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      Cardiac Arrest Caused by Torsades de Pointes Tachycardia after Successful Atrial Flutter Radiofrequency Catheter Ablation

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          Abstract

          A 66-year-old woman underwent successful radiofrequency catheter ablation for long-lasting, drug refractory fast atrial flutter. Two days later she had a cardiac arrest due to torsades de pointes (TdP) tachycardia attributed to relative sinus bradycardia and QT interval prolongation. After successful resuscitation further episodes of TdP occurred, which were treated with temporary pacing. Because of concomitant systolic dysfunction due to ischemic and valvular heart disease she was finally treated with an implantable defibrillator. In conclusion we strongly advise prolonged monitoring for 2 or more days for patients with structural heart disease following successful catheter ablation for long lasting tachyarrhythmias.

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          Meta-analysis of ablation of atrial flutter and supraventricular tachycardia.

          Peter S. Spector, Matthew R. Reynolds, Hugh Calkins … (2009)
          The purpose of this study was to perform a systematic review and meta-analysis to evaluate the safety and efficacy of radiofrequency ablation (RFA) of typical atrial flutter (AFL) and atrioventricular node-dependent supraventricular tachycardia (SVT) in adult patients. Medline and EMBASE were searched (1990 to 2007) for all study design trials of RFA. Data relating to single- and multiple-procedure success, arrhythmia recurrence, repeat ablation, adverse events, and death were extracted. For RFA in AFL, 18 primary studies with 22 treatment arms and 1,323 patients were identified. Single-procedure success for AFL was 91.7% (95% confidence interval [CI] 88.4% to 94.9%). Multiple-procedure success was 97.0% (95% CI 94.7% to 99.4%). Postablation arrhythmia was noted in 13.2% of patients (95% CI 7.5% to 18.9%), while repeat ablation was reported in 8% (95% CI 4.5% to 11.4%). For RFA of SVT, 39 primary studies with 49 treatment arms in 7,693 patients with accessory pathways and atrioventricular nodal reentrant tachycardia were identified. Single-procedure success for SVT was 93.2% (95% CI 90.8% to 95.5%). Multiple-procedure success was 94.6% (95% CI 92.4% to 96.9). Postablation arrhythmia was noted in 5.6% patients (95% CI 4.1% to 7.2%). Repeat ablation occurred in 6.5% (95% CI 4.7% to 8.3%). For AFL studies, all-cause mortality was 0.6%, and adverse events were reported in 0.5% of patients. For SVT studies, all-cause mortality was 0.1%, and adverse events were reported in 2.9% of patients. In conclusion, studies of RFA for the treatment of patients with AFL and SVT report high efficacy rates and low rates of complications.
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            Transient proarrhythmic state following atrioventricular junction radiofrequency ablation: pathophysiologic mechanisms and recommendations for management.

            Karolina Nowinski, Fredrik Gadler, Mats Jensen-Urstad … (2002)
            The induction of complete heart block by radiofrequency ablation of the atrioventricular junction combined with pacemaker implantation has become an established therapy for rate control in patients with atrial fibrillation who are unresponsive to drugs. Reports of ventricular arrhythmias and sudden death after ablation have, however, raised concerns about safety. Ventricular arrhythmias are usually polymorphic and related to a phase of electrical instability due to an initial prolongation and then slow adaptation of repolarization caused by the change in heart rate and activation sequence. Structural heart disease, and other factors that predispose for the acquired long QT syndrome, seem to add to the risk. Ventricular activation and repolarization stabilize during the first week after the procedure. Routine pacing at 80 beats per minute during this phase is recommended, as well as in hospital monitoring for at least 48 hours. Patients with high-risk features for arrhythmias, such as congestive heart failure or impaired left ventricular function, may require pacing at higher rates. Adjustment of the pacing rate-although rarely below 70 beats per minute-is usually undertaken after a week in most patients, preferably after an electrocardiographic evaluation for repolarization abnormalities at the lower rate.
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              Curative catheter ablation in atrial fibrillation and typical atrial flutter: systematic review and economic evaluation.

              M. Rodgers, C. McKenna, S. Palmer … (2008)
              To determine the safety, clinical effectiveness and cost-effectiveness of radio frequency catheter ablation (RCFA) for the curative treatment of atrial fibrillation (AF) and typical atrial flutter.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Cardiovasc Med J
                Journal ID (publisher-id): TOCMJ
                Title: The Open Cardiovascular Medicine Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-1924
                Publication date (Electronic): 1 February 2011
                Publication date Collection: 2011
                Volume: 5
                Pages: 1-3
                Affiliations
                []1 st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
                Author notes
                [* ]Address correspondence to this author at the 1 st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, 1 Stilponos Kiriakidi Str, 54636, Thessaloniki, Greece; Tel: +306977436678; Fax: +302310994673; E-mail: lmantziari@ 123456yahoo.com
                Article
                Publisher ID: TOCMJ-5-1
                DOI: 10.2174/1874192401105010001
                PMC ID: 3109644
                PubMed ID: 21660252
                SO-VID: 1f6cb471-fabe-4985-a187-44543c0a9c4e
                Copyright © © Mantziari et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 9 November 2010
                Date revision received : 17 November 2010
                Date accepted : 20 November 2010
                Categories
                Subject: Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: polymorphic ventricular tachycardia,implantable defibrillator,acquired long qt,ventricular fibrillation.
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: polymorphic ventricular tachycardia, implantable defibrillator, acquired long qt, ventricular fibrillation.

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