[Sudden cardiac death: prevention when is right! From evidence-based medicine to family-based medicine].
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Biomedical subjects
Publications and source records attributed to Luca Paperini.
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A dual-coil defibrillation lead was inserted in a 64-year-old male through a persistent left superior vena cava draining into the coronary sinus. The lead, connected to a cardioverter-defibrillator (ICD) implanted in the left pectoral area, was looped in the right atrium positioning the proximal and distal lead coils in the coronary sinus and right ventricular outflow track respectively and resulting in a low and stable defibrillation threshold. Because of its relative ease and effectiveness, this procedure may be recommended in patients with persistent left superior vena cava requiring an ICD implant.
Radiofrequency ablation inside the coronary sinus (CS) is associated with the risk of vein stenosis, or perforation or damage to the circumflex artery. Cryothermic ablation has proved less harmful, but there are no data on its use within a venous structure. A patient with a posterolateral accessory pathway underwent several unsuccessful attempts at endocardial ablation. Ablation then was performed with cool energy within the CS, where the shortest VA interval and a possible Kent potential were recorded. Selective left coronary angiography showed a normal circumflex artery and the absence of lesions of the CS. Six months later, the patient was asymptomatic without taking antiarrhythmic drugs. We conclude that cryoablation within the CS may be effective and safe.
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