Background— Puncture of the atrial appendage may provide access to the pericardial space. The aim of this study was to evaluate the feasibility of epicardial mapping and ablation through an endocardial transatrial access in a swine model. Methods and Results— An 8-F Mullins sheath was used to perforate the right (n=16) or left (n=1) atrial appendage in 17 pigs (median weight, 27.5 kg; first and third quartiles [Q1, Q3], 25.2, 30.0 kg). A 7-F ablation catheter was introduced into the pericardial space to perform epicardial mapping and deliver radiofrequency pulses on the atria. The pericardial space was entered in all 17 animals. In 15 (88%) animals, there was no hemodynamic instability (mean blood pressure monitoring, initial median, 80 mm Hg; Q1, Q3, 70, 86 mm Hg; final median, 88 mm Hg; Q1, Q3, 80, 96 mm Hg; P =0.426). In these 15, a mild hemorrhagic pericardial effusion was identified and aspirated (median, 20 mL; Q1, Q3, 15, 30 mL) during the procedure, and postmortem gross analysis revealed that the atrial perforation was closed in these animals. In 2 (12%) of the 17 animals, there was major pericardial bleeding with hemodynamic collapse. On gross examination, it was found that pericardial space was accessed through right ventricular perforation in 1 animal and the tricuspid annulus in the other. After the initial study, we used an occlusion device in 3 other animals to attempt to seal the puncture (2 at the right atrial appendage and 1 at the right ventricle). These 3 animals had no significant pericardial bleeding. Conclusions— Transatrial endovascular right atrial appendage puncture may provide a potential alternative route for pericardial access. Further studies are needed to evaluate its safety with longer and more-complex procedures before being applied in clinical settings.

Objective -To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). Methods -

No abstract

Background: Percutaneous coronary intervention is the most recommended method of myocardial revascularization in acute coronary syndrome patients. The objective of this study was to analyze the clinical profiles and outcomes of patients with non-ST segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Methods: We retrospectively analyzed 53,889 patients with non-ST segment elevation acute coronary syndrome, who underwent percutaneous coronary intervention between June 2006 and March 2016. A database was used to define the patients' clinical and angiographic characteristics, procedures and clinical outcomes. The patients were grouped into different chronological periods, and variables were analyzed to determine their influence over death outcomes. Results: Factors such as advanced age, female sex, history of infarction or coronary artery bypass surgery, diabetes, multivessel disease, left ventricular dysfunction, and collateral circulation were associated to a higher risk of in-hospital death for these patients. The success rate of the procedures increased along time and the risk of death decreased. Conclusion: Advances in the available medical technology have changed the profile of percutaneous coronary intervention, which has led to a higher rate of procedure success and a lower risk of death and complications.