Clinical results with catheter ablation: AV junction, atrial fibrillation and ventricular tachycardia

The future of interventional cardiology lies in the left atrium

The historic focus of interventional cardiology has been on treating atherosclerotic coronary artery disease. Balloons, stents, and debulking devices have been the mainstay tools of the interventionalist. However, as engineering skills have developed and clinical techniques have improved, new clinical avenues for the interventionalist beyond the coronary vessels are starting to evolve. One of the most opportunistic areas in cardiology for the interventionalist is the left atrium where treatment of clinically important issues such as mitral regurgitation, left atrial thrombus, atrial fibrillation, patent foramen ovale, and atrial septal defect may be approached. Additionally, the left atrium is a source of important hemodynamic information that can be captured with new implantable devices. While in the past the trans-septal puncture has been infrequently used, the future may hold this technique as one of the most common. The following manuscript describes the status of some of the newest opportunities for interventionalists that lie beyond atherosclerotic disease and within the left atrium.

Ethanol induction of complete heart block in swine

OBJECTIVES

A method for the induction of complete heart block (CHB) by ethanol injection and its success rate in a pig model of acute right ventricular failure is reported. Additionally, a review of the literature for the induction of CHB in laboratory animals is detailed. The literature review was undertaken to both compare our rate of success with other methods and provide insight into our technique and refine its implementation.

BACKGROUND

Animal models of CHB have facilitated the understanding of therapeutics for various cardiac pathologies in humans. In our laboratory, CHB in pigs is used for complete control of heart rhythm in studies of biventricular pacing.

MATERIALS AND METHODS

Experiments carried out on pigs in our laboratory that required the induction of CHB were reviewed retrospectively. In addition, review of the literature for creating CHB in animals was undertaken. Our success rate was compared to that of other groups.

RESULTS

Our success rate (93%) is similar to other models of CHB, in general, and to those models that used the injection of caustic substances with thoracotomy.

CONCLUSIONS

Review of the literature indicates that our success rate is comparable to other groups and that, although many approaches have been described in both open- and closed-chest models, success is likely dependent on the practice and skill of the experimenter. In addition, review of the literature has afforded us new perspectives on the experimental induction of CHB.

Ablation for atrial fibrillation: are cures really achieved?

During the past 10 years numerous studies on the treatment of paroxysmal atrial fibrillation (AF) by right and left atrial ablation procedures have been published. The results of studies based on follow-up periods of a few months have been repeatedly interpreted as providing evidence for curative therapy. However, insufficient focus on the variability of the natural history of paroxysmal AF, the inadequate detection of silent arrhythmic events, the eclectic post-interventional use of antiarrhythmic drugs, and the lack of appropriate control groups make the reports unconvincing. Randomized controlled trials are needed to confirm postulated long-term cure rates for AF.