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HISTORY: 60 yo m PMH a-fib and a-flutter s/p ablation and pulmonary venous isolation on 10/16/13, s/p CVA, Hx of HTN. Patient on Xarelto. Didn’t tolerate amiodarone and has low blood pressures with minimal medical therapy. Recurrent episodes of palpitations despite medical therapy. Last episode of palpitations on 01/13/15 s/p DCCV on 01/14/15. Patient wished to undergo ablation. Currently denies any cardiac symptoms. EKG on 01/23/15 – Rhythm: A -Flutter with atrial rate 254 bpm and V rate of 123 bpm; occasional VPCs, likely left atrial flutter ECHO: LVEF > 65%, RSVP 34 mmHg, mild mitral valve regurgitation, dilated left atrium at 4.3cm. Meds: Bystolic 5 mg ½ tab QPM, Cardizem 120mg 1 tab daily, and Xarelto 20 mg 1 tab daily No hx of smoking. No EtOH. Occasional marijuana use. Vegan diet. Holding off on exercise due to palpitations.

PROCEDURE: Radiofrequency Catheter Ablation Cardiac ablation is a procedure that uses RF energy to scar small areas in the heart that may be causing abnormal electrical signals or rhythms from moving through the heart. Typical a-flutter is found at the isthmus which is located where the tricuspid and IVC meet. Atypical a-flutter found on the mitral annulus and the ridge between the L appendage and L pulmonary veins.

RAF1

Echocardiogram Flouroscopy Duadecca cath Access femoral vein → IVC → RA → coronary sinus. Maps the electrical signals to determine area causing afib Transeptal cath Creates opening between RA and LA, allows Lasso and ablation cath to enter the LA. Lasso cath – for 3-dimensional mapping of the electrical circuit Ablation cath – delivers energy to ablate area of interest by burning tissue causing the arrhythmia. Differentiated between focal vs reentry tachycardia based on mapping and color gradient. Focal has a red hot spot that spreads out to other sites of the heart. Reentry tachy circuits in a loop back to the originating point Ablation at the hot spot and around the mitral annulus.

RAF2

Fractionated rhythm was found around initially at the ridge But testing in between ablation areas found a leak From the ridge and around the left atrial appendage Ablation was made from left atrial appendage to mitral annulus Complications of Cardiac Ablation ● Cardio-esophageal fistula. Risk reduced with intracardiac echo . ● Pulmonary hypertension due to pulmonary vein stenosis ● Bleeding or infection at the site where your catheter was inserted ● Vascular injury (2-4%) ● Cardiac trauma including perforation, MI, tamponade, coronary artery dissection, valvular damage, or embolism (1-2%) ● Damage to your heart’s electrical system, which could worsen your arrhythmia and require a pacemaker to correct (1-2%) ● Blood clots in the legs or lungs (venous thromboembolism) (<1%) ● Stroke or heart attack ● Damage to your kidneys from dye used during the procedure ● Radiation exposure ● Death in rare cases (approximately 0.1-0.3%)

 

Dr. Ben-Zur is a cardiologist who sees patients from Burbank, Encino, Sun Valley, Beverly Hills, Brentwood, Marina del Rey, Inglewood, El Segundo, Manhattan Beach, Redondo Beach, Torrance, Hollywood, Bel Air, Malibu, Calabasas, Saratoga Hills, Agoura hills, Thousand Oaks, Sherman Oaks, Studio City, Simi Valley, West Hills, Reseda, and Oak Park. He sees patients with all types of heart disease, including atrial fibrillation, a-fib, AF, sick sinus syndrome, av block, heart block, arrythmias, ischemia, congestive heart failure. He places pacemakers, defibrillators, implantable cardiac defibrillators. Bi-ventricular pacing. Palpitations, chest pain.

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