Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 53
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Pacing Clin Electrophysiol ; 43(3): 297-307, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32045008

RESUMO

AIMS: In this study, we investigated the characteristics and underlying mechanisms of the electrocardiographic (ECG) morphology during left bundle branch area pacing (LBBAP), which have not been systematically described. METHODS: Patients with indications for permanent cardiac pacing underwent LBBAP attempts. The ECGs of patients with confirmed left bundle branch (LBB) capture were compared with those of individuals with right bundle branch block (RBBB) on 12-lead ECG. Intracardiac electrograms recorded during implantation were analyzed in all patients who underwent pacing. RESULTS: LBBAP was successfully achieved in 87.5% (56/64) of patients. The QRS morphologies in lead V1 during LBBAP, which typically demonstrated Qr (60.7%), qR (19.6%), rSR' (7.1%), or QS (12.5%) patterns, differed from those of native RBBB, which featured rsR' (57.5%), M shape (23.7%), or monophasic R patterns (18.7%). The terminal R' wave duration in lead V1 was significantly shorter during LBBAP than during native RBBB (51 ± 12 ms vs 85 ± 19 ms, p < 0.001). LBB potentials were recorded in 66.1% (37/56) of the LBBAP patients. No significant differences in ECG characteristics were found between LBBAP with and without recorded LBB potentials. The presence of bundle branch block during LBBAP significantly prolonged QRS duration, R wave peak time, and terminal R' wave duration in lead V1 . CONCLUSION: LBBAP-ECG patterns are characterized by a shorter terminal R' wave duration in lead V1 compared with that of native RBBB configurations. Bundle branch conduction integrity has an impact on ECG characteristics during LBBAP.

2.
J Int Med Res ; 48(2): 300060520903608, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32056481
4.
Circ Cardiovasc Interv ; 12(12): e007635, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31833417

RESUMO

BACKGROUND: Mechanical injury in the conduction system requiring permanent pacemaker (PPM) associated with transcatheter aortic valve replacement (TAVR) procedure is a common complication. The objective of this study was to use ambulatory monitor BodyGuardian to assess late occurrence of atrioventricular block (AVB) after TAVR. METHODS: This prospective study evaluated 365 patients who underwent TAVR at Mayo Clinic, Rochester, Minnesota between June 2016 and August 2017. Patients who received PPM for bradycardia after TAVR before discharge were considered as the PPM group. Those not requiring PPM received a BodyGuardian system (BodyGuardian group) for 30 days of continuous monitoring. Primary end point was Mobitz II or third-degree atrioventricular block (II/III AVB) at 30-day follow-up. RESULTS: Of 365 patients, 74 who had a PPM or an implantable cardioverter-defibrillator before TAVR and 94 who were enrolled in other studies were excluded. Of 197 patients enrolled in the study, 70 (35.5%) received PPM and 127 had BodyGuardian before the hospital dismissal. Eleven of 127 (8.6%) BodyGuardian group required PPM within 30 days after TAVR for late occurrence of symptomatic bradycardia. In total, 33 of 197 (16.7%) patients developed II/III AVB (24 before and 9 after discharge). Thirty-four patients had preexisting right bundle branch block. Of them, 16 (47%) developed II/III AVB. Of 53 patients who developed new left bundle branch block after TAVR, 14% progressed to II/III AVB within 30 days. CONCLUSIONS: In patients without a standard post-TAVR pacing indication, yet a potential risk to develop AVB, a strategy of 30-day monitoring identifies additional patients who require permanent pacing.

5.
Circ Arrhythm Electrophysiol ; 12(9): e007118, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31514529

RESUMO

BACKGROUND: Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied. METHODS: This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications. RESULTS: Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%; P=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (P<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%; P=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%; P=0.009). There were no procedure-related major complications. CONCLUSIONS: SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.

7.
Pacing Clin Electrophysiol ; 42(9): 1276-1279, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31116434

RESUMO

We present the case of a 29-year-old man who developed ventricular tachycardia (VT) secondary to a cardiac lipoma located adjacent to the interventricular groove, which could not be fully resected. Antiarrhythmic drugs and endocardial and epicardial ablation failed to prevent VT recurrence. Finally, noninvasive stereotactic body radiation therapy (SBRT) targeting the lipoma was performed, with a total dose of 24 Gy delivered in three fractions. The number of VT episodes was reduced from 189/24 h before SBRT to 0 after the procedure. At 4-month follow-up, there were no signs of therapy-related complications. Our experience suggests that SBRT could emerge as a viable treatment option for patients with cardiac tumors who develop refractory ventricular arrhythmias.

8.
J Cardiovasc Electrophysiol ; 30(6): 815-823, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30891845

RESUMO

INTRODUCTION: Adenosine triphosphate (ATP)-provoked dormant conduction (DC) and pacing for unexcitability are used to identify conduction gaps along the ablation lines after circumferential pulmonary vein isolation (CPVI). We aim to determine whether ATP provocation and pacing are interchangeable as endpoints for ablation of paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: A total of 107 patients with PAF were randomly divided into two groups after completion of CPVI. In group I (A-P group, n = 53), ATP was administered first. If DC was uncovered, additional ablation was performed until ATP tests were negative. Bipolar pacing along the ablation line was performed subsequently. In group II (P-A group, n = 54), the same protocol was used, but the pacing and the ATP tests were performed in the opposite sequence. The 12-month ablation outcomes of all patients were compared with those of a historical control group of 107 patients with PAF in whom only ATP test was performed. Regardless of which test was performed first, the other modality still identified conduction gaps. In group I, pacing maneuvers identified gaps in 49% (n = 26) of patients who had negative ATP tests. In group II, ATP tests uncovered DC in 18.5% (n = 10) of patients in whom pacing identified no gaps. After 12 months, a higher proportion of patients (91.6%) were free from atrial tachyarrhythmias compared with the historical control group (81.3%; P = 0.031). CONCLUSION: Pacing along the ablation lines and ATP provocation are complementary tests for evaluating the durability of CPVI and can lead to better long-term outcomes when used in combination.

9.
Cardiol Res Pract ; 2019: 3210803, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30719341

RESUMO

Background: In patients with persistent atrial fibrillation (AF), the procedural and clinical outcomes of ablation combined with infusion of antiarrhythmic drug are unknown. Objectives: To determine the impact of low-dose ibutilide after circumferential pulmonary vein isolation (CPVI) and/or left atrial (LA) substrate modification on acute procedural and clinical outcome of persistent AF. Methods: In a prospective cohort of 135 consecutive patients with persistent AF, intravenous 0.25 mg ibutilide was administered 3 days before the procedure and intraprocedurally, if required, after CPVI and/or additional LA substrate modification of sites with continuous, rapid or fractionated, and low-voltage (0.05-0.3 mv) atrial activity. Results: Persistent AF was terminated by CPVI alone (n=15) or CPVI + ibutilide (n=32) in 47 (34.8%) patients (CPVI responders). Additional LA substrate modification without (n=33) or with subsequent administration of 0.25 mg ibutilide (n=19) terminated AF in another 52 (38.5%) patients (substrate modification responders). Sinus rhythm was restored by electrical cardioversion in the remaining 36 (26.7%) patients (nonresponders). The mean LA substrate ablation time was 14 ± 6 minutes. At follow-up of 24 ± 10 months, the rates of freedom from atrial tachyarrhythmias among the responders in CPVI and substrate modification groups were mutually comparable (66.0% and 69.2%) and higher than among the nonresponders (36.1%; P < 0.01). Among the responders, there was no difference in clinical outcome between patients whose persistent AF was terminated without or with low-dose ibutilide. Conclusion: Administration of low-dose ibutilide during ablation of persistent AF may allow select patients wherein substrate ablation is not or minimally required to optimize procedural and clinical outcomes.

10.
Clin Ther ; 41(1): 78-91, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30559005

RESUMO

PURPOSE: The aim of this study was to evaluate the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared with cryoballoon (CB) ablation in the treatment of patients with paroxysmal atrial fibrillation (PAF) from the payer's perspective in China. METHODS: We constructed a cohort model, combining a 12-month decision-tree model with a lifetime Markov state-transition model, in a hypothetical cohort of patients with drug-refractory PAF managed with either RFCA or CB ablation, to compare the cost-effectiveness of the 2 procedures. Data related to clinical outcomes and costs in this model were obtained from a retrospective 12-month follow-up study in patients in China and from related literature. The incremental cost-effectiveness ratio (ICER) over a 10-year time period was calculated and compared against the willingness-to-pay (WTP) threshold. We used a 1-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) to access the structural uncertainty and the parameter uncertainty, respectively. FINDINGS: Over a 10-year time horizon, the total costs per patient of RFCA and CB ablation were ¥98,164.04 (US $15,339.57; €13,058.94) and ¥107,542.37 ($16,805.07; €14,306.55), respectively, and quality-adjusted life-years (QALYs) gained were 5.47 and 5.43, respectively. The ICER ratio was -¥224,365.01 (-$35,060.32; -€29,847.68) per QALY, indicating that RFCA is associated with greater QALYs and lower costs than CB ablation. The 1-way sensitivity analysis demonstrated that the model results were most sensitive to the odds ratio of the atrial fibrillation recurrence within 12 months in the RFCA group versus the CB ablation group, the cost of RFCA, and the perioperative stroke risk with RFCA. According to the results of the PSA, RFCA was associated with a high probability of being cost-effective (99.48%) compared with CB ablation at a WTP threshold of ¥161,940 ($25,305.50; €21,543.17) per QALY. IMPLICATIONS: Our analysis indicates that RFCA is cost-saving compared with CB ablation in the treatment of patients with PAF in China, based on better QALYs and lower costs over a 10-year time horizon, from the payer's perspective.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Anos de Vida Ajustados por Qualidade de Vida , Idoso , China , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
11.
PLoS One ; 13(1): e0190170, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29298352

RESUMO

INTRODUCTION: Hybrid ablation, an emerging therapy that combines surgical intervention and catheter ablation, has become a viable option for the treatment of persistent atrial fibrillation. In this analysis, we aimed to evaluate the safety and efficacy of hybrid ablation, as well as compare the outcomes of one-step and staged approaches. METHODS: We conducted a search in major online databases and selected the studies that met the inclusion criteria. The primary endpoint was defined as no episode of atrial fibrillation or atrial tachycardia lasting longer than 30 seconds without administration of antiarrhythmic drugs. RESULTS: Sixteen studies including 785 patients (paroxysmal atrial fibrillation, n = 83; persistent atrial fibrillation, n = 214; long-standing persistent atrial fibrillation, n = 488) were selected. Average history of atrial fibrillation was (5.0±1.6) years. The pooled proportion of patients who were arrhythmia-free at the primary endpoint was 73% (95% CI, 64%-81%, Cochran's Q, P<0.001; I2 = 81%). The pooled rate of severe short-term complications was 4% (95% CI, 2%-7%, Cochran's Q, P = 0.01; I2 = 51%). The success rate after one-step procedures (69%) was lower than that after staged procedures (78%). The staged approach could ultimately prove to be safer, although complication rates were relatively low for both approaches (2% and 5%, respectively). CONCLUSIONS: Hybrid ablation is an effective and generally safe procedure. The current data suggest that staged hybrid ablation could be the optimal approach, as it is associated with a higher success rate and a seemingly lower complication rate. Additional randomized controlled trials are necessary to confirm these results.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , Humanos
12.
Environ Technol ; 38(24): 3074-3083, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28142646

RESUMO

Fracturing waste liquid (FWL) is generated during shale gas extraction and contains high concentrations of suspended solid, salinity and organic compounds, which needs proper management to prevent excessive environmental disruption. Biological treatment of the FWL was attempted in this study using a membrane-coupled internal circulation aerobic biological fluidized bed (MC-ICABFB) after being treated by coagulation. The results showed that poly aluminum chloride (PAC) of 30 g/L, polyacrylamide (PAM) of 20 mg/L and pH of 7.0 were suitable choices for coagulation. The pretreated FWL mixed with synthetic wastewater at different ratios were used as the influent wastewater for the reactor. The MC-ICABFB had relatively good performance on COD and NH4+-N removal and the main residual organic compound in the effluent was phthalates according to the analysis of GC-MC profiles. In addition, a suitable pretreatment process for the FWL to facilitate biological treatment of the wastewater needs further research.


Assuntos
Reatores Biológicos , Fraturamento Hidráulico , Eliminação de Resíduos Líquidos , Águas Residuárias/química , Resinas Acrílicas/análise , Aerobiose , Hidróxido de Alumínio/análise , Concentração de Íons de Hidrogênio
13.
Europace ; 17(12): 1798-806, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25957039

RESUMO

AIMS: This prospective clinical trial was designed to evaluate the efficacy of an ablation strategy, namely '2C3L', in the treatment of persistent atrial fibrillation (AF); and to compare its efficacy with that of the 'stepwise' approach, which has been acknowledged as a promising ablation technique for persistent AF. METHODS AND RESULTS: The '2C3L' technique is a fixed ablation approach consisting of bilateral circumferential pulmonary vein antrum isolation (PVAI) and three linear ablation lesion sets across the mitral isthmus, left atrial roof, and cavo-tricuspid isthmus. One hundred and forty-six patients with persistent AF were randomized to undergo ablation by using the '2C3L' or the 'stepwise' technique (n = 73, respectively). The primary endpoint was freedom from any atrial tachyarrhythmia off antiarrhythmic drug (AAD) after a single procedure at follow-up. Twelve months after a single procedure, there was no difference in sinus rhythm (SR) maintenance rate between the two groups (67% for '2C3L' vs. 60% for 'stepwise', P = 0.394; 95% confidence interval of between-group difference -8.7 to 22.4%). The procedure (222 ± 42 vs. 263 ± 41 min), fluoroscopy (41 ± 9 vs. 55 ± 8 min), and radiofrequency (RF) (107 ± 32 vs. 128 ± 38 min) time were significantly shorter in the '2C3L' group (all P < 0.001). At 25 ± 5 months after the first procedure, 57.5 and 52.1% of patients from the '2C3L' group and the 'stepwise' group were in SR off AAD (P = 0.494), respectively. CONCLUSIONS: For catheter ablation of persistent AF, the '2C3L' strategy is a fixed approach associated with clinical efficacy similar to that of the 'stepwise' approach but with less RF delivery, fewer X-ray exposure, and shorter procedural time.


Assuntos
Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/métodos , Sistema de Condução Cardíaco/cirurgia , Frequência Cardíaca , Potenciais de Ação , Adulto , Idoso , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Hong Kong , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Duração da Cirurgia , Estudos Prospectivos , Veias Pulmonares/fisiopatologia , Veias Pulmonares/cirurgia , Radiografia Intervencionista , Recidiva , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia
14.
Europace ; 17(4): 579-83, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25349227

RESUMO

AIMS: Transient ST-T elevation (STE) is a rare complication that occurs during transseptal catheterization. This study aims to delineate the incidence and characteristics of transient STE during transseptal catheterization for atrial fibrillation (AF) ablation. METHODS AND RESULTS: Consecutive patients who underwent fluoroscopy-guided transseptal catheterization for circumferential pulmonary vein radiofrequency ablation in Beijing An Zhen Hospital from January 2006 to January 2013 were enrolled in this study. Out of 2965 patients with a total of 3452 transseptal catheterization procedures, 13 patients (0.38%, mean age 57 ± 8, 6 female, 12 paroxysmal AF, mean left atrial diameter 35.4 ± 3.8 mm) had STE. ST-T elevation occurred after transseptal puncture in 10 patients and after pulmonary vein venography in three patients. Systolic blood pressure (129 ± 10 vs. 104 ± 20 mmHg, P < 0.001), diastolic blood pressure (78 ± 6 vs. 64 ± 11 mmHg, P < 0.001), and heart rate (83 ± 19 bpm vs. 64 ± 23 b.p.m., P = 0.022) significantly decreased when STE occurred. Eleven patients complained of chest pain, one patient complained of dizziness, and one patient had no symptoms. Patients recovered in about 4.6 min (2-10 min) with dopamine or fast saline drip. Catheter ablation of AF was completed in all the 13 patients without sequelae or other complications. Four of the 13 patients (30.8%) had recurrence of AF after a mean follow-up of 21.7 months. CONCLUSION: ST-T elevation is a rare complication associated with transseptal catheterization without sequelae. Catheter ablation of AF could be safely completed in these patients.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Veias Pulmonares/cirurgia , Fibrilação Atrial/diagnóstico , Cateterismo Cardíaco/estatística & dados numéricos , Causalidade , China/epidemiologia , Feminino , Septos Cardíacos/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Medição de Risco , Resultado do Tratamento
15.
J Cardiovasc Electrophysiol ; 23 Suppl 1: S29-35, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22994909

RESUMO

UNLABELLED: Atrial Remodeling and Lone Atrial Fibrillation. BACKGROUND: We sought to investigate the role of anatomic remodeling of the atria and pulmonary veins (PVs) in the progression of lone atrial fibrillation (AF) using dual-source computed tomography (DSCT). METHODS AND RESULTS: From 1,308 consecutive patients referred for an index ablation procedure for AF, we prospectively enrolled 29 consecutive patients with recently developed (<3 months) lone persistent AF (PsAF) and 23 consecutive patients with short-lasting (6-12 months) lone PsAF, all of whom had a history of paroxysmal AF (PAF). The control group consisted of 33 patients with lone PAF. On DSCT, the recently developed PsAF group showed more extensive atrial anatomic remodeling than the PAF group as shown by ∼40% higher spot biatrial volume, even though the mean duration of continuous AF was only 6 weeks. In contrast, the DSCT variables in the recently developed PsAF group and the short-lasting PsAF group were comparable, despite the fact that the mean duration of continuous AF in the latter group was 8 months. Series of cross-sectional areas of the ostial 1.5 cm of PV trunks were comparable in the PAF and PsAF groups in all but 3 ostial planes. A higher spot left atrial volume was the only independent factor associated with the progression of lone PAF to PsAF (OR: 1.06, 95% CI: 1.03-1.09, P<0.0001) on logistic regression. CONCLUSIONS: Prominent anatomic remodeling of the atria, rather than the PVs, underlies the mechanism of recent progression of lone paroxysmal AF to the persistent variety.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Flebografia/métodos , Veias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Distribuição de Qui-Quadrado , Progressão da Doença , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Veias Pulmonares/fisiopatologia , Veias Pulmonares/cirurgia , Recidiva , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Chin Med J (Engl) ; 125(6): 1175-8, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22613550

RESUMO

BACKGROUND: It is unclear whether a history of paroxysmal atrial fibrillation (PAF) would impact the effect of catheter ablation on persistent atrial fibrillation (AF). This study aimed to compare the effect of catheter ablation on persistent AF with and without a history of PAF. METHODS: One hundred and eighty-three patients underwent catheter ablation of persistent AF lasting for > 1 month and were reviewed. Patients were divided into two groups according to whether they had a history of PAF or not. Group I consisted of persistent AF patients with a history of PAF, and group II consisted of persistent AF patients without such a history. All patients received catheter ablation focused on pulmonary vein isolation and were observed for arrhythmia recurrences, which were defined as documented episodes of AF or atrial tachycardia after a blanking period of 3 months. RESULTS: One hundred and three patients (60.9%) in group I and sixty-six patients (39.1%) in group II were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between both groups except for a younger age and more male patients in group II. After (15.5 ± 10.7) months of follow-up, 59 (57.3%) patients in group I and 49 (74.2%) patients in group II maintained sinus rhythm free of anti-arrhythmia drugs (P = 0.025). Multivariate analyses found left atrial anteroposterior diameter (P = 0.006) and persistent AF with a history of PAF (OR 1.792, 95%CI 1.019 - 3.152; P = 0.043) as the only independent statistical predictors of arrhythmia recurrences. CONCLUSION: The arrhythmia recurrence rate of catheter ablation based on pulmonary vein isolation in persistent AF with a history of PAF was higher than those without a history of PAF.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Veias Pulmonares/cirurgia , Recidiva
17.
Chin Med J (Engl) ; 125(5): 941-4, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22490601

RESUMO

The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillation. This rare complication of transseptal puncture was resolved quickly within several minutes. The most likely mechanism of this phenomenon is coronary vasospasm, although coronary embolism can not be ruled out completely. This complication is characterized as follows: (1) The right coronary artery might be the most likely involved vessel and therefore myocardial ischemia usually occurs in the inferior wall of left ventricular; (2) Reflex hypotension and bradycardia by the Bezold-Jarisch reflex secondary to inferior ischemia often occur at the same time. Though it appears to be a transient and completely reversible phenomenon, there are still potential life-threatening risks because of myocardial ischemia and profound haemodynamic instability. Clinical cardiologists should be aware of this rare complication and properly deal with it.


Assuntos
Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , Septos Cardíacos/lesões , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Punções
18.
Chin Med J (Engl) ; 124(11): 1714-9, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21740783

RESUMO

BACKGROUND: Radiofrequency (RF) ablation has become a widely accepted treatment for atrial fibrillation (AF). This study aimed to identify the efficacy and safety of pulmonary vein (PV) ablation with ethanol and to explore an alternative energy source for catheter ablation of AF. METHODS: Twelve open-chest mongrel dogs were randomized into ethanol ablation group and control group. Both the injections and electrophysiological mapping procedures were performed epicardialy. In ethanol ablation group (n = 6), injections were performed to circumferentially ablate the root of each PV (0.2 ml each site, 3 mm apart) with 95% ethanol using an 1 ml injector. In control group (n = 6), saline was injected other than ethanol. PV isolation was confirmed with a circular catheter immediately after the procedure and at follow up of 30 days. PV isolation was defined as the absence of PV potentials at each electrode of the circular catheter positioned at the PV side of the lesions, as well as complete conduction block into left atrium (LA) during PV pacing. RESULTS: PV electrical isolation with complete bidirectional conduction block was achieved with ethanol immediately and at 30 days in 95% of PVs, while saline injection caused only transient conduction changes between LA and PVs. In ethanol group, histologic analysis showed transmural lesions at 30 days. And there was no evidence of PV stenosis or thrombus formation. Mean LA diameter was not significantly different between baseline and 30 days. CONCLUSION: Ethanol is a safe energy source to effectively isolate PV in canine model and may be promising in endocardial ablation procedure of AF patients in the future.


Assuntos
Ablação por Cateter/métodos , Etanol , Veias Pulmonares/cirurgia , Animais , Cães , Eletrofisiologia , Veias Pulmonares/fisiologia , Distribuição Aleatória
19.
Ying Yong Sheng Tai Xue Bao ; 22(1): 189-95, 2011 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-21548307

RESUMO

This paper explored the main driving forces and stresses contributing to the eco-environmental changes of Baishan City in Jilin Province, through the analysis of the ecological security problems in the City. The framework of DPSIR was applied to establish an ecological security assessment index system, and further, to create an ecological security assessment model suitable for mountain areas. By using the 1989, 1999, and 2006 TM images, and in combining with the DEM data and field survey data, the interpretation of the land cover in Baishan City was conducted, and the landscape classification was carried out. With the support of Fragstats, the important ecological indicators were extracted. Then, the situations of ecological security in various districts and counties of Baishan City were assessed. The results indicated that there was an obvious regional difference in the ecological security of Baishan City, with a deteriorating trend of the overall ecological security situation. Human activities had deeper influence on the land cover pattern and species habitat distribution, and even, became the main driving force of the pattern changes in ecological security.


Assuntos
Conservação dos Recursos Naturais/métodos , Ecologia/métodos , Ecossistema , Monitoramento Ambiental/métodos , Modelos Teóricos , China , Cidades , Medição de Risco
20.
J Cardiovasc Electrophysiol ; 22(5): 499-505, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21087327

RESUMO

BACKGROUND: It is difficult to ablate a right-sided accessory pathway (AP) with atrial insertion far from the tricuspid annulus (TA). We report our initial experience of ablating this rare AP by a 3-dimensional electroanatomical mapping system (CARTO). METHODS: From January of 2006 to April of 2008, 18 patients with right-sided APs who failed previous outside ablations were enrolled in this study. Retrograde AP conduction was mapped during pacing at the right ventricular apex by activation-mapping the right atrium (RA) using a 3-dimensional electroanatomical mapping system. AP atrial insertion was defined as the earliest retrograde atrial activations and successful ablation of the APs at this site. RESULTS: Among the 18 patients who had failed previous ablation, 10 patients (7 patients with right manifest APs and 3 patients with right conceal APs) had atrial insertions far from the TA. Of the 10 patients, the atrial insertions were found at the base of the RA appendage in 3 patients, at the high lateral RA in 5 patients, at the low lateral RA in other 2 patients. Ablation at the atrial insertions successfully abolished the AP conduction. The mean distance between the atrial insertion sites and the TA was 20.2 ± 2.7 mm. No patients reported recovered AP conduction or recurrent tachycardias after 6-month follow-up. CONCLUSIONS: The right-sided APs may have atrial insertion far from the TA. These uncommon variation of APs can be reliably identified and ablated using CARTO system.


Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Mapeamento Potencial de Superfície Corporal/métodos , Átrios do Coração/anormalidades , Sistema de Condução Cardíaco/anormalidades , Sistema de Condução Cardíaco/cirurgia , Valva Tricúspide/anormalidades , Adulto , Fibrilação Atrial/etiologia , Ablação por Cateter , Feminino , Átrios do Coração/cirurgia , Humanos , Masculino , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , Valva Tricúspide/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA