Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 14.047
Filtrar
1.
J Interv Cardiol ; 2021: 5591590, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34149322

RESUMO

Background: High power shorter duration (HPSD) ablation may lead to safe and rapid lesion formation. However, the optimal radio frequency power to achieve the desired ablation index (AI) or lesion size index (LSI) is insubstantial. This analysis aimed to appraise the clinical safety and efficacy of HPSD guided by AI or LSI (HPSD-AI or LSI) in patients with atrial fibrillation (AF). Methods: The Medline, PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing HPSD-AI or LSI and low power longer duration (LPLD) ablation. Results: Seven trials with 1013 patients were included in the analysis. The analyses verified that HPSD-AI or LSI revealed benefits of first-pass pulmonary vein isolation (PVI) (RR: 1.28; 95% CI: 1.05-1.56, P = 0.01) and acute pulmonary vein reconnection (PVR) (RR: 0.65; 95% CI: 0.48-0.88, P = 0.005) compared with LPLD. HPSD-AI or LSI showed higher freedom from atrial tachyarrhythmia (AT) (RR = 1.32, 95% CI: 1.14-1.53, P = 0.0002) in the subgroup analysis of studies with PVI ± (with or without additional ablation beyond PVI). HPSD-AI or LSI could short procedural time (WMD: -22.81; 95% CI, -35.03 to -10.60, P = 0.0003), ablation time (WMD: -10.80; 95% CI: -13.14 to -8.46, P < .00001), and fluoroscopy time (WMD: -7.71; 95% CI: -13.71 to -1.71, P = 0.01). Major complications and esophageal lesion in HPSD-AI or LSI group were no more than LDLP group (RR: 0.58; 95% CI: 0.20-1.69, P = 0.32) and (RR: 0.84; 95% CI: 0.43-1.61, P = 0.59). Conclusions: HPSD-AI or LSI was efficient for treating AF with shorting procedural, ablation, and fluoroscopy time, higher first-pass PVI, and reducing acute PVR and may increase freedom from AT for patients with additional ablation beyond PVI compared with LPLD. Moreover, complications and esophageal lesion were low and no different between two groups.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Duração da Terapia , Fluoroscopia/métodos , Humanos , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(19): e25942, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106664

RESUMO

ABSTRACT: Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children.To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage.Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed.Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months.Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF.


Assuntos
Ablação por Cateter/métodos , Fístula/cirurgia , Laringoscopia/métodos , Seio Piriforme/anormalidades , Seio Piriforme/cirurgia , Adolescente , Antibacterianos/administração & dosagem , Ablação por Cateter/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Laringoscopia/efeitos adversos , Tempo de Internação , Masculino , Recidiva , Estudos Retrospectivos
4.
Int J Comput Assist Radiol Surg ; 16(6): 1051-1057, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33974224

RESUMO

OBJECTIVES: Radiofrequency ablation (RFA) can be associated with local recurrences in the treatment of liver tumors. Data obtained at our center for an earlier multinational multicenter trial regarding an in-house developed simulation software were re-evaluated in order to analyze whether the software was able to predict local recurrences. METHODS: Twenty-seven RFA ablations for either primary or secondary hepatic tumors were included. Colorectal liver metastases were shown in 14 patients and hepatocellular carcinoma in 13 patients. Overlap of the simulated volume and the tumor volume was automatically generated and defined as positive predictive value (PPV) and additionally visually assessed. Local recurrence during follow-up was defined as gold standard. Sensitivity and specificity were calculated using the visual assessment and gold standard. RESULTS: Mean tumor size was 18 mm (95% CI 15-21 mm). Local recurrence occurred in 5 patients. The PPV of the simulation showed a mean of 0.89 (0.84-0.93 95% CI). After visual assessment, 9 incomplete ablations were observed, of which 4 true positives and 5 false positives for the detection of an incomplete ablation. The sensitivity and specificity were, respectively, 80% and 77% with a correct prediction in 78% of cases. No significant correlation was found between size of the tumor and PPV (Pearson Correlation 0.10; p = 0.62) or between PPV and recurrence rates (Pearson Correlation 0.28; p = 0.16). CONCLUSIONS: The simulation software shows promise in estimating the completeness of liver RFA treatment and predicting local recurrence rates, but could not be performed real-time. Future improvements in the field of registration could improve results and provide a possibility for real-time implementation.


Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/cirurgia , Software , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Idoso , Carcinoma Hepatocelular/diagnóstico , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento
5.
Am J Gastroenterol ; 116(4): 675-682, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33982936

RESUMO

INTRODUCTION: Low-grade dysplasia (LGD) is the best predictor of neoplastic progression in Barrett's esophagus (BE). Most LGD cases are downstaged to nondysplastic (ND) BE on expert pathologist review, which is prone to interobserver variation and not widely available. Recent studies indicate that a risk prediction assay (TissueCypher) risk stratifies patients with NDBE for neoplastic progression. We aimed to investigate whether this risk prediction assay predicts neoplastic progression in BE patients with LGD. METHODS: A blinded, retrospective cohort study was derived from the screening cohort of a randomized controlled trial of SURveillance vs RadioFrequency ablation for BE patients with LGD. Hematoxylin and eosin and p53 immunohistochemistry slides from the first endoscopy with LGD were independently reviewed by 3 expert pathologists and tested by the risk prediction assay. Revision diagnoses of NDBE were considered low risk, although indefinite for dysplasia, and LGD were considered high risk for progression. RESULTS: A total of 155 BE patients (123 men), mean age 61 ± 10 years, were analyzed. Thirty-four patients (22%) progressed to high-grade dysplasia/esophageal adenocarcinoma (median time 2.4 years) and 121 did not progress (median high-grade dysplasia/esophageal adenocarcinoma-free surveillance 7.9 years). The risk prediction assay sensitivity was 68% vs 76% for the 3 pathologists, and specificity was 79% vs 64%-77.0% for the pathologists. The assay detected 50%-56% of progressors that were downstaged to NDBE by the pathologists. DISCUSSION: The risk prediction assay provided significant risk stratification in BE patients with LGD and identified progressors that the experts downstaged to NDBE. This objective assay provides an effective solution to the lack of standardization of expert pathology review of LGD.


Assuntos
Esôfago de Barrett/patologia , Esofagoscopia/métodos , Esôfago/patologia , Medição de Risco/métodos , Esôfago de Barrett/cirurgia , Ablação por Cateter/métodos , Progressão da Doença , Feminino , Humanos , Hiperplasia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
BMC Cancer ; 21(1): 366, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827464

RESUMO

BACKGROUND: Given their widespread availability and relatively low cost, percutaneous thermal ablation is commonly performed under the guidance of computed tomography (CT) or ultrasound (US). However, such imaging modalities may be restricted due to insufficient image contrast and limited tumor visibility, which results in imperfect intraoperative treatment or an increased risk of damage to critical anatomical structures. Currently, magnetic resonance (MR) guidance has been proven to be a possible solution to overcome the above shortcomings, as it provides more reliable visualization of the target tumor and allows for multiplanar capabilities, making it the modality of choice. Unfortunately, MR-guided ablation is limited to specialized centers, and the cost is relatively high. Is ablation therapy under MR guidance better than that under CT guidance? This study retrospectively compared the efficacy of CT-guided and MR-guided microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC ≤ 5.0 cm). METHODS: In this retrospective study, 47 patients and 54 patients received MWA under the guidance of CT and MR, respectively. The inclusion criteria were a single HCC ≤ 5.0 cm or a maximum of three. The local tumor progression (LTP), overall survival (OS), prognostic factors for local progression, and safety of this technique were assessed. RESULTS: All procedures were technically successful. The complication rates of the two groups were remarkably different with respect to incidences of liver abscess and pleural effusion (P < 0.05). The mean LTP was 44.264 months in the CT-guided group versus 47.745 months in the MR-guided group of HCC (P = 0.629, log-rank test). The mean OS was 56.772 months in the patients who underwent the CT-guided procedure versus 58.123 months in those who underwent the MR-guided procedure (P = 0.630, log-rank test). Multivariate Cox regression analysis further illustrated that tumor diameter (< 3 cm) and the number of lesions (single) were important factors affecting LTP and OS. CONCLUSIONS: Both CT-guided and MR-guided MWA are comparable therapies for the treatment of HCC (< 5 cm), and there was no difference in survival between the two groups. However, MR-guided MWA could reduce the incidence of complications.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/radioterapia , Ablação por Cateter/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/radioterapia , Espectroscopia de Ressonância Magnética/métodos , Ablação por Radiofrequência/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Aging (Albany NY) ; 13(6): 8620-8627, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33714954

RESUMO

Antiarrhythmic drug therapy (ADT) and catheter ablation (CA) are the main treatments for paroxysmal atrial fibrillation. However, the short- and long-term clinical efficacy of these treatments remains controversial. Our goal is to investigate efficacy and safety of the standardized treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Eight randomized controlled trials on CA and ADT for treating PAF were included. Totally, 1336 patients were included. Studies on CA and ADT for treating PAF that were published between January 2005 and June 2020 in the Cochrane Library, PubMed and EMBASE were screened and identified. Atrial fibrillation-free rates and Short Form (SF-36) health score-related indexes were analyzed. Atrial fibrillation-free rates were similar in the CA and ADT groups [risk ratio (RR) 1.32; 95% confidence interval (CI) 0.96-1.82; P = 0.08] at 3 months. The CA group had a significantly higher atrial fibrillation-free rate at 6 months (RR 1.87; 95% CI 1.38-2.53; P < 0.001), 9 months (RR 2.38; 95% CI 1.43-3.96; P < 0.001), and 12 months (RR 2.21; 95% CI 1.28-3.84; P=0.005). However, there was no significant difference in terms of long-term efficacy at 24 months (RR 1.81; 95% CI 0.97-3.36; P = 0.06). The 12-month QOL physical and mental components (RR 2.41; 95% CI 0.89-3.93; P = 0.002) were significantly higher in CA group. The CA is more effective than ADT in the short-term prognosis. But the long-term prognosis of PAF needs to be verified via randomized controlled trials with longer follow-up durations.


Assuntos
Envelhecimento , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/terapia , Ablação por Cateter/métodos , Idoso , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Expert Rev Med Devices ; 18(4): 343-350, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33724120

RESUMO

Introduction: Despite advances in imaging technology to guide ablative therapies, catheter ablation of more complex arrhythmias continues to be a challenge in part due to suboptimal mechanistic understanding of these arrhythmias by conventional mapping systems. A novel noncontact charge density mapping system has been designed to overcome some of these limitations.Areas covered: Hereby, we present an overview of this novel, charge density-based global chamber mapping approach. We initially highlight the concept of charge density, describe further the device technology and finally summarize the clinical application of this system.Expert opinion: Noncontact charge density mapping provides a more localized, high-resolution global panoramic assessment of cardiac activation. This might contribute to uncover the mechanisms of more complex arrhythmias such as persistent atrial fibrillation or unstable atrial tachycardias with the ultimate goal to guide the ablation therapy.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Ensaios Clínicos como Assunto , Eletricidade , Humanos , Ultrassom
9.
Cochrane Database Syst Rev ; 3: CD004060, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33661543

RESUMO

This review has been withdrawn because it has been split into the following reviews: 'Pharmaceutical interventions for Barrett's oesophagus' and 'Endoscopic interventions for Barrett's oesophagus'.


Assuntos
Esôfago de Barrett/terapia , Adenocarcinoma/prevenção & controle , Ablação por Cateter/métodos , Neoplasias Esofágicas/prevenção & controle , Refluxo Gastroesofágico/terapia , Humanos , Fotocoagulação a Laser/métodos , Fotoquimioterapia/métodos , Lesões Pré-Cancerosas/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Int Heart J ; 62(2): 298-304, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731524

RESUMO

Radiofrequency and cryoballoon applications around the pulmonary veins (PVs) could provoke a vagal reflex (VR) by modulating the intrinsic cardiac autonomic nervous system (ICANS).This study aimed to investigate the incidence, timing, and clinical impact of a VR provoked by a laser balloon application for a PV isolation (PVI).A total of 92 consecutive paroxysmal atrial fibrillation (PAF) patients underwent a laser balloon PVI of PAF. Acute changes in the heart rate and blood pressure were recorded. The heart rate variability (HRV) was tested by Holter ECGs before and at three months following the ablation. Three hundred forty-five out of 363 PVs were successfully isolated (97%) with laser balloon applications. A VR such as sinus bradycardia (26.1%), transient sinus arrest (9.8%), transient atrioventricular block (1.1%), or a blood pressure reduction (8.7%) was observed during the laser balloon applications for the PVI. The follow-up ended at 12 months. The HRV attenuation was comparable before and at three months after the ablation procedure between that with and without a VR (P = 0.14). The PAF recurrence rate was also comparable between the two groups (P = 0.882).The laser balloon PVI often provoked a VR, however, the modulation of the ICANS was temporary and for up to three months as measured by the HRV changes after the ablation, and the freedom from any atrial fibrillation recurrence was comparable regardless of the occurrence of a VR.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Frequência Cardíaca/fisiologia , Terapia a Laser/métodos , Taquicardia Paroxística/cirurgia , Nervo Vago/fisiopatologia , Idoso , Fibrilação Atrial/fisiopatologia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Taquicardia Paroxística/fisiopatologia , Fatores de Tempo
11.
Expert Rev Cardiovasc Ther ; 19(3): 237-246, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33678103

RESUMO

INTRODUCTION: Atrial fibrillation (AF) is a complex and multi-factorial rhythm disorder. Catheter ablation is widely used for the management of AF. However, it is limited by relapse of the arrhythmia necessitating repeat procedures. AREAS COVERED: This review aims to discuss the predictors of post-ablation recurrent AF including age, gender, genetic predisposition, AF type and duration, comorbidities, lifestyle factors, echocardiographic parameters of heart chambers, left atrial fibrosis and ablation strategies and targets. An extensive literature search was undertaken on PubMed and Google Scholar to obtain full texts of relevant AF-related articles. EXPERT OPINION: Maintenance of stable sinus rhythm is the main intended outcome of AF ablation. Therefore, it is very crucial to identify the risk factors that may influence the ablation success. Most of these predictors such as comorbidities, ablation strategy and targets and lifestyle factors are either reversible or modifiable. Thus, not only the awareness of these known risk factors by both patients and their physicians but also future research to identify the unknown predictors are critical to optimize care in this multi-faceted morbidity.


Assuntos
Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Comorbidade , Ecocardiografia , Átrios do Coração/fisiopatologia , Humanos , Recidiva , Fatores de Risco , Resultado do Tratamento
12.
Phys Med Biol ; 66(5): 055022, 2021 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-33503590

RESUMO

Fast calculation or simulation of the ablation zone induced by radiofrequency ablation (RFA) has a critical role in hepatic RFA planning and therapy. However, it remains challenging to approximate the ablation zone in real time, especially when more than one probe is involved in one ablation session. This paper presents a novel computational technique to calculate the 3D ablation zone of one probe RFA and two-probe switching RFA. The main idea is to get an approximate solution of the temperature distribution from a simplified Pennes bioheat equation, and further fit the solution to the coagulation measurements on ex vivo porcine liver. With a closed-form solution of temperature distribution, the calculation of the ablation zone is as simple as the commonly used ellipsoidal model, but it allows a more realistic prediction of combined ablation zones with different inter-probe spacing. The new approximation technique could potentially replace the original ellipsoidal model in the intervention planning step.


Assuntos
Ablação por Cateter/métodos , Condutividade Térmica , Animais , Coagulação Sanguínea , Simulação por Computador , Fígado/fisiologia , Fígado/cirurgia , Suínos , Fatores de Tempo
13.
Cardiovasc Intervent Radiol ; 44(6): 952-958, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33462682

RESUMO

PURPOSE: To investigate the performance of two microwave ablation (MWA) systems regarding ablation volume, ablation shape and variability. MATERIALS AND METHODS: In this ex vivo study, the Emprint and Amica MWA systems were used to ablate porcine livers at 4 different settings of time and power (3 and 5 minutes at 60 and 80 Watt). In total, 48 ablations were analysed for ablation size and shape using Vitrea Advanced Visualization software after acquisition of a 7T MRI scan. RESULTS: Emprint ablations were smaller (11,1 vs. 21,1 mL p < 0.001), more spherical (sphericity index of 0.89 vs. 0.59 p < 0.001) and showed less variability than Amica ablations. In both systems, longer ablation time and higher power resulted in significantly larger ablation volumes. CONCLUSION: Emprint ablations were more spherical, and the results showed a lower variability than those of Amica ablations. This comes at the price of smaller ablation volumes.


Assuntos
Técnicas de Ablação/métodos , Fígado/cirurgia , Animais , Ablação por Cateter/métodos , Micro-Ondas , Modelos Animais , Reprodutibilidade dos Testes , Suínos
14.
Acta Diabetol ; 58(5): 603-614, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33459896

RESUMO

AIMS: As an emerging interventional technique to treat resistant hypertension, renal denervation (RDN) has also attracted considerable attention due to its potential beneficial effects on glucose and lipid metabolism. Given that inconsistent results were documented among studies, we aimed to perform a systematic review and meta-analysis to elaborate on this issue. METHODS: The PubMed, EMBASE, Web of Science (SCI) and ClinicalTrials.gov databases were comprehensively searched from their inception date to June 18, 2020, for relevant clinical studies evaluating the efficacy of RDN on glucose and lipid levels. The outcomes of interest were changes in fasting glucose, insulin, C-peptide, hemoglobin A1C (HbA1C), homeostatic model assessment-insulin resistance (HOMA-IR), cholesterol and triglyceride (TG) levels before versus after RDN and also RDN versus the control group. The mean differences (MDs) of the outcomes measured before versus after RDN and RDN versus the control group were pooled by a randomized effects model. Heterogeneity was quantified with Chi-square (χ2) and inconsistency index (I2). Assessment of publication bias was performed by the funnel plot and Egger's test. RESULTS: A total of 1600 studies were initially identified. Nineteen of the identified studies (six randomized controlled studies, one non-randomized controlled studies and 12 observational cohort studies) involving 2245 subjects were included in the final analysis. No significant change was observed after RDN in fasting glucose (weighted mean difference [WMD] - 0.19 mmol/L; 95% CI - 0.37, 0.00 mmol/L), insulin (standardized mean difference [SMD] - 0.01; 95% CI - 0.41, 0.39), C-peptide (SMD - 0.05; 95% CI - 0.30, 0.21), HbA1C (SMD - 0.05; 95% CI - 0.17, 0.07), HOMA-IR (SMD - 0.29; 95% CI - 0.72, 0.14), total cholesterol (TC) (WMD - 0.11 mmol/L; 95% CI - 0.37, 0.15 mmol/L), and low-density lipoprotein cholesterol (LDL-C) levels (WMD - 0.18 mmol/L; 95% CI - 0.59, 0.24 mmol/L) during follow-up. Changes in fasting glucose, insulin, HbA1C and TC levels in RDN groups were not significantly different from those in the control group. High-density lipoprotein cholesterol (HDL-C) and TG were slightly improved after RDN (WMD 0.07 mmol/L, 95% CI 0.01, 0.14 mmol/L; WMD - 0.26 mmol/l, 95% CI - 0.51, - 0.01 mmol/L, respectively). The funnel plot and Egger's test demonstrated the absence of potential publication bias. CONCLUSIONS: Catheter-based RDN appeared to have no impact on glucose metabolism. There was a statistically significant but clinically negligible improvement in HDL-C and TG levels based on the current evidence. Future research with more rigorous designs is warranted to draw definitive conclusions. REGISTRATION DETAILS: The protocol of this meta-analysis was registered on PROSPERO (CRD42020192805). ( https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=192805 ).


Assuntos
Denervação , Controle Glicêmico , Hipertensão/cirurgia , Rim/inervação , Metabolismo dos Lipídeos , Glicemia/metabolismo , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Cateteres/efeitos adversos , Estudos de Coortes , Denervação/efeitos adversos , Denervação/métodos , Hemoglobina A Glicada/metabolismo , Controle Glicêmico/métodos , Humanos , Hipertensão/sangue , Hipertensão/metabolismo , Insulina/metabolismo , Resistência à Insulina , Rim/cirurgia , Lipídeos/sangue , Estudos Observacionais como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
15.
Circ Arrhythm Electrophysiol ; 14(2): e009294, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33417476

RESUMO

BACKGROUND: Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon and laserballoon catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal atrial fibrillation (AF). METHODS: Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either cryoballoon or laserballoon PVI (cryoballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF versus laserballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF). All antiarrhythmic drugs were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6, and 12 months. Primary efficacy end point was defined as freedom from atrial tachyarrhythmia between 90 and 365 days after a single ablation. Secondary end points included procedural parameters and periprocedural complications. RESULTS: Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (cryoballoon) versus 95% (laserballoon) requiring focal touch-up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the cryoballoon group (50.9±21.0 versus 96.0±20.4 minutes; P<0.0001 and 7.4±4.4 versus 8.4±3.2 minutes, P=0.083). Overall, the primary end point of no atrial tachyarrhythmia recurrence was met in 79% (cryoballoon: 80.0% versus laserballoon: 78.0%, P=ns). No death, atrio-esophageal fistula, tamponade, or vascular laceration requiring surgery occurred. In the cryoballoon group, 8 transient but no persistent phrenic nerve palsy were noted compared with 2 persistent phrenic nerve palsy and one transient ischemic attack in the laserballoon group. CONCLUSIONS: Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Criocirurgia/métodos , Terapia a Laser/métodos , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Recidiva , Resultado do Tratamento
16.
Circ Arrhythm Electrophysiol ; 14(1): e008073, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33441001

RESUMO

Surveys and registries are widely used in medicine as valuable tools to integrate the information from randomized and observational studies. Early after its introduction in daily practice and parallel to its escalating popularity, catheter ablation of atrial fibrillation has been the subject of several surveys and registries. Over the years, relevant aspects associated with atrial fibrillation ablation have been investigated using these tools, including procedural safety and efficacy, discontinuation of anticoagulation therapy and risk of stroke postablation, and outcomes in special populations. The aim of this article is to provide a comprehensive review of the contributions offered by surveys and registries in catheter ablation of atrial fibrillation over the past 15 years.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Previsões , Sistema de Registros , Medição de Risco/métodos , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Seguimentos , Saúde Global , Humanos , Incidência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
17.
Pediatr Cardiol ; 42(3): 590-596, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33394109

RESUMO

Symptoms are the most common indication for ablation in children with atrioventricular nodal reentrant tachycardia (AVNRT). After the procedure, patients may continue to report palpitations. The objective of this study was to quantify the risk and duration of palpitations after pediatric slow pathway modification as well as demographic and technical associations. This was a retrospective review of consecutive patients at a pediatric center who underwent slow pathway modification for AVNRT from 2012 to 2018. Patients with a prior ablation attempt or congenital heart disease were excluded. Palpitations were documented in 35% of patients after ablation. Neither post-ablation echo beats nor other evidence of residual dual AV nodal physiology were associated with a higher risk of post-ablation palpitations. Of the 35 patients with post-ablation palpitations, the median time to resolution of palpitations was 48 months. Acute procedural success was achieved in all 100 cases. There were two recurrences of AVNRT during long-term follow-up and one instance of ectopic atrial tachycardia (3% SVT recurrence). Palpitations after AVNRT ablation occurred in approximately one-third of cases, despite a low recurrence of true arrhythmia. Prior to ablation, patients and families should be counseled that post-ablation palpitations are common and AVNRT recurrence is rare.


Assuntos
Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Adolescente , Estudos de Casos e Controles , Ablação por Cateter/métodos , Criança , Feminino , Humanos , Masculino , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
18.
Int Heart J ; 62(1): 65-71, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455982

RESUMO

Left atrial (LA) fibrosis is associated with a poor outcome after atrial fibrillation (AF) ablation. This study examined the extent of low-voltage areas in patients with recurrence of atrial tachyarrhythmia (ATA) after CB-based pulmonary vein isolation (PVI).Sixty patients (mean age 67 ± 10 years, n = 32 female; n = 34 paroxysmal AF) who received radiofrequency redo-procedure due to recurrence of ATA within 6 months after CB-based PVI were included. A point-by point 3D-map was performed, and low-voltage sites were delineated based on bipolar voltage < 0.5 mV. The extent of fibrosis was categorized as stage A (0-10% of the LA wall), stage B (10-30%), stage C (30-50%), and stage D (> 50%).The median area of LA low-voltage sites was 28.9 (9; 50.3) cm2, corresponding to 17.4 (6; 30.6) % of the LA wall surface. 17/60 (28.3%) patients were categorized as fibrosis stage A, 21/60 (35%) as stage B, 18/60 (30%) as stage C, and 4/60 (6.7%) as stage D. Patient age and LA diameter were associated with more pronounced LA fibrosis; the extent of LA fibrosis was significantly higher in patients with LA tachycardia (LAT) during redo-procedures (P < 0.01), and ablation of linear lesions was more often performed (P < 0.01).In patients after CB2-based PVI, expanded LA tissue fibrosis was associated with the occurrence of LAT and more extensive LA ablation during redo-procedures.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Fibrose/complicações , Átrios do Coração/patologia , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Feminino , Fibrose/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taquicardia Supraventricular/epidemiologia , Taquicardia Supraventricular/etiologia , Resultado do Tratamento
19.
Int Heart J ; 62(1): 72-77, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455989

RESUMO

Atrioventricular nodal reentry tachycardia (AVNRT) is the most common regular supraventricular tachycardia (SVT). Slow pathway modification (SPM) is the accepted first line treatment with reported success rates around 95%. Information regarding possible predictors of AVNRT recurrence is scarce.Out of 4170 consecutive patients with SPM in our department from 1993-2018, we identified 78 patients (1.9%) receiving > 1 SPM (69% female, median age 50 years) with a recurrence of AVNRT after a successful SPM. We matched these patients for age, gender and number of radiofrequency applications during first SPM with 78 patients who received one successful SPM in our center without AVNRT recurrence. Both groups were analyzed for possible predictors of a recurrence of AVNRT during long-term follow-up. The recurrence group contained a significantly lower proportion of patients with an occurrence of junctional beats during SPM (69% versus 89%, P = 0.006). Moreover, significantly more cases of previously diagnosed atrial fibrillation/tachycardia (AF/AT; 21% versus 5%, P = 0.007) and inducible AF/AT during electrophysiology study (23% versus 6%, P = 0.006) were present in the recurrence group. While more than half of patients had a recurrence within the first year, in 20% symptoms reappeared ≥ 4 years after ablation.In a small percentage of patients, AVNRT recurs after an initially successful ablation. Interestingly, these patients had significantly fewer junctional beats during ablation and a higher rate of other (inducible) arrhythmias. AVNRT recurrence spanned a considerable timeframe and should remain a differential diagnosis, even years after ablation.


Assuntos
Nó Atrioventricular/fisiopatologia , Fascículo Atrioventricular/cirurgia , Ablação por Cateter/métodos , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Adulto , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Nó Atrioventricular/cirurgia , Fascículo Atrioventricular/fisiopatologia , Eletrofisiologia Cardíaca/métodos , Eletrofisiologia Cardíaca/estatística & dados numéricos , Estudos de Casos e Controles , Diagnóstico Diferencial , Eletrocardiografia/métodos , Feminino , Seguimentos , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/classificação , Taquicardia Supraventricular/fisiopatologia , Resultado do Tratamento
20.
Int Heart J ; 62(1): 201-206, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455993

RESUMO

The definite diagnosis of cardiac sarcoidosis (CS) can be difficult because it mimics other cardiomyopathies and morphological abnormalities during its time course. Distinguishing CS isolated cardiac sarcoidosis from other cardiomyopathies is very important for the introduction of immunosuppressive therapy.In this study, we report a patient who had initially been diagnosed with hypertrophic obstructive cardiomyopathy (HOCM). The patient developed complete atrioventricular block (CAVB) and morphological abnormalities, which led to his primary diagnosis being re-conducted. Moreover, we made a definite diagnose of isolated CS (ICS) based on the guideline for the diagnosis and treatment using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT)1) and performed tailor-made treatment including immunosuppressive therapy.


Assuntos
Bloqueio Atrioventricular/etiologia , Cardiomiopatia Hipertrófica/diagnóstico , Sarcoidose/complicações , Sarcoidose/diagnóstico , Assistência ao Convalescente , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/terapia , Bloqueio Atrioventricular/diagnóstico , Terapia de Ressincronização Cardíaca/métodos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Ablação por Cateter/métodos , Ecocardiografia/métodos , Fluordesoxiglucose F18/farmacocinética , Humanos , Imunossupressores/uso terapêutico , Masculino , Miocárdio/patologia , Tomografia por Emissão de Pósitrons/métodos , Prednisolona/uso terapêutico , Sarcoidose/diagnóstico por imagem , Sarcoidose/tratamento farmacológico , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...