Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease

Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.

Prolonged QT interval syndrome in pediatric practice: literature data and clinical case description

The article provides basic information about the syndrome of prolonged QT interval, which is a rare pathology of the cardiovascular system and can cause sudden death. The mutations in the genes responsible for dysfunction of ion channels are the key in the pathogenesis of this disease. Jerwell and Lange—Nielsen, Romano—Ward, Andersen—Tavil and Timothy syndromes are described as the main hereditary variants of this syndrome. A own case of the disease in a patient was given. The peculiarity of this case was on the acute, atypical onset of the disease, which started with convulsions and sudden cardiac death. The clinical picture of this case, features of a current are described, indicators of the basic methods of research are resulted. Information on the treatment of this clinical case at the local level and in the department of surgical treatment of arrhythmias, where the patient underwent implantation of endocardial bicameral cardioverter-defibrillator, іs presented. Data on further observation and treatment of the child at the place of residence are given. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: syndrome, QT interval, etiology, pathogenesis, clinical picture, diagnosis, examination, treatment.

A Novel Tool for Improved Control and Maneuverability in Pediatric Cardiac Catheter Ablation Procedures

Cardiac ablation catheters commonly used for the diagnosis and treatment of arrhythmias are small in diameter and require extensive finger grip and dexterity for safe maneuverability during procedures. This is especially important in the pediatric population where the cardiac structures are smaller and potentially more variable as a result of congenital anatomic anomalies. We developed a novel catheter grip accessory tool for improved control and maneuverability of cardiac ablation catheters. Mechanical testing of the tool demonstrated it could grip the catheter with an average force of 0.031 kN and transfer an average torque of 0.0392 N-m before slipping, both well above forces experienced in normal clinical use. During tensile testing, the tool fractured at an average force of 0.554 kN. At the point of failure, testing found that the electrical conduction and resistance of the catheter remained unchanged. In simulated use testing, the tool was able to translate torque more accurately to the catheter tip compared to manual manipulation of the catheter. This novel tool has the potential to reduce physician muscle exertion in ablation procedures and increase the safety profile when manipulating catheters within the heart.

Dysrhythmias under General Anesthesia and Their Management

Cardiac arrhythmias during anesthesia are common and almost benign, with the incidence ranging from 60 to 90%. Arrhythmias are one of several significant predictors for severe cardiovascular outcomes. It is essential, therefore, for the anesthetist to evaluate patients at risk preoperatively with a careful history and to have an appropriate knowledge concerning the etiology, electrophysiology, diagnosis, drug effects and treatment of arrhythmias.