Heart rhythm : the official journal of the Heart Rhythm Society
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Randomized Controlled Trial Comparative Study
Continuation of warfarin during pacemaker or implantable cardioverter-defibrillator implantation: a randomized clinical trial.
Management of oral anticoagulation in patients undergoing pacemaker (PPM) or implantable cardioverter-defibrillator (ICD) implantation remains controversial. Prior studies demonstrate that continuation of warfarin may be safer when compared with strategies requiring interruption and/or heparin bridging. Limited data from randomized trials exist. ⋯ While the results were not statistically significant, there was a trend toward reduced complications in patients randomized to warfarin continuation. This strategy should be considered in patients undergoing PPM or ICD implantation.
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Randomized Controlled Trial Comparative Study
General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study.
Radiofrequency catheter ablation of atrial fibrillation can be performed under general anesthesia or conscious sedation at the physician's preference. ⋯ The use of general anesthesia is associated with higher cure rate with a single procedure, and it seems to reduce the prevalence of PV reconnection observed at the time of repeat ablation.
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Comparative Study
Real-time lesion assessment using a novel combined ultrasound and radiofrequency ablation catheter.
Assessment of lesion size and transmurality is currently via indirect measures. Real-time image assessment may allow ablation parameters to be titrated to achieve transmurality and reduce recurrences due to incomplete lesions. ⋯ Real-time lesion assessment using high-frequency ultrasound integrated into an ablation catheter is feasible and allows differentiation between true necrosis and hemorrhage. This may lead to safer and more efficient power delivery, allowing more effective lesion formation.
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Magnetic resonance imaging (MRI) allows visualization of location and extent of radiofrequency (RF) ablation lesion, myocardial scar formation, and real-time (RT) assessment of lesion formation. In this study, we report a novel 3-Tesla RT -RI based porcine RF ablation model and visualization of lesion formation in the atrium during RF energy delivery. ⋯ MRI-compatible catheters can be navigated and RF energy safely delivered under 3-Tesla RT MRI guidance. Recording electrograms during RT imaging also is feasible. RT visualization of lesion as it forms during RF energy delivery is possible and was demonstrated using T2W HASTE imaging.