Y HOC VIET NAM THANG 9 - SO 1tt014 cS khdi m^t giu'dng) la mot y^u to tien lu'dng tot
cho thoi TKNT va riit NKQ thanh cong.
- Thdi diem xuat hien SHH TB = 6,21 + 5,82 gid, thdi gian keo dai SHH TB la 223,6 ± 155,8 gid (9,3 ± 6,5 ngay). Cac yeu to co gia tri trong tien lu'dng SHH keo dai la: khdi phat SHH sdm { < 6 gid), liet cd gap co mire do nang va co cac bien chutig sdm.
- Cae bien chuhg sdm la thudng gap: viem phoi sac 31,8%, xep phoi 19,7%, NTH tru'dc vien la 7,5%.
TAi L l | U T H A M K H A O
1. Wairell, DJ\. (2010), Guidelines for the management of snake-bites. Guidelines for the management of snake-bites. WHO Regional Oflice for South-East Asia: p. 1-162.
2. Warrell, D A J- Meier, and 2. White (1995), Qinical toxioilogy of snakebite in Asia. Handbook of dinicai toxicology of animal venoms and poisons. CRC Press, Boca Raton.
3. Hung, H.T., J. Hojer, and N.T. Du (2009), GJnical features of 60 consecutive ICU-treated
patients envenomed by Bungarus muiticinctus.
Southeast Asian J Trop Med Public Health. 40(3):
p. 518-24.
Ariaratnam, C.A., et a i . (2008), Distinctive epidemiologic and clinical features of common Krait (Bungarus caeruleus) bites in Sn Lanka. The American journal of tropical medicine and hygiene.
79(3); p. 458-462.
Ahmed, S,M., et al. (2012), Retrospective analysis of snake victims in Northern India admitted in a tertiary level institute. Journal of anaesthesiology, clinical pharmacology. 28(1): p.
45-50.
Kularatne, S.A., et a l . (2002), Common krait (Bungarus caeruleus) bite in Anuradhapura, Sri Lanka: a praspective clinical study. Pos^rad Med J. 78(919): p. 276-80.
Nguyen Kim StJn, Vu V3n Dinh (2008), Nghien cutj dac diem lam sang Vci diiu tri b<|nh nhan bi mot so ran dpc tren can c3n thupc hg i^n ho (elapidae) d mien Bac Viet Nam, LuS'n an tign sy Y hoc, Tru'dng Dai hoc Y Ha Npi.
CO LAP TiNH MACH PHOI DIEU TRI CON RUNG NHI
Ph^in Tran Linh*, Pham Quoc Khanh*, Nguyen Lan Vi^t*
T6M TAT
D^i cuVng: Cae tinh mach phoi (TMP) da du'dc chuihg minh dong mpt vai tro quan trpng trong khdi
\!t\&t rung nhT (RN). Muc di'ch nghien culi ciia chung toi xcic djnh mii'c dO an to&n va hi^u qua co lap tTnh mach ph5i d b^nh nh3n bj rung nhT Idch phat.
Phu'dng ghap va ket qua: 43 benh nhan nghien oJfU (tuoi trung binh 52,6 ±12,3 tuoi) dUpc tien hanh c6 l^p tTnh mach phoi va nhT trai bang nang luUng song co tan so radio deu du'dc xac djnh giai phau nhT tr^l vti tinh mgch ph6i bSng chup MSCT 64 dSy vS lap ban d5 npi mac dien hpc 3chjeu nhi trai va 0nh m^ch phSi. Co 80% tJnh mach phoi tren trai va du'di tri\ va 90% tJnh mgch phoi tren phai va du'di phai du'dc CO l|ip ho^n to^n vdi thdi gian triet dot trung binh 3.476 ± 852 giay vdi mire nang lu'ong toi da la 35 W vdi lam mSt dSu dien cut dot toe dp 17ml/phut.
Sau can thiep co 86% benh nhan khong con cOn RN. Ttieo doi 12 thang, c6 79,0% b^nh nhan khong bi tA\ phit rung nhi. Ty l i bien chutig thap 4,7%, chi co 2 BN bi ep tim cap do tr^n mau mang tim da du'd dan
* Vi|n Tim mach Viet Nam - Benh vien Bach Mai Chiu trach nhi$m chfnh: Pham Tran Linh Email: [email protected] Dt: 0913363101 PhSn bi?n khoa hpc: PGS.TS Nguyen Thi Bach Yen Ngay nhan bai: 6.8.2014
lull cap citu thanh cong. Khdn^ co bien chiihg nSng nhu tir vong, hep tTnh mach phoi,,..
Ket iu$n: Triet dot co lap tTnh mach ph6i vei nhT trai dat dUdc ty le thanh cong 86% BN RN kjch phdt vk chi CO 21,0% tai phat sau 12 thang theo doi.
ny/choa: rung nhT - tri^t 68t - tTnh m?ch phoi - nhT trai.
SUIVIMARY
PULI^ONARY V E I N ISOLATION FOR PAROXYSMAL ATRIAL FIBRILLATION
Background: The pulmonary veins (PVs) have been demonstrated to often play an important role in generating atrial fibrillation (AF). The purpose of this study was to determine the safety and efficacy of segmental PV isolation in patients with paroxysmal AF.
Methods and Results: In 43 consecutive patients (mean age, 52,6 ± 12,3 years) vinth paroxysmal segmental PV isolation guided by ostial PV potentials was performed by MSCT and 3D re-con^ruction left atrial and pulmonary veints mapping. The left superior, left inferior, and right superior and the right inferior PVs were targeted for isolation in all patients. Among 80%
left PVs and 90% were completely isolated, with a mean of 3,476 ± 852 seconds of radiofrequency energy applied at a maximum power setting of 35 W with 17m!/min irrigated.
86% of patients with paroxysmal AF was free from recurrent AF after procedure. At 12 months of
Y HOC VigT WAM THANG 9 - SO 1/2014 fbliow-up, 79,0% of patients with paroxysmal was free
ftom recurrent AF. Two patients have been complicated tamponate after the procedure but survival cured. There were no other complications.
Conclusions: With a segmental isolation approach that targets for 4 PVs, a clinically satisfactory result can be achieved in 86% of patients with paroxysmal AF after procedure and in 79,0% at 12 month follow-up.
Keywords: fibrillation catheter ablation pulmonary vein - atnum.
I. DAT VAN
D ICac tsnh mach phoi da du'dc chu'ng minh thu'dng ddng mdt vai trd quan trpng trong viec khdi phat rung nhT (RN) [1]. Do eo vai tro quan trong trong RN, nep cd rat nhieu each thirc phau thuat va triet dSt qua catheter da du'dc sir dung de CO lap c^c tinh mach phoi vdi nhi trai ve di^n hpc [2], [ 3]. Mpt trong nhuh^ ky thuat triet dot ihig dung nan^ liTdng cd tan so radio (RF) co la^
xung quanh lo do ve nhi trai ciia tTnh mach phoi [5], [ 6]. Tren The gidi da cd nhieu nghien ciru ve van de nay, tuy nhien d Viet Nam ky thuat triet dot rung nhT bang each c6 lap tinh mach phoi vdi nhT trai qua catheter ciiua du'dc ap dung. Bing viec su" dung hS thong djnh vi 3 chieu (3D mapping) dinig hinh giai phau nhT trai v^ tTnh mach phoi ket lidp vdi cac hoat dong dien hpc ghi du'dc tai nhT trai va tTnh mach phoi ehung
Hinh 1: Lap ban do 3D nhT trai va co lap tTnh mach phoi d BN Vo D ,
toi tien hanh eo lap ve dien hoc nh! trai V£l tJnh mach phoi lan diu tien d nuiffc ta. Mgc dfch nghien cu'u ciia chiing toi la budc dBu danh gia dp an toan va hieu qua eua phu'dng phap nay d^
dieu trj RN.
ii. £>6l Tl/OMG VA PHirOTMG PHAP N G H I I N CIJU 2.1. fio^ tu'dng nghien cihi
Ool tiTdng nghien ciru tien ciru la 43 benh nhan bi RN cdn cd chi dinh dieu tri bang RF.
Tuoi trung binh la 52,6 ± i2,3 tuoi (tu' 27 - 70), vdi 36 benh nhan nam gidi (83,7%) va 7 nU gidi. So nam bj RN la 5,0 ± 3,5 nam vdi so cdn rung nhi xuat hien trung binh la 6,9 ± 9,4 cdn/thang. De duy tri nhjp xoang benh nhan phai sir dung trung binh 2,4 ±1,2 thuoc chong. loan nhjp nhdm IA, IC, nhdm III nhu'ng khong co hieu qua ngan ngCfa tai phat RN. Trong so 43 beiih nhan, cd 2 BN bi benh dpng mach vanh da can thiep dat stent, 22 BN bj tang huyit ^5 (THA), 1 BN mac benh ly van tim, 5 bSnh nhan bi tiefu du'dng type 2 va 13 BN khong ro yeu to nguy cd chiem 30,2%. Tren sieu am tim Gia tri trung binh phan suat tong mau that trai la plian 67,7 ± 8,7% va kich thu'dc nhT trai trung binh la 37,2 ± 3,7 mm. Diem CHA2DS2 - VASc trung binh cLia Bn nghien ciru la 1,12 ± 0,93.
2.2.Thani do Dien sinh ly tim
Tru'dc khi tien hanh thii thuat, chimg toi tien hanh chup MSCT 64 day di/ng hinh ba ehleu nhT trai va tinh mach phoi cho 100% BN nghien culi muc di'ch la de xac djnh giai phau tinh mach phot va nhT trai. Tat ca benh nhan deu du'dc giai thi'ch k^ va dong y lam thii thuat dam bao van de dao dut y hpc trong nghien CLTU. Chimg toi du'a dien ci/c 10 ciTc 6Fr (St. Jude quadripolar) vao xoang
vanh qua tTnh mach du'di don trai. Dien ci/c ctiafi
doan vong (Lasso) va dien CLTC diTng hinh 3D ket
hpp triet dot c6 tu'di nu'dc du'dc du^ vao nhT trai
qua tTnh mach diii phai va chpc xuyen vach liSn
nhT sang nhT trai. Sau khi chpc xuyen vach lien
nhT va siV dung dung cu md du'dng loai dai 8F
qua vach lien nhT sang nhT tral (long sheath 8Fr,
SL 0) chimg toi diing Heparin tiem tTnh macli
Y Hpc VigT NAM THANG 9 • S6' 1/2014 5.000 UI sau dd duy ft-i Heparin sao cho duy tri
mpt thdi gian dong mau hoat hda tir 250-350 giay (ACT). Chung toi eung tien hanh chup 4 tTnh mach phoi cho tat ca cae benh nhan righien cu'u.
Di^n cue Lasso 10 CLTC, 6Fr du^ vao lo do ve nhT trai ciia 4 tTnh mach phoi vdi khoang each cac dien cue 2-5-2-mm va dien ciTe triet dot RF 7Fr vdi dau dot 3,5 mm (Navistar) v^ he thong lam lanh bSng bdm nude (cool flow/). Tin hieu dien sinh Iy; eua tTnh mach phoi va nhT trai dUdc ghi Iai qua cac dien ci/c tren Lasso va Navistar dUde loe va cai dat tir 30 den 500 Hz va 0,05 den 200 Hz, tuWng uihg, va khuyech dai tren he thong EP Trace 72 kenh. Chung toi cung sijf dung chirc nSng ki'ch thfch tim theo chu'dng trinh tren cung he thon^ EP Trace vdi cac ki'eh thfch |3 xoang vanh, tieu nhT trai.
Chung tdi sil' dung he thong lap ban do noi mac buong nhi trai 3 chiiu (CARTO XP) vdi vi&
ghi di$n thS tCmg diem trong nhT trai va tTrih mach phoi (point by point) de ket noi va dying hinh buong nhT tral va tTnh mach phoi tu'dng img vdi hinh anh giai phau tir ket qua chup cat Idp Hinh 2. Co iSp thanh cong tTnh mach phoi
MSCT. Trung binh chiing toi phai tiep xiic 115,9
± 35,9 diem trong nhT trai va tTnh mach phoi de dUhg hinh nhT trai vdi thdi gian trung binh la 40,9
± 12,2 phut.
2.3. Ly do CO l|p tinh mach phoi
^SU khir cUe sdm phat sinh trong tTnh mach phoi thu'dng da d va da dang. Do vay, neu t r i ^ dot thong thu'dng tCTng 6 khdi phat trong tTnh mach phoi se ghai triet dot rat nhieu vj trf trong tTnh mach phot se cd nguy cd din den bien chirng nguy hiem la hep tTnh mach phoi, dong thdi cung rat khd khan de xac djnh tat ca cac o khdi phat d 4 tinh mach phoi. Do vay, duS vao ban do 3 chieu dien hpc buong tim cliiing toi tien hanlT^ trjpt dot tirng diem trong nhT trai ngay sdt l6JJ6 ve ciia tinh mgch phoi khoang 5mm, timg diem triet dot lien tiep nhau tao thanh mot vdno trdn khep kfn quanh lo d6 ve eiia tTnh mach phoi ngan canjoan bp eae xung dpng khu' ci/c tir Unh mach phoi khong the dan truyen vao nhT trSi va ngu'dc Iai tir nhT trai vao tTnh mach phoi.
2.4. Ky thuat co lap tTnh mach phoi d BN Vo D
Bang 1. Vi tn dot co la Thong so So It/Onq diem dot 1 dirdnq Nanq luHnq (W)
Niiiet do r g
Thdi qian dot 1 diem (s) Oien trd (JJ) Tonq thdi gian dotp tTnh mach phoi va nhT trai TTnh mach phoi trai Thanh tru'dc 37,5 ± 12,2 32,4 ± 2,5 41,3 ± 8,3 27,5 ± 3,4 100,5 ± 3,4 1162,5 ± 822,7
Thanh sau 35,8 ± 12,7
22,6 ± 3,2 36,4 ± 1,6 21,3 ±3,1 90,6 ± 3,3 742,3 ± 241,6
TTnh mach phdl phcii Thanh tru'dc
33,2 ± 9,7 29,9 ± 1,4 38,9 ± 1,3 25,3 ± 5,1 97,9 ± 2,5 827,3 ± 267,3
Thanh sau 34,5 ± 14,0
28,8 ± 2.2 37,8 ± 1,7 23,8 ± 4,9 93,2 ± 3,7 797,8 ± 319,1 Viec xac^dinh vj tri dot duS vao hinh anh ban
d5 3D cac lo tTnh mach phoi. Su' phan bo cac vi tri dot tao vong khep kin lo do vao tTnh mach phSi theo cac vung quanh Hnh mach phoi trai'va tinh mach phSi phai. Chung toi dot timg diem
lien tiep nhau tao thanh mpt du'dng gay ton thu'dng cac mo nil! lam mat klia nang dan truyen va phat xung dong. Chung toi cai dat che do triet dot vdi miJc nhiet do toi da 45°C, miJc njng lu'dng toi da 35W, vdi lu'dng d|ch lam lanh khi
Y HOC VIJT NAM T H A N G 9 • SO 112014
triet dot la 17ml/phut, thdi gian triet dot mot diem tir 20 - 30 giay. Mii'c nang lu'dng cung nhiT nhiet do khi co lap thanh trUdc nhieu hdn so vdi thanh sau va ben trai nhieu hdn ben phai. Danh gia ket qua triet dot thanh cong khi khong con ghi nhan du'dc dien the dan truyen vao tTnh mach phoi tir nhT trai.
2.5. Thuoc sau triet dot
Sau khi tri?t dot thanh cong chung_t6i tiep tuc cho benh nhan sir dung thuoc chong ioan rihip nhdm I hoSc nhdm III va thuoc chdng dong mau khang vitamin K hoac khang dong the he mdi (NOAC) them 3 thang. Sau 3 thang neu khong con bSng chiTng RN cliung toi se cho BN dimg thuoc chong loan nhip. O nhfflig benh nhan CO Iai phit RN ho^c triet dot khong thanh cong, Chung tdi tiep tuc dieu bi bang tliuoc chong loan nhjp kiem soat lan so tim va thuoc chong dong d^ phdng huyet khoi.
2.6. Theo doi
Cic b?nh nhan du'dc tai kham ngoai tru 4
tuan, 3 thing, 6 thang, 12 thang sau khi triet dot RN. TSt ca cac BN deu du'dc kham hdl trieu chu'ng theo B^nh an nghien ciru va du'dc ghi
Holter OTO 24h d thdi diem tai khani cung nhir sieu am tim va cac xet nghiem can thiet khac.
2.7. Xir ly so lieu
Cac so lieu thu thap du'dc cua nghien cuti du'dc xit ly theo cac thuat toian thong ke y hoc tren may vi tinh bang chu'dng trinh phan mem SPSS 17.2-2007 va OPEN EPI de tinh loan cac thong so thirc nghiem; trung binh thu'c nghiem, phu'dng sai, dp lech chuan. Oe so sanh hai trunp binh quan sat vdi mau Idn (n = 30) chung toi diing test "t". Gia trj p < 0,05 du'dc coi la co y nghia thdng ke.
III. KET QUA
3.1. Co lap tfnh mach ph£i
Co lap hoan toan dudc Hnh mach phoi tren trai (T>1PTT)la 80,5%, tlrih mach phoi dulS trai (TMPDT) la 78,0%, tTnh mach phoi tren phai (TMPTP) 92,7% va tTnh mach phoi dudi phai (TMPDP) la 92,7%.. Sau khi co lap thanh cong 4 tinh mach phoi chung toi tien hanh^kich thich nhi theo chu'dng trinh gay rung nhT de danh gia ket qua ciia thii thuat. Cd tdi 86% (37 BN) khong xuat hien RN ngay sau khi co lip thinh cong tinh mach phoi.
Bin
V|trl
ffZKetquacc lap tinh mach phoi va nhi trai Bloc hoan toan nhi trii
va TM phSl saiifdng 1 Tvrle(%)
Bloc Khong hoan toan nhi trii v i TM phoi So lu'tfng 1 Ty le (°/o)
Khong giy bloc nhT trii v i TM phoi seiu'tfng 1 TVI«(%) TM phoi trai
Tren (TMPTT)
DUdI flMPDT)
33 32
80,5 78,0
7 8 TM phoi pha Tr«n
(TMPTP) Du'di (TMPDP)
38 1 92,7 38 92,7
3 3
17,1 19,5
1 1
2,1
2,^7,3 7,3
0 0
0 0 3.2. Thdl glan liSn quan den thii thuit
Thdi gian lam thii thuat trung binh 288,8±eo,4 phut, thdi gian chieu tia trung binh 52 ± 13 phit. Tong thdi gian triet dot trung binh 3,476±B52 gliy.
Thdl gian trung binh co lap thanh tru'dc tinh mach phoi trai la 1.162,5±822,5 giay nhileu hdn ding ke so vdi thdi gian triet dot thanh sau tTnh madi phoi trii hay tinh mach phoi phai (p<0,05).
Nhi^t dp v i di?n trd khi triet dot thanh tru'dc ciing cab hdn cic thanh khac (p<0,05). Nguyen do la cd nhi viing thanh tru'dc day hdn va CD cac gd nhu' cd tieu nhi can phai triet dot nhieu hdn ve thdl glan v i mire ning lu'dng mdi dam bao co lip du'dc ve dien hpc. Thanh sau nhi trai cd mong hdn tiep glap vdi thirc quan nen mire nang
lu'dng cung thap hdn v i thdi gian W$t dot ciing ngan hdn.
3.3. Ty le tai phat con rung nhi Theo doi benh nhan sau 12 thing, chting toi thay cd 9/43 benh nhan tai phit cdn rung nhi chiem ty le 21,0%. Thu'dng ty I? t i l phit gip nhieu nhat trong 3 thing can thiep triet dot (6BN). Sau 1 nam, cd 79,0% b?nh niian khdng bi t i l phat cdn rung nhT va trieu chihig ciia binh nhan da du'dc cai thien nhieu.
3.4. Moi lien quan glD'a co l$p tTnh m^ch phoi va ket qua lam sing
RN tai phat d 7 trong so 9 benh nhan
(77,8%), CO lap khong hoan toin Hnh niach phoi,
va chi gip 2/9 (22,2%) BN da co l$p du'dc Hnh
mach phoi hoan toan (p < 0,005).
Y HOC VigT NAM THANG 9 - s6 1g014 3 . 5 . Bien c h i h i g
Bien chirng nang nhu*: thiing t i m , thong nhT trai thi/c quan, hep tTnh mach phoi, tfin thu'dng than kinh X,... cd the g3p trong dieu t n rung nhT.
Chung toi cd 2 BN bj ep tim cap do tran mau mang tim trong qua trinh triet ddt. 6 hai benh nhan nay, khi chiing toi triet dot dudng tran nhT trai vff\ nhiet dp tang cao > 45° va dien t r d 35W gay thung tran nhT trai. Chung toi da phai dimg thu thu3t va cap cillj benh nhan bang dat dan lUtJ kfn mpt chieu mang t i m , truyen mau va trung hoa Heparine bang Protamine sulfat. Theo doi b^nh nhan trong 1 tuan on djnh, khong cdn dich mang dm. Cac bien chirng kiiac nhu* ton thu'dng than kinh X, hep tTnh mach phoi chiing tdi khong g^p tru'dng hdp nao.
IV. BAN LUAN
4 . 1 . Cdc k e t qua chu y e u
Cac ket qua ciia nghien cu'u nay chiing minh rSng hieu qua ciia phu'dng phap co lap tTnh mach phoi being nSng lu'dng sdng cd tan so radio trong dieu t n aJn rung nhT kjch phat. Sau khi co lap tTnh mach phoi dat du'dc t^ le 8 6 % khong cdn a f n rung nhi ngay sau can thiep ma tru'dc do m3c du sir dung thuidng xuyen cac thuoc chong loan nhjp nhu'ng van khong kiem soat du'dc, Ket qua nay ciia chiing toi cung tu'dng du'dng nhu"
mpt so nghien cii\i khac tren the gidi [ 5 ] , [ 7 ] . Ty le tai phat sau 1 nam thap chf cd 21,0%. Bien chuTig cua phu'dng phap triet dot nay rat thap, chi 03 2/43 BN bj ep tim cap chiem 4,7%, khong cd BN nao tu' vong hoac bi cac bien chu'ng khac nhu' h?p tTnh mach phw'...
4 . 2 . L^ d o t a i p h a t R u n g nhT
Tai phat RN sau khi co lap tinh mach phoi cd the do nguyen nhan co lap tTnh m^ch phoi khdng hoan toan ho3c xuat hien nhu'ng 6 ngoai v.l khac khong phai d tTnh mach phoi gay rung nhi. Theo nhieu nghien ciru tren The gidl da chirng minh du'dc sit phuc hoi dan truyen dien hpc sau khi cd lap tJnh mach phoi la nguyen nhan chu yeu gay t^i phat rung nhT. Mat khac, cac nghien ciru tren the gidi da chutig minh rang 6 khdi phat kfeh hoat RN pliat sinh tir cac vj trf khac rat ft so vdi khdi phat tu' tTnh mach phoi chi cd 5% den 15%
benh nhan [ 4 ] . 4 . 3 . H?n c h g
Mpt han che cua nghien ciru nay la do so lu'dng BN nghien cu'u ciia chimg toi con ft va chi tap trung d nhdm BN RN cdn kjch phat, trong khi,.
d d cdn sd tu'dng Idn BN RN ben bi, RN man ti'nh.
Ben canh do phu'dng phap triet dot RN bang n3ng lu'dng song cd tan so radio cdn rat mdi d nu'dc ta, thdi gian lam thii thuat keo dai 4 - 6 gid, sir dung nhieu trang thiet bi hien dai, ton kem nen so lu'dng BN RN cd nhu cau dieu tri bang triet ddt bi han che. Trung binh mpt trudng hop triet dot RN chi phf tren 100 trieu dong.
V. KET LUAN
Cd tdi 8 0 % tTnh mach phoi tren trai va du'di trai va tren 9 0 % tTnh mach phoi tren phai va du'di phai du'dc cd lap hoan toan ve dl^n hpc vdi nhT trai. Ty le thanh cong ngay sau can thipp dat tdi 8 6 % , ty le bien chij'ng va tai phat thap nen phu'dng phap triet dot co lap tTnh mach phoi du'dc irng dijng ngay mpt rpng rai de duy tri nhjp xoang cho cho BN rung nhT ma khdng the kiem soat du'dc bang thuoc chong loan nhjp.
T A ! L l | U T H A M KHAO
1. Pham Nguyen Vinh (2009), "Rung nhT: cO che, chan doan va dieu tri", Nha xuat ban Yhgc.
2. Andrea B,Hindricks G (2012), "Impact of catheter ablation on quality of life in patients with atrial fibrillation", Journal of cardiovascular eledrophysioiogy, 23 (2), pp. 128-9.
3. Anton A.W. Mulder MCEFW, Eric F.D. Wever, and Lucas V.A. Boersma (2012), "Freedom from paroxysmal atrial fibnilation aftersuccessful pulmonary vein isolation with pulmonary vein ablation catheter-phased radiofrequency energy:
2-year follow-up and predictors of failure", Europace, 14 (6), pp. 818 - 825.
4. Calo L, Rebecchi M, Sciarra L, et al. (2012),
"Catheter ablation of right atrial ganglionated plexi in patients with vagal paroxysmal abial fibrillayon". Circulation. Arrhydimla and electrophysioiogy, 5 (1), pp. 22-31.
3. Calvo N, Nadal M, Berruezo A, et a l . (2012),
"Improved outcomes and complications of atrial fibrillation catheter ablation over time: learning curve, techniques, and methodology", Revista espanola de cardiologia, 65 (2), pp. 131-8.
6. Calvo N ML, Tamborero D, Bemiezo A, Viola G, Guasch E, Nadal M, Andreu D, Vidal B, Sitges M, Brugada J. (2010), "Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes", Europace, 12 pp. 30 - 36
/ . Cappato R CH, Chen SA, Davies W, Xesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A. (2009), "Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation", J Am Coll Cardiol 33, pp. 1798 -1803
