Ablation of Severe Drug‐Resistant Tachyarrhythmia During Pregnancy

Ablation of Tachyarrhythmia During Pregnancy. Aims: The goal of this study was to describe mapping and ablation of severe arrhythmias during pregnancy, with minimum or no X‐ray exposure. Treatment of tachyarrhythmia in pregnancy is a clinical problem. Pharmacotherapy entails a risk of adverse effects and is unsuccessful in some patients. Radiofrequency ablation has been performed rarely, because of fetal X‐ray exposure and potential maternal and fetus complications. Group and Method: Mapping and ablation was performed in 9 women (age 24–34 years) at 12–38th week of pregnancy. Three had permanent junctional reciprocating tachycardia, and 2 had incessant atrial tachycardia. Four of them had left ventricular ejection fraction ≤45%. One patient had atrioventricular nodal reciprocating tachycardia requiring cardioversion. Three patients had Wolff‐Parkinson‐White syndrome. Two of them had atrial fibrillation with ventricular rate 300 bpm and 1 had atrioventricular tachycardia 300 bpm. Fetal echocardiography was performed before and after the procedure. Results: Three women had an electroanatomic map and ablation done without X‐ray exposure. The mean fluoroscopy time in the whole group was 42 ± 37 seconds. The mean procedure time was 56 ± 18 minutes. After the procedure, all women and fetuses were in good condition. After a mean period of 43 ± 23 months follow up (FU), all patients were free of arrhythmia without complications related to ablation either in the mothers or children. Conclusion: Ablation can be performed safely with no or minimal radiation exposure during pregnancy. In the setting of malignant, drug‐resistant arrhythmia, ablation may be considered a therapeutic option in selected cases. (J Cardiovasc Electrophysiol, Vol. 21, pp. 877‐882, August 2010)     

Comparative Study of Same Sitting Hybrid Coronary Artery Revascularization versus Off‐Pump Coronary Artery Bypass in Multivessel Coronary Artery Disease

Objective: We compared the outcomes of same sitting robotic‐assisted hybrid coronary artery revascularization (HCR) with off‐pump coronary artery bypass grafting (OPCABG) in similar patients with multivessel coronary artery disease. Background: HCR is a novel procedure in selected patients with multivessel coronary artery disease (CAD). Although there are some data on staged HCR, the data on same sitting HCR are limited. Methods: We conducted a prospective study comparing same sitting robotic‐assisted HCR patients (n = 25) to a group of consecutive low to moderate risk OPCABG patients (n = 27) during the study period. HCR patients underwent robotic internal mammary artery takedown followed by OPCABG via minithoracotomy. After confirming graft patency, immediate percutaneous coronary intervention on the nonbypass arteries was performed. Comparative analyses were performed on in‐hospital and 30 day outcomes. Results: The baseline characteristics were similar for both groups including the severity of CAD (Syntax score 33.5+/?8.2 vs. 34.9+/?8.2, P = 0.556). Overall MACE was similar between both groups; however, the HCR group showed improved hospital outcomes with lower need for postoperative transfusions (12% vs. 67%, P < 0.001), and shorter length of hospital stay (5.1+/?2.8 vs. 8.2+/?5.4 days, P < 0.01). Despite lower postoperative costs, the HCR group had higher overall hospital costs due to higher procedural costs ($33,984 +/?$4,806 vs. $27,816+/?$11,172, P < 0.0001). Propensity model analysis showed similar findings. The HCR group showed improved quality of life measures with shorter time to return to work (5.3+/?3.0 vs. 8.2+/? 4.6 weeks, P = 0.01). Conclusions: Same sitting HCR appears to be feasible and may offer superior outcomes to standard OPCABG, further studies are warranted. (J Interven Cardiol 2012;25:460–468)     

Left Atrial Size and Wall Motion in Patients with Permanent Ventricular and Atrial Pacing

KUBICA, J., ET AL.: Left Atrial Size and Wall Motion in Patients with Permanent Ventricular and Atrial Pacing. It is well known that during permanent ventricular pacing atrial arrhythmias and embolic complications occur much more frequently in comparison to permanent atrial or sequential pacing. He-modynamic disturbances caused by ventriculoatrial conduction (VAC) are thought to be responsible for those complications. The aim of this study was to compare the left atrial size and its wall motion in three groups of patients with sick sinus syndrome. Group 1: 58 patients with VVI pacing and VAC observed (22 males, 36 females, aged 31–86, mean 62.3). Group 2: 43 patients with primary AAI pacing (13 males, 30 females, aged 27–74, mean 57.8). Group 3: 13 patients with AAI or DDD replacing the primary VVI mode due to pacemaker syndrome and/or heart failure, all with VAC present during VVI pacing (7 males, 6 females, aged 26–80, mean 59.8). Two-dimensional/M-mode echocardiography was performed in all these patients. In group 1 mean diastolic as well as mean systolic atrial diameters were significantly greater (p < 0.005) and wall motion significantly smaller (p < 0.005) in comparison to the other groups. Left atrial wall motion amounted to only 7.4% of the mean diastolic diameter in this group. Mean left atrial diastolic and systolic diameters and wall motion in patients with pacemakers preserving atrioventricular synchrony (group 2 and group 3) were almost identical and wall motion amounted to about 22% of the diastolic diameter in both these groups. We conclude that ventriculoatrial conduction leads to significant enlargement of left atrium and to the atrial wall-motion decrease. This predisposes to arrhythmias and embolic complications. Changes in atrial size and performance seem to be reversible with restoration of the physiological atrioventricular synchrony.