Cases reported "Atrial Fibrillation"

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1/168. Congestive heart failure induced by recipient atrial tachycardia conducted to the donor atrium after orthotopic heart transplantation: complete regression after successful radiofrequency ablation.

    We describe the case of a 30-year-old female patient who developed an interatrial tachycardia from the recipient to the donor atrium associated with signs of congestive heart failure 5 years after orthotopic heart transplantation. The patient underwent catheter mapping followed by successful radiofrequency (RF) ablation at the site of the presumed electrical connection between the recipient and the donor atria, through the interatrial surgical suture line, with stable recovery of sinus rhythm and disappearance of signs of left ventricular dysfunction. RF catheter ablation is confirmed to be feasible and safe in the treatment of heart transplant patients even in the presence of rare forms of arrhythmias, thus offering a cure for tachycardia to these patients.
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2/168. Right posterior atrioventricular ring: a location for different types of atrioventricular accessory connections.

    We present an unusual case of a 28-year-old female patient with recurrent episodes of tachycardias due to participation of two accessory connections located in the posterior tricuspid annulus. Both connections were of the atrioventricular type, the one with non decremental fast conducting properties at the right posteroseptal area, the other with node-like properties at the posterolateral tricuspid ring. Both pathways were successfully ablated transvenously with radiofrequency energy application at the same session. Implications about a common embryological origin of the two pathways as well as review of the literature for similar cases are presented.
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3/168. Symptomatic atrioventricular dual pathway double responses: a role for slow pathway ablation.

    Two patients with symptomatic fast/slow pathway double responses were evaluated with electrophysiology studies. Chronic palpitations were resistant or worsened by medical therapy. No reentry tachycardias were induced. A nonreentrant paroxysmal supraventricular tachycardia was documented. Radiofrequency ablation of the slow pathway was safely and successfully performed. patients remain asymptomatic for 16-18 months. Ablation of the slow pathway for this substrate is a viable option.
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4/168. atrial fibrillation following cardiac surgery.

    Atrial arrhythmias are the most common complication of cardiac surgeries, occurring in 30% of patients undergoing coronary revascularization and 60% of patients having valvular surgeries. The most frequently occurring atrial arrhythmia, atrial fibrillation (AF), not only causes uncomfortable palpitations, but has also been shown to increase postoperative hospital length of stay and morbidity, including hemodynamic compromise and stroke. Both the frequency and the potential consequences of AF make prevention and early intervention important aspects in the postoperative care of cardiac surgery patients.
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5/168. Radiofrequency catheter ablation of atrial fibrillation initiated by pulmonary vein ectopic beats.

    Ectopic beats from the pulmonary veins (PVs) have been demonstrated to initiate atrial fibrillation (AF). This article describes the conceptual approach to mapping, interpretation of different electrograms, and ablation of AF initiated by PV ectopic beats.
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6/168. Transient appearance of antegrade conduction via an AV accessory pathway caused by atrial fibrillation in a patient with intermittent wolff-parkinson-white syndrome.

    A 55 year old man with intermittent Wolff-Parkinson-White (WPW) syndrome had an episode of atrial fibrillation (AF) that lasted for 117 days. After interruption of the AF a Delta wave appeared that lasted for two days and then disappeared. exercise stress and isoprenaline infusion could not reproduce the Delta wave, but after another episode of AF which lasted for seven days a persistent Delta wave appeared that lasted for six hours. In an electrophysiological study performed on a day without a Delta wave, neither antegrade nor retrograde conduction via an accessory pathway was seen, but after atrial burst pacing (at 250 ms cycle length) for 10 minutes, a Delta wave appeared lasting for 16 seconds. Atrial electrical remodelling-that is, the shortening of the atrial effective refractory period caused by AF, is a possible mechanism of the appearance of the Delta wave.
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7/168. Exit block of focal repetitive activity in the superior vena cava masquerading as a high right atrial tachycardia.

    An unusual case of atrial tachycardia (AT) originating from the superior vena cava (SVC) is reported. A 34-year-old man without structural heart disease underwent catheter ablation for drug-resistant AT. During the tachycardia, low-amplitude spiky electrograms with a cycle length of 120 to 175 msec were recorded in the SVC and exhibited 2:1 exit block to the atria, masquerading as the atrial activation observed with high right AT. These spiky electrograms also were observed during sinus rhythm, but they appeared immediately after the local atrial electrograms. The spikes were traced to a point 3 cm above the junction of the right atrium. Radiofrequency ablation at the site of the earliest appearance of the spike in the SVC successfully eliminated the tachycardia. During the following 15 months, no clinically significant atrial arrhythmias, including atrial fibrillation, occurred. This report indicates that careful mapping, including inside the SVC, will be a requisite in patients with high right atrial tachyarrhythmias.
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8/168. Focal ablation of chaotic atrial rhythm in an infant with cardiomyopathy.

    Chaotic atrial rhythm in infants has been defined similar to multifocal atrial tachycardia in adults, implying a multifocal etiology. However, its ECG appearance resembles atrial fibrillation, which sometimes has a unifocal ectopic mechanism amenable to catheter ablation. Curative focal radiofrequency ablation was performed in a 4-month-old infant with chaotic atrial rhythm and dilated cardiomyopathy. Left ventricular function subsequently returned to normal. Reversibility of associated cardiomyopathy supports aggressive rhythm management of chaotic atrial rhythm. In this patient, the unifocal origin allows insight into the pathophysiology of the rhythm and demonstrates the potential utility of catheter ablation for refractory cases.
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9/168. Pulmonary vein stenosis complicating catheter ablation of focal atrial fibrillation.

    INTRODUCTION: A recently described focal origin of atrial fibrillation, mainly inside pulmonary veins, is creating new perspectives for radiofrequency catheter ablation. However, pulmonary venous stenosis may occur with uncertain clinical consequences. This report describes a veno-occlusive syndrome secondary to left pulmonary vein stenosis after radiofrequency catheter ablation. methods AND RESULTS: A 36-year-old man who experienced daily episodes of atrial fibrillation that was refractory to antiarrhythmic medication, including amiodarone, was enrolled in our focal atrial fibrillation radiofrequency catheter ablation protocol. The left superior pulmonary vein was the earliest site mapped, and radiofrequency ablation was performed. atrial fibrillation was interrupted and sinus rhythm restored after one radiofrequency pulse inside the left superior pulmonary vein. atrial fibrillation recurred and a new procedure was performed in an attempt to isolate (26 radiofrequency pulses around the ostium) the left superior pulmonary vein. Ten days later, the patient developed chest pain and hemoptysis related to severe left superior and inferior pulmonary veins stenosis. Balloon angioplasty of both veins was followed by complete relief of symptoms after 2 months of recurrent pulmonary symptoms. The patient has been asymptomatic for 12 months, without antiarrhythmic drugs. CONCLUSION: Multiple radiofrequency pulses applied inside the pulmonary veins ostia can induce severe pulmonary venous stenosis and veno-occlusive pulmonary syndrome.
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10/168. Elimination of focal atrial fibrillation with a single radiofrequency ablation: use of a basket catheter in a pulmonary vein for computerized activation sequence mapping.

    A focal source for atrial fibrillation (AF) may be found in the first few centimeters of the pulmonary veins. Radiofrequency (RF) ablation may be directed at this source using activation mapping, but if the responsible atrial extrasystoles are infrequent or difficult to map, elimination of the source may require complete electrical isolation of the vein with multiple RF lesions. A new three-dimensional mapping system using a 64-pole basket catheter has been developed recently. We report the use of this system for ablation of focal AF in two patients. Mapping identified foci in the left and right superior pulmonary veins. Each focus was eliminated with a single RF ablation.
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