Long-term outcome of right and left atrial radiofrequency ablation in patients with persistent atrial fibrillation

OBJECTIVES: To investigate the clinical outcome of right and left atrial radiofrequency ablation after the first 12 months in patients with drug-refractory persistent atrial fibrillation (AF), and to identify predictors of long-term success. METHODS: We analyzed the clinical outcome of 74 consecutive patients with a follow-up >12 months who underwent right and left atrial ablation for persistent AF. Patients who did not present symptomatic or asymptomatic atrial tachyarrhythmias (AT) lasting >30 seconds after the first 3 months of follow-up were defined responders to pulmonary veins ablation. RESULTS: After a mean follow-up of 20.2 +/- 6.3 months (12-36), 52/74 (70%) patients were deemed responders. AT relapsed within the first 12 months in 19/74 (26%) patients (17 AF and 2 left atrial flutter). Among those patients who did not relapse within the first 12 months, only 3 patients (5%) presented AF after the first year of follow-up. At the multivariate analysis presence of early AT relapse and history of AF >7 years inversely correlated with a successful long-term clinical outcome. CONCLUSION: Right and left atrial ablation, alone or in association with antiarrhythmic drugs, prevented AT relapses in 70% of patients with drug-refractory persistent AF also after the first 12 months. Presence of AT relapse within the first 3 months and history of AF >7 years identified patients with a lower probability of successful long-term clinical outcome.     

Self-inflicted long bone fractures for insurance fraud

International Journal of Legal Medicine - Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of...     

Sudden death in adolescence caused by cardiac haemangioma

Primary tumors of the heart in infants and children are rare. The types of heart tumors in pediatric age groups are generally different from those in adults. Cardiac myxoma is by far the most common tumor in adults, but in infants and adolescents the prevalent tumor of the heart is rhabdomyoma. Among benign cardiac tumors, cardiac hemangiomas are rare and often diagnosed post-mortem due to the lack of specific clinical symptoms and signs.We report a case of sudden death due to cardiac hemangioma in an apparently healthy 15-year-old adolescent. The autopsy revealed a cardiac hemangioma located at the apex of the heart; the histopathological examination showed the tumor was a mixed capillary and arteriolar hemangioma, a very rare type of primary tumor in adolescents.     

Straight screw-in atrial leads "J-post shaped" in right appendage versus J-shaped systems for permanent atrial pacing: a safety comparison

Background and Objectives: The reliability of active‐fixation atrial leads has been compared with that of passive‐fixation leads; comparisons have also been made between straight and J‐shaped screw‐in lead systems. However, few data are available on procedural and short‐term safety. This retrospective study compared the procedural safety of non‐pre‐shaped screw‐in leads with that of passive‐ and active‐fixation J‐shaped leads. Patients and Methods: From January 2004 to January 2010, 1,464 patients underwent new pacemaker/implantable cardioverter‐defibrillator implantation. Of these, 915 (study population) received a passive‐ or active‐fixation pre‐J‐shaped lead, or a straight screw‐in atrial lead; the remaining 549 patients, who received only a ventricular lead, were excluded. The three study groups were: Group S‐FIX (165 patients, 18%), receiving a straight screw‐in atrial lead (postshaped in the right appendage); Group J‐PASS (690 patients, 75.4%), receiving a passive‐fixation J‐shaped atrial lead; and Group J‐FIX (60 patients, 6.6%), receiving an active‐fixation screw‐in J‐shaped atrial lead. Procedural and short‐term complication rates were analyzed up to 3 months postimplantation. Results: One complication occurred in each group (S‐FIX 0.6% vs J‐PASS 0.1% vs J‐FIX 1.6%, P = 0.3, 0.1, and 0.4, respectively, for each comparison). The rate of atrial lead dislodgement was higher in Group J‐PASS than in S‐FIX but not J‐FIX (Group S‐FIX 0 vs Group J‐PASS 16 vs Group J‐FIX 1 dislodgements; P = 0.04 and 0.7, respectively). Conclusion: Straight screw‐in atrial leads, “J‐post shaped” in the right appendage, offer better stability than passive‐fixation J‐shaped leads and display a similarly acceptable safety profile compared with both the J‐shaped systems. (PACE 2011; 34:325–330)     

New-onset diabetes mellitus after kidney transplantation: the role of immunosuppression

BACKGROUND: Complications related to posttransplantation immunosuppressive therapy remain common. New-onset diabetes mellitus after transplantation (PTDM) is a well-recognized complication associated with reduced graft and patient survival. The type of immunosuppression may be responsible for more than two thirds of PTDM. We retrospectively reviewed our experience in a population of 284 kidney transplant recipients, evaluating the incidence of PTDM with regard to the type of immunosuppression. PATIENTS AND METHODS: From January 2001 to December 2005, 284 kidney transplantations were performed using tacrolimus-based (TAC) immunosuppression in 192 patients and a cyclosporine-based (CyA) regimen in 62 patients, whereas 30 patients received sirolimus-based immunosuppression. RESULTS: The overall incidence of PTDM was 4.9%. Among the immunosuppression protocols, 8 patients (4.1%) received TAC and 6 patients (9.6%) received CyA, whereas no patients treated with sirolimus developed PTDM. Graft and patient survival rates were 93% and 100%, respectively. CONCLUSIONS: The overall risk of PTDM with recent immunosuppressive protocols is low, but it is increased among calcineurin inhibitor (CNI)-treated kidney transplant recipients. Sirolimus did not increase the risk of PTDM, allowing potential clinical application in diabetic recipients and in patients affected by PTDM.     

Integration of three-dimensional left atrial magnetic resonance images into a real-time electroanatomic mapping system: validation of a registration method

Background: The alignment of three-dimensional (3D) left atrial images acquired by magnetic resonance (MR) with the anatomical information yielded by 3D mapping systems is one of the most critical issues in image integration techniques for catheter ablation of atrial fibrillation (AF). We assessed the accuracy of a simplified method of superimposing 3D MR left atrial images on real-time left atrial electroanatomic maps (registration).
Methods: MR data on the left atrium in 40 patients with drug-refractory AF were imported into the CartoMerge™ (Biosense Webster, Inc., Diamond Bar, CA, USA) electroanatomic mapping system. Registration was obtained by combining "visual alignment" of one endocardial point and "surface registration" of a limited number of points sampled on the posterior wall of the left atrium. The accuracy of the registration process was assessed through a statistical algorithm incorporated into the CartoMerge™ system, and through the percentage of pulmonary veins (PVs) in which electrical isolation was achieved after anatomical ablation.
Results: The mean registration surface-to-point distance and ablation surface-to-point distance were 1.33 ± 0.96 mm and 1.47 ± 1.15 mm, respectively. Upon completion of the circumferential anatomical ablation around the PVs, electrical PV isolation was confirmed by a multipolar circular mapping catheter in 129 of 146 PVs (89%).
Conclusions: Our registration method, which is mainly based on the surface registration of the posterior wall of the left atrium, enables almost 90% of PVs to be isolated by means of an anatomically based catheter ablation approach.     

Surveillance of Human Papilloma Virus Infection and Cervical Cancer in Kidney Transplant Recipients: Preliminary Data

Introduction

Development of cancer after transplantation has rapidly became one of the leading causes of death in kidney transplant recipients with functioning grafts. Anogenital malignant neoplasms may occur with a 14-fold increased incidence, and human papilloma virus (HPV) infection has been recently identified as the leading cause of cervical carcinoma. We report the preliminary findings of a prospective study that evaluated the incidence of HPV infection and cervical carcinoma in a population of kidney transplant recipients.

Patients and Methods

The study included 35 female recipients of a deceased donor kidney with at least 6 months of follow-up. All patients underwent a cervicovaginal brushing, an HPV DNA test, and a Papanicolaou test.

Results

Twenty-two patients (62.8%) were positive for HPV DNA. Thirteen of 22 HPV DNA-positive recipients (59%) demonstrated a high-risk HPV genotype. No cytologic anomalies were detected in Papanicolaou smears.

Conclusions

These preliminary data demonstrated a high incidence of HPV infection in renal transplant recipients. Most of our recipients exhibited a high-risk HPV genotype, which suggests higher aggressiveness of such infection in immunosuppressed patients. The HPV test is useful to monitor patients at higher risk of anogenital malignant neoplasms by identifying the cytologic anomalies at an earlier stage. This ongoing study will investigate the rate of progression of HPV infection and the clinical patterns of HPV-positive cytologic anomalies in renal transplant recipients.