Accelerated idioventricular rhythm during ajmaline test: a case report.

Contains fulltext : 87846.pdf (publisher's version ) (Open Access)We present an unusual transient pro-arrhythmic effect of ajmaline in a patient with resuscitated cardiac arrest and a left ventricular apical aneurysm. We discuss the clinical presentation and the possible physio-pathological explanation for this new pro-arrhythmic effect linked to administration of intravenous ajmaline

Carotid sinus hypersensitivity following radiotherapy delivery in a patient with bilateral glomus jugular tumour

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Ajmaline challenge in young individuals with suspected Brugada syndrome

Item does not contain fulltextBACKGROUND: The clinical characteristics and the results of ajmaline challenge in young individuals with suspected Brugada syndrome (BS) have not been systematically investigated. METHODS: Among a larger series of patients included in the BS database of our Department, 179 patients undergoing ajmaline challenge were included in the study and categorized in two groups according to age: group 1 (/=18 years old). Clinical features and results of the ajmaline challenge of each group were compared. RESULTS: Young individuals were more often asymptomatic compared to adult patients (P = 0.002). They showed a higher number of normal ECGs (P = 0.023), a lower percentage of Brugada type II electrocardiographic pattern compared to the adult population (P = 0.011), and a comparable amount of spontaneous Brugada type III electrocardiographic pattern (P = 0.695). Ajmaline provoked a higher degree of intraventricular conduction delay (P = 0.002) and higher degree of prolongation of the ventricular repolarization phase (P = 0.013) in young individuals but its pro-arrhythmic risk was comparable in the two groups (P = 0.684). Furthermore, inducibility of ventricular arrhythmias in young patients with a positive ajmaline test was comparable to that of the adults with a positive ajmaline test (P = 0.694). CONCLUSIONS: The present study demonstrates the low-risk profile of the ajmaline test in young patients when performed by experienced physicians and nurses in an appropriate environment

Anatomical extent of pulmonary vein isolation after cryoballoon ablation for atrial fibrillation: comparison between the 23 and 28 mm balloons

Item does not contain fulltextBACKGROUND: Pulmonary vein isolation seems to occur in the distal part of the ostium leaving the atrium largely unablated when using the 23 mm cryoballoon catheter ablation for atrial fibrillation. We hypothesize that ablating with the larger 28 mm cryoballoon would target a wider portion of the left atrial cavity. AIM: To compare the anatomical extent of pulmonary vein isolation using electroanatomical mapping when performing atrial fibrillation ablation with a 23 mm or a 28 mm cryoballoon. METHODS: Eight consecutive patients selected for circumferential pulmonary vein cryoballoon isolation for highly symptomatic paroxysmal atrial fibrillation were randomly assigned to ablation with the 23 or 28 mm balloon. After ablation, electroanatomical mapping was performed to compare the anatomical extent of pulmonary vein isolation between the two balloon dimensions. RESULTS: Extent of pulmonary vein isolation significantly differed when the lesions with either balloon dimensions were compared. Pulmonary vein isolation only occurred in the tubular part of the ostium when performed with the 23 mm balloon. Conversely, the lesion created with the 28 mm balloon included a larger portion of the left atrium. In fact, when using the smaller balloon (23 mm) the mean documented extent of electrical isolation was 20.7 +/- 2.8% of the maps' surface, whereas it was 40.2 +/- 3.9% when performing ablation with the bigger balloon (28 mm). The difference in calculated area of electrical isolation between group A and B was statistically significant (P < 0.05). CONCLUSION: Pulmonary vein isolation occurs significantly more proximally in the atrium when performing atrial fibrillation ablation with a 28 mm cryoballoon when compared with a 23 mm balloon

Dissociation between Anterograde and Retrograde Conduction during Transvenous Cryoablation of Parahissian Accessory Pathways

Item does not contain fulltextAblation of parahissian accessory pathways (APs) is a challenging procedure because of the high risk to provoke "iatrogenic" atrioventricular (AV) nodal block. The feasibility and safety of cryoablation (CA) have been already demonstrated both in patients with AV nodal reentry tachycardia and in those with anteroseptal APs. However, dissociation between anterograde and retrograde conduction after CA has not yet been described. We report two cases of CA of parahissian AP associated with transient dissociation between anterograde and retrograde conduction. (PACE 2011; 34:e98-e101)