Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report.
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ABSTRACT:
SUBMITTER: Miyamoto K
PROVIDER: S-EPMC5418567 | biostudies-literature | 2015 May
REPOSITORIES: biostudies-literature
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Parasternal intercostal approach as an alternative to subxiphoid approach for epicardial catheter ablation: A case report.
Miyamoto Koji K Noda Takashi T Aiba Takeshi T Kusano Kengo K
HeartRhythm case reports 20150423 3
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Project description:BackgroundOutcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing.ObjectiveWe sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF.MethodsWe enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding-persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients' symptom status during follow-up.ResultsThe stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis.ConclusionA single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.
| S-EPMC8457187 | biostudies-literature
Project description:Radiofrequency (RF) catheter ablation is the treatment of choice in patients with accessory pathways (APs) and Wolff-Parkinson-White syndrome. Endocardial catheter ablation has limitations, including the inability to map and ablate intramural or subepicardial APs. Some of these difficulties can be overcome using an epicardial approach performed through the epicardial venous system or by percutaneous catheterisation of the pericardial space. When a suspected left inferior or infero-paraseptal AP is refractory to ablation or no early activation is found at the endocardium, a transvenous approach via the coronary sinus is warranted because such epicardial pathways can be in close proximity to the coronary venous system. Associated congenital abnormalities, such as right atrial appendage, right ventricle diverticulum, coronary sinus diverticulum and absence of coronary sinus ostium, may also hamper a successful outcome. Percutaneous epicardial subxiphoid approach should be considered when endocardial or transvenous mapping and ablation fails. Epicardial mapping may be successful. It can guide and enhance the effectiveness of endocardial ablation. The finding of no epicardial early activation leads to a more persistent new endocardial attempt. When both endocardial and epicardial ablation are unsuccessful, open-chest surgery is the only option to eliminate the AP.
| S-EPMC5522715 | biostudies-other
Project description:BackgroundAcute post-ablation pericarditis is the most common complication of epicardial ablation of ventricular arrhythmias, while regional pericarditis following an initially uneventful endocardial catheter ablation (CA) procedure is a rare and elusive diagnosis.Case summaryWe report a case of a 66-year-old Russian female who developed chest pain accompanied by electrocardiogram (ECG) changes-biphasic T waves in V1-V4 leads after an initially uncomplicated premature ventricular complex CA procedure. After examination and investigations, including transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMR) and cardiac computed tomography (CCT), she was diagnosed with regional pericarditis, which occurred even though the ablation was uneventful with the limited number of radiofrequency applications. Furthermore, the diagnosis was difficult due to normal body temperature and the absence of pericardial effusion and myocardial abnormalities on TTE, findings that are not characteristic of pericarditis. The patient's last office visit was in 6 months after the procedure. Neither patient had any complaintsnor there were any changes on ECG and TTE.DiscussionRegional post-ablation pericarditis is a relatively rare type of post-cardiac injury syndrome (PCIS). The varying severity of the PCIS clinical course makes the diagnosis of post-ablation pericarditis initially difficult, especially in patients undergoing an uneventful CA procedure. Non-invasive imaging modalities as CMR and CCT should be considered initially in elusive cases of PCIS.
| S-EPMC8751802 | biostudies-literature
Project description:BackgroundAn endocardial radiofrequency ablation is a common approach for the treatment of idiopathic ventricular arrhythmia. However, rare cases have been reported in which ventricular arrhythmia could not be ablated from endocardium due to an epicardial origin of the arrhythmia.Case summaryIn this article, we describe the rarely used, but acceptable approach to terminate ventricular arrhythmias in the summit of the left ventricle. We present a case of a 56-year-old patient with sustained monomorphic premature ventricular complexes, originating from the summit of the left ventricle, that were successfully eliminated. After unsuccessful ablation of the anterior wall right ventricular outflow tract, left coronary cusp, and distal coronary sinus, arrhythmia was eliminated by method of transvenous ethanol ablation. Complaints, such as palpitations and weakness, resolved after the procedure.DiscussionThis approach is used when an epicardial location of the substrate of arrhythmia is suspected and ablation through the right ventricular outflow tract, left coronary cusp, and great cardiac vein fails. The total effectiveness of eliminating ventricular arrhythmia increases if it is possible to use endo- and epicardial methods of mapping and ablation. In clinics with extensive experience in this area, ethanol ablation of epicardial ventricular arrhythmia is safe and effective.
| S-EPMC7793234 | biostudies-literature
Project description:Atrial flutter (AFL) is the second most common atrial tachyarrhythmia after atrial fibrillation. Catheter ablation (CA) for typical AFL is well-established and has a high success rate and adequate safety. However, sick sinus syndrome (SSS) occasionally occurs when long-term, persistent AFL is terminated by ablation. Sinus node function cannot be assessed during AFL, and the preoperative prediction of underlying SSS has not yet been investigated. When this situation occurs, pacemaker implantation is often necessary. Here, we report a case of SSS after persistent AFL CA.
| S-EPMC10023878 | biostudies-literature
Project description:BackgroundAtrial infarction, usually concurrent with ventricular infarction, is under-recognized. Although most patients with atrial infarction have complicated supraventricular tachyarrhythmias, its mechanism is still unknown. We report a case of atrial tachycardia (AT) related to atrial infarction treated with catheter ablation.Case summaryA 51-year-old man was referred for acute chest pain. Electrocardiography showed a junctional rhythm with ST depression in the precordial leads. Emergency coronary angiography revealed an occluded dominant left circumflex coronary artery (LCX). A drug-eluting stent was deployed; however, the atrial branch from the distal side of the LCX was jailed by the stent and became occluded. On the 7th day, the premature atrial contractions (PACs) became frequent and changed to AT. Owing to its resistance to medication, we performed catheter ablation. The electro-anatomical map revealed counter-clockwise macro-reentrant tachycardia at the tricuspid valve annulus, with low-voltage and fragmented potential (FP) areas at the posterior wall of the right atrium (RA). After terminating the AT through linear ablation for the cavotricuspid isthmus, multiple-focus PACs originating from the FP area in the RA posterior wall were documented. Coronary angiography revealed that these damaged areas were perfused by the atrial branch of the LCX. Defragmentation in the FP area could eliminate PACs. The patient was discharged with sinus rhythm and without any complications.DiscussionWe can perform electro-anatomical mapping to identify tachycardia circuit and PACs arising from the FP area in the posterior RA, where the atrial branch was perfusing. Multiple PACs from infarcted myocardium result in tachycardia.
| S-EPMC9425842 | biostudies-literature
Project description: Not available
| S-EPMC10755214 | biostudies-literature
Project description:IntroductionVentricular perforation during radiofrequency ablation of ventricular tachycardia is a recognized serious complication that carries high morbidity and mortality. Perforation is often associated with local intramyocardial injury due to excess heat induced by catheter, 'steam pop'. The complication usually requires emergency surgical repair.Case presentationWe present a case, when the catheter found its way into the epicardium during left ventricular (LV) electroanatomic mapping without any serious complication. Angiography through the ablation catheter confirmed the diagnosis of LV coronary sinus fistula.DiscussionContrast injection through the irrigation port of the ablation catheter is a useful way of delineating anatomical anomalies during electrophysiology procedure.
| S-EPMC6426018 | biostudies-literature
Project description:IntroductionVideo-assisted thoracoscopic sleeve lobectomy is safe and feasible for lung cancer. We describe a case of video-assisted thoracoscopic sleeve lobectomy via a novel single intercostal space (SIC) three-port approach.ConclusionsThis case demonstrates that a SIC three-port thoracoscopic approach is effective in sleeve lobectomy, and possesses potential advantages in perioperative pain management and rehabilitation.
| S-EPMC5502186 | biostudies-literature
Project description:RationalePyomyositis is a microbial infection of the muscles and contributes to local abscess formation. Staphylococcus aureus frequently causes pyomyositis; however, transient bacteremia hinders positive blood cultures and needle aspiration does not yield pus, especially at the early disease stage. Therefore, identifying the pathogen is challenging, even if bacterial pyomyositis is suspected. Herein, we report a case of primary pyomyositis in an immunocompetent individual, with the identification of S aureus by repeated blood cultures.Patient concernsA 21-year-old healthy man presented with fever and pain from the left chest to the shoulder during motion. Physical examination revealed tenderness in the left chest wall that was focused on the subclavicular area. Ultrasonography showed soft tissue thickening around the intercostal muscles, and magnetic resonance imaging with short-tau inversion recovery showed hyperintensity at the same site. Oral nonsteroidal anti-inflammatory drugs for suspected virus-induced epidemic myalgia did not improve the patient's symptoms. Repeated blood cultures on days 0 and 8 were sterile. In contrast, inflammation of the soft tissue around the intercostal muscle was extended on ultrasonography.DiagnosesThe blood culture on day 15 was positive, revealing methicillin-susceptible S aureus JARB-OU2579 isolates, and the patient was treated with intravenous cefazolin.InterventionsComputed tomography-guided needle aspiration from the soft tissue around the intercostal muscle without abscess formation was performed on day 17, and the culture revealed the same clone of S aureus.OutcomesThe patient was diagnosed with S aureus-induced primary intercostal pyomyositis and was successfully treated with intravenous cefazolin for 2 weeks followed by oral cephalexin for 6 weeks.LessonsThe pyomyositis-causing pathogen can be identified by repeated blood cultures even when pyomyositis is non-purulent but suspected based on physical examination, ultrasonography, and magnetic resonance imaging findings.
| S-EPMC10158914 | biostudies-literature