Texas Heart Institute Journal Volume 47: Issue 1

We evaluated whether an irrigated contact force–sensing catheter would improve the safety and effectiveness of radiofrequency ablation of premature ventricular contractions originating from the right ventricular outflow tract.

We retrospectively reviewed the charts of patients with symptomatic premature ventricular contractions who underwent ablation with a contact force–sensing catheter (56 patients, SmartTouch) or conventional catheter (59 patients, ThermoCool) at our hospital from August 2013 through December 2015. During a mean follow-up of 16 ± 5 months, 3 patients in the conventional group had recurrences, compared with none in the contact force group. Complications occurred only in the conventional group (one steam pop; 2 ablations suspended because of significantly increasing impedance). In the contact force group, the median contact force during ablation was 10 g (interquartile range, 7–14 g). Times for overall procedure (36.9 ± 5 min), fluoroscopy (86.3 ± 22.7 s), and ablation (60.3 ± 21.4 s) were significantly shorter in the contact force group than in the conventional group (46.2 ± 6.2 min, 107.7 ± 30 s, and 88.7 ± 32.3 s, respectively; P <0.001). In the contact force group, cases with a force-time integral <560 gram-seconds (g-s) had significantly longer procedure and fluoroscopy times (both P <0.001) than did those with a force-time integral ≥560 g-s.

These findings suggest that ablation of premature ventricular contractions originating from the right ventricular outflow tract with an irrigated contact force–sensing catheter instead of a conventional catheter shortens overall procedure, fluoroscopy, and ablation times without increasing risk of recurrence or complications.

The 6-minute walk distance (6MWD) test is a useful prognostic tool in chronic heart failure. Its usefulness after percutaneous coronary intervention is unknown.

In a prospective observational study, patients underwent a 6MWD test within 2 weeks after percutaneous coronary intervention. The primary endpoint was major adverse cardiovascular events (MACE) (death, acute coronary syndrome, and heart failure admission) at one year. Receiver operating characteristic curves and area under the curve were used to determine the 6MWD test's predictive power, and the Youden index was used to measure its effectiveness.

A total of 212 patients were enrolled (98% men; mean age, 65 ± 9 yr). Major comorbidities were hypertension in 187 patients (88%), dyslipidemia in 186 (88%), and diabetes mellitus in 95 (45%). Among the 176 patients (83%) who completed the 6MWD test, the incidence of MACE at one year was 22% (acute coronary syndrome in 17%; heart failure admission in 4%; and death in 3%). The area under the curve for MACE was 0.59, and 6MWD was shorter for patients with MACE than for those without (290 vs 326 m; P=0.03). For 39 patients with previous heart failure who completed the 6MWD test, the area under the curve was 0.64 for MACE and 0.78 for heart failure admission.

The 6MWD test predicted reasonably well the incidence of MACE one year after percutaneous coronary intervention. In a subgroup of patients with previous heart failure, it fared even better in predicting heart failure admission. Larger studies are needed to confirm these findings.

Surgery for complex congenitally corrected transposed great arteries is one of the greatest challenges in cardiovascular surgery. We report our experience with bidirectional Glenn shunt placement as a palliative procedure for complex congenitally corrected transposition.

We retrospectively identified 50 consecutive patients who had been diagnosed with congenitally corrected transposition accompanied by left ventricular outflow tract obstruction and ventricular septal defect and who had then undergone palliative bidirectional Glenn shunt placement at our institution from January 2005 through December 2014. Patients were divided into 3 groups according to subsequent surgeries: Fontan completion (total cavopulmonary connection, 13 patients) (group 1), anatomic repair (hemi-Mustard and Rastelli procedures without Glenn takedown, 11 patients) (group 2), and prolonged palliation (no further surgery, 26 patients) (group 3).

After shunt placement, no patient died or had ventricular dysfunction. Overall, mean oxygen saturation increased significantly from 79.5% ± 13.5% preoperatively to 94.1% ± 7.3% (P <0.001). The median time from shunt placement to Fontan completion and anatomic repair, respectively, was 2.1 years (range, 1.6–5.2 yr) and 1.1 years (range, 0.6–2.4 yr). Only 2 late deaths occurred, both in group 1. In group 3, time from shunt placement to latest follow-up was 4.5 years (range, 2.3–8 yr). At latest follow-up, mean oxygen saturation was 91.6% ± 10.3%, and no patients had impaired ventricular function.

Bidirectional Glenn shunt placement as an optional palliative procedure for complex congenitally corrected transposition has favorable outcomes. Later, patients can feasibly be treated by Fontan completion or anatomic repair. Use of a bidirectional Glenn shunt for open-ended palliation is also acceptable.

Overview

Cardiac electrophysiologic therapy has evolved substantially from primarily managing arrhythmias with drugs to using various nonpharmacologic methods to detect and terminate arrhythmias. Among these are treatment options for patients with ventricular tachycardia and fibrillation (VT/VF), the chief cause of sudden cardiac death. Pharmacotherapy has not proved adequate for many patients. Although implantable cardioverter-defibrillators (ICDs) can effectively terminate VT/VF, repetitive shocks impair quality of life, and inappropriate shocks in patients with heart failure are associated with higher mortality. Percutaneous catheter ablation is a promising therapy, particularly in patients with recurrent, drug-refractory VT.

Methods for managing patients who have atrial fibrillation

Stafford I. Cohen, MD. 240 pages. Independently published; 2019. Paperback, US $19.95; eBook, US $11.95. ISBN: 978-1793176974. Available from: Amazon.com.

Field of Medicine: All fields.

Format: Paperback book. Trim size: 6 × 9 inches.

Recommended Readership: Any medical doctor in training or in practice who cares for patients; allied health specialists.

Purpose: To provide readers an appreciation of the limitations that the current medical system in the United States imposes on doctors and allied health specialists as they care for patients.

Content: This book includes 240 pages of text divided into an acknowledgment

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Marco KaldasMD,

Moneal ShahMD,

Diana PashaievaBDS,

Georgios LygourisMD, and

Anita RadhakrishnanMD

Faith and Medicine

Benefit of Contact Force–Guided Catheter Ablation for Treating Premature Ventricular Contractions

Prognostic Value of 6-Minute Walk Distance in Patients Undergoing Percutaneous Coronary Intervention: a Veterans Affairs Prospective Study

Effectiveness of Bidirectional Glenn Shunt Placement for Palliation in Complex Congenitally Corrected Transposed Great Arteries

Modified Pull-Through Technique for Cardiac Resynchronization Therapy Upgrades in Patients with Occluded Access Veins

Proximal Descending Thoracic Aortic Pseudoaneurysm in a 24-Year-Old Man after 2 Childhood Repairs of Interrupted Aortic Arch

Obstruction of 2 Coronary Arteries from Different Causes Immediately after Transapical Transcatheter Aortic Valve Replacement

Double-Valve Heart Disease and Glomerulonephritis Consequent to Abiotrophia defectiva Endocarditis

Unusual Cause of Heart Failure in a Patient with Marfan Syndrome: A Late Complication of Bioprosthetic Valved Graft Replacement

Orbital Atherectomy and Heavily Calcified Saphenous Vein Graft Intervention

Coronary Artery Anomaly in Takotsubo Cardiomyopathy: Cause or Innocent Bystander?

Tall R Waves in Precordial Electrocardiogram Leads

The Ali Massumi Cardiac Arrhythmia Symposium: (★ CME Information)

Overview

Implantable Cardioverter-Defibrillators and Wearable Defibrillators: Guidelines and Updates

Zero-Fluoroscopy Ablation at the Texas Heart Institute

Postural Orthostatic Tachycardia Syndrome

Definition and Epidemiology

Left Atrial Appendage Closure and Pulmonary Vein Isolation

★ CME Assessment Questions

Unstable Angina Caused by Honeycomb-Like Coronary Lesion Identified with Use of Optical Coherence Tomography

Posterior Descending Artery Arising from Septal Perforator Causes Angina in an Otherwise Healthy 20-Year-Old Man

Vertebral Doppler Bunny Waveform Suggesting Subclavian Stenosis and Influencing Coronary Artery Bypass Technique

Doctor, Stay by Me: A Medical Memoir

Lyme Carditis and Inflammation-Driven Plaque Erosion Presenting as Sudden Cardiac Arrest

Risk Factors for Development of Stroke in Patients With Continuous-Flow Left Ventricular Assist Device Support as Destination Therapy

Midterm Outcomes of Pediatric Mitral Valvuloplasty for Moderate to Severe Mitral Valve Regurgitation and Associated Risk Factors for Postoperative Deterioration

Navigating the Complexities of Mitral Valve Clipping: Early Severe Mitral Valve Stenosis After Mitral Valve Clipping

The Department of Cardiovascular Anesthesia of The Texas Heart Institute: An Informal History

Ectopic Right Renal Artery Originating from Anomalous Common Celio-Mesenteric Trunk: Multifaceted Imaging Approach

ACAOS Is Better Revealed by Intravascular Ultrasonography than by Computed Tomographic Angiography

Low-Velocity Nail-Gun Injuries to the Interventricular Septum: Report of Two Cases, One in a Child

Pulmonary Artery Sling Causing Tracheal Stenosis in a Neonate

Transcatheter Aortic Valve Replacement: A Physician-Patient's Story