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• W4249243390 abstract "Removal of chronic leads remains one of the most challenging aspects of long-term pacemaker and implantable cardioverter-defibrillator (ICD) management, and procedural morbidity and mortality remain relatively high compared to other electrophysiology procedures. Singleton et al (DOI: https://doi.org/10.1016/j.hrcr.2019.08.007) shared a case of a 78-year-old man with an ICD due to a history of ventricular tachycardia and high-grade atrioventricular block. He was referred for an elective generator replacement and lead extraction because of a 16-year-old recalled right ventricular lead (St. Jude Medical Riata 1580, St. Paul, MN). Extraction required a laser sheath and a rotating dilator sheath with countertraction to free the lead. Shortly thereafter, the patient developed tamponade and required emergent percutaneous pericardiocentesis (300 mL of blood) for stabilization. In-hospital complications included a stroke and large left pleural effusion. Two weeks later, the patient presented with heart failure and required repeat pleurocentesis (1 L of bloody fluid), and a computed tomography scan revealed a right ventricular apical aneurysm (4.6 × 2.3 × 6.1 cm with a 7-mm neck). An 8-mm Amplatzer ventricular septal defect occluder device (Abbott Medical, Minneapolis, MN) was deployed into the pseudoaneurysm with no residual flow across the neck. The device remained well seated without residual flow in the pseudoaneurysm at 2 months. A pseudoaneurysm after chronic lead extraction is a rare complication that can be life-threatening and typically requires surgical repair. This case highlights an alternative approach for select patients in which surgery is felt not to be an option. Multiple approaches to successfully perform catheter ablation atrioventricular (AV) nodal tachycardia (AVNRT) have been advocated. In children, approaches must accommodate a smaller anatomy, a need to minimize radiation exposure, and to err on procedural safety due to the risks associated over a life with a pacemaker if AV node block develops. One approach is to map low-voltage ridges in the region of the Koch’s triangle to precisely identify arrhythmogenic substrate. Drago et al (DOI: https://doi.org/10.1016/j.hrcr.2019.09.009) shared a case of a 12-year-old boy with typical AVNRT. The procedure was guided by an EnSite Precision navigation system and high-definition grid mapping catheter (Abbott Medical, Minneapolis, MN). The right atrial map contained 1576 points collected in 238 seconds. With this map resolution, they identified 2 small closely spaced areas of low-voltage bridges anterior to the coronary sinus ostium. Cryoablation was performed in this region using a 6-mm-tip catheter with resolution of the arrhythmia as well as dual AV nodal physiology. A repeat transesophageal electrophysiology study 7 months later confirmed the acute result. This case highlights high-resolution mapping of arrhythmogenic substrate in a pediatric patient to focally treated AVNRT. Idiopathic ventricular fibrillation (VF) can be triggered from closely coupled premature ventricular contractions (PVCs) from the left- or right-sided Purkinje network. Catheter ablation can be curative; however, PVCs originating from the moderator band pose a challenge due to anatomy of the region, deep foci with variable exits, and catheter stability. Chinitz et al (DOI: https://doi.org/10.1016/j.hrcr.2019.09.001) shared a case of a 40-year-old woman with recurrent syncope and implantable cardioverter-defibrillator (ICD) shocks due to PVC-triggered VF. During an electrophysiology study, PVCs were mapped to the lateral insertion of the moderator band. Radiofrequency in this region resulted in PVC suppression only and a permanent right bundle branch block. The patient continued to experience recurrent ICD shocks for PVC-triggered VF events despite the ablation procedure, β-blockers, and class 1C and III antiarrhythmic drugs. A second radiofrequency ablation attempt was made using half normal saline unsuccessfully. Then under intracardiac ultrasound guidance, a 23-mm cryoballoon was advanced to the septal region of the moderator band with care to avoid an apical position. Two cryothermal ablation procedures were performed, each 4 minutes, with the lowest temperature −47°C. Afterward, there were no PVCs and the patient has remained free of ventricular arrhythmias and ICD shocks. This case highlights a novel use of a cryoballoon system to deliver broad and deep energy to the moderator band to treat refractory PVC foci." @default.
• W4249243390 created "2022-05-12" @default.
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• W4249243390 date "2019-12-01" @default.
• W4249243390 modified "2023-10-14" @default.
• W4249243390 title "EP News: Case Reports" @default.
• W4249243390 doi "https://doi.org/10.1016/j.hrthm.2019.10.012" @default.
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