Antiarrhythmic Drug Therapy after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation

Objectives: The use of antiarrhythmic drugs after ablation is a controversial issue when evaluating the efficacy of atrial fibrillation (AF) ablation. This study compares in a prospective and randomized fashion the impact of an antiarrhythmic drug in preventing AF recurrence after AF ablation.
Methods: From February 2004 to May 2005, 107 consecutive patients (mean age 57 ± 10 years, 69 men), with paroxysmal (60%) or persistent (40%) drug refractory AF, were randomly assigned to ablation alone (Group A, 53 patients) or combined with the best antiarrhythmic therapy, preferably amiodarone (Group B, 54 patients). All patients underwent cavo-tricuspid and left inferior pulmonary vein (PV)-mitral isthmus ablation plus circumferential PV ablation, using a guided electro-anatomical approach. Standard electrocardiograms (ECG), and ambulatory and transtelephonic ECG monitoring were used to assess AF recurrences. Recurrences during the first month after ablation were excluded from this analysis.
Results: At 12 months of follow-up, no significant difference was observed in the rates of AF recurrences between Group A (18/53 patients, 34%) and Group B (16/54 patients, 30%). The percentage of patients with ≥1 asymptomatic AF episode was higher in Group B than in Group A (10/16 patients, 63%, vs 5/18 patients, 28%, P = 0.04).
Conclusions: Continuing antiarrhythmic drug therapy in patients who undergo catheter ablation for AF did not lower the rate of AF recurrences. Antiarrhythmic drugs increased the proportion of patients with asymptomatic AF episodes.     

Coexistence of Complete Infra-Hisian Block, WPW Syndrome and Mobitz Type II Kent Bundle Block

MOSSUTI, E., ET AL.: Coexistence of Complete Infra-Hisian Block, WPW Syndrome and Mobitz Type II Kent Bundle Block. A 65-year-old patient with a chief complaint of syncope had an ECG with ventricular preexcitation and intermittent second-degree atrioventricular [AV] block. AV conduction was maintained by the accessory pathway only, with no evidence of AV nodal conduction. Electrophysiological study demonstrated that the QRS duration and morphology did not increase with atrial pacing; however, A-H prolongation occurred with increased pacing rates.     

Thorax Percutaneous Approach for Epicardial Ventricular Ablation in a Patient with Electrical Storm

Subxiphoid puncture is considered the standard approach for epicardial ablation of ventricular arrhythmia, but in some cases this access is impracticable due to the patient's anatomy. We describe the case of a patient with electrical storm and abnormal subdiaphragmatic anatomy that precluded the usual subxiphoid approach. In this patient the pericardial space was gained through a direct thorax puncture at the fifth intercostals space close to the mammary line. The tools and technique utilized in this case were similar to what is usually used for traditional subxiphoid puncture. The thorax percutaneous puncture was successfully carried out without complication.     

ICD Implantation in Noncompaction of the Left Ventricular Myocardium: A Case Report

Isolated noncompaction of the ventricular myocardium (INVM) is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with prominent trabecular meshwork and deep intertrabecular recesses, often associated with systolic dysfunction and ventricular dilatation. A 23-year-old man from Burkina Faso was referred to our operative unit with a diagnosis of INVM, made with echocardiogram and magnetic resonance imaging and nonsustained ventricular tachycardia. The literature reports the incidence of malignant ventricular arrhythmias in as many as 47% of the patients and sudden cardiac death in almost 50% of them and this supported our decision to perform implantable cardioverter-defibrillators implantation.     

Effects of Different Electromagnetic Fields on Circadian Rhythms of Some Haematochemical Parameters in Rats

Objective To investigate the effects of different electromagnetic fields on some haematochemical parameters of circadian rhythms in Sprague-Dawley rats. Methods The study was carried out in 18 male and 18 female rats in good health conditions exposed to 50 Hz magnetic sinusoid fields at the intensity of 1000 μT, 100 μT, and 0 μT （control group） respectively, and in 18 male and 18 female rats in good health conditions exposed to 1.8 GHz electromagnetic fields at the intensity of 50 V/m, 25 V/m and 0 V/m （control group）, respectively. Following haematochemical parameters for glucose, triglycerides, and total cholesterol were measured. Results Different effects of electromagnetic fields on circadian rhythms of both male and female rats were observed. Different changes occurred in some haematochemical parameters for glucose, triglycerides, and total cholesterol （P〈0.05）. Conclusion Exposure to different electromagnetic fields is responsible for the variations of some haematochemical parameters in rats.