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1.
Curr Opin Cardiol ; 38(1): 1-5, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36598443

RESUMO

PURPOSE OF REVIEW: This review aims to summarize the recent development, benefit, and safety of extrapulmonary vein ablation for atrial fibrillation. RECENT FINDING: Studies have shown that extrapulmonary vein ablation can help maintain normal sinus rhythm for patients with persistent atrial fibrillation. As prior strategies targeting anatomical lines and triggers are well utilized, novel techniques for substrate mapping have been rapidly developing. These strategies are well tolerated and could be chosen based on patients' conditions and physicians' experience. SUMMARY: Extrapulmonary vein ablation could be safely and effectively performed for patients with atrial fibrillation. It provides further consolidation of normal sinus rhythm.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Humanos , Veias Pulmonares/cirurgia , Ablação por Cateter/métodos , Resultado do Tratamento
2.
BMC Cardiovasc Disord ; 23(1): 8, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624380

RESUMO

BACKGROUND: Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (AF). This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation (CBA) and point-by-point radiofrequency ablation (RFA). METHODS: The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other. RESULTS: The analysis included 1560 CBA patients and 1344 RFA patients from the FREEZE Cohort. Some baseline patients' characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p < 0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1285 h with RFA and 253 h with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% vs 11.5% days with one hour left, respectively). CONCLUSION: CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including: fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage. Clinical trial registration NCT01360008 (first registration 25/05/2011).


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Humanos , Estudos de Coortes , Criocirurgia/efeitos adversos , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Veias Pulmonares/cirurgia , Eletrofisiologia , Resultado do Tratamento , Recidiva
3.
J Med Case Rep ; 17(1): 11, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36631902

RESUMO

BACKGROUND: Pulmonary vein thrombosis (PVT) is rarely associated with malignancies. Leiomyosarcoma, a malignant tumor originating from smooth muscles, has never been reported as the etiology of PVT. CASE PRESENTATION: In this case report, we described a 43-year-old Kurdish woman with a known case of leiomyosarcoma who presented with hemoptysis, dyspnea, and pleuritic chest pain. Chest computed tomography (CT) angiography revealed a thrombus in the left infero-posterior pulmonary vein. She was successfully treated with unfractionated heparin administered intravenously followed by orally administered warfarin. At the end of the article, we describe and compare other reports of malignancy-related PVT. CONCLUSIONS: While malignancies are not a common cause of PVT, both primary lung tumors and metastatic cancers could be associated with PVT. Delay in diagnosis may lead to serious complications and even death. Therefore, clinicians should be aware of the possibility of the development of PVT in different malignancies for appropriate diagnosis and treatment.


Assuntos
Leiomiossarcoma , Neoplasias Pélvicas , Veias Pulmonares , Neoplasias Uterinas , Trombose Venosa , Feminino , Humanos , Adulto , Heparina , Anticoagulantes/uso terapêutico , Leiomiossarcoma/complicações , Leiomiossarcoma/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico por imagem
4.
JAMA ; 329(2): 127-135, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36625809

RESUMO

Importance: Pulmonary vein isolation (PVI) alone is less effective in patients with persistent atrial fibrillation (AF) compared with paroxysmal AF. The left atrial posterior wall may contribute to maintenance of persistent AF, and posterior wall isolation (PWI) is a common PVI adjunct. However, PWI has not been subjected to randomized comparison. Objective: To compare PVI with PWI vs PVI alone in patients with persistent AF undergoing first-time catheter ablation. Design, Setting, and Participants: Investigator initiated, multicenter, randomized clinical trial involving 11 centers in 3 countries (Australia, Canada, UK). Symptomatic patients with persistent AF were randomized 1:1 to either PVI with PWI or PVI alone. Patients were enrolled July 2018-March 2021, with 1-year follow-up completed March 2022. Interventions: The PVI with PWI group (n = 170) underwent wide antral pulmonary vein isolation followed by posterior wall isolation involving linear ablation at the roof and floor to achieve electrical isolation. The PVI-alone group (n = 168) underwent wide antral pulmonary vein isolation alone. Main Outcomes and Measures: Primary end point was freedom from any documented atrial arrhythmia of more than 30 seconds without antiarrhythmic medication at 12 months, after a single ablation procedure. The 23 secondary outcomes included freedom from atrial arrhythmia with/without antiarrhythmic medication after multiple procedures, freedom from symptomatic AF with/without antiarrhythmic medication after multiple procedures, AF burden between study groups at 12 months, procedural outcomes, and complications. Results: Among 338 patients randomized (median age, 65.6 [IQR, 13.1] years; 76.9% men), 330 (97.6%) completed the study. After 12 months, 89 patients (52.4%) assigned to PVI with PWI were free from recurrent atrial arrhythmia without antiarrhythmic medication after a single procedure, compared with 90 (53.6%) assigned to PVI alone (between-group difference, -1.2%; hazard ratio [HR], 0.99 [95% CI, 0.73-1.36]; P = .98). Of the secondary end points, 9 showed no significant difference, including freedom from atrial arrhythmia with/without antiarrhythmic medication after multiple procedures (58.2% for PVI with PWI vs 60.1% for PVI alone; HR, 1.10 [95% CI, 0.79-1.55]; P = .57), freedom from symptomatic AF with/without antiarrhythmic medication after multiple procedures (68.2% vs 72%; HR, 1.20 [95% CI, 0.80-1.78]; P = .36) or AF burden (0% [IQR, 0%-2.3%] vs 0% [IQR, 0%-2.8%], P = .47). Mean procedural times (142 [SD, 69] vs 121 [SD, 57] minutes, P < .001) and ablation times (34 [SD, 21] vs 28 [SD, 12] minutes, P < .001) were significantly shorter for PVI alone. There were 6 complications for PVI with PWI and 4 for PVI alone. Conclusions and Relevance: In patients undergoing first-time catheter ablation for persistent AF, the addition of PWI to PVI alone did not significantly improve freedom from atrial arrhythmia at 12 months compared with PVI alone. These findings do not support the empirical inclusion of PWI for ablation of persistent AF. Trial Registration: anzctr.org.au Identifier: ACTRN12616001436460.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Idoso , Feminino , Humanos , Masculino , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/etiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Átrios do Coração/cirurgia , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos
5.
Am J Transplant ; 23(1): 111-114, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36695613

RESUMO

Pulmonary vein stenosis (PVS) and pulmonary vein occlusion (PVO) represent rare complications after lung transplantation (LTx), with limited therapeutic options and a high risk of graft loss. We present 2 cases of successful endovascular transatrial stenting following double LTx. A 60-year-old woman with chronic obstructive pulmonary disease who underwent double lobar LTx was diagnosed at postoperative day 72 with a high-grade PVS on the left side. A 22-year-old woman with idiopathic pulmonary arterial hypertension who underwent double LTx was diagnosed 9 days later with PVO of the left upper lobe vein. To avoid surgical reintervention, endovascular transatrial dilatation and stenting were performed successfully in both cases. Transatrial endovascular stenting of PVS or PVO after LTx seems an effective and safe treatment option that should be considered for these life-threatening complications and executed with care.


Assuntos
Pneumopatias , Transplante de Pulmão , Veias Pulmonares , Pneumopatia Veno-Oclusiva , Estenose de Veia Pulmonar , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Adulto , Estenose de Veia Pulmonar/cirurgia , Estenose de Veia Pulmonar/complicações , Veias Pulmonares/cirurgia , Pneumopatia Veno-Oclusiva/etiologia , Pneumopatia Veno-Oclusiva/cirurgia , Pulmão , Pneumopatias/complicações , Transplante de Pulmão/efeitos adversos , Resultado do Tratamento , Estudos Retrospectivos
6.
Orv Hetil ; 164(4): 140-147, 2023 Jan 29.
Artigo em Húngaro | MEDLINE | ID: mdl-36709438

RESUMO

INTRODUCTION: Left common pulmonary vein is the most common anatomical variant of pulmonary veins that may affect the outcome of pulmonary vein isolation. OBJECTIVE: Our aim was to compare procedural data and outcomes in patients with common trunk versus normal left atrial anatomy for radiofrequency and cryoballoon catheter ablation. METHOD: Data from patients who underwent pulmonary vein isolation for atrial fibrillation and had a preprocedural cardiac CT scan at our Institution between 01. 10. 2019 and 10. 03. 2022 were retrospectively evaluated. We defined a common trunk where the left superior and inferior pulmonary vein merged at least 5 mm before the left atrial ostium. RESULTS: From the study population (n = 210), data from 42 patients with a left common trunk (LCPV group) and 60 patients with normal left atrial anatomy (control group) were examined. No significant differences were found between the common trunk and the control group in terms of demographic data. There was no significant difference between the two groups in procedural data for radiofrequency and cryoballoon ablation (procedure time, fluoroscopy time, left atrial dwelling time, radiation dose). After radiofrequency ablation, the success rate at 1-year follow-up was 72.0% in the common trunk group and 76.2% in the control group (p = 0.659). For cryoballoon ablation, the success rate was 64.7% and 69.2% for common trunk and normal anatomy, respectively (p = 0.641). CONCLUSION: There was no significant difference in the procedural parameters and clinical outcome between patients with left common pulmonary vein and those with normal left atrial anatomy. Both radiofrequency and cryoballoon ablation techniques are well suited for this population. Orv Hetil. 2023; 164(4): 140-147.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Prognóstico , Resultado do Tratamento , Estudos Retrospectivos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Ablação por Cateter/métodos , Recidiva
7.
Int J Cardiovasc Imaging ; 39(1): 245-254, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36598699

RESUMO

Cryoballoon (CB) has proven to be very effective in the percutaneous treatment of atrial fibrillation (AF). CB ablation is still hampered by X-ray exposure and the doses applied are consistently higher if compared to radiofrequency ablation. All patients who underwent CB ablation between 2015 and 2020 were analysed. Intracardiac echography was consistently used for transeptal puncture. To demonstrate the differences in radiation exposure 3 groups of 50 consecutive patients were selected. In the first group (G1) 3D rotational angiography (3DRA) was used as an intraprocedural imaging method. In the second group (G2), traditional X-ray imaging was used and frame rates both for fluoro and cine modes of diascopy were lowered. In the third group (G3) only 2-3 frames per second were used, cine mode was abandoned and the grid was removed from the X-ray detector. A total of 150 patients were included (76% males, mean age 57.3 ± 11.5 years). A dramatic reduction of radiation dose was obtained from 9585 ± 5610 µGy/m2 in G1 to 2469 ± 2002 µGy/m2 in G2 and finally 227.1 ± 360 µGy/m2 in G3 (p < 0.0001). There was also a significant decrease of procedural and fluoroscopy times. No difference in major complications and midterm outcomes was found between the groups. By following a few relatively simple steps (omitting the pre-procedural imaging, removing grid from the X-ray detector and using very low frame rates) CB ablation could be performed with ultralow radiation exposure without compromising the safety of efficacy of the procedure.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Fibrilação Atrial/etiologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Redução da Medicação , Ecocardiografia , Fluoroscopia/efeitos adversos , Valor Preditivo dos Testes , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento
8.
Artigo em Inglês | MEDLINE | ID: mdl-36718850

RESUMO

The infracardiac variant of total anomalous pulmonary venous return occurs only rarely and is frequently obstructive in nature, thereby presenting in the early days of life [1]. An atrial septal defect is present in most cases and is necessary for survival, but a ventricular septal defect is extremely rare; only a few cases have been reported. Surgery is the only treatment option but carries a high risk of morbidity and mortality.


Assuntos
Comunicação Interatrial , Comunicação Interventricular , Veias Pulmonares , Síndrome de Cimitarra , Humanos , Síndrome de Cimitarra/cirurgia , Veias Pulmonares/cirurgia , Veias Pulmonares/anormalidades , Comunicação Interventricular/cirurgia , Comunicação Interatrial/cirurgia
9.
Zhonghua Jie He He Hu Xi Za Zhi ; 46(1): 51-55, 2023 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-36617929

RESUMO

We reported the manifestations, auxiliary examination, and treatment courses of a case of scimitar syndrome with pulmonary sequestration containing carcinoma. The clinical characteristics of scimitar syndrome with pulmonary sequestration, pulmonary sequestration containing carcinoma were summarized based on the data of this case and the related literatures before January 2022. Scimitar syndrome can coexist with ipsilateral pulmonary sequestration. Because sequestered lung tissue has a risk of malignant transformation, a cancer screening test is useful for early diagnosis and timely treatment.


Assuntos
Sequestro Broncopulmonar , Carcinoma , Neoplasias Pulmonares , Veias Pulmonares , Síndrome de Cimitarra , Humanos , Sequestro Broncopulmonar/complicações , Síndrome de Cimitarra/complicações , Pulmão , Neoplasias Pulmonares/complicações , Carcinoma/complicações
11.
J Am Heart Assoc ; 12(1): e027795, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36565183

RESUMO

Background Left atrial substrate may have mechanistic relevance for ablation of atrial fibrillation (AF). We sought to analyze the relationship between low-voltage zones (LVZs), transition zones, and AF recurrence in patients undergoing pulmonary vein isolation. Methods and Results We conducted a prospective multicenter study on consecutive patients undergoing pulmonary vein isolation-only approach. LVZs and transition zones (0.5-1 mV) were analyzed offline on high-density electroanatomical maps collected before pulmonary vein isolation. Overall, 262 patients (61±11 years, 31% female) with paroxysmal (130 pts) or persistent (132 pts) AF were included. After 28 months of follow-up, 73 (28%) patients experienced recurrence. An extension of more than 5% LVZ in paroxysmal AF and more than 15% in persistent AF was associated with recurrence (hazard ratio [HR], 4.4 [95% CI, 2.0-9.8], P<0.001 and HR, 1.9 [95% CI, 1.1-3.7], P=0.04, respectively). Significant association was found between LVZs and transition zones and between LVZs and left atrial volume index (LAVI) (both P<0.001). Thirty percent of patients had significantly increased LAVI without LVZs. Eight percent of patients had LVZs despite normal LAVI. Older age, female sex, oncological history, and increased AF recurrence characterized the latter subgroup. Conclusions In patients undergoing first pulmonary vein isolation, the impact of LVZs on outcomes occurs with lower burden in paroxysmal than persistent AF, suggesting that not all LVZs have equal prognostic implications. A proportional area of moderately decreased voltages accompanies LVZs, suggesting a continuous substrate instead of the dichotomous division of healthy or diseased tissue. LAVI generally correlates with LVZs, but a small subgroup of patients may present with disproportionate atrial remodeling, despite normal LAVI.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Humanos , Feminino , Masculino , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Estudos Prospectivos , Veias Pulmonares/cirurgia , Resultado do Tratamento , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Ablação por Cateter/métodos , Recidiva
12.
Comput Med Imaging Graph ; 103: 102163, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36566530

RESUMO

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease, with which some patients suffer from postoperative pulmonary venous obstruction (PPVO), requiring particular follow-up strategies and treatments. PPVO prediction has important clinical significance, while building a PPVO prediction model is challenging due to limited data and class imbalance distribution. Inspired by the anatomical evidence of PPVO, which is related to the structure of the left atrium (LA) and pulmonary vein (PV), we design an effective multi-task network for PPVO classification. The proposed method incorporates clinical priors and merits of the segmentation-based network into the classification task. The features learned from segmenting LA and PV are concatenated into the PPVO classification branch to constrain the learning of discriminative features. Anatomical-guided attention is applied in the aggregation of these features to restrict them focusing on TAPVC-related regions. To deal with the imbalance classification problem of PPVO, a novel classification loss derived by masked class activation map (MCAM) is designed to improve the classification performance. Computed tomography angiography (CTA) images of 146 patients diagnosed with supracardiac TAPVC in Shanghai Children's Medical Center and Guangdong Provincial People's Hospital were enrolled in this work. The comprehensive experiments demonstrate the effectiveness and generalization of our proposed method. The automatic PPVO prediction model shows the potential application in helping clinicians develop follow-up strategies, thereby improving the survival rate of TAPVC patients.


Assuntos
Cardiopatias Congênitas , Veias Pulmonares , Pneumopatia Veno-Oclusiva , Síndrome de Cimitarra , Criança , Humanos , Lactente , Angiografia por Tomografia Computadorizada , Estudos Retrospectivos , China , Pneumopatia Veno-Oclusiva/diagnóstico por imagem , Pneumopatia Veno-Oclusiva/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Veias Pulmonares/anormalidades , Síndrome de Cimitarra/cirurgia
13.
Wiad Lek ; 75(10): 2491-2496, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36472286

RESUMO

OBJECTIVE: The aim: To determine the topographic features and morphometric parameters of the pulmonary veins and inferior vena cava in human fetuses during the eighth month of intrauterine development. PATIENTS AND METHODS: Materials and methods: A morphometric and histological research of 25 human fetuses in the eighth month of prenatal ontogenesis (271.0 - 310.0 mm parietal-coccygeal length) was conducted. The topographic features of the inferior vena cava and pulmonary veins during the eighth month of intrauterine development were established, and their length and diameter, as well as the change in the angle of their formation, were morphometrically determined. The formation of the topography of these veins is due to the formation of the chest and abdominal organs and continues throughout the entire fetal period of development. RESULTS: Results: The inferior vena cava is formed at the level of the body of the IV lumbar vertebra in the eighth month of the intrauterine period of human development. The initial part of the trunk of the inferior vena cava obliquely "crosses" the common iliac artery from the left to the right. At this level, the vein is located to the right and slightly behind the aorta. In fetuses of the given age group, the right adrenal gland borders the inferior vena cava only at the level of the lower 2/3 of its medial edge. At the level of the subhepatic section of the inferior vena cava, 4-5 pairs of lumbar veins flow into it. In most cases, the ductus venosus flowed into the inferior vena cava independently between the middle and left hepatic veins. Compared to other sections of the inferior vena cava, the lumen of its diaphragmatic section, which passes through the opening in the dorsal part of the tendinous center of the diaphragm on the right, increases. During this period, it was established that the pulmonary veins lie completely in the heart cavity and are surrounded by a serous membrane. In all fetuses, two pulmonary veins flow from each lung into the left atrium. The level of confluence of the venous ducts of the pulmonary veins and their number varies individually. Pulmonary veins and their ducts lie more superficially and do not repeat the passage of the corresponding bronchi and arteries, lying, as a rule, within the limits of interlobular, intersegmental, and intersubsegmental connective tissue membranes. CONCLUSION: Conclusions: In this age group, changes in venous vessels and complications in the structure of their walls and their ducts continue. The passage and branching of the bronchial tree and arterial branches (starting with the segmental branches) are almost completely identical. A significant increase in the number of small ducts was found in the system of pulmonary veins. There is an increase in the morphometric indicators of the size of the inferior vena cava in comparison with its other parts. In the wall of the pulmonary veins and inferior vena cava, all three tunics are clearly visible, which in structure are close to the definitive one.


Assuntos
Veias Pulmonares , Veia Cava Inferior , Gravidez , Feminino , Humanos , Feto , Átrios do Coração , Aorta
14.
J Cardiovasc Magn Reson ; 24(1): 70, 2022 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-36503589

RESUMO

BACKGROUND: Pulmonary vein (PV) stenosis represents a rare but serious complication following radiofrequency ablation of atrial fibrillation with a comprehensive diagnosis including morphological stenosis grading together with the assessment of its functional consequences being imperative within the relatively narrow window for therapeutic intervention. The present study determined the clinical utility of a combined, single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating pulmonary perfusion and PV angiographic assessment for pre-procedural planning and follow-up of patients referred for interventional PV stenosis treatment. METHODS: CMR examinations (cine imaging, dynamic pulmonary perfusion, three-dimensional PV angiography) were performed in 32 consecutive patients prior to interventional treatment of PV stenosis and at 1-day and 3-months follow-up. Degree of PV stenosis was visually determined on CMR angiography; visual and quantitative analysis of pulmonary perfusion imaging was done for all five lung lobes. RESULTS: Interventional treatment of PV stenosis achieved an acute procedural success rate of 90%. Agreement between visually evaluated pulmonary perfusion imaging and the presence or absence of a ≥ 70% PV stenosis was nearly perfect (Cohen's kappa, 0.96). ROC analysis demonstrated high discriminatory power of quantitative pulmonary perfusion measurements for the detection of ≥ 70% PV stenosis (AUC for time-to-peak enhancement, 0.96; wash-in rate, 0.93; maximum enhancement, 0.90). Quantitative pulmonary perfusion analysis proved a very large treatment effect attributable to successful PV revascularization already after 1 day. CONCLUSION: Integration of CMR pulmonary perfusion imaging into the clinical work-up of patients with PV stenosis allowed for efficient peri-procedural stratification and follow-up evaluation of revascularization success.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Estenose de Veia Pulmonar , Humanos , Estenose de Veia Pulmonar/diagnóstico por imagem , Estenose de Veia Pulmonar/etiologia , Estenose de Veia Pulmonar/terapia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Ablação por Cateter/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/patologia , Constrição Patológica/cirurgia , Valor Preditivo dos Testes , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Pulmão/diagnóstico por imagem , Espectroscopia de Ressonância Magnética
15.
Zhonghua Yi Xue Za Zhi ; 102(48): 3875-3880, 2022 Dec 27.
Artigo em Chinês | MEDLINE | ID: mdl-36540926

RESUMO

Objective: To compare the efficacy, safety and recurrence rate between ablation index (AI) and contact force (CF) guided radiofrequency ablation of paroxysmal atrial fibrillation in elderly patients. Methods: Elderly patients (age ≥60 years) with paroxysmal atrial fibrillation who received radiofrequency ablation for the first time at Department of Cardiology, Beijing Friendship Hospital from April 2018 to April 2019 were enrolled. Patients were divided into 2 groups: AI-group (n=40) and CF group (n=37) depending on their ablation methods. Follow-up was performed until 1 year post the procedure, and efficacy related indexes like first-pass pulmonary vein isolation (PVI) rate, ablation duration, operation duration and major complications were compared between 2 groups. The recurrence rates between 2 groups and related risk factors after radiofrequency ablation were analyzed. Results: A total of 77 patients [mean age (68.5±6.4) years, 40 were male] were enrolled at last. In AI guided patients, frequency of first-pass PVI rate was higher [52.5%(21 cases) vs 29.7%(3 cases), P=0.011] with a shorter ablation duration [(24.5±1.7) min vs (33.7±2.2) min, P<0.001] and operation duration [(136.6±6.1) min vs (139.7±7.4) min, P=0.048] compared with CF guided group. At 1 year follow-up, AI group showed an amendatory recurrence rate in Kaplan-Meier analysis (22.5% vs 40.5%,log-rank P=0.048). Multivariate Cox regression analysis showed that CF guided ablation (HR=3.272,95%CI:1.319-8.114,P=0.011), enlarged anteroposterior diameter of the left atrium (HR=4.233,95%CI:1.511-11.862,P=0.006) and complicated with coronary heart disease (HR=4.829,95%CI:1.399-16.666,P=0.013) were independent risk factors for recurrence of atrial fibrillation in elderly patients. Conclusions: Compared with CF guided ablation, radiofrequency ablation of paroxysmal atrial fibrillation in elderly patients guided by AI showed a higher first-pass PVI rate, shorter procedure duration of both ablation time and total operation time, meanwhile a lower recurrence rate. Further analysis revealed that different ablation alternation (AI or CF), enlarged anteroposterior diameter of left atrium, and complicated with coronary heart disease are independent risk factors for recurrence after radiofrequency ablation of atrial fibrillation in elderly patients.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Ablação por Radiofrequência , Humanos , Masculino , Idoso , Pessoa de Meia-Idade , Feminino , Fibrilação Atrial/cirurgia , Resultado do Tratamento , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Veias Pulmonares/cirurgia , Fatores de Risco , Recidiva
16.
Medicina (Kaunas) ; 58(12)2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36556902

RESUMO

Background and Objectives: Selective pulmonary vein (PV) angiography has been established as the gold standard for PV visualization in cryoballoon (CB)-based pulmonary vein isolation (PVI). We sought to simplify this approach to reduce procedural complexity and radiation exposure. Materials and Methods: Patients with paroxysmal and recently diagnosed persistent AF undergoing CB-based PVI from January 2015 to December 2017 were retrospectively analyzed. Patients underwent either selective PV angiography or conventional left atrial (LA) angiography for PV visualization. Results: A total of 336 patients were analyzed. A total of 87 patients (26%) received PV angiography and 249 (74%) LA angiography. LA angiography required fewer cine-sequences for PV visualization, translating into a significant reduction in procedure duration, fluoroscopy time and dose area product. Additionally, less contrast medium was utilized. PV occlusion by the CB, CB temperature and time to isolation showed no significant differences. The number of CB applications and total application time (LA angiography: 1.4 ± 0.02 vs. PV Angiography: 1.6 ± 0.05; p < 0.0001; LA angiography: 297.9 ± 4.62 vs. PV-Angiography: 348.9 ± 11.03; p < 0.001, respectively) per vein were slightly but significantly higher in the PV angiography group. We observed no difference in late AF recurrence (24.7% LA angiography vs. 21.3% PV angiography; p = 0.2657). Conclusions: A simplified protocol, using LA angiography for PV visualization, entails a reduction in procedure time and radiation exposure while equally maintaining procedural efficiency and safety in both groups.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Humanos , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Estudos Retrospectivos , Criocirurgia/métodos , Resultado do Tratamento , Ablação por Cateter/métodos , Recidiva
18.
Biomolecules ; 12(12)2022 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-36551306

RESUMO

Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary arterial hypertension (PAH) occurring in a heritable form (hPVOD) due to biallelic inactivating mutations of EIF2AK4 (encoding GCN2, general control nonderepressible 2) or in a sporadic form in older age (sPVOD), following exposure to chemotherapy or organic solvents. In contrast to PAH, PVOD is characterized by a particular remodeling of the pulmonary venous system and the obliteration of small pulmonary veins by fibrous intimal thickening and patchy capillary proliferation. The pathobiological knowledge of PVOD is poor, explaining the absence of medical therapy for PVOD. Lung transplantation remains the only therapy for eligible PVOD patients. As we recently demonstrated, respiratory diseases, chronic obstructive pulmonary disease, or cystic fibrosis exhibit lipointoxication signatures characterized by excessive levels of saturated phospholipids contributing to the pathological features of these diseases, including endoplasmic reticulum stress, pro-inflammatory cytokines production, and bronchoconstriction. In this study, we investigated and compared the clinical data and lung lipid signature of control (10 patients), idiopathic PAH (7 patients), heritable PAH (9 BMPR2 mutations carriers), hPVOD (10 EIF2AK4 mutation carriers), and sPVOD (6 non-carriers) subjects. Mass spectrometry analyses demonstrated lung lipointoxication only in hPVOD patients, characterized by an increased abundance of saturated phosphatidylcholine (PC) at the expense of the polyunsaturated species in the lungs of hPVOD patients. The present data suggest that lipointoxication could be a potential player in the etiology of PVOD.


Assuntos
Hipertensão Arterial Pulmonar , Pneumopatia Veno-Oclusiva , Humanos , Lipidômica , Pulmão/patologia , Proteínas Serina-Treonina Quinases/genética , Hipertensão Arterial Pulmonar/patologia , Veias Pulmonares , Pneumopatia Veno-Oclusiva/genética , Pneumopatia Veno-Oclusiva/patologia
19.
BMJ Open ; 12(11): e063359, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368743

RESUMO

OBJECTIVES: Pulmonary vein isolation (PVI) is widely accepted as an effective and safe treatment for symptomatic atrial fibrillation (AF). However, data on sex-related differences and associations with clinical outcome and safety of PVI with cryoballoon ablation are limited. We sought to compare sexrelated efficacy and safety of cryoballoon ablation and identify sex-related associations with clinical outcomes. METHODS AND RESULTS: We included 650 consecutive patients with AF undergoing PVI with cryoballoon ablation at our institution between 2013 and 2017. The efficacy outcome was the first documented recurrence (>30 s) of AF, atrial flutter or atrial tachycardia (AF/AT) or repeat ablation during follow-up, after a 90-day blanking period. The safety outcome was the incidence of periprocedural complications. Mean age of the population was 58±10, and 210 (32.3%) patients were women. Women were older, had a higher body mass index, had more renal dysfunction and less coronary artery disease as compared with men. The rate of AF/AT recurrence was similar between women and men at 12-month follow-up (27.6% vs 24.8%, p=0.445). The incidence of periprocedural complications was higher in women (12.9% vs 4.6%; p<0.001), specifically groin haematomas and phrenic nerve palsy. On multivariate analysis, left atrial volume index (adjusted OR 1.05, 95% CI 1.00 to 1.10; p=0.032) was associated with the incidence of procedural complications in women. For men, no relation with complications could be found. CONCLUSION: The efficacy of cryoballoon ablation was similar between women and men; however, women had a higher risk of procedural complications.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Masculino , Humanos , Feminino , Veias Pulmonares/cirurgia , Fibrilação Atrial/epidemiologia , Criocirurgia/métodos , Resultado do Tratamento , Estudos de Coortes , Recidiva , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos
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