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1.
Artigo em Inglês | MEDLINE | ID: mdl-32468323

RESUMO

PURPOSE: Progress of balloon devices for pulmonary vein (PV) isolation in atrial fibrillation (AF) has been remarkable. However, these techniques were specialized in pulmonary vein treatment; predicting non-PV foci in advance is important to decide the treatment strategy. In this study, we investigate the predictors for paroxysmal AF. METHODS: Subjects were consecutive paroxysmal AF patients who underwent high-dose isoproterenol provocation after PV isolation in the first session. The PV group (n = 102) and non-PV group (n = 222) were defined as the patients with and without non-PV ablation, respectively. Non-PV ablation was performed when frequent repetitive premature atrial contractions or triggered AF occurred spontaneously or by isoproterenol provocation. Predictors of non-PV origin in paroxysmal AF patients were examined using clinical characteristics and preoperative echocardiography. RESULTS: In the multivariate logistic regression analysis, female sex, body mass index (BMI < 23.8), absence of hypertension, and higher ratio of mitral early diastolic peak (E-wave) to early diastolic mitral annulus peak (e') velocity (E/e' > 8.44) were significant independent predictors of non-PV foci (hazard ratio 2.04, 1.88, 3.63, and 2.33; 95% confidence interval 1.17-3.55, 1.05-3.39, 1.72-7.67, and 1.34-4.05; p = 0.011, 0.035, < 0.001, and 0.003, respectively). If a patient had these four factors, non-PV was detected with 96.8% specificity. CONCLUSION: Female sex, lower BMI, absence of hypertension, and higher E/e' were significant indicators of non-PV foci in patients with paroxysmal AF. Reviewing these factors in advance may be useful for selecting a device to perform pulmonary vein isolation.

2.
Int Heart J ; 61(2): 249-253, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173706

RESUMO

Cryoballoon ablation is an established catheter-based approach to treat atrial fibrillation (AF). However, thromboembolic events cannot be avoided during cryoablation. There is little data regarding the blood coagulation status during freezing.The thrombin antithrombin complex (TAT) and prothrombin fragment 1+2 (F 1+2) of patient blood were measured during cryoballoon application when the cryoballoon temperature reached the nadir in 63 AF patients. TAT was also measured from porcine blood during cryoballoon freezing in 5 pigs.The TAT and F 1+2 increased from 6.60 ± 5.65 to 9.16 ± 7.28 ng/mL (P = 0.004) and from 279.6 ± 146.4 to 323.6 ± 169.1 pmol/L (P = 0.003) between the control and during freezing, respectively. The TAT increased from 0.46 to 0.87 ng/mL during freezing compared to that of pre-freezing (P < 0.05), and it returned to 0.39 ng/mL in 30 minutes after an intravenous edoxaban administration (N.S.).Dabigatran failed to exert sufficient anticoagulant effects during cryofreezing. In contrast, intravenous edoxaban seemed to provoke anticoagulation effects under extreme low temperature circumstances.


Assuntos
Antitrombinas/uso terapêutico , Criocirurgia/efeitos adversos , Dabigatrana/uso terapêutico , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Tromboembolia/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/prevenção & controle
3.
JACC Clin Electrophysiol ; 6(2): 231-240, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32081228

RESUMO

OBJECTIVES: This study sought to evaluate the prevalence, mapping features, and ablation outcomes of non-scar-related ventricular tachycardia (NonScar-VT) and Purkinje-related VT (Purkinje-VT) in patients with structural heart disease. BACKGROUND: VT in structural heart disease is typically associated with scar-related myocardial re-entry. NonScar-VTs arising from areas of normal myocardium or Purkinje-VTs originating from the conduction system are less common. METHODS: We retrospectively analyzed 690 patients with structural heart disease who underwent VT ablation between 2013 and 2017. RESULTS: A total of 37 (5.4%) patients (16 [43%] with ischemic cardiomyopathy, 16 [43%] with nonischemic dilated cardiomyopathy, and 5 [14%] others) demonstrated NonScar/Purkinje-VTs, which represented the clinical VT in 76% of cases. Among the 37 VTs, 31 (84%) were Purkinje-VTs (28 bundle branch re-entrant VT). The remaining 6 (16%) VTs were NonScar-VTs and included 4 idiopathic outflow tract VTs. A total of 16 patients had prior history of VT ablations: empirical scar substrate modification was performed in 6 (38%) patients and residual inducibility of VT had not been assessed in 7 (44%). In all 37 patients, the NonScar/Purkinje-VT was successfully ablated. After a median follow-up of 18 months, the targeted NonScar/Purkinje-VT did not recur in any patients, and 28 (76%) of patients were free from any recurrent VT episodes. CONCLUSIONS: NonScar/Purkinje-VTs can be identified in 5.4% of patients undergoing VT ablation in the setting of structural heart disease. Careful effort to induce, characterize, and map these VTs is important because substrate-based ablation strategies would fail to eliminate these types of VT.

4.
J Cardiovasc Electrophysiol ; 31(4): 875-884, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32017303

RESUMO

INTRODUCTION: Pulmonary vein isolation (PVI) and linear ablation with a roof line and bottom line on the left atrial (LA) posterior wall (LAPW) can be achieved with a cryoballoon (CB). This study sought to investigate the long-term durability of these linear lesions. METHODS AND RESULTS: Among 290 persistent patients with atrial fibrillation (AF) who had undergone linear ablation with a CB on the roof and bottom line of the LAPW in addition to the PVI, we analyzed those patients who underwent a re-do AF ablation. Arrhythmia recurrence was confirmed in 70 (24%) out of 290 patients, and 47 (16%) patients underwent re-do sessions. At the beginning of the re-do ablation, we examined the reconnection sites of the linear lesions on the LAPW and PVI. Maintenance of the conduction block on the LAPW roof and bottom lines was observed in 35 out of 47 patients (74.5%), and 16 out of 35 patients (45.7%), respectively. The length of the roof line was significantly shorter in patients with preservation of the conduction block on the LAPW roof than in those without (36.2 ± 6.5 mm vs 41.6 ± 4.7 mm, P = .02). CONCLUSION: Durable lesions could be obtained after linear ablation with the CB for the LAPW roof line, especially in those with a relatively short LAPW roof line. However, patients requiring touch-up ablation with radiofrequency were included, and that was associated with a potential financial implication.

5.
Int Heart J ; 61(1): 39-45, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956141

RESUMO

Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and hypertrophic cardiomyopathy (HCM) implanted with implantable cardioverter-defibrillators (ICDs) may show a large decrease in R-wave amplitude during long-term follow-up. However, it is unclear whether this decrease is higher in these patients than in those without structural heart disease. This study investigated ICD-lead intracardiac parameters over a long duration in patients with ARVC and HCM and compared these parameters with those of a control group. We included 50 patients (mean age, 55.2 ± 17.2 years; 26% female) with ICD leads in the right ventricular apex, and compared 7 ARVC and 14 HCM patients with 29 control patients without structural heart disease. ICD-lead parameters, including R-wave amplitude, pacing threshold, and impedance during follow-up, were compared. The difference in these parameters between the time of implantation and year 5 were also compared. There were no significant differences in R-wave amplitude at implantation among the 3 groups. The change in R-wave amplitude between the time of implantation and year 5 was significantly greater in the ARVC group (-3.3 ± 5.4 mV, P = 0.012) in comparison to the control group (1.3 ± 2.8 mV); the HCM group showed no significant difference (-0.4 ± 2.3 mV, P = 0.06). Thus, in the ARVC group, R-wave amplitude at year 5 was significantly lower than that in the control group (5.7 ± 4.8 mV versus 12.5 ± 4.5 mV, P = 0.001). In ARVC patients with ICDs, ventricular sensing is likely to deteriorate during long-term follow-up; however, in HCM patients, sensing may not deteriorate.


Assuntos
Displasia Arritmogênica Ventricular Direita/terapia , Cardiomiopatia Hipertrófica/terapia , Ventrículos do Coração/fisiopatologia , Adolescente , Adulto , Idoso , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Cardiomiopatia Hipertrófica/fisiopatologia , Estudos de Casos e Controles , Desfibriladores Implantáveis , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Int Heart J ; 61(1): 121-127, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956142

RESUMO

Laserballoon-based pulmonary vein isolation has proven to be safe and effective. However, the influence of the laser energy titration on the lesion formation has never been fully investigated. The aim of this study was to determine the relationship between the delivered laser energy and lesion size, as well as the incidence of steam pop.The whole porcine heart was excised, and the left ventricular myocardium was separated into four specimens. Myocardial specimens were embedded in a warm mattress to keep the myocardial temperature around 37°C. The laserballoon was located so that the surface of the laserballoon was attached to the myocardium. The laser energy was irradiated against the surface of myocardium at 5.5, 8.5, 10.0, and 12.0 W for 3, 5, 10, and 20 seconds. The depth, surface area, and lesion volume were measured using a digital vernier caliper.At constant laser energy and time, the lesion size increased significantly with the increasing energy (P < 0.001) and application duration (P < 0.001). The steam pop was provoked when a 12.0 W laser energy was applied for longer than 16 seconds, and it occurred in 2 out of 8 lesions.The laserballoon demonstrated the ability to create a lesion formation in a dose- and time-dependent manner. Steam pop could be provoked with high-energy irradiation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/instrumentação , Ablação por Cateter/instrumentação , Animais , Suínos , Fatores de Tempo
7.
Artigo em Inglês | MEDLINE | ID: mdl-31907832

RESUMO

PURPOSE: Whether or not pulmonary vein isolation (PVI) plus left atrial posterior wall isolation (PWI) using contact force (CF) sensing improves the ablation outcome for persistent atrial fibrillation (AF) is unclear. This study compared the outcome of PVI plus PWI and additional non-PV trigger ablation for persistent AF with/without CF sensing. METHODS: This retrospective cohort study analyzed 148 propensity score-matched persistent AF patients (median duration of persistent AF, 8 months (interquartile range, 3-24 months); left atrial diameter, 43 ± 7 mm) undergoing PVI plus PWI and ablation of non-PV triggers provoked by high-dose isoproterenol, including 74 with CF-sensing catheters (CF group) and 74 with conventional catheters (non-CF group). PVI plus PWI with no additional ablation but cavotricuspid isthmus ablation was performed without non-PV triggers in 48 CF patients (65%) and 54 non-CF patients (73%) (P = 0.38). In all other patients, we performed additional ablation of provoked non-PV triggers. RESULTS: The Kaplan-Meier estimate of the rate of freedom from atrial tachyarrhythmia recurrence off antiarrhythmic drugs at 12 months after the single procedure was higher in the CF group than in the non-CF group (85 vs. 70%, log-rank P = 0.030). A multivariable analysis revealed that using CF sensing and non-inducibility of AF from a non-PV trigger after PVI and PWI were significantly associated with a reduced rate of atrial tachyarrhythmia recurrence. CONCLUSIONS: Compared with non-CF sensing, PVI plus PWI and additional non-PV trigger ablation using CF-sensing catheters for persistent AF can reduce the rate of atrial tachyarrhythmia recurrence.

8.
Artigo em Inglês | MEDLINE | ID: mdl-31897933

RESUMO

PURPOSE: Rapid ventricular pacing (RVP) was reported to improve the cooling effects of the cryoballoon (CB). The aim of this study was to investigate the safety and efficacy of RVP for left atrial posterior wall isolation (PWI) by the CB. METHODS: One hundred consecutive patients (males 80, mean age 63 ± 10 years) with persistent atrial fibrillation underwent left atrial roof (LA-RB) and bottom block line (LA-BB) creation by CB to achieve PWI. Patients were randomized into two groups according to whether they underwent PWI with (RVP group, n = 50) or without RVP (control group, n = 50). RESULTS: The nadir CB temperature (NCT) during the LA-RB and LA-BB creation was significantly lower in the RVP group than control group (LA-RB - 45.7 °C and - 43.9 °C, p < 0.001, and LA-BB - 42.4 °C and - 40.0 °C, p < 0.001). The success rate of the LA-RB creation was significantly higher in the RVP group than the control group (98% vs. 88%, p = 0.039), however, there were no significant differences regarding the LA-BB creation (66% vs. 52%, p = 0.15) and PWI (66% vs. 50%, p = 0.1) between the two groups. The PWI success rate did not differ whether CB freezing was prematurely terminated due to an excessive luminal esophageal temperature (LET) drop in the RVP group (65.8% vs. 66.7%, respectively, p = 0.96). CONCLUSIONS: RVP significantly decreased the NCT during the CB application resulting in the significant improvement of success rate of the LA-RB. The advantage of RVP in terms of the accomplishing PWI was not affected even when the CB freezing was prematurely terminated due to an excessive LET drop.

9.
J Cardiovasc Electrophysiol ; 31(1): 112-118, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31724790

RESUMO

INTRODUCTION: Isolation of the left atrial appendage (LAA) is often performed in persistent atrial fibrillation (AF). Propagation patterns in the LAA during AF remain to be elucidated. We sought to characterize propagation patterns in the LAA during AF in persistent AF. METHODS: Persistent AF patients undergoing catheter ablation were studied. Pulmonary vein isolation (PVI) was performed during continuous AF. If AF was not terminated by PVI, bi-atrial mapping was performed using a multi-electrode catheter during AF. Maps were collected at each site for 30 seconds and analyzed offline with a novel software, CARTOFINDER. This software made automatic determinations of whether activation was focal or rotational. The left atrium (LA) was divided into five regions, of which the LAA was one, and the right atrium (RA) into three. RESULTS: Eighty patients were studied (62 ± 10 years, 65 males). On average, 9.6 ± 2.2 and 4.1 ± 1.2 maps were created in the LA and RA, respectively. The LAA was mapped in 70 patients, resulting in 85 maps. In the LAA, activation was identified as focal more often than rotational (64 [91%] vs 10 [14%] patients, P < .001), seven patients displayed both. The number of focal activation events was greatest in the LAA (28.5 events/30 seconds [interquartile range, 15-54]) of the eight atrial regions. During focal activation, sites designated as earliest activation frequently covered a wide area, rather than being localized to a discrete site (5.4 ± 3.1 electrodes). CONCLUSIONS: The results of this study suggest that focal activation is a major mechanism underlying the arrhythmogenicity of the LAA in persistent AF.

10.
Pacing Clin Electrophysiol ; 43(1): 47-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707738

RESUMO

PURPOSE: The aim of this study was to test regional pharmacological effects of an antiarrhythmic agents to predict ablative effects. BACKGROUND: The vein of Marshall (VOM) providing vascular access to myocardial tissue has been used for ablative purposes using ethanol. METHODS: A total of 35 patients (male 21, 63.2 ± 7.8 years old) were included. A balloon-tipped infusion catheter was inserted into the VOM. Endocardial ultrahigh-resolution mapping was performed along the VOM region to record the change in atrial electrograms (AEs) after VOM injection of cibenzoline of 3.5 mg during sustained atrial fibrillation (AF). Subsequently, ethanol was infused into the VOM and ablative region was mapped. RESULTS: In 17 patients (49 %), cibenzoline reduced AEs amplitude by >50%, all of which had also complete elimination of AEs following ethanol (Group A). In 18 patients (Group B), cibenzoline failed to eliminate AEs; yet, in 13 of 18 AEs were eliminated by ethanol. In the remaining five patients, ethanol did not eliminate AE. CONCLUSIONS: Cibenzoline into the VOM could reliably predicts the results of subsequent ethanol infusion into the VOM using ultrahigh-resolution mapping system, which leads to avoid unnecessary permanent lesion creation by ethanol infusion.

11.
J Cardiol ; 75(4): 410-414, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31606246

RESUMO

BACKGROUND: The feasibility and safety of lead extraction of cardiac implantable electronic devices (CIEDs) in the elderly Asian population remain uncertain. We report the outcome and safety of transvenous excimer laser-assisted lead extraction of CIEDs in Japanese patients aged ≥80 years. METHODS: Consecutive 235 patients (age 67±15 years, 167 male) undergoing lead extraction of CIED with an excimer laser system (Philips, Andover, MA, USA) were included. RESULTS: Of 235 consecutive patients, 51 (22%) were ≥80 years (age 86±5 years, 14 were aged ≥90 years; 42 had pacemakers, 3 had implantable cardioverter defibrillators, and 6 had cardiac resynchronization therapy devices). The median implant duration was 110±95 months. Patients aged ≥80 years had lower body mass index (BMI, 20.7±3.1kg/m2 vs. 22.6±3.4kg/m2, p<0.001), higher incidence of CIED infection (98% vs. 63%, p<0.010), and longer duration of hospitalization (31±17 days vs. 24 ± 31 days, p<0.001) than patients aged <80 years. There were no differences between the age groups in the rate of complete retrieval (94.1% vs. 95.1%, p=0.726) and major complications, including cardiac tamponade and cardiogenic shock (2.0% vs. 2.7%, p=1.000). CONCLUSIONS: Excimer laser-assisted lead extraction was safe and feasible in the Japanese elderly population with low BMI, despite the high likelihood of procedural complications. Early removal of infected CIEDs should be performed without delay in elderly Asian populations.

12.
J Cardiol ; 75(1): 82-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31327705

RESUMO

BACKGROUND: The ATRIA, Outcomes Registry for Better Informed Treatment (ORBIT), and modified (m) HAS-BLED (excluding a labile international normalized ratio element from the HAS-BLED score) scores are currently used to predict the bleeding risk in atrial fibrillation (AF) patients receiving oral anticoagulant treatment. We assessed the usefulness of these scores in estimating the catheter ablation (CA)-related bleeding risk in AF patients from the Japanese Anti-Coagulation Regimen Exploration in AF Catheter Ablation Registry (JACRE). METHODS: We investigated 1322 consecutive patients enrolled in the prospective, multicenter JACRE registry of AF patients receiving CA. The patients also received rivaroxaban (n=1118) or warfarin (n=204) during the perioperative period and complications were monitored for 30 days post-surgery. RESULTS: Periprocedural bleeding complications occurred in 42 patients (3.2%) and were significantly associated with the mHAS-BLED [hazard ratio=1.46, 95% confidence interval (1.06-2.01)], ATRIA [1.16 (1.00-1.35)], and ORBIT [1.29 (1.06-1.57)] scores. However, only the mHAS-BLED score predicted a significantly greater bleeding prevalence in the high-score group than in the low-score group stratified by a threshold maximizing the sensitivity and specificity (threshold=3, p<0.001). The incidence of all bleeding complications was significantly lower in the rivaroxaban cohort in patients with a mHAS-BLED score ≥3 (rivaroxaban vs. warfarin cohort, 5.56% vs. 25%, p=0.028). CONCLUSIONS: All three common bleeding scores were associated with a periprocedural risk of CA-related bleeding in AF patients and a mHAS-BLED score ≥3 best distinguished high-risk patients from low-risk patients.

13.
Clin Case Rep ; 7(11): 2036-2041, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31788247

RESUMO

Ventricular tachycardia (VT) arising from the left ventricular summit is very tough to treat endocardially and epicardially due to the distance from the VT origin and close proximity to the coronary arteries, respectively. Ethanol infusions into coronary veins feeding VT origins were able to safely abolish this type of VT.

14.
J Interv Cardiol ; 2019: 3146848, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777468

RESUMO

Background: The long-term safety of first-generation drug-eluting stent (DES) in acute coronary syndrome (ACS) was controversial. Purpose: The purpose of this study was to establish 5-year real-world data regarding the long-term efficacy and safety of second-generation DES in Japanese patients with ACS. Methods: The Tokyo-MD PCI study is a multicenter, observational cohort study enrolling consecutive patients who underwent everolimus-eluting stent (EES) implantation. The 5-year clinical events were compared between the ACS group (n = 644) and the stable coronary artery disease (SCAD) group (n = 1255). The primary efficacy endpoint was ischemia-driven target lesion revascularization (TLR), and the primary safety endpoint was the composite of all-cause death or myocardial infarction (MI). Results: The median follow-up duration was 5.4 years. The cumulative incidence of ischemia-driven TLR was similar between ACS and SCAD (1 year: 3.0% versus 2.7%; P=0.682, 1-5 years: 2.7% versus 2.9%; P=0.864). The cumulative incidence of all-cause death or MI within 1 year was significantly higher in ACS than in SCAD (7.4% versus 3.8%; P < 0.001); however, ACS did not increase the risk of all-cause death or MI after adjusting confounders (adjusted hazard ratio, 1.260; 95% confidence interval, 0.774-2.053; P=0.352). From 1 to 5 years, the cumulative incidence of all-cause death or MI was not significantly different between ACS and SCAD (11.6% versus 11.4%; P=0.706). The cumulative incidence of very late stent thrombosis was low and similar between ACS and SCAD (0.2% versus 0.2%; P=0.942). Conclusion: This real-world registry suggested that EES has comparable long-term efficacy and safety in patients with ACS and SCAD.

15.
J Interv Cardiol ; 2019: 6515129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772538

RESUMO

Objectives: We aimed to compare the results of neointimal modification before drug-coated balloon (DCB) treatment with excimer laser coronary atherectomy (ELCA) plus scoring balloon predilation versus scoring balloon alone in patients presenting with in-stent restenosis (ISR). Background: Treatment of ISR with ELCA typically results in superior acute gain by neointima debulking. However, the efficacy of combination therapy of ELCA and DCB remains unknown. Methods: A total of 42 patients (44 ISR lesions) undergoing DCB treatment with ELCA plus scoring balloon (ELCA group, n = 18) or scoring balloon alone (non-ELCA group, n = 24) were evaluated via serial assessment by optical coherence tomography (OCT) performed before, after intervention, and at 6 months. Results: Although there was significantly greater frequency of diffuse restenosis and percent diameter stenosis (%DS) after intervention in the ELCA group, comparable result was shown in %DS, late lumen loss, and binary angiographic restenosis at follow-up. On OCT analysis, a decreased tendency in the minimum lumen area and a significant decrease in the minimum stent area were observed in the ELCA group between 6-month follow-up and after intervention (-0.89 ± 1.36 mm2 vs. -0.09 ± 1.25 mm2, p = 0.05, -0.49 ± 1.48 mm2 vs. 0.28 ± 0.78 mm2, p = 0.03, respectively). The changes in the neointimal area were similar between the groups, and target lesion revascularization showed comparable rates at 1 year (11.1% vs. 11.4%, p = 0.85). Conclusions: Despite greater %DS after intervention, ELCA before DCB had possible benefit for late angiographic and clinical outcome.


Assuntos
Angioplastia Coronária com Balão , Aterectomia Coronária , Angiografia Coronária/métodos , Reestenose Coronária , Neointima , Tomografia de Coerência Óptica , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/instrumentação , Aterectomia Coronária/métodos , Reestenose Coronária/diagnóstico , Reestenose Coronária/cirurgia , Stents Farmacológicos , Feminino , Humanos , Japão/epidemiologia , Lasers de Excimer/uso terapêutico , Masculino , Neointima/diagnóstico por imagem , Neointima/etiologia , Neointima/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Tomografia de Coerência Óptica/métodos , Tomografia de Coerência Óptica/estatística & dados numéricos
16.
J Interv Cardiol ; 2019: 9282876, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772552

RESUMO

Background: While the evaluation of burr speed was discussed regarding platelet aggregation, the association between platform speed and acute lumen gain of rotational atherectomy remains unknown. Methods: Through the evaluation of the potential of low-speed rotational atherectomy (LSRA) in in-vitro experiments, minimum lumen diameter (MLD) and minimum lumen area (MLA) after conventional high-speed rotational atherectomy (HSRA group) and those after LSRA following HSRA (LSRA+HSRA group) treated by 1.5 mm burrs were measured by optical frequency domain imaging (OFDI) in 30 consecutive human lesions. Results: The in-vitro experiments demonstrated that MLD and MLA after LSRA+HSRA were significantly larger (MLD: LSRA+HSRA=1.50 ±0.05 mm, HSRA= 1.43 ±0.05 mm, p=0.015; MLA: LSRA+HSRA= 1.90 ±0.17 mm2, HSRA= 1.71±0.11 mm2, and p= 0.037), requiring more crossing attempts (LSRA= 134 ±20 times, HSRA= 72 ±11 times, and p< 0.001). In human studies, there was no significance in reference vessel diameter and lesion length before the procedure between two groups. MLDs after LSRA+HSRA were significantly larger than those in HSRA (LSRA+HSRA= 1.22 ±0.16 mm, HSRA= 1.07 ±0.14 mm, and p= 0.0078), while MLAs after LSRA+HSRA tended to be larger (LSRA+HSRA= 1.79 ±0.51 mm2, HSRA= 1.55 ±0.47 mm2, and p= 0.19). There was no significance in the occurrence of in-hospital complication, including slow flow or no reflow, major dissection, and procedural myocardial infarction, between LSRA+HSRA and HSRA. Conclusions: LSRA can achieve larger lumen gain compared, whereas HSRA can pass calcified lesions easily. Combination of LSRA and HSRA is a safe and feasible strategy for severely calcified lesions in clinical practice.


Assuntos
Aterectomia Coronária , Doença da Artéria Coronariana , Vasos Coronários , Teste de Materiais/métodos , Intervenção Coronária Percutânea/métodos , Idoso , Aterectomia Coronária/efeitos adversos , Aterectomia Coronária/instrumentação , Aterectomia Coronária/métodos , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Desenho de Equipamento , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Calcificação Vascular/cirurgia
17.
J Interv Card Electrophysiol ; 56(3): 249-257, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31654337

RESUMO

PURPOSE: Ripple map (RM) is a novel method for displaying activation pattern on the surface of a cardiac chamber. The aim of this study was to determine the utility of the RM in interpreting the atrial propagation in atrial tachycardia (AT) in comparison with a conventional local activation (LAT) map. METHODS: Three-dimensional electroanatomical mapping and ablation of AT were performed using multielectrode catheters and the CARTO3 ConfiDENSE Module (Biosense Webster). LAT maps and RMs were retrospectively reviewed by two independent observers who were blinded to the ablation results. RESULTS: High-density maps (1683 ± 1362 points) of 45 ATs (274 ± 64 ms; macroreentry 28, focal 17) were obtained in 39 patients. Of the 45 ATs, 41 (91%) were terminated by catheter ablation. A retrospective review of the LAT map alone by two observers resulted in correct diagnosis in 27% (12 ATs), whereas additional reviews of the RMs improved the diagnostic accuracy to 80% (36 ATs, P < 0.001). The diagnostic accuracy using the RM was equally high for macroreentrant (79%) and focal ATs (82%, P = 1.000). Of the 33 LAT maps in disagreement with the observers, adjusting the window-of-interest (WOI) after reviewing the RMs achieved diagnostic agreement of 91% (30 ATs). CONCLUSION: RMs allow us to have precise understanding of the atrial propagation on high-density CARTO maps for both focal and macroreentrant ATs, which is particularly useful for cases with difficult-to-interpret LAT maps.

18.
J Cardiol Cases ; 20(3): 81-83, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31497170

RESUMO

The mechanism of adenosine-sensitive atrial tachycardia (AT) originating near the His bundle region has been reported to be due to reentry, as indicated by entrainment pacing at a site remote from the 'entrance' to the slow conduction zone of the postulated reentrant circuit. We report a case of AT, in which the change in response to the entrainment pacing following radiofrequency applications at the 'entrance' to the slow conduction zone not only suggested that the mechanism of the AT was reentry, but also the size of the reentrant circuit. .

19.
Artigo em Inglês | MEDLINE | ID: mdl-31367961

RESUMO

PURPOSE: Cryoenergy has been demonstrated to be a safe alternative to radiofrequency ablation for catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). This study aimed to evaluate the safety and efficacy of cryoablation in patients with AVNRT. METHODS: A multicenter retrospective study was performed. Two hundred eighty-three consecutive patients with AVNRT underwent cryoablation. Cryomapping at - 30 °C and - 80 °C was performed to predict cryoablation outcome and ascertain antegrade conduction. Cryoenergy was delivered subsequently at the same spot (cryoablation at - 80 °C) for 240 s. RESULTS: Ablation procedure was acutely successful in 281 out of 283 patients (99.3%). Of note, 22 patients (10.1%) had transient AV block during the cryoablation, but no injurious effects on AV conduction were provoked during cryomapping. During a follow-up period of 367 ± 35 days, the recurrence rate was 3.9% (11 out of 281). There were no significant differences among the patients with a complete elimination of slow pathway conduction, AH jump without an echo beat, and AH jump with a single echo beat, in terms of the long-term recurrence of AVNRT. CONCLUSIONS: Cryoablation of AVNRT appears to be effective both acutely and during the long-term with a minimal risk of unwanted injuries to the conduction system. It seems to be important to monitor the antegrade conduction during cryoenergy applications, even when cryomapping demonstrates a safe location for cryoablation. The recurrence rate of AVNRT did not differ according to the properties of the residual slow pathway conduction.

20.
Eur Heart J Case Rep ; 3(2)2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31449630

RESUMO

BACKGROUND: Verapamil-sensitive fascicular ventricular tachycardia (VT) is the most common type of idiopathic left ventricular tachycardia, and it is divided into three types. Upper septal ventricular tachycardia (US-VT) is likely in patients with prior episodes of left posterior fascicular (LPF)-VT ablation, however, little is known about the recurrence mechanism of US-VT. CASE SUMMARY: A 53-year-old man had an US-VT after two catheter ablation sessions for a common idiopathic LPF-VT. The US-VT was successfully treated by ablating the proximal site of the LPF without making any further branch or fascicular block. This successful ablation point corresponded completely with the earliest pre-systolic potential (P2) site of the LPF-VT during the 1st session of catheter ablation. DISCUSSION: An US-VT recurrence could occur if a critical slow conduction is not affected by the catheter ablation. This recurrence might be the result of changing the re-entrant circuit after damage to the LPF. In order to eliminate the LPF-VT and prevent an US-VT recurrence, the earliest P2 site should be investigated carefully and ablated sufficiently.

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