Background Whether cooling catheters should be preferred for atrial fibrillation (AF) ablation is not yet clear. Methods From April 2005 to October 2006, 991 (74% men) consecutive patients who underwent AF ablation were prospectively enrolled in 10 Italian centers. For the present subanalysis, patients were ranked in the two study groups on the basis of the catheter system chosen: 8-mm tip was used in 86 patients (9% conventional group) and open-irrigated tip in 905 patients (91% cooled group). Results The registry clinical data of both groups showed marked heterogeneity due to the fact that the higher number of patients of the cooled group had longer AF history (4.9 ± 4.1 versus 1.2 ± 1.8 years; P = 0.0001), permanent/persistent AF (41.2 versus 27.9%; P = 0.01), and larger left atrium (LA) size (44.1 ± 6.2 versus 33.4 ± 10.5 mm; P ≤ 0.00001). Moreover, they underwent a longer procedure (207.2 ± 70.8 versus 85.2 ± 58 min; P = 0.00001), with longer fluoroscopy time (36.5 ± 20.1 versus 15.6 ± 12 min; P ≤ 0.0000), and LA roof ablation lines were more frequently added (29.6 versus 3.5%; P < 0.0001). Data were confirmed in the multivariate analysis, in which a longer procedure [odds ratio (OR) 1.018; 95% CI 1.009–1.027; P = 0.0001], added linear lesions (OR 16.847; 95% CI 4.288–66.190; P = 0.0001), and a longer AF history (OR 1.311; 95% CI 1.063–1.616; P = 0.01) continued to characterize the cooled group. Even though the lack of homogeneity of the groups could not render any reliable comparison about safety, we report that the rate of cumulative complications (4.7 versus 3.8%; P = NS), cerebral thromboembolism (0 versus 0.4%; P = NS), pulmonary vein (PV) stenosis (0 versus 0.5%; P = NS), pericardial effusions or tamponade (1.2 versus 1.5%; P = NS), and groin complications (4.7 versus 2.0%, P = NS) was low and similar in both the groups. Conclusion In the present subanalysis, both the systems showed a similar safety procedural profile, though the lack of homogeneity observed in the two study groups could render any straight conclusion as mere speculation. The longer availability and the consequent higher use of open-irrigated catheters technology for LA ablation in Europe could explain the large preference given to the latter system in the present registry.
Objectives: Aim of this prospective study was to compare the long-term follow-up after transisthmic ablation of patients (pts) with preablation lone atria1 flutter (AFL), coexistent atria1 fibrillation (AF), and drug-induced AFL in order to analyse if postablation AF occurrence presented a different clinical course and different predictors in these groups.
Intraoperative left atrial radiofrequency (RF) ablation recently has been suggested as an effective surgical treatment for atrial fibrillation (AF). The aim of this study was to verify the outcome of this technique in a controlled multicenter trial.One hundred three consecutive patients (39 men and 65 women; age 62 +/- 11 years) affected by AF underwent cardiac surgery and RF ablation in the left atrium (RF group). The control group consisted of 27 patients (6 men and 21 women; age 64 +/- 7 years) with AF who underwent cardiac surgery during the same period and refused RF ablation. Mitral valve disease was present in 89 (86%) and 25 (92%) patients, respectively (P = NS). RF endocardial ablation was performed in order to obtain isolation of both right and left pulmonary veins, a lesion connecting the previous lines, and a lesion connecting the line encircling the left veins to the mitral annulus. Upon discharge from the hospital, sinus rhythm was present in 65 patients (63%) versus 5 patients (18%) in the control group (P < 0.0001). Mean time of cardiopulmonary bypass was longer in the RF group (148 +/- 50 min vs 117 +/- 30 min, P = 0.013). The complication rate was similar in both groups, but RF ablation-related complications occurred in 4 RF group patients (3.9%). After a mean follow-up of 12.5 +/- 5 months (range 4-24), 83 (81%) of 102 RF group patients were in stable sinus rhythm versus 3 (11%) of 27 in the control group (P < 0.0001). The success rate was similar among the four surgical centers. Atrial contraction was present in 66 (79.5%) of 83 patients in the RF group in sinus rhythm.Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients. This technique is easy to perform and reproducible. Rare RF ablation-related complications can occur. During follow-up, sinus rhythm persistence is good, and biatrial contraction is preserved in most patients.
Slow pathway ablation in common AVNRT can be complicated by total AV block. When radiofrequency energy is delivered to the posterior aspect of the triangle of Koch, total AV block may be the consequence of the absence of anterograde conduction along the fast pathway or of inadvertent damage to a fast pathway abnormally located close to the slow pathway. To localize the anterogradely conducting fast pathway, the triangle of Koch was pacemapped in 72 patients who underwent the ablation of common AVNRT. In all cases, before ablation the St-H interval was calculated by stimulating the anteroseptal (AS), mid-septal (MS), and posteroseptal (PS) aspect of the triangle of Koch at a rate slightly faster than the sinus rate. In all patients, common AVNRT was induced. In 64 (89%) of 72 patients (group A) the shortest St-H interval was recorded on stimulating the AS region. In six (8%) patients (group B) the shortest St-H interval was recorded on stimulating the MS region. Finally, in two (3%) patients (group C) the shortest St-H interval was recorded stimulating in the PS region. In group C, AH interval, calculated on stimulating in the AS region, was significantly longer than in patients of groups A and B (200 +/- 99 ms vs 64 +/- 18 and 62 +/- 3, respectively). In group A, on stimulating in the AS, MS, and PS regions, the AH interval remained constant in all patients. In contrast, in groups B and C on stimulation in the MS and PS regions, AH interval shortened (in group B from 56 +/- 8 to 27 +/- 37 and 37 +/- 14, respectively; in group C from 200 +/- 99 to 170 +/- 100 and to 137 +/- 109, respectively). In groups A and B, a posteroseptal slow pathway, and in group C, an anteroseptal retrograde fast pathway were successfully ablated without AV block. Pacemapping of the triangle of Koch can help to recognize patients in whom the anterograde conducting fast pathway is abnormally located far from the anteroseptal region or in whom anterograde conduction of the fast pathway is absent. In these cases the risk of AV block can be reduced by performing slow pathway ablation in a site sufficiently far from the site of the anterograde fast pathway or ablating the retrogradely conducting fast pathway.
Abstract Introduction In response to regional requirements and the ever–increasing complexity of the needs of the patients, the UOC Health Professions of the ULSS 2 Marca Trevigiana Company, in collaboration with the team of the Cardiology UOC of the Conegliano Hospital decided, in the year 2022, to start a Field Training project (FSC) oriented towards the implementation of Modular Nursing (MN) in the specific context. Methods The project involved all the staff of the Cardiology, Hemodynamics, and Intensive Care Unit, with the contribution of the Coordinator and the support of the Health Professions Unit. 4 working groups were therefore formed, relating to the User Path in the care setting, Nursing Handover, Management of care–organizational resources and Indicators of the quality of care. Furthermore, we surveyed to collect the perception of the care staff concerning Relationship Time, Clinical Risk, Safety of Professional Action, and Continuity of Care. Results During the process, each working group presented the results of the work developed, which were: the description of the admission and discharge paths, the structuring of a Handover model based on the SBAR method, the definition of standard Care Plans for care cases, the analysis of the data deriving from the collection of defined indicators and the perception of the care staff pre–post implementation of the Care Model. The first data that emerged shows a 26% decrease in phlebitides observed in patients and an average reduction of 4 minutes in the Handover process. Furthermore, the survey conducted shows how nurses, with the introduction of the NM, perceive they have more time for the relationship with patients and family members (42.6%), a reduction (65%) of interruptions in the management of drug therapy, and an improvement in the quality of information given and received during the handover (95.6%) between shifts. Discussion The data collected demonstrates how the implementation of the MN has had positive effects not only on the organizational well–being and the working methods of the assistance staff but has also contributed to better management of assistance needs. Moreover, in this first phase, the increase in the Safety of Care provided emerges, thus, the continuity of care even after discharge.
