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Di C, Wang Q, Wu Y, Li L, Lin W. Monitoring Spike Potential and Abrupt Impedance Rise with Concomitant Temperature/Contact Force Change for Timely Detection of the Occurrence of “Silent” or “Nonaudible” Steam Pop. J Interv Cardiol 2023; 2023:8873404. [PMID: 37064642 PMCID: PMC10098411 DOI: 10.1155/2023/8873404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
Aim. Steam pop (SP) during radiofrequency catheter ablation (RFCA) for pulmonary vein isolation (PVI) may cause cardiac perforation, which may require drainage and emergent thoracotomy or even lead to death. Data investigating the timely detection of the occurrence of “silent” or “nonaudible” SP events are limited. Methods and Results. A total of 516 consecutive atrial fibrillation (AF) patients who underwent index PVI were included in this retrospective observational study. The duration, power, impedance, temperature, and contact force (CF) of RFCA were continually monitored and recorded throughout the procedure. A total of 15 (2.9%) audible SP events occurred in 14 patients; 2 of the patients developed pericardial tamponade, 1 patient underwent drainage, and 1 patient underwent emergent thoracotomy. The time from RFCA initiation to the occurrence of audible SP was 19.4 ± 6.9 s. Abrupt temperature change occurred in 13 (86.7%) of the 15 SP events, of which 8 (53.3%) exhibited an abrupt temperature rise of 2.3 ± 1.0°C, 5 (33.3%) exhibited an abrupt temperature drop of 2.3 ± 1.3°C, and 2 (13.3%) exhibited no discernible temperature change. Conclusions. In conclusion, simultaneously recorded spike potentials and abrupt impedance rise with concomitant temperature and/or CF change could be a feasible method for the timely detection of the occurrence of audible, “silent,” or “nonaudible” SP events, particularly in regions where the risk of perforation may be of concern.
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Affiliation(s)
- Chengye Di
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Qun Wang
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Yanxi Wu
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Longyu Li
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
| | - Wenhua Lin
- Cardiac Electrophysiology Unit, First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
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Seghatol-Eslami F, Farris GR, Chapman GD, Lloyd SG, Siegal GP. A Rare Cause of Left Atrial Mass. ACTA ACUST UNITED AC 2020; 4:260-262. [PMID: 32875192 PMCID: PMC7451912 DOI: 10.1016/j.case.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
LAIH may be a complication of blunt chest trauma. Multimodality imaging with TEE and CMR can lead to the correct diagnosis. Conservative management may be considered in hemodynamically stable patients.
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Affiliation(s)
- Frank Seghatol-Eslami
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary Ross Farris
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory D Chapman
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven G Lloyd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gene P Siegal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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Meier D, Antiochos P, Herrera-Siklody C, Eeckhout E, Delabays A, Tzimas G, Fournier S, Pascale P, Muller O, Monney P. Interatrial septum dissection and atrial wall hematoma following transseptal puncture: A systematic review of the literature. Catheter Cardiovasc Interv 2019; 96:424-431. [PMID: 31642609 DOI: 10.1002/ccd.28554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/08/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interatrial septum (IAS) dissection due to transseptal puncture (TSP) is a rare, underreported complication of the procedure. Data on the mechanism, diagnosis, and management of this complication are lacking. METHODS We conducted a systematic review of all reported cases of IAS dissection with or without associated LA hematoma due to TSP, by thoroughly searching MEDLINE and EMBASE through May 2019. RESULTS After screening of n = 882 studies, eight studies with a total of 19 patients addressed the complication of IAS dissection and/or LA hematoma secondary to TSP. Median age was 63 years with a 1:1 male to female ratio. Ablation of atrial fibrillation was the most frequently reported procedure (84%). Diagnosis was established using fluoroscopy with contrast injection (58%), TEE (32%) or intracardiac echocardiography (5%). The mechanism identified involved puncture of the septum secundum portion of the IAS, leading to transient needle passage into the extracardiac space. In the majority of patients, the hematoma remained localized in the IAS and management was conservative with progressive resolution of the hematoma during follow-up (95%). Two patients (11%) required further intervention by either pericardiocentesis or surgical drainage due to hemodynamic instability. CONCLUSIONS IAS dissection with or without hematoma after TSP remains an underdiagnosed entity. The main mechanism involves lesion to the septum secundum portion of the IAS, resulting in needle passage into the extracardiac space and local bleeding. Although conservative management may be sufficient in the majority of cases, interventional cardiologists should be familiar with this complication and its diagnosis.
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Affiliation(s)
- David Meier
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Panagiotis Antiochos
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | | | - Eric Eeckhout
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Alain Delabays
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Georgios Tzimas
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Stephane Fournier
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Patrizio Pascale
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Olivier Muller
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
| | - Pierre Monney
- Division of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
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