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1.
J Cardiovasc Electrophysiol ; 35(1): 86-93, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37975544

RESUMO

INTRODUCTION: Esophageal injury is one of the most serious complications of pulmonary vein isolation (PVI) with thermic energy sources. Better tissue selectivity of primarily non-thermic pulsed field ablation (PFA) may eliminate collateral injury, particularly the risk of atrio-esophageal fistula (AEF). OBJECTIVE: To compare the incidence of any (peri)-esophageal injury following PVI using PFA to thermic energy sources. METHODS: Using endoscopy, endoscopic ultrasound, and electrogastrography before and after PVI, esophageal and periesophageal injury (mucosal lesions, food retention, periesophageal edema, or vagal nerve injury) were assessed following PFA and radiofrequency (RF)- or cryoballoon (CB)-PVI. RESULTS: Between December 2022 and February 2023, 20 patients (67 ± 10 years, 53% male) undergoing PFA (Farapulse, Boston Scientific) for atrial fibrillation (AF) were studied and compared with a previous cohort of 57 patients who underwent thermic PVI (CB: n = 33; RF: n = 24). Following PFA-PVI, none of the patients had mucosal lesions, food retention, or ablation-induced vagal nerve injury; four patients showed periesophageal edema. Following thermic ablation, 33/57 patients (58%) showed esophageal and/or periesophageal injury (CB: 21/33 [64%], RF: 12/24 [50%]), in detail 4/57 mucosal lesions, 18/57 food retention, 17/57 vagal nerve injury, and 20/52 edema. Midterm success rates were similar for all energy sources. CONCLUSION: In contrast to thermic ablation tools, PFA is not associated with relevant esophageal and periesophageal injury, and might, therefore, reduce or eliminate the risk of potentially lethal AEF in interventional treatment of AF. The etiology of ablation-induced periesophageal edema is unknown but has not been shown to be related to lesion progression.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fístula Esofágica , Veias Pulmonares , Humanos , Masculino , Feminino , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Resultado do Tratamento , Ablação por Cateter/efeitos adversos , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/etiologia , Veias Pulmonares/cirurgia , Edema/cirurgia
2.
Respir Physiol Neurobiol ; 243: 7-12, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28467884

RESUMO

PURPOSE: Central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) are highly prevalent in heart failure (HF) and are linked to increased mortality. Impaired pulmonary diffusion capacity [DLCO] and [KCO]) have been suggested to play a key role in CSA-CSR pathophysiology. This study investigated the relationship between HF, CSR, DLCO and KCO in well-characterized HF patients. METHODS: This prospective study included HF patients with CSR, all patients underwent full overnight polysomnography (PSG) and lung function testing. RESULTS: A total of 100 patients were included (age 70.7±9.7years, 95% male, body mass index 28.9±5.3kg/m2, left ventricular ejection fraction 33.5±7.7%, New York Heart Association class III 65%. DLCO and oxygenation were significantly correlated with hypoxemic burden (p<0.05). Mean oxygen saturation, oxygen desaturation, C-reactive protein level and pH were significantly associated with CSA-CSR severity (p<0.05). CONCLUSION: The finding that lung diffusion capacity is significantly associated with hypoxemic burden in HF patients with CSA-CSR highlights the important of lung function in HF patients.


Assuntos
Respiração de Cheyne-Stokes/fisiopatologia , Insuficiência Cardíaca/complicações , Hipóxia/fisiopatologia , Apneia do Sono Tipo Central/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Oxigênio/metabolismo , Polissonografia , Estudos Prospectivos , Testes de Função Respiratória , Estatística como Assunto , Fatores de Tempo
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