Heart rhythm : the official journal of the Heart Rhythm Society
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Although rare, atrioesophageal fistula is a serious and often lethal complication of radiofrequency catheter ablation in patients with atrial fibrillation (AF). Consequently, esophagogastroduodenoscopy after AF catheter ablation has been suggested to detect thermal esophageal lesions. ⋯ Upper GI pathologies are observed frequently in asymptomatic patients. Half of all patients have a requirement for treatment. Among the findings, thermal esophageal lesions and gastroparesis can be attributed to AF catheter ablation. The high incidence of gastroparesis is a novel finding that deserves further investigation.
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The outcomes of patients requiring emergent surgical or endovascular intervention during transvenous lead extraction (TLE) have not been well characterized. ⋯ Major vascular injury or cardiac perforation requiring emergent surgical or endovascular intervention during TLE is uncommon but carries significant in-hospital mortality. Despite high mortality, nearly two-thirds of these patients were rescued with immediate response and surgical or endovascular intervention.
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Editorial Comment
Bilateral cardiac sympathetic denervation: the last resort?
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Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF), but long-term outcomes are still unknown. ⋯ In patients with heart failure undergoing AF ablation, there is an initial short-term LVEF improvement related to baseline heart rate. However, long-term LVEF improvement is associated with rhythm outcome.
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Left and bilateral cardiac sympathetic denervation (CSD) have been shown to reduce burden of ventricular arrhythmias acutely in a small number of patients with ventricular tachyarrhythmia (VT) storm. The effects of this procedure beyond the acute setting are unknown. ⋯ In patients with VT storm, bilateral CSD is more beneficial than left CSD. The beneficial effects of bilateral CSD extend beyond the acute postsympathectomy period, with continued freedom from ICD shocks in 48% of patients and a significant reduction in ICD shocks in 90% of patients.