BACKGROUND: Perforation during catheter procedures in either the atrium or ventricle is relatively uncommon, but potentially fatal if tamponade ensues. This study analyzes the occurrence and outcomes of cardiac perforation during catheter-based radiofrequency ablation procedures in the left atrium. METHODS: All patients with a periprocedure perforation who have undergone radiofrequency ablation for atrial fibrillation (AF) or tachycardia were included. RESULTS: Of 632 procedures performed from January 1999 to October 2004, 15 (2.4%) were complicated by perforation requiring pericardiocentesis. The perforation site was left atrium in 9 (60.0%), right atrium in 1 (6.7%), and right ventricle in 5 (33.3%). Intracardiac echocardiography was used in 13 (86.7%) and revealed an effusion before overt instability in 11 (73.3%). Thirteen (86.7%) patients developed a blood pressure <60 mmHg. The pressure stabilized in all patients after pericardiocentesis (hypotension to intervention: 10.1 +/- 5.1 minutes). The total blood volume removed was 848 +/- 880 mL (left atrium/right atrium: 1,074 +/- 1,002 vs right ventricle: 396 +/- 266, P = 0.168). Two patients required surgery to close left atrium dome perforations. The ablation was completed in 7 (46.7%) patients. Ten (66.7%) later developed early reoccurrence of AF. All patients were neurologically intact at hospital discharge. During a 1.5 +/- 1.1 year follow-up, AF was eliminated (n = 4) or controlled (n = 1) in 5 (71.4%) patients with complete procedures, and 2 (20.0%) patients underwent successful repeat ablation. CONCLUSION: The incidence of perforation during ablation of the left atrium is low. Most perforations occur in the left atrium; however, few require surgical closure. Although less than with uncomplicated procedures, the majority of patients with complete ablations achieve long-term elimination of AF.

Adult↗

PubMed2003

Advances in imaging for cardiac electrophysiology.

Explore the source record for details and available documents.

Atrial Fibrillation↗

PubMed2002

Noncontact mapping to guide ablation of right ventricular outflow tract tachycardia.

OBJECTIVES: [corrected] The aim of this study was to determine whether noncontact mapping is feasible in the right ventricle and assess its utility in guiding ablation of difficult-to-treat right ventricular outflow tract (RVOT) ventricular tachycardia (VT). BACKGROUND: In patients without inducible arrhythmia, RVOT VT may be difficult to ablate. Noncontact mapping permits ablation guided by a single tachycardia complex, which may facilitate ablation of difficult cases. However, the mapping system may be geometry-dependent, and it has not been validated in the unique geometry of the RVOT. METHODS: Ten patients with left bundle inferior axis VT, no history of myocardial infarction and normal left ventricular function underwent noncontact guided ablation; seven had failed previous ablation and three had received a defibrillator. All noncontact maps were analyzed by a blinded reviewer to determine whether the arrhythmia focus was epicardial and to predict on the basis of the map whether arrhythmia would recur. RESULTS: The procedure was acutely successful in 9 of 10 patients. During a mean follow-up of 11 months, 7 of 9 patients remained arrhythmia-free. Both patients in whom the blinded reviewer predicted failure had arrhythmia recurrence: one due to epicardial origin with multiple endocardial exit sites and one due to discordance between site of lesion placement and earliest activation on noncontact map. CONCLUSIONS: Mechanisms of ablation failure in RVOT VT include absence of sustained arrhythmia, difficulty with substrate localization and epicardial origin of arrhythmia. In this study, noncontact mapping was safely and effectively used to guide ablation of patients with difficult-to-treat RVOT VT.

Adult↗

PubMed2002

Intracardiac echocardiography in the detection of pacemaker lead endocarditis.

At times, infection of pacemaker leads can be difficult to confirm even with transesophageal echocardiography. We describe a patient with pacemaker lead infection where the transesophageal echocardiogram was nondiagnostic, and intracardiac echocardiography made the diagnosis by demonstrating the vegetation on the pacemaker lead. This illustrates a potential role for intracardiac echocardiography in infective endocarditis when transesophageal echocardiography is nondiagnostic.

Echocardiography, Transesophageal↗