Five Years of Catheter Ablation Procedures in South-Western Europe: Meta-Analysis of National Registries

Background: Radiofrequency catheter ablation is a well-established approach to treating several types of cardiac arrhythmias. The aim of our study was to provide data on the diffusion of catheter ablation procedures in clinical practice through a meta-analysis of National Registries of electrophysiological procedures performed over a 5-year period, from 2000 to 2005.
Methods: We found only two national registries of catheter ablation procedures published in the journals indexed in PubMed: The Spanish Catheter Ablation Registry and the Portuguese National Registry on Cardiac Electrophysiology. In addition, we included in our analysis the data from the Italian Registry of Electrophysiological Procedures.
Results and Conclusions: This meta-analysis revealed a steady increase in the total number of catheter ablation procedures, particularly for the ablation of atrial flutter, of tachycardia due to double nodal pathways, and of the left atrial substrate in atrial fibrillation. However, the progress of catheter ablation and the impetus for additional research and development of new approaches and technologic advances requires further data on clinical indications, methodologic approach, complications, and long-term success rate in the real world.     

Long-Term Outcomes of CRT-PM Versus CRT-D Recipients

Objective: To compare the rates of all-cause mortality in recipients of cardiac resynchronization therapy devices without (CRT-PM) versus with defibrillator (CRT-D).
Methods: Between February 1999 and July 2004, 233 patients (mean age = 69 ± 8 years, 180 men) underwent implantation of CRT-PM or CRT-D devices. New York Heart Association (NYHA) heart failure functional class II was present in 11%, class III in 69%, and class IV in 20% of patients; mean left ventricle ejection fraction (LVEF) was 26.5 ± 6.5 %, 48% presented with idiopathic dilated cardiomyopathy and 49% with ischemic heart disease. Cox multiple variable regression analysis was performed in search of predictors of death.
Results: The clinical characteristics of the 117 CRT-PM and 116 CRT-D recipients were similar, except for LVEF (28.2 ± 6.2% vs 25.0 ± 6.5%, respectively; P < 0.001), and ischemic versus nonischemic etiology of heart failure (41% vs 56%, respectively P = 0.02). Over a mean follow-up of 58 ± 15 months, no significance difference in overall mortality rate was observed between the two study groups. Male sex, NYHA functional class IV, and atrial fibrillation at implant were significant predictors of death.
Conclusions: There was no difference in long-term survival rate among patients with CRT-D versus CRT-PM, although CRT-D more effectively lowered the sudden death rate. Male sex, NYHA functional class IV, and atrial fibrillation predicted the worst prognosis.     

Sleep Disordered Breathing and Arrhythmia Burden in Pacemaker Recipients

Background: Sleep disordered breathing (SDB), a common condition among patients with permanent pacemaker (PM), is associated with greater incidence of cardiac arrhythmias. Scarce availability of sleep laboratories and the high costs of nocturnal‐attended polysomnography limit the routine screening of patients with PM for SDB. We investigated whether a novel PM that utilizes variations in transthoracic impedance to record the fluctuations in breathing pattern and minute ventilation could be used to screen patients for SDB. Methods: Twenty patients who underwent dual‐chamber PM implantation were studied. The Talent 3 DR PM (SORIN Group Italy S.r.l., Milan, Italy) calculates apnea‐hypopnea index (AHI) by computing minute ventilation signal derived from transthoracic impedance measurements. Within a month after PM implantation, an in‐home respiratory monitoring was performed to evaluate the accuracy of PM‐derived AHI. Patients were followed for mean ± standard deviation, 487 ± 166 days. The PM was checked at each follow‐up visit to retrieve the information about recurrent arrhythmias. Results: Eleven patients were diagnosed with SDB by an in‐home respiratory monitoring. An AHI derived from an in‐home respiratory monitoring was similar to pacemaker‐derived AHI (27 ± 14 vs 16 ± 13 events/hour, P = 0.15). The cumulative incidence of cardiac arrhythmias, including atrial fibrillation, extrasystolic beats, sustained and nonsustained ventricular tachycardia, and supraventricular tachycardia was similar in patients with and without SDB. Conclusion: SDB is highly prevalent in patients with permanent pacemaker. Screening for SDB with Talent 3 DR PM may facilitate diagnosis and treatment of SDB. (PACE 2010; 33:1462–1466)     

Uncommon complication of endoscopic ureterolithotripsy: The stone granuloma

Endoscopic management of urolithiasis is one of the commonest urological procedures today. It is usually safe and effective but one of the possible complications is ureteral obstruction. Stone fragmentation after ballistic lithotripsy and ureteral wall perforation could explain the mechanism responsible for this occurrence. We report a case of stone granuloma, occurring after a ballistic ureterolithotripsy.     

Permanent Mechanical Catheter Ablation of an Accessory Pathway in a Child

Permanent mechanical ablation of an accessory atrioventricular pathway was observed in an infant during intracavitary electrophysiological mapping. The persistent lack of preexcitation was confirmed during a 15-month follow-up period.     

Low Energy Intracardiac Cardioversion of Persistent Atrial Fibrillation

The aims of the study were to verify the efficacy and safety of low energy internal Cardioversion (LEIC) in patients with persistent at rial fibrillation (AF) and to identify the factors affecting the at rial defihrillation threshold (ADT). Forty-nine patients with persistent (lasting ≥ 10 days) AF underwent LEIC. In each patient, two 6 Fr custom-made catheters with large active surface areas were positioned in the coronary sinus (cathode) and the lateral right wall (anode), respectively, for shock delivery, and a tetrapolar lead was placed in the fight ventricular apex for R wave synchronization. Truncated, biphasic (3 ms+3 ms). exponential shocks were used, beginning at 50 V and increasing in steps of 50 V until sinus rhythm had been restored. Mild sedation (diazepam 5 mg IV) was administered to 12 patients. Sinus rhythm was restored in all the subjects with mean voltage and energy levels of 352.0 ± 80.3 V and 8.2 ± 3.4 J, respectively. The ADT in patients pretreated with amiodarone (6.4 ± 1.8 J) was lower than that of patients who had not received any antiarrhythmic drugs (9.2 ± 3.7) (P = 0.04). No ventricular arrhythmias were induced by any of the atrial shocks, and no other complications were observed. During a mean follow-up of 162.9 ± 58.7 days, AF recurred in 21 (43%) patients; 71% of these occurred in the first week after Cardioversion. LEIC is effective in restoring sinus rhythm in patients with persistent AF. The technique seems to be safe and does not require general anesthesia or, in most cases, sedation. Patients pretreated with amiodarone have lower ADTs.     

A population-based study of familial clustering of inflammatory bowel disease in Florence

In the frame of a population-based epidemiological study inthe metropolitan area of Florence in a 15 year period (1978–1992)all prevalent patients affected with ulcerative colitis (UC)or Crohn's disease (CD) (alive and resident in the area at theend of the study) were investigated in order to identify familialclustering. Only 45 patients (5.2%) reported at least 1 relativewith a diagnosis of inflammatory bowel disease (IBD). Amongthese, 25 patients reported a first-degree relative affectedwith IBD (2.9%). All the 28 families were contacted and detailedpersonal interviews were carried out in order to collect familytrees. The affected relatives living outside the study areawere also identified and their IBD diagnoses were verified.Fifteen families included only affected members with a diagnosisof UC; 5 had only CD, while 8 families had members affectedwith both forms. Two large families had 4 affected members and2 other families had 3. Overall 9 parent-child affected pairswere identified (1 out of every 3 families). The high concordancewithin families for the type of disease (p=0.015) suggests thatthe disease susceptibility is specific. The authors discussthese findings and a possible interpretation of the low proportionof familial cases in this area.     

Modulated Parasystole Complicating Permanent Ventricular Pacing: The Different Influence of Spontaneous and Paced Impulses Upon the Parasystolic Rhythm

A case of modulated ventricular parasystole observed in a patient with a VVIM pacemaker is reported. Analysis reveals that the electronic influence (modulation) effected upon the parasystolic focus by the sinus impulses is different from that exerted by the paced impulses. Furthermore, fusion beats reflect an intermediate modulating effect according to the prevalence of the sinus or the paced wavefront.     

Ventricular Parasystole: A Chronobiologic Study

Previous works have reported circadian rhythms for several cardiovascular parameters. A chronobiologic rhythm is characterized by: mesor (a rhythm-determined average), amplitude (half difference between the highest and lowest values), and acrophase (timing of high point in degrees and/or in hours) along with 95% confidence limits. We performed 24-hour ECG Holler monitoring in seven patients (mean age, 50.6 years) with ventricular parasystole (VP) in order to determine whether the chronotropic activity of parasystolic foci has a circadian rhythm similar to that of the sinus node. For each Holter recording parasystolic rates (PRs) and heart rates (HRs) were calculated every hour. Furthermore, a mean hourly PR and a mean hourly HR were calculated from the hourly PRs and HRs of the patients. The statistic chronobiologic analysis was done by single and mean cosinor methods. Correlation between mean hourly PR and HR was evaluated by Pearson's V coefficient. A statistically significant rhythm (P < 0.05) was found for the single and mean rhythms both of HR and PR. In our patients, HR had acrophase at 1.27 P.M., mesor at 73.28 beats/min, and amplitude at 9.53 beats/min, whereas PR had acrophase at 1.42 P.M., mesor al 38.31 beats/min, and amplitude at 3.64 beats/ min. Chronobiological data and the high direct correlation between mean hourly HRs and mean hourly PRs (r = 0.96, P < 0.001) indicate a similar circadian variability of the chronotropic activity of sinus nodes and parasystolic foci. Although several hypotheses can be made, responsiveness of parasystolic foci to circadian variations of the autonomic nervous system tone (sympathetic and/or vagal) and/or circulating substances (particularly catecholamines) seems the more probable one for explaining our findings.