IMAGEN EN CARDIOLOGÍAVena pulmonar accesoria posterior y fibrilación auricular
References (0)
Cited by (3)
A new classification for right top pulmonary vein
2013, Annals of Thoracic SurgeryThe right top pulmonary vein (PV) has been defined as an anomalous branch of the right superior PV draining into the left atrium (LA); however, various PV anomalies and terminologies have been reported. To clarify the concept of the right top PV, we reviewed the literature and our cases.
We reviewed the literature on the right top PV, right PV passing behind the intermediate bronchus (BIB), and related PV anomalies. We also reviewed our anomalous PV cases, which were analyzed using 3-dimensional computed tomography (3D-CT).
Authors of the previous reports were radiologists, surgeons, and cardiologists. The terminologies used in the literature included PV branch crossing BIB, right upper lobe vein posterior to the bronchus intermedius, and right isolated superior posterior branch. The frequency of the anomaly in the literature ranged from 0.3% to 9.3%. Anomalous PVs originated from either the right upper lobe or the lower lobe. We found the following among 303 patients with chest disorders at our hospital: 10 (3.3%) of these PV anomalies were observed—4 drained directly into the LA and the other 4 drained into the right superior PV. Among 9 patients who were analyzed and had complete interlobar fissures between the upper and lower lobes, 4 patients had drainage from both the right upper and the lower lobes. Eight PVs passed BIB, 1 passed behind the main bronchus (BMB), and the other passed both BIB and BMB.
We propose that the term right top PV should be used in a broad sense, being defined as “an anomalous branch of PV draining directly into the left atrium (LA),” and that it be classified into 6 types.
Improved outcomes and complications of atrial fibrillation catheter ablation over time: Learning curve, techniques, and methodology
2012, Revista Espanola de CardiologiaLos resultados y las complicaciones del procedimiento de ablación de fibrilación auricular varían ampliamente entre los diferentes centros. Nuestro objetivo es analizar los resultados y las complicaciones derivadas de este procedimiento en nuestro centro e identificar los factores predictores de éxito y de seguridad.
Entre 2002 y 2009 se realizó un total de 726 procedimientos de ablación de fibrilación auricular. Basándonos en la aplicación sistemática de un protocolo de anticoagulación y sedación consciente desde enero 2008, podemos establecer dos estrategias de ablación que constituyen dos grupos bien diferenciados: grupo A, constituido por 419 procedimientos realizados antes de enero 2008, y grupo B, formado por 307 procedimientos realizados después.
El 60,9% de los pacientes no presentaron recurrencia arrítmica tras varios procedimientos durante un seguimiento medio de 8,7 meses. Con un único procedimiento, la tasa total de éxito fue del 41%, significativamente mayor entre los pacientes del grupo B (el 51,6 frente al 35,2% de éxito en el grupo A; p = 0,001). Hubo un total de 31 complicaciones mayores (4,2%); 26 en el grupo A (6,2%) y 5 en el grupo B (1,6%) (p = 0,002). La protocolización del procedimiento fue un factor predictor de la ausencia de complicaciones (odds ratio = 0,406; intervalo de confianza del 95%, 0,214-0,769; p < 0,006).
La aplicación sistemática de un protocolo de anticoagulación y sedación consciente se asocia a la mejora de los resultados y la reducción de las complicaciones en el procedimiento de ablación de fibrilación auricular. Otros factores no evaluados en este estudio, como la curva de aprendizaje de los operadores y la progresiva mejora tecnológica, pueden haber influido en los cambios observados.
The outcomes of atrial fibrillation ablation procedures vary widely between different centers. Our objective was to analyze the results and complications of this procedure in our center and identify factors predicting the efficacy and safety of atrial fibrillation ablation.
In total, 726 atrial fibrillation ablation procedures were performed in our center between 2002 and 2009. Beginning in January 2008, a protocol for anticoagulation and conscious sedation was systematically applied. Outcomes and complications could therefore be compared in 2 well-differentiated groups: group A included 419 procedures performed prior to 2008 and group B included 307 procedures completed after 2008 using the new protocol.
During an average follow-up of 8.7 months, 60.9% of patients were arrhythmia-free after one or repeat procedures. After only 1 procedure, the success rate was 41% and significantly higher in group B (51.6% vs 35.2% in group A; P=.001). There were 31 major complications (4.2%), 26 in group A (6.2%) and 5 in group B (1.6%) (P=.002). The implementation of the new protocol was an independent predictor of the absence of complications (odds ratio=0.406; 95% confidence interval, 0.214-0.769; P<.006).
Systematic application of an anticoagulation and conscious sedation protocol is associated with improved results and fewer complications of atrial fibrillation ablation. Factors not evaluated in the present study, such as operator experience and ongoing improvements in atrial fibrillation ablation technology, could have influenced these findings.
Full English text available from: www.revespcardiol.org
Anatomy of Structures Relevant to Atrial Fibrillation Ablation
2011, Atrial Fibrillation Ablation, 2011 Update: The State of the Art Based on the Venicechart International Consensus Document