Pulsed field ablation (PFA) is a novel nonthermal energy source for catheter ablation, which is potentially useful also for ablation of ventricular arrhythmias since it mitigates the risk of collateral damage to adjacent tissues and may better penetrate through the scar tissue. Solid-tip PFA within the great cardiac vein appears to be advantageous for arrhythmias originating from the left ventricular summit. The use of a large-footprint catheter that toggles between radiofrequency current and PFA may provide an additional advantage since it allows the development of larger lesions to modify myocardial substrate. More experience is expected in the next few years.
- MeSH
- katetrizační ablace * metody MeSH
- komorová tachykardie * chirurgie MeSH
- lidé MeSH
- srdeční arytmie * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- fibrilace komor MeSH
- komorová tachykardie * MeSH
- komorové extrasystoly MeSH
- lidé MeSH
- náhlá srdeční smrt etiologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Management of hypertrophic obstructive cardiomyopathy (HOCM) is often challenging, depending on clinical manifestation. This case report illustrates the complex treatment of HOCM with associated recurrent ventricular arrhythmias. CASE SUMMARY: A 54-year-old female with HOCM diagnosed in 2012 underwent a failed attempt for alcohol septal ablation, implantation of an implantable cardioverter-defibrillator, and repeated radiofrequency ablations (including ablation of the septal bulge to reduce LV obstruction). For ventricular tachycardia (VT) recurrences, she had stereotactic arrhythmia radioablation with subsequent epicardial cryoablation from mini-thoracotomy, and endocardial ablation with pulsed field energy. The situation was finally solved by mechanical support and heart transplantation. DISCUSSION: A few important lessons can be learned from the case. First, radiofrequency ablation was used successfully to decrease left outflow tract obstruction. Second, stereotactic radiotherapy has been used after four previous endo/epicardial catheter ablations to decrease the recurrences of VT. Third, mini-thoracotomy was used after previous epicardial ablation with subsequent adhesions to modify the epicardial substrate with cryoenergy. Fourth, pulsed field ablation of atrial fibrillation resulted in an excellent therapeutic effect. Fifth, pulsed field ablation was also used to modify the substrate for VT, and was complicated by transient AV block with haemodynamic deterioration requiring mechanical support. Finally, a heart transplant was the ultimate solution in the management of recurrent VT.
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Catheter ablation (CA) has become an established treatment strategy for managing recurrent ventricular tachycardias (VTs) in patients with structural heart disease. In recent years, percutaneous mechanical circulatory support (PMCS) devices have been increasingly used intra-operatively to improve the ablation outcome. One indication would be rescue therapy for patients who develop haemodynamic deterioration during the ablation. However, more efforts are focused on identifying subjects who are at high risk of such deterioration and could benefit from the pre-emptive use of the PMCS. The third reason to use PMCS could be the inability to identify diffuse substrate, especially in non-ischaemic cardiomyopathy. This paper reviews available experiences using various types of PMCS in different clinical scenarios. Although PMCS allows mapping during VT, it does not significantly influence acute outcomes and not convincingly long-term outcomes. On the contrary, the complication rate appears to be higher in PMCS cohorts. Our data suggest that even in patients with severe left ventricular dysfunction, the substrate modification can be performed without the need for general anaesthesia and risk of haemodynamic decompensation. In end-stage heart failure associated with the electrical storm, implantation of a left ventricular assist device (or PMCS with a transition to the left ventricular assist device) might be the preferred strategy before CA. In high-risk patients who are not potential candidates for these treatment options, radiotherapy could be considered as a bail-out treatment of recurrent VTs. These approaches should be studied in prospective trials.
- MeSH
- hemodynamika MeSH
- katetrizační ablace * metody škodlivé účinky MeSH
- komorová tachykardie * chirurgie patofyziologie MeSH
- lidé MeSH
- podpůrné srdeční systémy * MeSH
- rizikové faktory MeSH
- srdeční selhání patofyziologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
x
x
- MeSH
- bradykardie chirurgie MeSH
- katetrizační ablace * škodlivé účinky MeSH
- lidé MeSH
- vazovagální synkopa * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- úvodníky MeSH
1. vydání 117 stran : ilustrace (některé barevné) ; 21 cm
Příručka obsahuje odpovědi na nejdůležitější otázky, které se týkají poruch srdečního rytmu. Určeno odborné veřejnosti.; Nepravidelné bušení nebo přeskakování srdce trápí čím dál víc lidí. Kdo tyto potíže někdy zažil, ví, jak nepříjemné a obtěžující můžou být. Jak poznat, že jde jen o neškodnou epizodu, za kterou stojí například vyčerpání, a kdy už svítí červená kontrolka, která oznamuje závažný problém? A jak ho umí moderní medicína řešit? To vše se dozvíte v publikace uznávaného odborníka.
- MeSH
- srdeční arytmie MeSH
- Publikační typ
- příručky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- kardiologie
- NLK Publikační typ
- otázky a odpovědi
AIMS: The interpretation of intracardiac electrograms recorded from conventional electrophysiology recording systems is frequently impacted by powerline (50/60 Hz) noise and distortion due to notch filtering. This study compares unipolar electrograms recorded simultaneously from a conventional electrophysiology recording system and one of two 3D mapping systems (control system) with those from a novel system (ECGenius, CathVision ApS) designed to reduce noise without the need for conventional filtering. METHODS: Unipolar electrograms were recorded simultaneously from nine consecutive patients undergoing catheter ablation for AF (five patients), atrioventricular nodal re-entrant tachycardia (three patients), or ventricular tachycardia (one patient) over the course of 1 week in 2020. RESULTS: The noise spectral power of the novel system (49-51 Hz) was 6.1 ± 6.2 times lower than that of the control system. Saturation artefact following pacing (duration 97 ± 85 ms) occurred in eight control recordings and no novel system recordings (p<0.001). High frequency, low amplitude signals and fractionated electrograms apparent on unfiltered novel system unipolar recordings were not present on control recordings. Control system notch filtering obscured His bundle electrograms observable without such filtering using the novel system and induced electrogram distortion that was not present on novel system recordings. Signal saturation occurred in five of seven control system recordings but none of the novel system recordings. CONCLUSION: In this study, novel system recordings exhibited less noise and fewer signal artefacts than the conventional control system and did not require notch filtering that distorted electrograms on control recordings. The novel recording system provided superior electrogram data not apparent with conventional systems.
- Publikační typ
- časopisecké články MeSH
Závěrečná zpráva o řešení grantu Agentury pro zdravotnický výzkum MZ ČR
nestr.
Srdeční resynchronizační léčba (SRL) je nedílnou součástí léčby pacientů se srdečním selháním a širokým komplexem QRS. Klinické studie prokázaly její schopnost zlepšit kvalitu života léčených pacientů a snížit jejich morbiditu a mortalitu. Přesto nadále kolem 30 % pacientů neodpovídá na SRL očekávaným způsobem. V současné době se rozvíjí techniky stimulace levé komory z více než z jednoho místa, využívající stimulace z více míst jedné elektrody v žíle koronárního sinu (multipoint pacing) nebo ze dvou transvenosních elektrod zavedených do dvou oddělených žil (multisite pacing). Cílem tohoto projektu je detailní analýza elektrofyziologických vlastností a akutní hemodynamické odpovědi u triventrikulární SRL realizované pomocí dvou minimálně invazivně chirurgicky implantovaných levokomorových epikardiálních elektrod u pacientů se sníženou pravděpodobností příznivé odpovědi při použití konvenční SRL.; Cardiac resynchronization therapy (CRT) is an established part of management in patients with heart failure and wide QRS. Clinical studies have demonstrated its capacity to improve quality of life, morbidity and mortality. Nevertheless, around 30% of patients do not respond adequately to CRT. Currently, techniques are under development and investigation of pacing the left ventricle from more than one site within the coronary sinus vein (multipoint pacing) or using two pacing leads inserted in two different veins (multisite pacing). The aim of this project is to evaluate electrophysiological properties and acute hemodynamic response of triventricular CRT with two left ventricular leads introduced via miniinvasive thoracoscopic approach in patients with an increased risk of reduced response to conventional CRT.
- Klíčová slova
- Heart failure, srdeční selhání, Srdeční resynchronizační léčba, Cardiac resynchronization therapy, Srdeční funkce, Cardiac function,
- NLK Publikační typ
- závěrečné zprávy o řešení grantu AZV MZ ČR
- MeSH
- amiodaron terapeutické užití MeSH
- beta blokátory terapeutické užití MeSH
- biologické markery analýza MeSH
- blokáda autonomních nervů metody MeSH
- defibrilátory implantabilní normy MeSH
- ganglion stellatum účinky léků MeSH
- katetrizační ablace MeSH
- lidé MeSH
- náhlá srdeční smrt * etiologie prevence a kontrola MeSH
- srdeční arytmie etiologie komplikace terapie MeSH
- srdeční selhání * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
