No abstract

Radial artery punctures for diagnostic coronary angiography or coronary balloon angioplasty were performed in 211 patients with a success rate of 98% (207 patients). In the four failed transradial accesses, the procedure was accomplished via the transfemoral route. Major local vascular complications included one arteriovenous fistula, one pseudoaneurysm, and one ischemic contracture of the right hand. Reduced radial pulses were noted in 25 (12%) patients at follow‐up without ischemic manifestations. Transradial diagnostic coronary angiography was successfully completed in 184 (98%) of 187 patients. The technical success for balloon angioplasty was obtained in 73 (97%) of 75 patients. Clinical success was observed in 68 (91%) patients; balloon angioplasty resulted in one nonfatal myocardial infarction and four late deaths (3 cardiac and 1 stroke). We believe that transradial catheterization for diagnostic coronary angiography and balloon angioplasty in our relatively small built Chinese population is a safe and practical alternative approach. Cathet. Cardiovasc. Diagn. 40:159–163, 1997. © 1997 Wiley‐Liss, Inc.

trial tachycardia (AT) originating focally from diverse anatomical structures in both atria has been well described. [1][2][3][4][5][6][7][8] Focal AT is distinguished from macroreentrant AT by its electrophysiological characteristics and electropharmacological responses, and by the approaches to mapping and ablation of the tachycardia. 7,8 The underlying mechanism of focal AT is thought to be automaticity, triggered activity or atrial microreentry. 7,8 Recently, Tsai et al reported an unusual form of focal atrial fibrillation (AF) triggered by ectopic beats originating from the superior vena cava (SVC), and radiofrequency (RF) ablation of the triggering SVC focus was safe and highly effective in eliminating the focal AF. 9 Theoretically, it is possible that focal electrical firing in the SVC could initiate AT in addition to AF; however, the mechanism of this type of focal AT remains unclear. In this study, we describe the distinct electrocardiograms and electrophysiological characteristics in 3 patients with focal AT originating from various parts of the SVC. The location of the successful RF site in the SVC was proven by multi-plane SVC angiography. All 3 patients underwent uneventful ablations of their SVC foci within a few seconds of RF current application. Methods PatientsThe study group were 3 patients with drug-refractory atrial tachyarrhythmias who were admitted for electrophysiological study and RF ablation therapy. Each patient had a focal AT originating from the SVC that had been diagnosed and confirmed by the electrophysiological study, SVC angiography and RF ablation. Two (cases 1 and 2) of the 3 patients did not have significant organic heart diseases detectable by physical examination, chest roentgenograms, echocardiography, and coronary angiography. The other patient (case 3) had one-vessel coronary artery disease. The definition of focal AT was based on previously established criteria. 7,10-12 Electrophysiological Study and RF AblationThe electrophysiological study was performed in a postabsorptive state after each patient gave written informed consent. All antiarrhythmic drugs except amiodarone were discontinued for at least 5 half-lives before the study. Two 6F quadripolar electrode catheters with a 5-mm interelectrode spacing were positioned at the high right atrium and the right ventricular apex, respectively, for pacing and recording. Another 6F quadripolar electrode catheter with a 10-mm interelectrode spacing was positioned across the tricuspid annulus to record the His bundle potential. A 6F decapolar electrode catheter with a 2-10-2-mm interelectrode spacing (Daig Corp) was positioned in the coronary sinus for recording and pacing. A 7F deflec- Electrophysiological Characteristics and Radiofrequency Ablation of Focal Atrial Tachycardia Originating From the Superior Vena CavaKuan-Cheng Chang, MD; Yu-Chin Lin, MD; Jan-Yow Chen, MD; Hsiang-Tai Chou, MD, PhD; Jui-Sung Hung, MDThe initiation of focal atrial tachycardia (AT) from the superior vena cava (SVC) remains unclear. In 3 patients (2...

Slow/no-reflow phenomenon is a serious problem complicating primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and is associated with a poor prognosis. From January 2002 to November 2002, 11 of the 70 consecutive patients with ST elevation AMI who were subjected to primary PCI using balloon angioplasty and/or stenting developed slow/no-reflow phenomenon (TIMI 1 flow in 2, TIMI 2 in 8, and TIMI 2.5 in 1). They were 10 men and 1 woman, aged 64 +/- 11 years (range, 46-81). The culprit vessels were six in the left anterior descending coronary artery, three in the right coronary artery, one in the left circumflex coronary artery, and one in saphenous vein graft. Multiple bolus doses (100 microg) of nitroprusside were injected into the index artery through the guiding catheter using a 3 ml syringe until the TIMI flow grade improved by at least one grade or the systolic pressure decline below 80 mm Hg (one patient). The total drug dose varied from 100 to 700 microg. Following the drug treatment, angiographic TIMI flow grade improved by at least one grade in 9 (82%) of the 11 patients (P = 0.007). The TIMI frame counts significantly decreased from 36 +/- 17 frame counts to 16 +/- 11 frame counts (P = 0.012). All patients were discharged without major adverse cardiovascular events. Intracoronary bolus injection of nitroprusside using a 3 ml syringe appears to be a feasible, safe, and effective technique for the management of slow/no-reflow phenomenon complicating primary PCI.