What Next After Failed Septal Ventricular Tachycardia Ablation?

Ablation of ventricular tachycardia (VT) by conventional radiofrequency ablation can be impossible if the ventricular wall at the targeted ablation site is very thick, as for example the ventricular septum. We present a case of a patient with incessant, non-sustained slow VT originating from the septal part of the lower outflow tracts. Radiofrequency catheter ablation from both ventricles as well as from the anterior cardiac vein were not successful. Both high power radiofrequency ablation and bipolar radiofrequency ablation neither were successfull. Finally, ethanol ablation of the first septal perforator successfully terminated arrhythmia. We discuss the possibilities to overcome failed conventional radiofrequency VT ablation of a septal focus.     

Electrophysiological Features of Atrial Flutter in Cardiac Sarcoidosis: A Report of Two Cases

We report two cases of systemic sarcoidosis with atrial flutter as the clinical manifestation. In one patient, who had symptoms of shorter duration, the arrhythmia was no longer inducible after a course of glucocorticoid therapy. Electroanatomical mapping in the other case revealed patchy fibrosis of the left atrial myocardium and multiple macro-reentrant circuits. Sinus rhythm could be restored with ablation of these reentrant circuits. To our knowledge, this is the first report on the demonstration of atrial scarring in a patient with sarcoidosis using 3-D electroanatomical mapping. These two cases illustrate that the inflammation of atrial myocardium is the primary mechanism of atrial arrhythmias in patients with cardiac sarcoidosis.     

Symptomatic Bradycardia Caused By Premature Atrial Contractions Originating From Right Atrial Appendage

Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation.     

针刺麻醉复合小剂量瑞芬太尼用于甲状腺良性结节消融术的临床疗效观察

目的:探讨小剂量瑞芬太尼复合针刺麻醉在甲状腺良性结节消融术中的麻醉镇痛效果。方法:选取2015年6月至2016年6月在我院进行甲状腺良性结节射频消融术的患者71例,并将其随机分为对照组(n=35)和复合麻醉组(n=36)。对照组患者接受单纯芬太尼麻醉,复合麻醉组患者接受小剂量瑞芬太尼复合针刺麻醉,观察和比较两组患者麻醉前(T0)、麻醉后(T1)、消融术中(T2)、手术结束(T3)时患者的平均动脉压(MAP)、心率(HR)、血氧饱和度(HPO_2)和VAS评分。结果:复合麻醉组患者T2和T3时间点MAP(95.00±6.09,90.86±3.23)(P0.05)、HR值(65.19±3.52,75.03±6.00)均显著低于对照组(P0.05),HPO_2水平(98.78±1.15,97.81±1.47)均显著高于对照组(P0.05),VAS评分(3.25±1.38,1.69±1.43)均显著低于对照组(P0.05)。结论:电针刺激结合小剂量瑞芬太尼复合麻醉用于甲状腺良性结节消融术可有效镇痛并维持较稳定的血压和心率,效果明显优于单纯芬太尼麻醉。     

小剂量米非司酮联合射频消融术治疗子宫肌瘤95例疗效观察

目的探讨小剂量米非司酮对子宫肌瘤的疗效。方法 190例患者随机分为试验组95例和对照组,分别使用米非司酮和射频消融术及单纯使用射频消融术进行治疗,术后随访,观察其疗效。结果所有患者均手术成功,术后均未出现阴道大出血、感染等并发症,均无复发。二组月经量减少、痛经、下腹酸痛坠胀、贫血纠正情况及子宫大小比较,差异有统计学意义。结论与单纯手术相比,米非司酮联合射频消融术治疗子宫肌瘤效果更好。     

Electrical storm: Incidence, Prognosis and Therapy

Implantable defibrillators are lifesavers and have improved mortality rates in patients at risk of sudden death, both in primary and secondary prevention. However, they are unable to modify the myocardial substrate, which remains susceptible to life-threatening ventricular arrhythmias. Electrical storm is a clinical entity characterized the recurrence of hemodynamically unstable ventricular tachycardia and/or ventricular fibrillation, twice or more in 24 hours, requiring electrical cardioversion or defibrillation. With the arrival of the implantable cardioverter-defibrillator, this definition was broadened, and electrical storm is now defined as the occurrence of three or more distinct episodes of ventricular tachycardia or ventricular fibrillation in 24 hours, requiring the intervention of the defibrillator (anti-tachycardia pacing or shock). Clinical presentation can be very dramatic, with multiple defibrillator shocks and hemodynamic instability. Managing its acute presentation is a challenge, and mortality is high both in the acute phase and in the long term. In large clinical trials involving patients implanted with a defibrillator both for primary and secondary prevention, electrical storm appears to be a harbinger of cardiac death, with notably high mortality soon after the event. In most cases, the storm can be interrupted by medical therapy, though transcatheter radiofrequency ablation of ventricular arrhythmias may be an effective treatment for refractory cases.This narrative literature review outlines the main clinical characteristics of electrical storm and emphasises critical points in approaching and managing this peculiar clinical entity. Finally focus is given to studies that consider transcatheter ablation therapy in cases refractory to medical treatment.     

Catheter ablation of ventricular tachycardia originating from the left posterior papillary muscle guided by the shadow of a multipolar catheter

A 62-year-old man without structural heart disease underwent electrophysiological testing for ventricular tachycardia (VT). Hemodynamically unstable VT was induced after isoproterenol (ISP) provocation. Electroanatomical mapping using a multipolar catheter identified the earliest activation originating from the posterior papillary muscle (PPM) where prepotentials preceding the local ventricular electrogram were observed. Irrigated radiofrequency current guided by the shadow of a multipolar catheter eliminated the VT. This case suggested that multipolar catheters may be helpful for identifying tachycardia origins arising from the PPM.