Argentine Journal of Cardiology最新文献

{"title":"Bicuspid Aortic Valve: In Search of Valve Dysfunction and Aortic Dilatation Determinants","authors":"A. Evangelista, G. Maldonado, N. Villalva","doi":"10.7775/RAC.85.6.12272","DOIUrl":"https://doi.org/10.7775/RAC.85.6.12272","url":null,"abstract":"Bicuspid aortic valve is a common congenital heart abnormality, with moderate familial aggregation (1:8), which develops, with high heterogeneity, valvular dysfunction and aortic dilatation. Complications such as significant valve dysfunction, endocarditis or aortic aneurysm are present in more than 50% of these subjects. Recent imaging studies have shown determinant factors of these complications. Bicuspid aortic valve with right coronary-non coronary cusp fusion has a higher risk of calcification, aortic stenosis and distal ascending aorta and aortic arch dilatation, while in the case of left-right coronary sigmoid fusion it dilates the proximal segment of the aorta, mainly in the presence of aortic regurgitation. Improvement in understanding the pathogenesis of valve degeneration and aortic dilatation will favour new drug therapies, reducing surgical treatment requirements.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123275763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Coronary Syndrome in Essential thrombocythemia: Usefulness of Optical Coherence Tomography","authors":"J. Damonte, Alejandro D. Fernández, F. Garagoli, Daniel Berrocal, José L. Navarro Estrada","doi":"10.7775/rac.85.6.11632","DOIUrl":"https://doi.org/10.7775/rac.85.6.11632","url":null,"abstract":"Essential thrombocythemia is a rare myeloproliferative neoplasm, characterized by platelet proliferation with quantitative and qualitative alterations. Patients suffering from this condition are more likely to have thrombosis and hemorrhages. It has an incidence of 1 to 2.5 new cases per 100,000 inhabitants per year, (1, 2) and its frequency increases with age, with a 2:1 ratio in favor of women. (3) One of the complications of essential thrombocythemia is coronary thrombosis, which can be potentially fatal. The incidence of acute coronary events with this hematology-oncology disease is 9.4%, with a rate of fatal and non-fatal thrombotic events of 1.9 per 100 patients/year. (4) We report the case of a 35-year old female patient with thrombocythemia under study and no cardiovascular history, who presented with moderate, oppressive chest pain lasting 20 minutes, in functional class IV. Physical examination showed the patient was hemodynamically stable, with blood pressure of 110/60, heart rate of 60 bpm, and no signs of heart failure. The electrocardiogram revealed sinus rhythm without conduction disorders, narrow-QRS with 0.5 mm transient ST segment elevation (lasting < 20 minutes) from V1 to V3. Lab tests reported hematocrit 37%, hemoglobin 13 mg/dl, white blood cells 5500/mm3, and platelets 1,200,000/mm3. Ultrasensitive troponin was requested, with negative value: 5 pg/ml (normal <14 pg/ml). JAK2 was negative, Leyden factor V was negative, lupus anticoagulants were negative, and bone marrow puncture revealed megakaryocytic hyperplasia consistent with chronic myeloproliferative neoplasm. Coronary CT angiography showed lack of filling in proximal anterior descending artery causing 80% luminal obstruction, possibly indicative of thrombus or soft plaque (Figure 1A). The patient was started on anticoagulation with unfractionated heparin and aspirin 100 mg/day. The patient coursed asymptomatic for angina, and a coronary angiography was performed at 72 hours of admission, which showed no significant obstructions (Figure 1B); the study was completed with an optical coherence tomography (OCT) that revealed atherosclerotic fibrolipid plaques in the anterior descending artery at the proximal and middle-third levels (Figure 2A), and an image consistent with plaque rupture (fissure) at the proximal third level in the origin site of the first diagonal branch (Figure 2B). Due to findings in the catheterization study, atorvastatin 80 mg/day was added to the previous treatment. Echocardiography showed no motility disorders. Left ventricular systolic function was normal, with no relevant valve diseases. The patient made good progress with no further chest pain, platelet reduction (450,000/mm3 on discharge), and no changes suggestive of necrosis in the electrocardiogram. The patient was discharged 7 days after admission, continuing with aspirin 100 mg/day, anticoagulation with enoxaparin 80 mg/12 hours, atorvastatin 80 mg/day, and hydroxyurea 2000 mg/ day. Essenti","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"189 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117315100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sisyphus’s Dilemma: Measurement of Ventricular-Arterial Coupling by Doppler Echocardiography Predicts the Incidence of Right Ventricular Failure after Heart Transplantation Better than Right Catheterization","authors":"I. Bluro, E. Espinosa, R. Marenchino, P. Oberti, M. Falconi, P. White, R. Pizarro, C. Belziti","doi":"10.7775/RAC.85.6.12266","DOIUrl":"https://doi.org/10.7775/RAC.85.6.12266","url":null,"abstract":"Background: Increased pulmonary vascular resistance, assessed by right catheterization, is usually mentioned as a relative contraindication for inclusion in the list of heart transplantation since it is associated with failure of the implanted right ventricle. There is evidence suggesting that the behavior of the pulmonary circulation depends on its interaction with theright ventricle, so a parameter that evaluates ventricular-arterial coupling could predict right ventricular failure better than isolated hemodynamic parameters. Objective: The aim of this study was to assess the ability of the tricuspid annular plane systolic excursion/pulmonary systolic pressure ratio (TAPSE/PSP) to predict the incidence of post-transplantation right ventricular failure compared with invasive hemodynamic parameters measured before transplantation. Methods: This was a retrospective cohort study using variables prospectively collected from the heart transplantation database of a University Hospital of the City of Buenos Aires. A total of 56 consecutive patients with complete echocardiographic and hemodynamic tests, undergoing heart transplantation between January 2012 and April 2017, were included in the study. Patients with more than one parenchymal transplantation, retransplantation, congenital heart disease, those requiring ventricular assistance at the time of pre-transplantation assessment or with incomplete data were excluded. Results: Three patients (5.3%) died within the first 30 days, 2 from right ventricular failure. No preoperative hemodynamic or echocardiographic parameters were associated with mortality. The incidence of right ventricular failure in the immediate postoperative period was 28.5% (16 patients). All the hemodynamic variables of pulmonary pressure and resistance, and the TAPSE/PSP ratio measured by echocardiography were associated with the development of right ventricular failure after heart transplantation. In a multivariate analysis including hemodynamic and echocardiographic variables, the TAPSE/PSP ratio was the only one independently associated with right ventricular failure (0R>10, 95% CI 2.2->100, p=0.03). A TAPSE/PSP cut-off value of 0.26 showed sensitivity of 81% and specificity of 88% to predict right ventricular failure, with an area under the ROC curve of 0.84 ± 0.06 and X2=0 in the Hosmer-Lemeshow test (p=1) when considering quartiles of TAPSE/PSP. A predictive model of right ventricular failure composed of hemodynamic variables showed a sensitivity of 38% and a specificity of 97.5%, with an area under the ROC curve of 0.78±0.06 and X2=2.37 (p=0.3) in the Hosmer-Lemeshow test. Conclusions: We can conclude that the TAPSE/PSP ratio showed better discrimination and calibration to predict right ventricular failure, with 0.26 as the best prognostic performance value.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130116750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strong negative correlation between estimated pulmonary artery systolic pressure and right atrial strain","authors":"Agustina Amenabar, N. Casso, J. Gantesti, Pablo Ottonello, C. T. Bianqui, G. Matta, Mariana Carnevalini, Héctor Deschle","doi":"10.7775/rac.85.6.12265","DOIUrl":"https://doi.org/10.7775/rac.85.6.12265","url":null,"abstract":"Background: Echocardiography is used to assess pulmonary artery pressure, but the magnitude of tricuspid regurgitation is a limiting factor. Objectives: The aim of this study was to evaluate the correlation between estimated pulmonary artery systolic pressure and right atrial strain. Methods: A total of 40 patients with sinus rhythm and adequate tricuspid regurgitation were included. Tricuspid annular plane systolic excursion, the velocity of this excursion, right ventricular dimension and right atrial volume were determined. Peak right atrial basal strain and mid-lateral strain during the reservoir phase were averaged. Right atrial strain was compared in patients with estimated pulmonary artery systolic pressure <36 mmHg and ≥36 mmHg using Student’s t test. Pearson’s correlation coefficient was calculated between right atrial strain and estimated pulmonary artery systolic pressure using the bootstrapping method to evaluate the corresponding confidence interval. Results: Mean age was 59±11 years and 45% were men. There were statistically significant differences in right atrial strain between patients with estimated pulmonary artery systolic pressure <36 mmHg and ≥36 mmHg (69.92±11.69 vs. 29.40±11.06; p=0.001; 95% CI: -53.93- -27.09). The correlation between estimated pulmonary artery systolic pressure and right atrial strain was -0.87 (p <0.01; 95% CI: -0.72- -0.93). The correlation coefficient was positive but weaker between estimated pulmonary artery systolic pressure, right atrial volume (r=0.67) and right ventricular dimension (r=0.59). Conclusions: The results show a strong negative correlation between estimated pulmonary artery systolic pressure and right atrial strain which could be useful when tricuspid regurgitation is absent.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122886439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Status of Cardiology Residencies: Results of the 5th National Residents’ Survey (ENARE V)","authors":"Ignacio Manuel Cigallini, D. Igolnikof, S. Garcia-Zamora, Luciano N. Fallabrino, G. Tissera, R. Melchiori, Nicolas Colombo Viña, E. Duronto, Ricardo Iglesias, H. Grancelli","doi":"10.7775/RAC.85.5.10168","DOIUrl":"https://doi.org/10.7775/RAC.85.5.10168","url":null,"abstract":"Background: Due to the great disparity between medical residencies, the Argentine Council of Cardiology Residents has developed surveys to know the reality of its members. Objective: The aim of this survey was to present the results of the fifth survey on this topic. Methods: A closed and pre-established survey was carried out during the 35th Inter-Residencies of Cardiology Conference. Results: A total of 390 participants were included in the study. Median age was 29 years, 54% were male, 54.2% belonged to private institutions and 34.9% lived in the Autonomous City of Buenos Aires. Thirty-two per cent of first-year residents performed more than 8 shifts per month, 33.2% worked more than 80 hours/week, and 33.6% reported sleeping less than 35 hours/week. Only 48.5% said they were supervised on decision making of hospitalized patients. Likewise, 65% of participants did not have at least one of the basic rotations for a training program in cardiology. In 5.8% of cases they had lower incomes than the national minimum wage, while 14.9% did not receive meals during their workday, 41.5% had no health coverage and 33.3% had no labor risk insurance. In 90.8% of cases, residents said that if they could they would choose their specialty again, but 23.1% said they would not choose their training center again. Conclusions: Although the residency system is the best method for training specialists, it is necessary to implement urgent changes in order to improve the conditions in which they are developed, both academically and from the working point of view","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114581889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Minimally Invasive Mitral Valve Surgery Possible in Complex Patients","authors":"G. Fortunato, Matías Ríos, R. Battellini, M. Halac, Torsten Doenst, V. Kotowicz","doi":"10.7775/AJC.85.4.10396","DOIUrl":"https://doi.org/10.7775/AJC.85.4.10396","url":null,"abstract":"Introduccion: Los pacientes con riesgo preoperatorio alto de morbimortalidad, endocarditis mitral y aquellos con cirugia cardiaca previa son considerados “limitantes” para ser operados por via cirugia miniinvasiva. Objetivos: Evaluar resultados en pacientes complejos sometidos a cirugia miniinvasiva. Primario: mortalidad posoperatoria dentro de los 30 dias. Secundario: resultados tecnico-quirurgicos y complicaciones posoperatorias tempranas. Material y metodos: Analisis retrospectivo de las cirugias mitrales realizadas en el Hospital Italiano de Buenos Aires desde enero de 2010 hasta abril de 2016. Se realizaron 135 cirugias mitrales, 63 de ellas mediante tecnica miniinvasiva (46,6%). Los pacientes considerados “complejos” fueron 45 (71,4%), incluyendose aquellos con riesgo > 10% del STS PROMM, los pacientes con endocarditis activa y/o los pacientes con cirugia cardiaca previa. Resultados: El 73,3% (n = 33) fueron cirugias electivas, el 22,2% (n = 10) de urgencia y el 4,4% (n = 2) de emergencia. El STS PROM% y el STS PROMM% fueron de 6,08 ± 10,8 y de 26,7 ± 16,8, respectivamente. Se incluyen 6 pacientes con cirugia cardiaca previa, 5 pacientes con endocarditis en tratamiento activo. Se realizaron reemplazo valvular mitral (14 reumaticas) en el 62% (n = 28) y plastica mitral en el 38% (n = 17). No se constataron obitos en plastica mitral ni mediastinitis. La mortalidad a los 30 dias fue del 4,4% (n = 2). Hubo conversion a esternotomia en un caso. Conclusiones: La mortalidad observada es inferior a la calculada por puntaje de riesgo (STS PROMM%: 6,08 ± 10,8 vs. 4,4). La minitoracotomia derecha videoasistida nos ofrecio una excelente exposicion e interpretacion de la patologia. La tecnica de cirugia miniinvasiva puede ser utilizada en pacientes con cirugia cardiaca previa, endocarditis y/o pacientes con puntaje alto de riesgo preoperatorio.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116937200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel transfer of low viscosity ultraviolet light curable cyan methacrylate on saline immersed in-vitro sheep heart model and paintbrush technique","authors":"M. Arokiaraj","doi":"10.7775/ajc.85.4.10491","DOIUrl":"https://doi.org/10.7775/ajc.85.4.10491","url":null,"abstract":"Aim: To develop a novel technique for the transfer of cyan methacrylate on the inner and outer surfaces of the heart. Methods: Low viscosity (40cps) ultraviolet curable cyan methacrylate was mixed with commercially available dye to demonstrate the ability of transfer on the outer and inner surfaces of the in-vitro heart model. 0.5 ml of cyan methacrylate was mixed with 0.2 ml of ink, and the material was injected over the surface of the heart in dry air, and it was allowed to fix for 2-3 seconds. Subsequently, the whole preparation was immersed in saline, and it was vigorously shaken to remove unbound compound. The similar experiment was performed without cyan methacrylate, and cyanmethacrylate with high viscosity (3000 cps). By visual assessment, a significant quantity of the compound attaches to the surfaces of the heart compared to the ink alone, which was visualized after washing. After that, various techniques were investigated for efficient transfer of the compound to the inner and the outer surfaces of the heart after the tissue was soaked in saline. Of the various techniques paintbrush technique for the targeted transfer of the compound was effective. With this technique, it was very effective to transfer the compound on the epicardial and endocardial surfaces. Also, targeted areas like left atrial appendage, left ventricular inner surfaces at the origin of papillary muscle and left ventricular apex were some of the areas investigated successfully. The ultraviolet light source was a pen shaped device based on light emission diode. It was observed after the ultraviolet treatment to certain extent precipitation of the compound was observed. The experiment was repeated in 3 different samples to observe the results. Conclusion There is potential for transfer of low viscosity, ultraviolet curable cyan methacrylate for the study on the inner and outer surfaces of the heart. This could be potentially of use for transfer of growth factors or protein molecules on the surface of the heart.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116127650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of breaking the status quo in hypertension","authors":"J. Boggia","doi":"10.7775/AJC.85.4.11685","DOIUrl":"https://doi.org/10.7775/AJC.85.4.11685","url":null,"abstract":"","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114749279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Readmissions on Long-term Mortality of Patients Undergoing Cardiac Surgery","authors":"Y. Korolov, P. Lamelas, J. Espinoza, M. Benzadón, M. Vrancic, F. Piccinini, M. Camporrotondo, D. Navia","doi":"10.7775/AJC.85.4.9433","DOIUrl":"https://doi.org/10.7775/AJC.85.4.9433","url":null,"abstract":"Introduccion: Las reinternaciones luego de cirugia cardiaca son un problema relevante para los pacientes y para el sistema de salud en general. Existen pocos datos respecto de la relacion entre las reinternaciones despues de cirugia cardiaca y el pronostico evolutivo de los pacientes, ni su impacto en la mortalidad alejada. Objetivo: Analizar la incidencia, factores predictores de las reinternaciones a 30 dias luego de cirugia cardiaca y su asociacion con la mortalidad alejada. Material y Metodos: Se analizo en forma retrospectiva la base de datos informatizada del servicio de cirugia cardiaca. En el analisis se incluyeron a todos los pacientes sometidos a cirugia cardiaca en forma consecutiva, dados de alta en el periodo comprendido entre junio del 2010 y mayo del 2013. Se excluyeron a los pacientes operados de trasplante cardiaco. Reinterna� iaco. Reinterna� aco. Reinterna� cion se definio como el reingreso hospitalario no planificado dentro de los 30 dias transcurridos desde el egreso hospitalario. Mortalidad alejada fue considerada la muerte de causa cardiovascular o no cardiovascular a partir del dia 30 posterior al alta hasta finalizar el seguimiento. Resultados: Se incluyeron 1327 pacientes, de los cuales se reinternaron 184 (13,9%). La mediana de seguimiento fue de 826 dias (IQ 581 a 1085 dias). Los pacientes que se reinternaron presentaban mayor tasa de comorbilidades como EPOC (6,5% vs. 2,1%; p 0,002) e insuficiencia cardiaca (12% vs. 6%; p 0,0064). Tambien, en este grupo se observo mayor incidencia de las complicaciones posoperatorias de fibrilacion auricular (35% vs. 19%; p < 0,0001) y de bajo gasto cardiaco posoperatorio (9,2% vs. 4%; p 0,004). Entre las causas mas frecuentes de las reinternaciones se identificaron a las infecciones (no mediastinitis) (25%), arritmias e implante de MCP (15,2%), insuficiencia cardiaca (13%), derrame pleural (6,5%), derrame pericardico (3,8%), fiebre sin foco establecido (3,26%) y mediastinitis (6%), entre otras. Segun el analisis de regresion logistica los factores que se asociaban con mayor riesgo de reinternacion fueron la cirugia cardiaca no CRM (IC 95% 1,55�3,37; p<0,0001), antecedentes de enfermedad respiratoria (IC 95% 1,32�6,6; p 0,0084), fibrilacion auricular (OR 1,99; IC 95% 1,34�2,94; p 0,0005) e IMC (OR 1,046; IC 95% 1,008�1,085; p 0,017). En cuanto al punto final, las reinternaciones se asociaron en forma significativa con aumento en la mortalidad a 1 y 3 anos: 8,7% vs. 2,3%; p<0,0001 y 13,6% vs. 4,2%, p<0,0001, respectivamente. Conclusiones: La reinternacion a 30 dias luego de cirugia cardiaca se asocia en forma significativa con mayor mortalidad alejada de los pacientes operados. La implementacion de las medidas asistenciales adecuadas podria reducir la probabilidad de las reinternaciones, y por ende, mejorar el pronostico de este grupo de pacientes","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114339298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrhythmias Originating in Left Ventricular Papillary Muscles: Clinical Characteristics, Multislice Imaging and Catheter Ablation","authors":"S. Rivera, G. Albina, Leandro Tomás, M. Ricapito, I. Mondragon, María de los Milagros Caro, Marcelo Reinoso, Diego Belardi, A. Giniger, F. Scazzuso","doi":"10.7775/RAC.85.5.10249","DOIUrl":"https://doi.org/10.7775/RAC.85.5.10249","url":null,"abstract":"Background: Ventricular arrhythmias can arise from the left ventricular papillary muscles. Objectives: The aim of this study was to describe the most relevant features of this type of ventricular arrhythmias and to compare outcomes with either cryoenergy or radiofrequency catheter ablation. Methods: Forty-two patients undergoing catheter ablation for ventricular arrhythmias originating in the left ventricular papillary muscles were included in the study. Mean age was 47±16 years, 70% were men, and median ejection fraction was 55±11%. Ventricular arrhythmias were localized using three-dimensional mapping, multislice computed tomography and intracardiac echocardiography, with arrhythmia foci mapped at either the anterolateral or posteromedial papillary muscles. Ablation was performed using an 8-mm focal cryoablation catheter or a 4mm open-irrigated radiofrequency ablation catheter. Results: All clinical ventricular arrhythmias exhibited a right bundle branch block pattern, with mean QRS duration of 150±13 ms and R>r’ pattern in the left ventricle in 71.4% of cases. Acute success rate was 100% for cryoablation (n=18) and 83% for radiofrequency ablation (n=20) (p=0.06). Ventricular arrhythmia recurrence at 12 months was 4% for cryoablation and 46% for radiofrequency ablation (p=0.02). Use of radiofrequency ablation (HR 0.2; P=0.04) and lack of intracardiac echocardiography (HR 0.1; p=0.01) were associated with higher risk of recurrence.  Conclusions: Right bundle branch block morphology with left ventricular R>r’ pattern and QRS duration >135 milliseconds are the most frequent clinical characteristics of these ventricular arrhythmias Use of cryoablation and intracardiac echocardiography were associated with lower recurrence rates, while radiofrequency ablation was associated with 20% increase of clinical arrhythmia recurrence after ablation.","PeriodicalId":447734,"journal":{"name":"Argentine Journal of Cardiology","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127241759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}