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Amiloidosis , Bloqueo Atrioventricular , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/diagnóstico , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Amiloidosis/diagnóstico , Cardiomiopatías/diagnóstico , Miocardio/patología , Anciano de 80 o más Años , Biopsia/métodos , Femenino , Masculino , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnósticoAsunto(s)
Angioscopía , Fibrilación Atrial , Ablación por Catéter , Imagen Multimodal , Ultrasonografía Intervencional , Humanos , Persona de Mediana Edad , Angioscopía/métodos , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico por imagen , Ablación por Catéter/efectos adversos , Venas Pulmonares/diagnóstico por imagen , Venas Pulmonares/cirugía , Estenosis de Vena Pulmonar/diagnóstico por imagen , Estenosis de Vena Pulmonar/etiologíaAsunto(s)
Amiloidosis , Terapia de Resincronización Cardíaca , Insuficiencia Cardíaca , Humanos , Prealbúmina , Bloqueo de Rama/diagnóstico por imagen , Bloqueo de Rama/terapia , Sistema de Conducción Cardíaco , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/terapia , Amiloidosis/complicaciones , Amiloidosis/diagnóstico por imagen , Amiloidosis/terapia , Electrocardiografía , Estimulación Cardíaca Artificial , Resultado del Tratamiento , Función Ventricular IzquierdaRESUMEN
Bipolar radiofrequency catheter ablation (RFCA) is a novel strategy for refractory or recurrent ventricular arrhythmias (VAs) resistant to conventional ablation methods. Lesions created during bipolar RFCA are larger than those created during sequential unipolar ablation. We present a case of refractory LV summit VAs, which identified the origin using a 2.7-F over-the-wire microelectrodes catheter, and it was successfully treated with bipolar RFCA in the acute phase.
Asunto(s)
Angioplastia de Balón , Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Enfermedad Veno-Oclusiva Pulmonar , Humanos , Venas Pulmonares/cirugía , Angioplastia de Balón/efectos adversos , Enfermedad Veno-Oclusiva Pulmonar/etiología , Enfermedad Veno-Oclusiva Pulmonar/cirugía , Ablación por Catéter/efectos adversos , Fibrilación Atrial/complicaciones , Resultado del TratamientoRESUMEN
Pulmonary vein isolation (PVI) with a balloon-based visually guided laser ablation (VGLA) is regarded as a useful therapeutic tool for treating atrial fibrillation (AF). The clinical efficacy of a VGLA has never been fully investigated in patients with left common pulmonary vein (LCPV). We investigated the procedural safety as well as clinical usefulness of VGLA in patients with LCPV.This study consisted of 130 consecutive patients who underwent VGLA of de novo nonvalvular paroxysmal AF.Eleven patients (8.5%) had an LCPV (ostium maximal average diameter: 27.5 ± 4.9 mm, ostium minimal average diameter: 17.7 ± 3.5 mm). Nine out of 11 (81.8%) LCPVs were successfully occluded and isolated at the ostium with a VGLA-guided PVI. The ablation procedure time was significantly shorter in the patients with than without an LCPV (61.5 ± 15.4 versus 86.9 ± 32.9 minutes, P = 0.01). There was no difference regarding the atrial tachyarrhythmia recurrence between those with and without an LCPV (P = 0.18). A total of 15 patients underwent a redo procedure, but reconnections were not observed in any of the LCPV patients.The VGLA-guided PVI was a useful therapeutic tool even in patients with an LCPV. The presence of an LCPV might not be associated with an increased risk of any atrial tachyarrhythmia recurrence.
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Fibrilación Atrial , Terapia por Láser , Venas Pulmonares , Humanos , Venas Pulmonares/cirugía , Atrios Cardíacos , Fibrilación Atrial/cirugía , Rayos LáserRESUMEN
Cryoballoon ablation is an effective method for pulmonary vein isolation for atrial fibrillation; however, unexpected complications may occur while performing the ablation procedure. We report an extremely rare case of pulmonary vein perforation with hemoptysis that required emergency lobectomy caused by injury from a circular mapping catheter. (Level of Difficulty: Intermediate.).
RESUMEN
A suture-mediated vascular closure device is useful for hemostasis of the femoral vein after catheter ablation; however, venous complications remain unclear. We encountered 2 cases of femoral vein occlusion and stenosis using a suture-mediated vascular closure device. Both patients underwent surgical repair and recovered venous flow. (Level of Difficulty: Intermediate.).
RESUMEN
BACKGROUND: This study aimed to clarify the clinical outcomes of cryoballoon ablation of the left atrial (LA) posterior wall (LAPW), including the LA roof, in patients with non-paroxysmal atrial fibrillation (AF). METHODS: We analyzed the outcomes of 284 patients with non-paroxysmal AF, of whom 210 underwent the cryoballoon ablation of the LAPW, including the LA roof, in addition to pulmonary vein isolation with a cryoballoon. RESULTS: Complete conduction block at the LA roof was obtained in 95.7% (201/210) of patients, and LAPW was isolated in 83.3% (130/156) of patients. Over 372 (range, 208-477) days of follow-up, atrial arrhythmia recurrence was observed in 84 (29.6%) patients, and atrial tachycardia (AT) recurrence accounted for 27.4% of cases. The prevalence of LA roof cryoballoon ablation was significantly higher in patients without recurrence than in those with recurrence (78.6% vs. 63.1%, respectively; p = .01), especially those with persistent AF recurrence (77.0% vs. 55.0%, p = .01). No significant difference was found in the prevalence of AT recurrence between patients who had undergone additional LAPW ablation and those who had not. Durable LA roof lesions were confirmed in 29 (72.5%) of 40 patients who underwent redo ablation. CONCLUSIONS: Cryoballoon ablation of the LAPW leads to a sufficient acute success rate of complete conduction block and durable lesions of the LA roof without increasing AT recurrence risk. The prevalence of persistent AF recurrence decreases after additional cryoballoon ablation of the LAPW in patients with non-paroxysmal AF.
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We reported a unique case of slow-fast atrioventricular nodal reentrant tachycardia induced by double ventricular response with reproducibility.
RESUMEN
BACKGROUND: Contrast computed tomography (CT) is a useful tool for the detection of intracardiac thrombi. We aimed to assess the accuracy of the late-phase prone-position contrast CT (late-pCT) for thrombus detection in patients with persistent or long-standing persistent atrial fibrillation (AF). METHODS: Early and late-phase pCT were performed in 300 patients with persistent or long-standing AF. If late-pCT did not show an intracardiac contrast defect (CD), catheter ablation (CA) was performed. Immediately before CA, intracardiac echocardiography (ICE) from the left atrium was performed to confirm thrombus absence and the estimation of the blood velocity of the left atrial appendage (LAA). For patients with CDs on late-pCT, CA performance was delayed, and late-pCT was performed again after several months following oral anticoagulant alterations or dosage increases. RESULTS: Of the 40 patients who exhibited CDs in the early phase of pCT, six showed persistent CDs on late-pCT. In the remaining 294 patients without CDs on late-pCT, the absence of a thrombus was confirmed by ICE during CA. In all six patients with CD-positivity on late-pCT, the CDs vanished under the same CT conditions after subsequent anticoagulation therapy, and CA was successfully performed. Furthermore, the presence of residual contrast medium in the LAA on late-pCT suggested a decreased blood velocity in the LAA ( ≤ 15 cm/s) (sensitivity = 0.900 and specificity = 0.621). CONCLUSIONS: Late-pCT is a valuable tool for the assessment of intracardiac thrombi and LAA dysfunction in patients with persistent or long-standing persistent AF before CA.
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Apéndice Atrial , Fibrilación Atrial , Ablación por Catéter , Trombosis , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Ecocardiografía Transesofágica , Humanos , Posición Prona , Trombosis/diagnóstico por imagen , Trombosis/etiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Pulmonary vein (PV) isolation (PVI) with balloon-based visually guided laser ablation (VGLA) is useful for treating atrial fibrillation (AF), but phrenic nerve injury (PNI) is an important complication. We investigated the predictors of developing PNI during VGLA.MethodsâandâResults:We included 130 consecutive patients who underwent an initial VGLA of non-valvular paroxysmal AF. Twenty patients developed PNI during the PVI. The patients with PNI had a significantly larger right superior PV ostial area (RSPVOA) than the other patients (mean [±SD] 284.7±47.0 vs. 233.1±46.4 mm2, respectively; P<0.01). Receiver operating characteristic analyses revealed that the area under the RSPVOA curve was 0.79 (95% confidence interval [CI] 0.69-0.90) with an optimal cut-off point of 238.0 mm2(sensitivity, 0.58; specificity, 0.95). In multivariate analyses, a large RSPVOA (HR 1.02, 95% CI 1.01-1.03, P<0.01) and small balloon size (HR 0.70, 95% CI 0.50-0.99, P=0.04) were independent risk factors for PNI during VGLA. PNI remained in 13 patients after the procedure, but 12 of these patients recovered from the PNI during the follow-up period. CONCLUSIONS: The incidence of PNI during VGLA was relatively high, but PNI improved in most cases. A large RSPVOA and small balloon size were predictors of PNI during VGLA.
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Fibrilación Atrial , Ablación por Catéter , Terapia por Láser , Traumatismos de los Nervios Periféricos , Nervio Frénico/lesiones , Venas Pulmonares , Fibrilación Atrial/cirugía , Ablación por Catéter/efectos adversos , Humanos , Traumatismos de los Nervios Periféricos/etiología , Venas Pulmonares/cirugía , Resultado del TratamientoRESUMEN
Therapeutic drug monitoring (TDM) is used in certain clinically selected cases and in research settings to optimize the response to antiretroviral therapy. Plasma of blood is commonly used for TDM, but blood sampling is invasive and at risk for transmission of infectious agents. On the other hand, saliva sampling is noninvasive, safe, cheap, and easily performed compared to blood. Dolutegravir (DTG) is now widely prescribed as a key component of antiretroviral therapy for HIV infection. In this study, we examined the relationship between DTG concentrations in plasma and saliva of treated patients to explore the possibility of using saliva as an alternative body fluid of TDM. A total of 17 pairs of blood and saliva samples were obtained from 15 consented HIV-1-infected subjects treated with DTG containing regimens for more than one month. Both blood and saliva samples were collected within 1 h of each other. Drug concentrations were determined by liquid chromatography-tandem mass spectrometry using DTG-d5 as an internal standard. The LLOQ was 0.5 ng/mL. The calibration curves were prepared with pooled plasma or saliva containing DTG in a range of 0.5-100 ng/mL with precision of <14.4% and accuracy within ±14.7%. The DTG concentrations in the plasma and saliva were significantly correlated (Pearson's correlation coefficient r = 0.76, p < 0.001). The median ratio of the drug concentration in saliva to those in plasma was 0.0056, which is close to the rate of non-protein-bound DTG in plasma (0.70%), suggesting that only free DTG in plasma is transported to the salivary glands and secreted into saliva. The present study demonstrates that DTG concentration in saliva reflects the pharmacologically active drug concentration in plasma and may provide an easily accessible alternative for monitoring effective antiretroviral treatment.
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Monitoreo de Drogas/métodos , Infecciones por VIH/tratamiento farmacológico , Inhibidores de Integrasa VIH/sangre , Compuestos Heterocíclicos con 3 Anillos/sangre , Oxazinas/sangre , Piperazinas/sangre , Piridonas/sangre , Espectrometría de Masas en Tándem/métodos , Cromatografía Liquida/métodos , Femenino , Inhibidores de Integrasa VIH/uso terapéutico , VIH-1/efectos de los fármacos , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Humanos , Límite de Detección , Masculino , Oxazinas/uso terapéutico , Piperazinas/uso terapéutico , Piridonas/uso terapéutico , Saliva/químicaRESUMEN
Glycemic variability (GV) is relevant to impaired myocardial salvage in acute ST-elevation myocardial infarction (STEMI). Severity of hypokinesis at the infarct site as assessed from contrast left ventriculography can reportedly predict infarct size in STEMI. We prospectively studied 58 consecutive patients (mean age, 63 ± 11 years) with anterior or inferior STEMI who underwent successful reperfusion therapy. Mean amplitude of glucose excursion (MAGE) was obtained from continuous glucose monitoring system. Patients were divided into the upper tertile of MAGE as Group H, and the other two-thirds as Group L. Serial regional wall motion severity at the infarct site was computed postprocedure and at follow-up using a quantitative left ventricular analysis system. Impaired myocardial salvage was defined as severity recovery ratio < 20%. Significantly shorter onset-to-balloon time (196.9 vs. 279.0 min, p = 0.033) and relatively lower postprocedural wall motion severity (2.4 vs. 2.9, p = 0.096) were observed in Group H, but absolute severity recovery was significantly smaller in Group H (0.5 vs. 1.3, p = 0.017). Multivariate analysis showed higher MAGE as predictive of impaired myocardial salvage (OR, 406.10; 95% CI, 4.41-37,366.60; p = 0.009). Recovery of reginal wall motion severity at the infarct site was compromised in STEMI patients with higher MAGE. Our results suggest that final infarct size is potentially larger than expected in STEMI patients with higher GV.
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Glucemia/metabolismo , Ventrículos Cardíacos/diagnóstico por imagen , Contracción Miocárdica , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Anciano , Cinerradiografía , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Estudios ProspectivosRESUMEN
Accurate diagnosis of earlier HIV infection is essential for treatment and prevention. Currently, confirmation tests of HIV infection in Japan are performed using Western blot (WB), but WB has several limitations including low sensitivity and cross-reactivity between HIV-1 and HIV-2 antibodies. To address these problems, a new HIV testing algorithm and a more reliable confirmation and HIV-1/2 differentiation assay are required. The Bio-Rad Geenius HIV-1/2 Confirmatory Assay (Geenius) has recently been approved and recommended for use in the revised guidelines for diagnosis of HIV infection by the Center for Disease Control and Prevention (USA). We made comprehensive comparison of the performance of Geenius and the Bio-Rad NEW LAV BLOT 1 and 2 (NLB 1 and 2) which are WB kits for HIV-1 and HIV-2, respectively, to examine if Geenius is a suitable alternative to these WB assays which are now being used in HIV testing in Japan. A total of 166 HIV-1 positive samples (146 from patients with established HIV-1 infection and 20 from patients with acute infection), five HIV-1 seroconversion panels containing 21 samples and 30 HIV-2 positive samples were used. In addition, a total of 140 HIV negative samples containing 10 false-positives on screening tests were examined. The sensitivity of Geenius and NLB 1 for HIV-1 positive samples was 99.3% and 98.6%, respectively. Geenius provided more positive results in the samples from acute infections and detected positivity 0 to 32 days earlier in seroconversion panels than NLB 1. NLB 2 gave positive results in 12.3% of HIV-1 positive samples. The sensitivity of both Geenius and NLB 2 for HIV-2 positive samples was 100%. The specificity of Geenius, NLB 1 and NLB 2 was 98.5%, 81.5% and 90.0%, respectively. Geenius is an attractive alternative to WB for confirmation and differentiation of HIV-1 and HIV-2 infections. The adaptation of Geenius to the HIV testing algorithm may be advantageous for rapid diagnosis and the reduction of testing costs.