Evidence map›Paper›PMID 35707126›Full record

ArticleFrontiers in cardiovascular medicine2022

Case Report: Pulmonary Vein Isolation as a Tailored Treatment for Recurrent Ventricular Tachycardia During Hemodialysis in a Patient With Right Coronary Artery Chronic Total Occlusion.

Cosmin Cojocaru, Adelina Pupăză, Corneliu Iorgulescu, Sebastian Onciul, Lucian Câlmâc, Radu Vătăşescu

Open access · goldAbstract readCase Reports
In one paragraph

Article in Frontiers in cardiovascular medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 0 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Cosmin CojocaruDepartment of Cardiothoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Adelina PupăzăEmergency Clinic Hospital of Bucharest, Bucharest, Romania.
Corneliu IorgulescuEmergency Clinic Hospital of Bucharest, Bucharest, Romania.
Sebastian OnciulDepartment of Cardiothoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Lucian CâlmâcEmergency Clinic Hospital of Bucharest, Bucharest, Romania.
Radu VătăşescuDepartment of Cardiothoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Clinical Emergency Hospital Bucharest · ROCarol Davila University of Medicine and Pharmacy · RO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Catheter ablation of the ventricular substrate can reduce ventricular tachycardia (VT) recurrence and mortality in an electrical storm (ES). However, identification and specific treatment of plausible triggers is mandatory and may lead to the resolution of ES. Objective: This case presentation seeks to exemplify how pulmonary vein isolation (PVI) may represent a tailored treatment of ES in cases of ventricular substrate, which only becomes arrhythmogenic during high-rate episodes of paroxysmal atrial fibrillation (PAF). Results: A 54-year-old male with a history of inferior myocardial infarction (MI) and long-term hemodialysis was referred for repetitive implantable cardioverter-defibrillator (ICD) shocks for apparently scar-related monomorphic VT episodes preceded by PAF initiation strictly during hemodialysis. He had recently undergone ICD implantation for similar episodes of ES preceded by the rapid-ventricular response (RVR) PAF during hemodialysis. The patient had no other history of VTs. Electrocardiogram (EKG) changes occurred exclusively during PAF and suggested functional myocardial ischemia. Coronary angiography demonstrated isolated right coronary artery (RCA) chronic total occlusion (CTO). Cardiac magnetic resonance demonstrated RCA-territory residual myocardial viability and mild LV systolic dysfunction. Surgical revascularization was not feasible due to a history of bilateral above-the-knee post-traumatic amputation and severe calcification of internal mammary (IMA) and radial arteries. Subsequent CTO-percutaneous coronary intervention attempt was unsuccessful. The difficulty of assessing LV-substrate ablation end-points due to the "functional" character of the substrate, which only became arrhythmogenic during hemodialysis-related PAF, was considered. Consequently, PVI was performed rather than VT/VF substrate ablation. Twelve months after PVI, the patient remains free of PAF and VT/VF despite chronic hemodialysis sessions. Conclusion: The ES episodes can be triggered by situational factors, such as RVR-PAF and functional ischemia, during hemodialysis in patients with CTO with otherwise no episodes of VT. Tailored treatment of such factors may lead to long-term VT freedom.

Indexed as

catheter ablationelectrical stormischaemic cardiomyopathyparoxysmal atrial fibrillationtrigger

Identifiers

PMID35707126
PMCPMC9189425
OpenAlexW4282049497

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