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1.
Kyobu Geka ; 73(11): 905-909, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130711

RESUMO

A 48-year-old woman developed paralysis of the left upper limb and dysarthria. Two days later, she was admitted to a local hospital due to no improvement of symptoms. Brain magnetic resonance imaging showed acute hemorrhagic cerebral infarction in the left nucleus basalis. Echocardiography demonstrated a large left atrial mass in the left atrium, shuttling between the left atrium and the left ventricle and moderate mitral regurgitation. Then, she was transferred to our hospital for surgery. Five days after the initial symptoms, resection of the left atrial mass was performed under total cardiopulmonary bypass. First, heparin sodium, and then nafamostat mesilate were used as intraoperative anticoagulation treatment. The left mitral mass was removed via an atrial septal incision and the defect was repaired using a bovine pericardium. The mitral valve was intact and there was no regurgitation. The mass was immunohistologically diagnosed as myxoma. Postoperative brain computed tomography scans demonstrated no exacerbation of the cerebral infarction. She was discharged 13 days after surgery without neurological symptoms.


Assuntos
Fibrilação Atrial , Neoplasias Cardíacas , Insuficiência da Valva Mitral , Mixoma , Animais , Bovinos , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Infarto Cerebral/cirurgia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Mixoma/complicações , Mixoma/diagnóstico por imagem , Mixoma/cirurgia
5.
J Card Surg ; 35(10): 2860-2862, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32827157

RESUMO

Left atrial perforation is a known complication following pulmonary vein catheter ablation. Our case of a 62-year-old female underwent urgent surgery for repair of left atrium perforation with left pleural effusion as a late complication after multiple transcatheter radiofrequency pulmonary vein ablations for persistent atrial fibrillation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Lesão Pulmonar/etiologia , Veias Pulmonares , Procedimentos Cirúrgicos Cardíacos/métodos , Emergências , Feminino , Átrios do Coração/lesões , Átrios do Coração/cirurgia , Humanos , Lesão Pulmonar/cirurgia , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Derrame Pleural/cirurgia , Resultado do Tratamento
6.
Asian Cardiovasc Thorac Ann ; 28(8): 500-503, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32757656

RESUMO

A regular check up on a 59-year-old man showed a high carcinoembryonic antigen level in his blood. A computed tomography scan showed tumors in the right atrium. We performed tumor resection successfully. The resected specimen was found to be blood cysts that had developed from the right atrium to the inferior vena cava. Intracardiac blood cysts are generally observed in infants, spontaneously disappear during the first 6 months of life, and are located in the left side of heart and on atrioventricular valves. Therefore, this case is extremely rare. Also, it is worth considering the timing of this surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cistos/cirurgia , Átrios do Coração/cirurgia , Cardiopatias/cirurgia , Tempo para o Tratamento , Cistos/diagnóstico por imagem , Cistos/patologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Cardiopatias/diagnóstico por imagem , Cardiopatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(32): e21630, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769926

RESUMO

RATIONALE: Hepatocellular carcinoma (HCC) with intracavitary metastasis extending to the heart, also known as inferior vena cava (IVC) tumor thrombus, is an extremely rare late-stage disease with no effective treatment. In fact, the median survival is reportedly less than 2 months; thus, there is an urgent need for better treatment. PATIENT CONCERNS: In this study, a 48-year-old patient was admitted to our hospital to seek medical treatment for advanced primary HCC with right atrial metastasis. DIAGNOSIS: The patient was diagnosed as primary HCC with a large mass in the right lobe of the liver and intracavitary metastasis to the right atrium. INTERVENTIONS: A new surgical treatment of right hemihepatectomy, complete resection of the involved IVC and the right atrium thrombus, plus reconstruction of the resected IVC using autologous pericardial tube graft were undertaken and successfully performed. OUTCOMES: The patient recovered rapidly, and 14 days after the surgical procedures, he was discharged from the hospital. Notably, serum levels of alpha-fetoprotein dropped to normal range and no clinical signs of recurrence were observed during follow-up. LESSONS: This report highlights an unusual case of right atrial metastasis from HCC. The surgical treatment appeared to be suitable and effective, together with postoperative administration of lenvatinib, a tyrosine kinase multitarget inhibitor selected by performing whole-exome sequencing. These therapies have offered favorable clinical outcomes such as prevention of recurrence and prolongation of patient survival. In addition, clinicians may benefit from our experience for their future treatment of patients with similar clinical conditions.


Assuntos
Carcinoma Hepatocelular/cirurgia , Átrios do Coração/anormalidades , Metástase Neoplásica/diagnóstico , Carcinoma Hepatocelular/complicações , Átrios do Coração/cirurgia , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/fisiopatologia , Metástase Neoplásica/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Veia Cava Inferior/cirurgia
9.
Circ Arrhythm Electrophysiol ; 13(8): e008191, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32660260

RESUMO

BACKGROUND: Electrical remodeling precedes structural remodeling. In adjunctive left atrial (LA) low-voltage area (LVA) ablation to pulmonary vein isolation of atrial fibrillation (AF), LA areas without LVA have not been targeted for ablation. We studied the effect of adjunctive LA posterior wall isolation (PWI) on persistent AF without LA-LVA according to electrophysiological testing (EP test). METHODS: We examined consecutive patients with persistent AF with (n=33) and without (n=111) LA-LVA. Patients without LA-LVA were randomly assigned to EP test-guided (n=57) and control (n=54) groups. In the EP test-guided group, an adjunctive PWI was performed in those with positive results (PWI subgroup; n=24), but not in those with negative results (n=33). The criteria for positive EP tests were an effective refractory period ≤180 ms, effective refractory period>20 ms shorter than the other sites, and/or induction of AF/atrial tachycardia (AT) during measurements. LVA ablation was performed in the patients with LA-LVA. RESULTS: During the follow-up period (62±33 weeks), the EP test-guided group had significantly lower recurrence rates (19%,11/57 versus 41%, 22/54, P=0.012) and higher Kaplan-Meier AF/AT-free survival curve rates than the control group (P=0.01). No significant differences in the recurrence and AF/AT-free survival curve rates between the PWI (positive EP test) and non-PWI (negative EP test) subgroups were observed. Therefore, PWI for positive EP tests reduced the AF/AT recurrence in the EP test-guided group. A stepwise Cox proportional hazard analyses identified EP test-guided ablation as a factor reducing the recurrence rate. The recurrence rates in the LA-LVA ablation group and EP test-guided group were similar. CONCLUSIONS: This pilot study proposed that an EP test-guided adjunctive PWI of persistent AF without LA-LVA potentially reduced AF/AT recurrences. The results suggest that there is an AF substrate in the LA with altered electrophysiological function even when there is no LA-LVA. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Potenciais de Ação , Fibrilação Atrial/diagnóstico , Função do Átrio Esquerdo , Remodelamento Atrial , Técnicas Eletrofisiológicas Cardíacas , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Veias Pulmonares/fisiopatologia , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Feminino , Átrios do Coração/cirurgia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Veias Pulmonares/cirurgia , Recidiva , Fatores de Tempo , Resultado do Tratamento
10.
J Card Surg ; 35(10): 2844-2846, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32678970

RESUMO

BACKGROUND: An intracardiac foreign body causing recurrent fungemia is a rare clinical situation. Clinicians should be that aware of rare sources of sepsis despite a thorough history and examination. RESULTS: The authors describe a 63 year-old man, with unremarkable past medical history, who presented with a fever for 2 weeks. Blood cultures persistently grew Candida albicans and Streptococcus constellatus. Echocardiogram assessment showed a suspected vegetation over the tricuspid valve. Surgical exploration with median sternotomy and cardiopulmonary bypass revealed a tooth-pick impacted within the right atrium surrounded by vegetation. The authors postulate accidental ingestion of the foreign body and translocation into the right atrium via the esophagus and thoracic cavity. CONCLUSION: Surgical removal of symptomatic intracardiac foreign bodies is highly recommended.


Assuntos
Candidíase/etiologia , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/cirurgia , Fungemia/etiologia , Candida albicans , Ponte Cardiopulmonar , Corpos Estranhos/complicações , Corpos Estranhos/patologia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/patologia , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Raras , Recidiva , Esternotomia/métodos , Resultado do Tratamento , Valva Tricúspide
11.
J Card Surg ; 35(10): 2863-2865, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720392

RESUMO

BACKGROUND: Cardiac myxomas are common and account for 50% of primary intracardiac tumors. Atypical locations of cardiac myxoma increase the risk of intraoperative iatrogenic injuries. Herein, we report a case of using three-dimensional printing (3D) to facilitate the removal of an atypical cardiac myxoma in a 63-year-old woman. METHODS AND RESULTS: Mass in the high posterior atrial septum was confirmed through imaging. Due to the potential involvement of the mass to surrounding vital structures, 3D printing of the cardiac mass was performed. The tumor was completely resected via median sternotomy and the resulting defect was repaired with the bovine pericardium. The patient had an uncomplicated postoperative course except for the development of sick sinus syndrome. One-year follow-up showed no tumor recurrent. CONCLUSION: 3D printing technology in patients with atypical cardiac tumors enhances our understanding of the extent of the tumor invasion and facilitates planning the operation to avoid intraoperative complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Doença Iatrogênica/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Modelos Anatômicos , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Impressão Tridimensional , Animais , Bioprótese , Bovinos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/patologia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/patologia , Invasividade Neoplásica , Pericárdio/transplante , Esternotomia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Card Surg ; 35(7): 1743-1745, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32485051

RESUMO

The association of absent right superior vena cava and persistent left superior vena cava draining into unroofed coronary sinus with common atrium and the atrioventricular septal defect is an extremely rare form of the congenital cardiac disorder with only one case reported so far, hence, can be missed preoperatively if not carefully looked for. Failure to detect absent right superior vena cava beforehand may otherwise pose difficulties in carrying out invasive surgical or medical interventions.


Assuntos
Anormalidades Múltiplas/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Seio Coronário/anormalidades , Seio Coronário/cirurgia , Defeitos dos Septos Cardíacos/cirurgia , Malformações Vasculares/cirurgia , Veia Cava Superior/anormalidades , Veia Cava Superior/cirurgia , Pré-Escolar , Ecocardiografia , Ecocardiografia Transesofagiana , Feminino , Átrios do Coração/anormalidades , Átrios do Coração/cirurgia , Defeitos dos Septos Cardíacos/diagnóstico por imagem , Humanos , Resultado do Tratamento
13.
Khirurgiia (Mosk) ; (6): 114-117, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573542

RESUMO

Patients with anterior mediastinum tumors fall into a difficult category due to high risk of invasion of vital structures and complexity of surgical correction. We report resection of recurrent hemangioma of anterior mediastinum with aortic arch replacement and simultaneous resection of left atrial myxoma in a 35-year-old woman. Successful treatment of these patients correlates with aggressive surgical approach followed by total resection of tumor and all affected vessels and other tissues.


Assuntos
Neoplasias Cardíacas/cirurgia , Hemangioma/cirurgia , Neoplasias do Mediastino/cirurgia , Mixoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Adulto , Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Cirúrgicos Cardiovasculares/métodos , Feminino , Átrios do Coração/cirurgia , Humanos , Mediastino/cirurgia
14.
Chirurgia (Bucur) ; 115(2): 267-273, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369732

RESUMO

A 52 years old woman, asymptomatic, with no significant medical history, presented to a thoracic surgery department for excision of a giant mediastinal mass that was incidentally detected during a routine abdominal ultrasound. Various imaging methods (echocardiography, chest X-ray, CT-scan, MRI) located the mediastinal mass as paracardiac and the excision using video-assisted thoracoscopic surgery (VATS) was proposed, in general thoracic surgery department. Although initially considered a paracardiac mass, intraoperatively the tumor location proved to be intrapericardial. Reaching the limits of VATS, a median sternotomy and longitudinal pericardiotomy were performed, demonstration a right atrium tumor with intrapericardial extension. At this stage, the excision was considered impossible without cardiopulmonary bypass and cardiac arrest. Having this information, the case was deferred to cardiovascular surgery, one week after and, a complete resection of the tumor was performed without incidents. Both atria were reconstructed with patches of autologous and bovine pericardium. The postoperative outcome of the patient was very good and the histopathology report showed that the tumor was a cavernous hemangioma. The literature was reviewed for this pathology. a rare case of a giant cavernous hemangioma of the heart, with diagnostic pitfalls had a successful multidisciplinary staged approach.


Assuntos
Neoplasias Cardíacas/cirurgia , Hemangioma Cavernoso/cirurgia , Procedimentos Cirúrgicos Cardíacos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Reoperação , Cirurgia Torácica Vídeoassistida
15.
J Card Surg ; 35(6): 1380-1382, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353896

RESUMO

Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53-year-old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Hepatocelular/cirurgia , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Carcinoma Hepatocelular/patologia , Ponte Cardiopulmonar , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Veia Cava Inferior/patologia , Trombose Venosa/etiologia , Trombose Venosa/patologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-32436664

RESUMO

Surgical ablation is a safe and effective treatment for atrial fibrillation. In the procedure demonstrated in this video tutorial, surgery was performed under general anesthesia with a double-lumen tube. After opening of the pericardium and blunt dissection of the oblique and transverse sinuses, surgical ablation was performed. Two guidance catheters were introduced through the oblique and transverse sinus from the left side. A bipolar radiofrequency clamp was attached to the guidance catheters and positioned to encircle the pulmonary veins and posterior left atrium. Complete electrical isolation was confirmed by measurement of bidirectional block. The left atrial appendage was excluded using an Atriclip PRO II device.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Toracoscopia/métodos , Dissecação , Feminino , Átrios do Coração/cirurgia , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Pericárdio/cirurgia , Veias Pulmonares/cirurgia , Resultado do Tratamento
17.
J Surg Res ; 253: 173-184, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32361612

RESUMO

BACKGROUND: Heart chymase rather than angiotensin (Ang)-converting enzyme has higher specificity for Ang I conversion into Ang II in humans. A new pathway for direct cardiac Ang II generation has been revealed through the demonstration that Ang-(1-12) is cleaved by chymase to generate Ang II directly. Herein, we address whether Ang-(1-12), chymase messenger RNA (mRNA), and activity levels can be differentiated in human atrial tissue from normal and diseased hearts and if these measures associate with various pathologic heart conditions. MATERIALS AND METHODS: Atrial appendages were collected from 11 nonfailing donor hearts and 111 patients undergoing heart surgery for the correction of valvular heart disease, resistant atrial fibrillation, or ischemic heart disease. Chymase mRNA was analyzed by real-time polymerase chain reaction and enzymatic activity by high-performance liquid chromatography using Ang-(1-12) as the substrate. Ang-(1-12) levels were determined by immunohistochemical staining. RESULTS: Chymase gene transcripts, chymase activity, and immunoreactive Ang-(1-12) expression levels were higher in left atrial tissue compared with right atrial tissue, irrespective of cardiac disease. In addition, left atrial chymase mRNA expression was significantly higher in stroke versus nonstroke patients and in cardiac surgery patients who had a history of postoperative atrial fibrillation versus nonatrial fibrillation. Correlation analysis showed that left atrial chymase mRNA was positively related to left atrial enlargement, as determined by echocardiography. CONCLUSIONS: As Ang-(1-12) expression and chymase gene transcripts and enzymatic activity levels were positively linked to left atrial size in patients with left ventricular heart disease, an important alternate Ang II forming pathway, via Ang-(1-12) and chymase, in maladaptive atrial and ventricular remodeling in humans is uncovered.


Assuntos
Angiotensinogênio/metabolismo , Fibrilação Atrial/epidemiologia , Quimases/metabolismo , Átrios do Coração/patologia , Fragmentos de Peptídeos/metabolismo , Acidente Vascular Cerebral/epidemiologia , Idoso , Angiotensinogênio/análise , Animais , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Quimases/análise , Quimases/genética , Ecocardiografia , Feminino , Perfilação da Expressão Gênica , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/cirurgia , Ventrículos do Coração/fisiopatologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/patologia , Isquemia Miocárdica/cirurgia , Fragmentos de Peptídeos/análise , RNA Mensageiro/isolamento & purificação , RNA Mensageiro/metabolismo , Remodelação Ventricular
18.
Circ Arrhythm Electrophysiol ; 13(6): e008716, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32370542

RESUMO

BACKGROUND: A novel ablation and mapping system can toggle between delivering biphasic pulsed field (PF) and radiofrequency energy from a 9-mm lattice-tip catheter. We assessed the preclinical feasibility and safety of (1) focal PF-based thoracic vein isolation and linear ablation, (2) combined PF and radiofrequency focal ablation, and (3) PF delivered directly atop the esophagus. METHODS: Two cohorts of 6 swine were treated with pulsed fields at low dose (PFLD) and high dose (PFHD) and followed for 4 and 2 weeks, respectively, to isolate 25 thoracic veins and create 5 right atrial (PFLD), 6 mitral (PFHD), and 6 roof lines (radiofrequency+PFHD). Baseline and follow-up voltage mapping, venous potentials, ostial diameters, and phrenic nerve viability were assessed. PFHD and radiofrequency lesions were delivered in 4 and 1 swine from the inferior vena cava onto a forcefully deviated esophagus. All tissues were submitted for histopathology. RESULTS: Hundred percent of thoracic veins (25 of 25) were successfully isolated with 12.4±3.6 applications/vein with mean PF times of <90 seconds/vein. Durable isolation improved from 61.5% PFLD to 100% with PFHD (P=0.04), and all linear lesions were successfully completed without incurring venous stenoses or phrenic injury. PFHD sections had higher transmurality rates than PFLD (98.3% versus 88.1%; P=0.03) despite greater mean thickness (2.5 versus 1.3 mm; P<0.001). PF lesions demonstrated homogenous fibrosis without epicardial fat, nerve, or vessel involvement. In comparison, radiofrequency+PFHD sections revealed similar transmurality but expectedly more necrosis, inflammation, and epicardial fat, nerve, and vessel involvement. Significant ablation-related esophageal necrosis, inflammation, and fibrosis were seen in all radiofrequency sections, as compared with no PF sections. CONCLUSIONS: The lattice-tip catheter can deliver focal PF to durably isolate veins and create linear lesions with excellent transmurality and without complications. The PF lesions did not damage the phrenic nerve, vessels, and the esophagus.


Assuntos
Ablação por Cateter/métodos , Átrios do Coração/cirurgia , Veias Pulmonares/cirurgia , Irrigação Terapêutica , Potenciais de Ação , Animais , Cateteres Cardíacos , Ablação por Cateter/efeitos adversos , Ablação por Cateter/instrumentação , Técnicas Eletrofisiológicas Cardíacas , Estudos de Viabilidade , Feminino , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Modelos Animais , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Veias Pulmonares/patologia , Veias Pulmonares/fisiopatologia , Sus scrofa , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/instrumentação
20.
Circ Arrhythm Electrophysiol ; 13(6): e008580, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32372696

RESUMO

BACKGROUND: Pulsed field ablation (PFA) is a nonthermal energy that may provide safety advantages over radiofrequency ablation (RFA). One-shot PFA catheters have been developed for pulmonary vein isolation, but they do not permit flexible lesion sets. This study investigated a novel lattice-tip catheter designed for focal RFA or PFA ablation. METHODS: The effects of PFA (biphasic, 24 amperes) were investigated in 25 swine using a lattice-tip catheter and system (Affera Inc). Step 1 (n=14) examined the feasibility to create atrial line of block and described its acute effects on the phrenic nerve and esophagus. Step 2 (n=7) examined the subacute effects of PFA on block durability, phrenic nerve, and esophagus ≥2 weeks. Step 3 compared the effects of PFA and RFA on the esophagus using a mechanical deviation model approximating the esophagus to the right atrium (n=4) and by direct ablation within its lumen (n=4). The effects of endocardial PFA and RFA on the phrenic nerve were also compared (n=10). Histological analysis was performed. RESULTS: PFA produced acute block in 100% of lines, achieved with 2.1 (1.3-3.2) applications/cm line. Histological analysis following (35 [18-37]) days showed 100% transmurality (thickness range 0.4-3.4 mm) with a lesion width of 19.4 (10.9-27.4 mm). PFA selectively affected cardiomyocytes but spared blood vessels and nervous tissue. PFA applied from the posterior atria (23 [21-25] applications) to the approximated esophagus (6 [4.5-14] mm) produced transmural lesions without esophageal injury. PFA (16.5 [15-18] applications) applied inside the esophageal lumen produced mild edema compared with RFA (13 [12-14] applications) which produced epithelial ulcerations. PFA resulted in no or transient stunning of the phrenic nerve (<5 minutes) without histological changes while RFA produced paralysis. CONCLUSIONS: PFA using a lattice-tip ablation catheter for focal ablation produced durable atrial lesions and showed lower vulnerability to esophageal or phrenic nerve damage compared with RFA.


Assuntos
Cateterismo Cardíaco/instrumentação , Cateteres Cardíacos , Ablação por Cateter/instrumentação , Eletrodos , Átrios do Coração/cirurgia , Animais , Cateterismo Cardíaco/efeitos adversos , Ablação por Cateter/efeitos adversos , Desenho de Equipamento , Esôfago/lesões , Esôfago/patologia , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/patologia , Nervo Frênico/lesões , Nervo Frênico/patologia , Sus scrofa , Fatores de Tempo
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