔内即成为非轴支撑导管。采用EnSite Velocity~(TM)心脏三维标测系统重建左房及右上肺静脉。实验内容包括导管在右上肺静脉邻近区域的贴靠标测及标测消融两部分。结果 8只动物中,房间隔穿刺致2例动物心包压塞,1例死亡,7例动物完成实验程序。在贴靠标测实验中,轴支撑组完成环肺静脉间断贴靠、环肺静脉连续贴靠和肺静脉前庭放射状线性连续贴靠的操作时间和曝光时间分别显著少于非轴支撑组(P均0.001);在标测消融实验中,完成环肺静脉消融和肺静脉前庭放射状线性消融的操作时间和曝光时间分别显著少于非轴支撑组(P均0.001)。在左房操作过程中,轴支撑组不经意退回右房的次数显著少于非轴支撑组[(0.7±0.8)次vs(5.1±1.3)次,P0.001];轴支撑组从原房间隔穿刺孔再进入左房的时间显著少于非轴支撑组[(1.0±0.2)min vs(5.0±0.9)min,P0.001]。动物解剖未见留置在肺静脉及左房内的导引钢丝表面及导管钢丝腔开口有血栓附着,右上肺静脉内膜未见划痕、撕裂和血栓附着。结论轴支撑消融导管的操控性能明显优于非轴支撑导管。轴支撑导管的移动方向及移动距离易于控制,到位精准,贴靠标测稳定,具有较高的安全性。     

A successful catheter ablation of a ventricular fibrillation

Malignant ventricular arrhythmias are challenging to manage, requiring a multidisciplinary approach. The mechanism, which triggers ventricular fibrillation (VF) associated with ventricular extrasystoles has not been clarified yet, however, abolishing ventricular extrasystoles may stop ventricular fibrillation in these patients. By this case presentation, we aimed to present a successful treatment of an electrical storm (ES), which developed after an acute myocardial infarction, by catheter ablation.     

A NavX-guided ablation of a nodo-fascicular fibre.

The NavX system was used to guide mapping and successful ablation of a reciprocating antidromic tachycardia involving anterograde conduction over a nodo-fascicular fibre and retrograde conduction over the His bundle and AV node. This novel mapping system allowed visualization of the lower insertion site of the nodo-fascicular accessory pathway approximately 1.5-2 cm away from the tricuspid annulus in a three-dimensional reconstruction of the right atrium and right ventricle.