RESUMO
BACKGROUND: The best approach to management of anticoagulation before and after atrial fibrillation ablation is not known. METHODS AND RESULTS: We compared outcomes in consecutive patients undergoing pulmonary vein antrum isolation for persistent atrial fibrillation. Early in our practice, warfarin was stopped 3 days before ablation, and a transesophageal echocardiogram was performed to rule out clot. Enoxaparin, initially 1 mg/kg twice daily (group 1) and then 0.5 mg/kg twice daily (group 2), was used to "bridge" patients after ablation. Subsequently, warfarin was continued to maintain the international normalized ratio between 2 and 3.5 (group 3). Minor bleeding was defined as hematoma that did not require intervention. Major bleeding was defined as either cardiac tamponade, hematoma that required intervention, or bleeding that required blood transfusion. Pulmonary vein ablation was performed in 355 patients (group 1=105, group 2=100, and group 3=150). More patients had spontaneous echocardiographic contrast in groups 1 and 2. One patient in group 1 had an ischemic stroke compared with 2 patients in group 2 and no patients in group 3. In group 1, 23 patients had minor bleeding, 9 had major bleeding, and 1 had pericardial effusion but no tamponade. In group 2, 19 patients had minor bleeding, and 2 patients developed symptomatic pericardial effusion with need for pericardiocentesis 1 week after discharge. In group 3, 8 patients developed minor bleeding, and 1 patient developed pericardial effusion with no tamponade. CONCLUSIONS: Continuation of warfarin throughout pulmonary vein ablation without administration of enoxaparin is safe and efficacious. This strategy can be an alternative to bridging with enoxaparin or heparin in the periprocedural period.
Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/terapia , Ablação por Cateter/métodos , Idoso , Anticoagulantes/toxicidade , Fibrilação Atrial/complicações , Enoxaparina/administração & dosagem , Feminino , Hemorragia/induzido quimicamente , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Veias Pulmonares , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento , Varfarina/administração & dosagemRESUMO
AIMS: Catheter ablation is an effective treatment for atrial fibrillation (AF). The outcome of AF ablation in septuagenarians is not clear. Our aim was to evaluate success rate, outcome, and complication rate of AF ablation in septuagenarians. METHODS AND RESULTS: We collected data from 174 consecutive patients over 75 years of age who underwent AF ablation from 2001 to 2006. AF was paroxysmal in 55%. High-risk CHADS score (>or=2) was present in 65% of the population. Over a mean follow-up of 20 +/- 14 months, 127 (73%) maintained sinus rhythm (SR) with a single procedure, whereas 47 patients had recurrence of AF. Twenty of them had a second ablation, successful in 16 (80%). Major acute complications included one CVA and one hemothorax (2/194 [1.0%]). During the follow-up, three patients had a CVA within the first 6 weeks after ablation. Warfarin was discontinued in 138 out 143 patients (96%) who maintained SR without AADs with no embolic event occurring over a mean follow-up of 16 +/- 12 months. CONCLUSION: AF ablation is a safe and effective treatment for AF in septuagenarians.
Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/métodos , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
UNLABELLED: Intracardiac Echo-Guided Radiofrequency Catheter. INTRODUCTION: Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients. METHOD: We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed. RESULTS: In group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 +/- 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months. CONCLUSION: Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Fibrilação Atrial/complicações , Ablação por Cateter/efeitos adversos , Estudos de Viabilidade , Feminino , Forame Oval Patente/complicações , Comunicação Interatrial/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Medição de Risco , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: Electrocardiographic (ECG) characteristics were analyzed in postoperative cardiac surgery patients in an attempt to predict development of new-onset postoperative atrial fibrillation (AF). METHODS: Nineteen ECG characteristics were analyzed using computer-based algorithms. The parameters were retrospectively analyzed from ECG signals recorded in postoperative cardiac surgery patients while they were in the cardiovascular intensive care unit (CVICU) at our institution. ECG data from 99 patients (of whom 43 developed postoperative AF) were analyzed. A bootstrap variable selection procedure was applied to select the most important ECG parameters, and a multivariable logistic regression model was developed to classify patients who did and did not develop AF. RESULTS: Premature atrial activity (PAC) was greater in AF patients (P < 0.01). Certain heart rate variability (HRV) and turbulence parameters also differed in patients who did and did not develop AF. In contrast, P-wave morphology was similar in patients with and without AF. Receiver operating curve (ROC) analysis applied to the model produced a C-statistic of 0.904. The model thus correctly classified AF patients with more than a 90% sensitivity and a 70% specificity. CONCLUSION: Among the 19 ECG parameters analyzed, PAC activity, frequency-domain HRV, and heart rate turbulence parameters were the best discriminators for postoperative AF.
Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Eletrocardiografia/métodos , Medição de Risco/métodos , Adulto , Fibrilação Atrial/prevenção & controle , Feminino , Humanos , Masculino , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
This work introduces, for the first time worldwide, the means to preserve and protect the natural nanoporous structure of the never-dried plant cell wall, against the irreversible collapse, which occurs due to drying. Simultaneously, these means, used for the above-mentioned aim, provide a gateway to novel nanocomposite materials, which retain the super reactive and super absorbent properties of the never-dried biological cellulose fibers. The present work showed, for the first time worldwide, that glucose can be vaccinated into the cell wall micropores or nanostructure of the never-dried biological cellulose fibers, by simple new techniques, to create a reactive novel nanocomposite material possessing surprising super absorbent properties. Inoculation of the never dried biological cellulose fibers, with glucose, prevented the collapse of the cell wall nanostructure, which normally occurs due to drying. The nanocomposite, produced after drying of the glucose inoculated biological cellulose, retained the super absorbent properties of the never dried biological cellulose fibers. It was found that glucose under certain circumstances grafts to the never dried biological cellulose fibers to form a novel natural nanocomposite material. About 3-8% (w/w) glucose remained grafted in the novel nanocomposite.
Assuntos
Celulose/química , Fibra de Algodão , Glucose/química , Nanocompostos/química , Nanotecnologia/métodos , PorosidadeRESUMO
UNLABELLED: PV isolation at the antrum (PVAI) has improved safety and efficacy of ablation procedures for atrial fibrillation (AF). AF triggers from the superior vena cava (SVC) may compromise the outcome of PVAI. PURPOSE: We evaluated the (1) incidence of SVC triggers, (2) feasibility of empiric SVC electrical isolation (SVCI) as an adjunct to PVAI, and (3) SVCI safety. METHODS AND RESULTS: Of 190 patients (group I), 24 (12%) showed SVC triggers. Following PVAI, seven patients had AT originating from the SVC and three had AF. After SVCI, all 24 patients were arrhythmia-free 450 +/- 180 days post procedure. In the subsequent 217 patients (group II), empirical SVCI was performed following PVAI. Sixty-six of all 407 patients (16%) experienced recurrence of AF. A repeat procedure in 25 of the 66 patients showed that five (20%) had AF recurrence initiated by SVC triggers, of whom four were among group I patients (4/190; 2%) and one was from group II (1/217; 0.4%), (P < 0.05). Transient diaphragmatic paralysis can be avoided by pacing at the lateral aspect of the SVC using high output (30 mA). There was no SVC stenosis on CT scans before or 3 months after the procedure. There was no sinus node injury. CONCLUSIONS: The SVC harbors the majority of non-PV triggers of AF. SVCI is feasible, safe, and may be considered as an adjunctive strategy to PVAI for ablation of AF. The long-term favorable outcome of this hybrid approach remains to be evaluated in a larger series of patients.
Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/estatística & dados numéricos , Sistema de Condução Cardíaco/cirurgia , Veias Pulmonares/cirurgia , Veia Cava Superior/cirurgia , Fibrilação Atrial/diagnóstico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Resultado do TratamentoRESUMO
INTRODUCTION: Image integration is being used in ablation procedures. However, the success of this approach is dependent on the accuracy of the image integration process. This study aims to evaluate the in vivo accuracy and reliability of the integrated image. METHODS AND RESULTS: One hundred twenty-four patients undergoing radiofrequency (RF) ablation catheter ablation for atrial fibrillation (AF) were recruited for this study from three different centers. Cardiac computerized tomography (CT) was performed in all patients and a 3D image of the left atrium (LA) and pulmonary veins (PVs) was extracted for registration after segmentation using a software program (CartoMerge, Biosense Webster, Inc.). Different landmarks were selected for registration and compared. Surface registration was then done and the impact on integration and the landmarks was evaluated. The best landmark registration was achieved when the posterior points on the pulmonary veins were selected (5.6 +/- 3.2). Landmarks taken on the anterior wall, left atrial appendage (LAA) or the coronary sinus (CS) resulted in a larger registration error (9.1 +/- 2.5). The mean error for surface registration was 2.17 +/- 1.65. However, surface registration resulted in shifting of the initially registered landmark points leading to a larger error (from 5.6 +/- 3.2 to 9.2 +/- 2.1; 95% CI 4.2-3.05). CONCLUSION: Posterior wall landmarks at the PV-LA junction are the most accurate landmarks for image integration in respect to the target ablation area. The concurrent use of the present surface registration algorithm may result in shifting of the initial landmarks with loss of their initial correlation with the area of interest.
Assuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Ecocardiografia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Humanos , Interpretação de Imagem Assistida por Computador/instrumentação , Imageamento Tridimensional/instrumentação , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/diagnóstico por imagem , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: The efficacy of radiofrequency ablation of atypical atrial flutter (AAFL) remains relatively low. This is probably related to the complex mechanism of this arrhythmia or may be due to an inability to deliver sufficient energy during ablation. OBJECTIVE: The aim of this study is to assess whether an open-irrigation-tip catheter or an 8-mm-tip catheter is more effective for ablation of AAFL in patients with prior history of cardiac surgery and/or catheter ablation of atrial fibrillation. METHODS: Seventy patients with AAFL after cardiac surgery/atrial fibrillation ablation were randomized for ablation with either an open-irrigation-tip catheter (Group 1, n=36) or an 8-mm-tip catheter (Group 2, n=34). Acute success was defined as the termination of AAFL by radiofrequency delivery and noninducibility by programmed pacing at the end of procedure. Patients' postoperative courses were followed up by means of intermittent standard electrocardiogram (ECG), transtelephonic ECG monitoring, and telephone interview. All patients underwent 48-hour Holter monitoring at their 3-, 6-, and 9-month follow-up after ablation. RESULTS: Acute success was achieved in 34 patients (94.4%) in Group 1 and 26 patients (76.5%) in Group 2 (P<.05). As compared with the patients in Group 2, more patients in Group 1 remained in sinus rhythm without antiarrhythmic drugs at 90-day follow-up (22 vs 8, P<.05). After 10 months of follow-up, 91.7% of the patients from Group 1 were free of atrial tachyarrhythmias, whereas only 58.9% of the patients from Group 2 remained in sinus rhythm (P <.05). The fluoroscopy and radiofrequency times were significantly shorter when an open-irrigation-tip ablation catheter was used. CONCLUSION: In patients with a prior history of cardiac surgery or ablation for atrial fibrillation, an open-irrigation-tip catheter is superior to an 8-mm-tip catheter for radiofrequency ablation of scar-related AAFLs. Patients ablated with an open-irrigation-tip catheter seem to have higher acute success rate with less x-ray exposure and radiofrequency delivery, and have a more favorable long-term outcome with more patients maintaining sinus rhythm without antiarrhythmic drugs.
Assuntos
Fibrilação Atrial/terapia , Flutter Atrial/terapia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Phrenic nerve injury (PNI) is a complication that can occur with catheter ablation. METHODS: Data from 17 patients with PNI following different catheter ablation techniques were reviewed. PNI was defined as decreased motility (transient) or paralysis (persistent) of the hemi-diaphragm on fluoroscopy or chest X-ray. Patient's recovery was monitored. Normalization of chest images and sniff test would be considered as complete clinical recovery. RESULTS: Out of the 17 PNI patients (16 right, 1 left), 13 (11 persistent, 2 transient) occurred after pulmonary veins isolation with or without superior vena cava ablation. Three patients had persistent PNI after sinus node modification and one other patient experienced PNI after epicardial ventricular tachycardia ablation. Ablation was performed with different energy source including radiofrequency (n = 13), cryothermal (n = 1), ultrasound (n = 2) and laser (n = 1). Patient's symptoms varied broadly from asymptomatic to dyspnea, and even to respiratory insufficiency that required temporary mechanical ventilation support. Two patients with transient PNI resolved immediately after the procedure and the other 15 persistent PNI patients resolved within a mean time of 8.3 +/- 6.6 months. CONCLUSIONS: PNI caused by catheter ablation appears to functionally recover over time regardless of the energy sources used for the procedure.
Assuntos
Ablação por Cateter/efeitos adversos , Nervo Frênico/lesões , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos RetrospectivosRESUMO
BACKGROUND: A persistent left superior vena cava (SVC) can be an arrhythmogenic source in patients with atrial fibrillation (AF) through connections from the coronary sinus (CS) and the left atrium (LA). The left SVC can be electrically isolated. However, little clinical data about the impact of left SVC disconnection on AF outcome are available. We report on six patients with left SVC and recurrent AF. OBJECTIVES: The purpose of this study was to assess the impact of left SVC isolation on AF recurrence. METHODS: Six patients (4 men and 2 women; age 50 +/- 6.4 years) with symptomatic drug-refractory AF and persistent left SVC presented to our laboratory for treatment. Four of the patients had left SVC isolation only because there was no conduction recovery in the pulmonary veins (PVs) after several previous procedures. RESULTS: Conduction between the left SVC and the CS and LA was documented, as was spontaneous ectopies in three patients that degenerated into AF in one patient. Isolation of the left SVC was successful in all patients. Isolation was relatively easy to perform (10.25 +/- 1.6 minutes), with no complications. After follow-up of 13 +/- 7.4 months, all patients were in sinus rhythm and free from AF without antiarrhythmic drugs. CONCLUSION: This study stresses the importance of looking for unusual sources of AF in patients presenting for repeat procedures or in those in whom the PVs have been ruled out as a source triggering AF. We present clinical evidence that in patients with AF and left SVC, isolation of the PVs only may not be sufficient to suppress AF. Thus, diagnosis and isolation of the left SVC appears critical to preventing AF recurrence in patients with AF when ablation is considered.
Assuntos
Fibrilação Atrial/terapia , Ablação por Cateter , Veias Pulmonares/cirurgia , Veia Cava Superior/fisiopatologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/métodos , Angiografia Coronária , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/fisiopatologia , Recidiva , Tomografia Computadorizada por Raios X , Ultrassonografia , Veia Cava Superior/diagnóstico por imagemRESUMO
For the first time worldwide, it is shown that our novel nanocomposite produced from natural fibers vaccinated with glucose--by fully green nanotechnology--possesses surprising reactivity towards urea. Magic super absorbent carbamated nanocomposite cotton fabrics having remarkable distinguished properties were obtained in few minutes. It is well established that carbamates possess antibacterial effects. The produced magic nanocomposite fabrics, we discovered for the first time worldwide, find their use as woven or nonwoven hygienic pads, bandages or paper nanocomposites.
Assuntos
Fibra de Algodão , Química Verde/métodos , Nanotecnologia/métodos , Carbamatos/química , Celulose/química , Glucose/química , Nanocompostos/química , Água/químicaRESUMO
Ventricular tachycardia associated with prior myocardial infarction account for significant morbidity, mortality, and health care costs despite the favorable outcomes shown by ICD clinical trials. Catheter ablation has been increasingly used as an adjunctive therapy in the management of scar-related ventricular tachycardia. Novel technologies have facilitated the outcomes of current ablation strategies. Three-dimensional mapping systems have allowed identification of the scar substrate, its critical sites in the tachycardia circuit, and selection of ablation sites based on fairly precise electroanatomic substrate.
Assuntos
Ablação por Cateter/métodos , Mapeamento Epicárdico/métodos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia , Diagnóstico por Imagem , Eletrocardiografia , HumanosRESUMO
BACKGROUND: Ablation of long-standing persistent atrial fibrillation (AF) remains challenging, with a lower success rate than paroxysmal AF. A reliable ablation endpoint has not been demonstrated yet, although AF termination during ablation may be associated with higher long-term maintenance of sinus rhythm (SR). OBJECTIVE: The purpose of this study was to determine whether the method of AF termination during ablation predicts mode of recurrence or long-term outcome. METHODS: Three hundred six patients with long-standing persistent AF, free of antiarrhythmic drugs (AADs), undergoing a first radiofrequency ablation (pulmonary vein [PV] antrum isolation and complex fractionated atrial electrograms) were prospectively included. Organized atrial tachyarrhythmias (AT) that occurred during AF ablation were targeted. AF termination mode during ablation was studied in relation to other variables (characteristics of arrhythmia recurrence, redo procedures, the use of adenosine/isoproterenol for redo, and comparison of focal versus macroreentrant ATs). Long-term maintenance of SR was assessed during the follow-up. RESULTS: During AF ablation, six of 306 patients converted directly to SR, 172 patients organized into AT (with 38 of them converting in SR with further ablation), and 128 did not organize or terminate and were cardioverted. Two hundred eleven of 306 patients (69%) maintained in long-term SR without AADs after a mean follow-up of 25 +/- 6.9 months, with no statistical difference between the various AF termination modes during ablation. Presence or absence of organization during ablation clearly predicted the predominant mode of recurrence, respectively, AT or AF (P = .022). Among the 74 redo ablation patients, 24 patients (32%) had extra PV triggers revealed by adenosine/isoproterenol. Termination of focal ATs was correlated with higher long-term success rate (24/29, 83%) than termination of macroreentrant ATs (20/35, 57%; P = .026). CONCLUSION: AF termination during ablation (conversion to AT or SR) could predict the mode of arrhythmia recurrence (AT vs. AF) but did not impact the long-term SR maintenance after one or two procedures. AT termination with further ablation did not correlate with better long-term outcome, except with focal ATs, for which termination seems critical.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Sistema de Condução Cardíaco/fisiopatologia , Monitorização Intraoperatória/métodos , Fibrilação Atrial/fisiopatologia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Seguimentos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive, genetically determined fibro-fatty infiltrative myocardial disease with an estimated prevalence in the general population to be 1:5,000 to 1:10,000. ARVD leads to electrical instability that may predispose to life-threatening ventricular arrhythmia, heart failure, and sudden death. We reviewed the pathological substrate for ventricular arrhythmias, ECG findings and treatment modalities in ARVD. Importantly, novel techniques such as electroanatomic and voltage mapping has greatly improved the identification of the scared substrate in the settings of ARVD and have improved safety and efficacy of VT ablation procedures associated with this entity.
Assuntos
Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/cirurgia , Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirurgia , Displasia Arritmogênica Ventricular Direita/complicações , Humanos , Taquicardia Ventricular/complicaçõesRESUMO
BACKGROUND: Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation. METHODS AND RESULTS: Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 (P<0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2) (40.6+/-1 degrees C versus 39.6+/-0.8 degrees C; P< 0.003). The time to peak temperature was 9+/-7 seconds in group 1 and 21+/-9 seconds in group 2, and this difference was statistically significant (P<0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination. CONCLUSIONS: The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.
Assuntos
Anestesia Geral , Fibrilação Atrial/cirurgia , Endoscopia por Cápsula , Ablação por Cateter/efeitos adversos , Sedação Consciente , Esôfago/lesões , Idoso , Queimaduras por Corrente Elétrica/etiologia , Queimaduras por Corrente Elétrica/patologia , Queimaduras por Corrente Elétrica/prevenção & controle , Cápsulas Endoscópicas , Fístula Esofágica/etiologia , Fístula Esofágica/patologia , Fístula Esofágica/prevenção & controle , Esôfago/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , TemperaturaRESUMO
BACKGROUND: Whether different ablation strategies affect paroxysmal atrial fibrillation (AF) long-term freedom from AF/atrial tachyarrhythmia is unclear. We sought to compare the effect of 3 different ablation approaches on the long-term success in patients with paroxysmal AF. METHODS AND RESULTS: One hundred three consecutive patients with paroxysmal AF scheduled for ablation and presenting in the electrophysiology laboratory in AF were selected for this study. Patients were randomized to pulmonary vein antrum isolation (PVAI; n=35) versus biatrial ablation of the complex fractionated atrial electrograms (CFAEs; n=34) versus PVAI followed by CFAEs (n=34). Patients were given event recorders and followed up at 3, 6, 9, 12, and 15 months postablation. There was no statistical significant difference between the groups in term of sex, age, AF duration, left atrial size, and ejection fraction. At 1 year follow-up, freedom from AF/atrial tachyarrhythmia was documented in 89% of patients in the PVAI group, 91% in the PVAI plus CFAEs group, and 23% in the CFAEs group (P<0.001) after a single procedure and with antiarrhythmic drugs. CONCLUSIONS: No difference in terms of success rate was seen between PVAI alone and PVAI associated with defragmentation. CFAEs ablation alone had the smallest impact on AF recurrences at 1-year follow-up. These results suggest that antral isolation is sufficient to treat most patients with paroxysmal AF.
Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Taquicardia Atrial Ectópica/cirurgia , Idoso , Fibrilação Atrial/patologia , Eletrocardiografia , Feminino , Seguimentos , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/patologia , Veias Pulmonares/cirurgia , Taquicardia Atrial Ectópica/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Despite the recent advances in cardiac mapping, ablation of scar-related ventricular tachycardia (VT) still remains a clinical challenge. A detailed electroanatomical map is a prerequisite for accurate localization and ablation of the VT substrate. OBJECTIVE: The purpose of this study was to evaluate the feasibility and accuracy of integrating the positron emission tomography (PET)/computed tomography (CT) with the electroanatomical map and compare the accuracy of the voltage-based scar with the biological scar. METHODS: Patients undergoing radiofrequency ablation (n = 19) for scar-related VT were enrolled. CT angiography and PET scans were performed for all patients. Tomographic and volumetric data from both images were processed and coregistered using internally designed software. That image was segmented in an electrophysiology mapping system and registered to the electroanatomical map. Eight different thresholds were applied on the voltage map to define the scar. The surface areas of the biological and electrical dense scars at different thresholds were measured and compared. RESULTS: The PET/CT image was well integrated with the electroanatomical map with a mean surface registration error of 5.1 +/- 2.1 mm. Of the eight different thresholds defining the scar, the surface area of the scar at a threshold of 0.9 mV (68.6 +/- 49.2 cm(2)) correlated best with the surface area of the PET-based scar (70.4 +/- 49.3 cm(2)) and had the least total area error (4.8 +/- 1.8 cm(2)) compared with the 0.5 threshold (29.7 +/- 23.9 cm(2)). CONCLUSION: Integrating PET/CT with the electroanatomical map is feasible and accurate. Based on the biological scar, readjustment of the voltage scar threshold to 0.9 mV is suggested. In view of the better accuracy of PET/CT in defining scar, the need for acquiring detailed voltage maps may be obviated.
Assuntos
Cicatriz/etiologia , Infarto do Miocárdio/complicações , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/cirurgia , Idoso , Idoso de 80 Anos ou mais , Mapeamento Potencial de Superfície Corporal , Ablação por Cateter , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Taquicardia Ventricular/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: This prospective multicenter randomized study aimed to compare the efficacy of 3 common ablation methods used for longstanding permanent atrial fibrillation (AF). METHODS: A total of 144 patients with longstanding permanent AF (median duration 28 months) were randomly assigned to circumferential pulmonary vein ablation (CPVA, group 1, n = 47), to pulmonary vein antrum isolation (PVAI, group 2, n = 48) or to a hybrid strategy combining ablation of complex fractionated or rapid atrial electrograms (CFAE) in both atria followed by a pulmonary vein antrum isolation (CFAE + PVAI, group 3, n = 49). RESULTS: Scarring in the left atrium and structural heart disease/hypertension were present in most patients (65%). After a mean follow-up of 16 months, 11% of patients in group 1, 40% of patients in group 2 and 61% of patients in group 3 were in sinus rhythm after one procedure and with no antiarrhythmic drugs (P < .001). Sinus rhythm maintenance would increase respectively to 28% (group 1), 83% (group 2), and 94% (group 3) after 2 procedures and with antiarrhythmic drugs (AADs, P < .001). The AF terminated during ablation, either by conversion to sinus rhythm or organization into an atrial tachyarrhythmia, in 13% of patients (group 1), 44% (group 2), and 74% (group 3) respectively. CFAE alone, performed as the first step of the ablation in group 3, organized AF in only 1 patient. CONCLUSION: In this study, the hybrid AF ablation strategy including antrum isolation and CFAE ablation had the highest likelihood of maintaining sinus rhythm in patients with longstanding permanent AF. Electrical isolation of the PVs, although inadequate if performed alone, is relevant to achieve long-term sinus rhythm maintenance after ablation. Bi-atrial CFAE ablation had a minimal impact on AF termination during ablation.
Assuntos
Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Sistema de Condução Cardíaco/cirurgia , Fotocoagulação a Laser/métodos , Veias Pulmonares/cirurgia , Fibrilação Atrial/fisiopatologia , Doença Crônica , Feminino , Seguimentos , Átrios do Coração/inervação , Átrios do Coração/fisiopatologia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/inervação , Resultado do TratamentoRESUMO
OBJECTIVES: We aimed at assessing the feasibility and efficacy of remote magnetic navigation (MN) and ablation in patients with atrial fibrillation (AF). BACKGROUND: This novel MN system could facilitate standardization of the procedures, reducing the importance of the operator skill. METHODS: After becoming familiar with the system in 48 previous patients, 45 consecutive patients with AF were considered for ablation using the Niobe II remote magnetic system (Stereotaxis, St. Louis, Missouri) in a stepwise approach: circumferential pulmonary vein ablation (CPVA), pulmonary vein antrum isolation (PVAI), and, if failed, PVAI using the conventional approach. Remote navigation was done using the coordinate or the wand approach. Ablation end point was electrical disconnection of the pulmonary veins (PVs). RESULTS: Using the coordinate approach, the target location was reached in only 60% of the sites, whereas by using the wand approach 100% of the sites could be reached. After step 2 ablation, only 1 PV in 4 patients (8%) could be electrically isolated. Charring on the ablation catheter tip was seen in 15 (33%) of the cases. In 23 patients, all PVs were isolated with the conventional thermocool catheter, and in 22 patients only the right PVs were isolated with the conventional catheter. After a mean follow-up period of 11 +/- 2 months, recurrence was seen in 5 patients (22%) with complete PVAI and in 20 patients (90%) with incomplete PVAI. CONCLUSIONS: Remote navigation using a magnetic system is a feasible technique. With the present catheter technology, effective lesions cannot be achieved in most cases. This appears to impact the cure rate of AF patients.